DS-DE 12 F4-07
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
/ ~ OFFICE USE ONLY
Name ~
~ ~
Address (number and street) ~-, c~ ;T1
City, State, Zip Code ~ N
ID Number: "~~ a ~
^ CHECK IF ADDRESS HAS CHANGED (3) ~ r -~-
(4) Check appropriate box(es): ~" ~ ~
~ndidate (office sought): C~„~m ,:.r~F~L'~/~' ~/" ~u ~ ~ -°'' °'
^ 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
Cov r Period: From ~ / ~ / ~ To ~ / ~ / ~ Report Type ~,1,/ ~"7
[Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report _
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ~~ ~~ ~`~ Expenditures $ ~ ~~Cl - ~,~
Loans $ Transfers to Office
Account $
~~~ Total
Total Monetary $ ~ _ _ ` c~
` Monetary $ ~` f l-3
I n-Kind $
(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) ~ (Type name) ~ .f
Individual (only for reasurer ^ Deputy Treasurer [~rfiiidate Chairperson (only for PC, PTY &
electioneering commun.) electioneering commun. organization)
X - X
Si natur ,~ ~ Signature
9
DS-DE 12 (Rev. 08104)
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name ~~~~~/~/~ r7 (2) LD. Number
(3) Cover Period ~ / ~ / ~ through ~ / ~~ / -~ ~ (4) Page of
(5)
Date (7)
Full Name (8) (9) (10) (11) (12)
(g)
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
~ ~ ~~/~~ ~f I~
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DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND cove va~uts
~\
~'~~ ~
CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name ~ r.,i~ /`d~/`Z-, (2) LD. Number
(3) Cover Period /f~ /~~/~Zthrough ~_/~_/~.~, (4) Page of
(5)
Date (~)
Full Name
ddl (8)
Purpose
(add office sought if (9) (10) (11)
(s)
Sequence
Number e)
(Last, Suffix, First, Mi
Street Address 8~
City, State, Zip Code
contribution to a
candidate) Ex enditure
Type
Amendment
Amount
~
d ~
to ~~ ~ v~ .
i,D~
7~-Z ~, cT/, ~eJ
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DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES