DS-DE 12 F3-07 Campaign Treasurer's Report EUFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CA PAIGN TREASURER'S REPORT X~
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(1) r~ ~5 A Fj'F,~J! Z~; Z~~l ~~TF~9 E ~tO4 IY
Name _ /~ _
Address (nu er and street)
City, Sta e, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
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n
Yt/I ,~? 6~~
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^ Candidate (office sought): ~
^ Political Committee ^ CHECK IF PC HAS ISBANDED
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED
^ Party Executive Committee
^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From G~ / ~ / ~ To ~~ / /~ / ~ Report Type '~"~"~
^ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Cash & Checks $ '~~: ; ~~ , C} ~~ Monetary ,".~ ~_ .~
Expenditures $ > > ,~`~
Loans $ Transfers to Office
Account $
Total Monetary $ ~~ 2 S ~' ~ ~' G Total
Monetary $ C<,~ ~ , ~ ~ ~~.
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ ~i"C _ 1~~~yL, $ C~~~~,~~1~
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(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, I certify that I have examined this report and it is true,
correct, and complete. ~
correct, and complete.
(TYPe name) ~- C~ i..,r r (~ ~ t. v5 1 O S /
(Type name) ~/,Sc~ (~'l~Gz J i Z-e~.
^ Individual (only for Treasurer ^ Deputy Treasurer
ng commun.)
elecUoneen ^ Candidate ^ Chairperson (only for PC, PTY &
/'~ electioneering commun. organization)
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Signature ----- ~, <~ 4 ..a;
Signature
DS-DE 12 (Rev. 08104) C '~ ~~ ~ ~
/'~ . ,~ ~~
CAMPAIGN T ASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name ~/--5~ ~~~~`~~~ (2) I.D. Number
(3) Cover Period ~ / ~ / (~~ through / 0 / ~ a l ~ (4) Page ~ of
(5)
Date (~)
Full Name (8) (9) (~ ~) (~ ~) (12)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
Cit ,State, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
Amendment
Amount
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DS-DE 73 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~~AMP~~~N TREASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name S /! ~ Ll ~ ~~~ (2) I.D. Number
(3) Cover Period ~_/~/~ through ~(~/ ~oZ /~ (4) Page
of
(5)
Date (~)
Full Name ($)
Purpose (9) (10) (11)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address 8~
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expende ure
YP
amendment
Amount
l~ o =S ~ ~s f' ~~~r ~~ F~
I3 ~ % ~ u ~ ~ ~~~ ~ ~~ ~°~ -3~ ~w
7 ~ J
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DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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