DS-DE 12 F3-07 Campaign Treasurer's Report LGFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMP
A
IGN TREASURER'S REPORT SUMMARY
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Name .
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Address (number and street)
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City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
(^~andidate (office sought): _ ~
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^ Political Committee ~
^ CHECK IF PC HAS DISBANDED
^ 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 ~ / ~ / ~ To lU / ~_ / ~ Report Type ~~`
[~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
~~,
Cash & Checks $ ~~~ ~ ~ Monetary
Expenditures $ j~ ~ , ~ 'C~
-
Loans $ Transfers to Office
Account $
Total Monetary $ ~( ~' ~ 7 r Total
Monetary $ ~'
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In-Kind $ ~
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(8) Other Distributions
$ ~~
(9) 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 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)
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Individual (only for
rer ^ Deputy T
asurer
electioneering commun.) andidate ^ Chairperson (only for PC, PTY &
X ' electioneering commun organization)
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Signat re
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CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name ~/~ (~r'~yf ~ (2) LD. Number
(3) Cover Period ~_ / _~ / ~ through ~ / /~ / ~ (4) Page ~_ of~
(5)
Date (~)
Full Name (8) (9) (~~) (11) (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 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE V~~~ ~ ~~ ~~~ ~`
CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name _ (2) I.D. Number _ _
(3) Cover Period ~/~~/~ through ~ I~IL~I~~ (4) Page ~ of
`~
(5)
Date (7)
Full Name (8)
Purpose (9) (10) (11)
(s)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expenditure
TYPe
Amendment
Amount
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DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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