Amended F1 FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) '~-~ ~¥..f-F_~F--A. ~,.~
Candidate, Committee or Party Name
Address (number and street)
(2)
I.D. Number
City State
'-']Check box if address has changed since last report
Zip Code
m
(4)
Check appropriate box(es):
~r' Candidate (office sought):
~-'~ Political Committee
--']Committee of Continuous Existence
[~ Party Executive Committee
~ Checkif PC has DISBANDED
r -] Check if CCE has DISBANDED
(5) REPORT IDENTIFIERS
Cover Period: From ~ / ol / c~% To c~ / ~:~/ C)-'~
Report Type F1
Original~J,~ Amendment ~ Special Election Report E~] Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Cash & Checks $ ,
Loans $__,
Total Monetary $ ,
in-kind $
Monetary
Expenditures $ ,
Transfers to
Office Account $ , ,
Total Monetary $ ,
(8) Other Distributions $
TOTAL Monetary Contributions to Date (10) TOTAL Monetary Expenditures to Date
$ , · $ ,
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I cedify that I have examined this report and it is
true, (;orrect and complete /~__
Nameof [-~ Treasurer ~'~ Deputy Treasurer
DS-DE 12 (7/98)
I certify that I have examined this report and it is
true, c~)rrect, and complete
/
Na~e of [~ Candidate ~ Chairman (PC/PTY
k,. t ) , /31 ..0nly)
Sign~tur~.. - ~ ' ' "-- v ,
~ , ?A_~_MPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name ~'~,~\ \ '\ ~-~%~,-_~__~ ~~-- (2) I.D. Number
(3) Cover Period '~i / (~\ / O'~ through C~ / ~/o / O'~ (4) Page ~ of
(5) (7) (8) (9) (10) (11 ) (12)
Date Full Name Contributor
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE ~3 (~,~) s~.EvE.sE FO. ,.s~.uc~o.s A.DCOOE VA'UES i~ ?~ ~ ~_