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DS-DE 12 F3-07 Amended
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) ,~,i~5~i~'+/1.. ~ ~.U~-.Z_ OFFICE USE ONLY Name Ca ~ _ Address (number and street) r`~-- .° 'n ~ ~dl,~~~l~ ~3/~`1 ru ~' ~ City, State, Zip Code ~ --- ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: ° 'TI .. (4) Check_appropriate box(es): ~ ~ ~ / i ndidate (office sought): ~ r ^ Political Committee ^ CHECK IF PC HAS DIS A DE ^ 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 ~ / ~ / d7 To ~ / ~ / ~ Report Type ~ ~ ^ Original [~]~l1 endment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Cash & Checks $ ~'~C7 ©~ Monetary Expenditures $ ~ ~~~ ~ ~~ , Loans $ Transfers to Office Account $ Total Monetary $ ~~F~ O~ Total Monetary $ ~ ~G~ ~~ In-Kind $ ~ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ Grp ~ ~s ~~ $ ~~ ~.~~.~ . f~~ __ (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. RYPe name) G., / ///~ /~2~f ~ (TYPe name) ~ /~j~~ ~J f ~~ ^ Individual (only for Q~easurer ^ Deputy Treasurer andidate ^ Chairperson (only for PC, PTY & electioneering commun.) electioneering commun. organization) X ~/ /~ _ ,,' Signature Signature DS-DE 12 (Rev. 08/04)