F1 AmendedFLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
Candidate, Committee or Party Name
(4)
Address (number and street) City
[] Check box if address has changed since last report
Candppropriate box(es)'.
C,
(2)
I.D. Number
State Zip Code
[] Political Committee
[] Committee of Continuous Existence
[] Party Executive Committee
[] Check if PC has DISBANDED
[] Check if CCE has DISBANDED
Cover Period: From '~ /
[] Original [~Amendment
(6) CONTRIBUTIONS THIS REPORT
Ce,h&Ch cks $ .
Loans $ , ,
Total Monetary $ .....
TOTAL Monetary Contributions to Date
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures $ , ~("', __
Transfers to
Office Account $ , ,
Total Monetary $__ ,
Ot~er
(8)
Distributions $ - ' , /~
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 certify that I have examined this report and it is true,
correct and complete
Name of ~eputy Treasurer
X
Signature
I certify that I have examined this report and it is true,
correct and complete
Signature
DS-DE t2 (9101)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
FLORIDA DEPARTMENT OF STATE, DIVISION OF .ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
.J.D. Number
<
State e
[] Check box if address has changed since last report
[~,/Candidate (office sought): ~ i C , ~ A~,F.C ~ -/~
[] Political Committee [] CheCK(if PC has DISBANDE~
[] Committee o~ Continuous Existence [] Check if CCE has DISBANDED
(6) CONTmBUTIONS THIS
(g) TOTAL M~
$ ,
It ia
Nitre of
X
Contributions to Date
10) TOTAL Monetary Expenditum. to Da;a
1) CER1tFICATIOH
. m!_=demeanor for any perlon to falMly a ixlbllc record (8s. ~3~.t~, F.S.)
it is true,
certify that I have exa,.i..~.d this rep~,~ and it is true,
Name of ~)"/'C.,andidate [] Chairman (I:~_./PI'Y
x
~P~¢ I ~7