F3 Amended - ReedFLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(4)
Candidate, Committee or Party Name
Address (number and street) City
[] Check box if address has changed since last report
C~hec~.l~priate box(es): ,/~ ,,,cb, t,~'
Cd-Candidate (office sought): ,
[] Political Committee
[] Committee of Continuous Existence
I.D. Number
State Zip Code
[] Party Executive Committee
[] Check if PC has DISBANDED
[] Check if CCE has DISBANDEE~
Cover Period:
[] Original
From / ~ /
[~Amendment
(5) REPORT IDENTIFIERS ~
(( / 0.,~ To '0 /_.~1 ~ Repor~yP~ ~_~
[] Special Election Report [] Independent E3q~no~ure Report
(6)
Cash & Checks
Loans
Total Monetary
In-kind
(9)
CONTRIBUTIONS THIS REPORT
$__, /, )~'o.
$__, /, ')50.
$ , , ' s5,
TOTAL Monetary Contributions to Date
{7) EXPENDITURES THIS REPORT
Monetary
Expenditures $ , .~,
Transfers to
Office Account $ , ,
Total Monetary
Other
(8) Distributions $
(10) TOTAL Monetary Expenditures to Date
$__, oo
(11) CERTIFICATION
It Is a first degree misdemeanor for any person to falsify a public ;cord (ss. 839.13, F.S.)
I certify that I have examined this report and it is true,
correct and complete
Name of E~asurer [~ De?ty Treasurer
X
Signature
I certify that I have examined this report and it is true,
correct and complete
Name of [:]~didate [] (:~hairman (PC/P'FY
X ~~ten-j)
Signature
DS-DE 12 (9101)
SEE REVERSE FOR INSTRUCTION8 AND CODE VALUES