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DS-DE 12 F4-07~~ r~ov a, ao4 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONL~ ev (1) Ed Tobin ~ o Name -~C 2 ~ c, q m (2) 1800 Sunset Harbour Drive Suite 2 r- ,,,~ Address (number and street) m r Miami Beach, FT, 33139-0000 ~ tJt City, State, Zip Code ~'' ~' ^ Check box if address has changed -,-1 .:. '~ (3) I.D. Number: 00000 ~~_ (4) Check appropriate box(es): r-> '- -.-, w X Candidate (office sought): City Commission Group 5 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 10/13/2007 To 11/01/2007 Report Type: -~ Fu-o-7 ^X Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Cash & Checks $23,750.00 Monetary Expenditures $57,130.58 $30,000.00 Transfers to Office Account $0.00 Loans Total Monetary $53,750.00 Total Monetary $57,130.58 In-Kind $250.00 (8) Other Distributions $0.00 (9) TOTAL Monetary Contributions to Date (10) TOTAL Monetary Expenditures to Date $177,543.39 $149,799.86 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) certify that I have examined this report and it is I certify that I have examined this report and it is true, correct and complete true, correct and complete d Tobin E Ed Tobin ~ ^ Individual (only for Treasurer ^ Deputy Treasurer electioneering }{ ^ Candidate ^ Chairman (only for PC, PTY & X electioneering commun,yrgdn ~ commun.) X X Signature Signature DS-DE 12 (Rev. 08/04) AdJutant Sot[ware -campaign i ooiaox PR~c ~ ~ i r CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (2) I.D. Number 00000 1 of 8 (3) Cover Period 10/13/2007 - 11/01/2007 (4) Page (5) (7) (8) (9) (10) (11) (12) Date Full Name Contributor (6) (Last, Suffix, First, Middle) In-kind Sequence Number Street Address & City, State, Zip Code Type Occupation Contribution Type Description Amendmen Amount 10/16/2007 Miranda, Elda I Home CHE $ 500.00 8960 SW 4th Lane Maker Miami, FL 33174-0000 000001 10/16/2007 Mudd, Laura I Professor CHE $ 500.00 450 N.E. 52nd Terrace Miami, FL 33137-0000 000002 10/16/2007 Lincoln, Timothy I Attorney CHE $ 500.00 450 N.E. 52nd Terrace Miami, FL 33137-0000 000003 10/16/2007 Lincoln Esq., P.A. B Law Firm CHE $ 500.00 46 N.E. 6th Street Miami, FL 33132-0000 000004 10/16/2007 Arkin Group Construction B Construct CHE $ 500.00 Suite 100 ion 4205 Alton Road Company Miami Beach, FL 33140-0000 000005 10/16/2007 Diener, Robert I Business CHE $ 500.00 8 Indian Creek Island Rd. man Indian Creek Village, FL 33154-0000 000006 10/16/2007 Frucher, Meyer I Investor CHE $ 250.00 324 West 101st Street New York, NY 10025-0000 000007 10/16/2007 Rubio, Julian I Import/Ex CHE $ 300.00 2537 Eagle Run Drive port Weston, FL 33327-0000 000008 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBOx PA~c a ~- ~r CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (2) I.D. Number 00000 (4) Page 2 of 8 (3) Cover Period 10/13/2007 - 11/01/2007 ~5) (7) (8) (9) (10) (11) (12) Date Full Name Contributor (6) (Last, Suffix, First, Middle) In-kind Sequence Number Street Address & city, State, Zip Code Type Occupation Contribution Type Description mendmen Amount 10/16/2007 Mitrani, Isaac I Attorney CHE $ 200.00 5352 Lagorce Drive Miami Beach, FL 33140-0000 000009 10/16/2007 Jeffrey, Rynor A. I Attorney CHE $ 200.00 5385 N. Bay Rd. Miami Beach, FL 33140-0000 000010 10/16/2007 Cohen, Loren I CHE $ 100.00 855 W. 46th Street Miami Beach, FL 33140-0000 000011 10/16/2007 Holtz, Abel I Retired CHE $ 500.00 Suite 220 420 Lincoln Road Miami Beach, FL 33139-0000 000012 10/16/2007 Holtz, Fana I Retired CHE $ 500.00 Suite 220 420 Lincoln Road Miami Beach, FL 33139-0000 000013 10/17/2007 Zelcer, Alan I Textiles CHE $ 500.00 88 Bal Bay Drive Bal Harbour, FL 33154-0000 000014 10/19/2007 Tate, James D. I Real CHE $ 500.00 Suite 102 Estate 1175 NE 125th Street Sales North Miami, FL 33161-0000 000015 10/19/2007 Tate Enterprises B Real CHE $ 500.00 Suite 102 Estate 1175 NE 125th Street North Miami, FL 33161-0000 000016 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign Tooigox PRE 3 ~ ~~ CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 3 of 8 ~5) (7) (8) (9) (10) (11) (12) Date Full Name ib t C t (6) (Last, Suffix, First, Middle) on r u or In-kind Sequence Number Street Address & city, State, Zip Code Type Occupation Contribution Type Description Amendmen Amount 10/19/2007 Emmanuel Perez & Associates, P.A. B Law Firm CHE $ 100.00 901 Ponce De Leon Blvd. Coral Gables, FL 33134-0000 000017 10/22/2007 Yaffa Dermer Revocable Trust O Trust CHE $ 250.00 2525 Flamingo PL. Miami Beach, FL 33140-0000 000018 10/22/2007 Chopp, Jonathan B. I Real CHE $ 250.00 4477 Sheridan Avenue Estate Miami Beach, FL 33140-0000 Sales 000019 10/24/2007 Mayer, Maria I Attorney INK Meet and $ 250.00 4500 N. Jefferson Greet Miami Beach, FL 33140-0000 event 000020 10/26/2007 4035 North Meridian, LLC B Property CHE $ 250.00 P.O. Box 402249 Owner Miami Beach, FL 33140-0000 000021 10/26/2007 2228 Park Avenue, LLC B Property CHE $ 250.00 P.O. Box 402249 Owner Miami Beach, FL 33140-0000 000022 10/26/2007 64 La Gorce, LLC B Property CHE $ 250.00 P.O. Box 402249 Owner Miami Beach, FL 33140-0000 000023 10/26/2007 88 La Gorce, LLC B Property CHE $ 500.00 P.O. Box 402249 Owner Miami Beach, FL 33140-0000 000024 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBox Pe~~ 4 elsrs CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 4 of 8 (5) (7) (8) (9) (10) (11) (12) Date Full Name ntrib tor C (6~ (Last, Suffix, First, Middle) o u In-kind Sequence Number Street Address & City, State, Zip Code Type Occupation Contribution Type Description Amendmen Amount 10/26/2007 Glaser, Todd I Entrepre CHE $ 500.00 P.O. Box 402249 nuer Miami Beach, FL 33140-0000 000025 10/29/2007 Browning, Stuart E. I Entertain CHE $ 500.00 2535 Lucerne Avenue ment Miami Beach, FL 33140-0000 000026 10/29/2007 Diaz-Granados, Lina C. I Business CHE $ 500.00 4720 Bay Point Rd. woman Miami, FL 33137-0000 000027 10/30/2007 Pardo, Stevan J. I Attorney CHE $ 500.00 1401 Northview Drive Miami Beach, FL 33140-0000 000028 10/30/2007 Tighe, Cathy I CHE $ 50.00 4951 Cherokee Avenue Miamimi Beach, FL 33140-0000 000029 10/30/2007 Nestor, M.D., Mark Steven I Doctor CHE $ 500.00 3026 N. Bay Road Miami Beach, FL 33140-0000 000030 10/30/2007 Tobin, Ed S Lawyer LOA $ Suite 2 30,000.00 1800 Sunset Harbour Dr Miami Beach, FL 33139-0000 000031 10/31/2007 Gans, Stephen L. I Investor CHE $ 500.00 11 La Gorce Cir. Miami Beach, FL 33141-0000 000032 DSDE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBox CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 5 of 8 (5) (7) (8) (9) (10) (11) (12) Date Full Name ntribut r C (6) (Last, Suffix, First, Middle) o o In-kind Sequence Number Street Address & City, State, Zip Code Type Occupation Contribution Type Description Amendmen Amount 10/31/2007 Goldberg, Joseph I Business CHE $ 400.00 No. 1819 man 325 S. Biscayne Blvd. Miami, FL 33131-0000 000033 10/31/2007 750 Jefferson Avenue, LLC B Property CHE $ 500.00 1434 Collins Avenue Owner Miami Beach, FL 33139-0000 000034 10/31/2007 The Stern Companies B Develope CHE $ 500.00 Suite 200 r 1434 Collins Avenue Miami Beach, FL 33139-0000 000035 10/31/2007 Kramer, Boz I Salesma CHE $ 500.00 Apt. 2104 n 650 West Avenue Miami Beach, FL 33139-0000 000036 10/31/2007 Nicolas Brocherie, P.A. B Real CHE $ 500.00 570 NE 52nd Terrace Estate Miami, FL 33137-0000 Sales 000037 10/31/2007 Barclays Real Estate Group, LLC B Real CHE $ 500.00 Suite 200 Estate 555 NE 15th Street Sales Miami, FL 33132-0000 000038 10/31/2007 Latour Design & Development B Develope CHE $ 500.00 1784 West Avenue, Bay 4 r Miami Beach, FL 33139-0000 000039 10/31/2007 Andre V. Texeira, P.A. B Real CHE $ 500.00 685 NE 59th Street Estate Miami, FL 33137-0000 Sales 000040 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBox CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 6 of 8 ~5) (7) (8) (9) (10) (11) (12) Date Full Name Contributor (6) (Last, Suffix, First, Middle) In-kind Sequence Number Street Address & city, state, Zip Code Type Occupation Contribution Type Description Amendmen Amount 10/31/2007 Latour, Daniel Charles I Develope CHE $ 500.00 9559 Harding Avenue r Surfside, FL 33154-0000 000041 11/01/2007 Tobin, Michael I Attorney CHE $ 500.00 8605 SW 79th PL Miami, FL 33143-0000 000042 11 /01 /2007 Siegel, David I CHE $ 100.00 333 E Rivo Alto Dr Miami Beach, FL 33139-0000 000043 11/01/2007 Jove, Fred I Insuranc CHE $ 250.00 9826 West Broadview Drive e Bay Harbor Islands, FL 33154-0000 000044 11/01/2007 Jove, Terry I Home CHE $ 250.00 9826 West Broadview Drive Maker Bay Harbor Islands, FL 33154-0000 000045 11/01/2007 Ocean Collision Center B Body CHE $ 500.00 12000 NE 14th Avenue Shop Miami, FL 33161-0000 000046 11 /01 /2007 LG Capital Partners, LLC B Lender CHE $ 500.00 Suite 300 1691 Michigan Avenue Miami Beach, FL 33139-0000 000047 11/01/2007 Ziehm, Robert I CHE $ 100.00 1788 Opechee Drive Coconut Grove, FL 33133-0000 000048 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBox P~~ ~ ~- i s CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (2) I.D. Number (3) Cover Period 10/13/2007 - 11 /01 /2007 (4) Page 00000 7of8 ~5) (7) (8) (9) (10) (11) (12) Date Full Name Contributor (6~ (Last, Suffix, First, Middle) In-kind Sequence Number Street Address & City, State, Zip Code Type Occupation Contribution Type Description Amendmen Amount 11/01/2007 Polisar, Steven M. I CHE $ 100.00 Suite 2A 407 Lincoln Rd Miami Beach, FL 33139-0000 000049 11/01/2007 Wynd, LLC B CHE $ 100.00 681 Washington Avenue Miami Beach, FL 33139-0000 000050 11/01/2007 Yarus, Gary J. I Financial CHE $ 250.00 2 S. Biscayne Blvd, Suite 1742 Planner 1 Biscayne Tower Miami, FL 33131-0000 000051 11/01/2007 Gary J. Yarus Management, Inc. B Manage CHE $ 250.00 2 S. Biscayne Blvd, Suite 2 ment 1 Biscayne Tower Miami, FL 33131-0000 000052 11/01/2007 Amdur, Alan I Executive CHE $ 500.00 Rivo Alto Island 109 2nd Rivo Alto Ter Miami Beach, FL 33139-0000 000053 11/01/2007 Hernandez, Jessica A. I Executive CHE $ 500.00 2458 Westminster Dr. Cocoa, FL 32926-0000 000054 11/01/2007 Durand, Miguel Angel I Executive CHE $ 500.00 Apt. 806 540 Brickell Key Dr. Miami, FL 33131-0000 000055 11 /01 /2007 Sosa, Adianes I Executive CHE $ 500.00 13218 N.W. 4th Miami, FL 33182-0000 000056 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBox PA~~ ~ ~ -s CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Ed Tobin (2) I.D. Number (3) Cover Period 10/13/2007 - 11/01/2007 (4) Page 00000 8of8 (5) (7) (8) (9) (10) (11) (12) Date Full Name ntributor C (6) Sequence Number (Last, Suffix, First, Middle) Street Address 8 city, State, zip code o Type Occupation Contribution Type In-kind Description Amendmen Amount 11/01/2007 Soriano, Denise I Executive CHE $ 500.00 16005 Kingsmoor Way Miami Lakes, FL 33014-0000 000057 11/01/2007 Orosz, Bruce I Business CHE $ 500.00 5025 Collins Avenue Owner Miami Beach, FL 33140-0000 000058 11/01!2007 David R. Custin & Associates, Inc. B Consultin CHE $ 500.00 6401 S.W. 113 PL g Miami, FL 33173-0000 000059 11/01/2007 Bogomilsky, Tzvi I Business CHE $ 500.00 3701 Pine Tree Drive Owner Miami Beach, FL 33140-0000 000060 11/01/2007 Holtz, Andria I Home CHE $ 500.00 28 Indian Creek Island Rd. Maker Indian Creek Village, FL 33154-0000 000061 11/01/2007 Sharpstein, Richard I Attorney CHE $ 500.00 Suite 500 777 Brickell Avenue Miami, FL 33131-0000 000062 DS-DE 13 (Rev. 08/03) Adjutant Software -Campaign ToolBOx ('ASE V ~- ~~ CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 1 of 4 ~5) (7) (8) (9) (10) (11) Date Full Name ~6) (Last, Suffix, First, Middle) Purpose Sequence Number Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure Type Amendmen Amount 10/17/2007 Washington Square Partners Printing/Advertising MON $ 618.69 Suite 1-D 16 Island Avenue Miami Beach, FL 33139-0000 000001 10/17/2007 Washington Square Partners Expense MON $ 1,242.00 Suite 1-D Reimbursement 16 Island Avenue Miami Beach, FL 33139-0000 000002 10/17/2007 Recognition Media Website MON $ 134.85 # 226 1521 Alton Road Miami Beach, FL 33139-0000 000003 10/19/2007 Cooke, Bill Office Clerical MON $ 250.00 P.O. Box 432591 Miami, FL 33243-0000 000004 10/22/2007 Campaigns That Matter, Inc. Advertising MON $ 6,153.00 Suite 708 407 Lincoln Road Miami Beach, FL 33139-0000 000005 10/22/2007 Universal Parking, LLC reimbursements MON $ 20.00 1800 Sunset Harbour Drive Miami Beach, FL 33140-0000 000006 10/22/2007 Bollinger, Ann reimbursement MON $ 12.00 27 Hunting Lodge Drive Miami Springs, FL 33166-0000 000007 10/23/2007 PR Concepts Inc. Printing MON $ 6,882.00 14931 SW 70th Street Miami, FL 33193-0000 000008 DS-DE 14 (Rev. 08/03) Adjutant Software -Campaign ToolCOx CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Ed Tobin (2) I.D. Number 00000 2of4 (3) Cover Period 10/13/2007 - 11/01/2007 (4) Page ~5) (7) (8) (9) (10) (11) Date Full Name (6) (Last. Suffix, First, Middle) Purpose ' Sequence Number Street Address & City, State, Zip Code (add office sought rf contribution to a candidate) Expenditure Type Amendmen Amount 10/23/2007 PR Concepts Inc. Advertising MON $ 6,315.00 14931 SW 70th Street Miami, FL 33193-0000 000009 10/24/2007 Washington Square Partners Polling MON $ 2,000.00 Suite 1-D 16 Island Avenue Miami Beach, FL 33139-0000 000010 10/25/2007 Campaigns That Matter, Inc. Advertising MON $ 2,462.00 Suite 708 407 Lincoln Road Miami Beach, FL 33139-0000 000011 10/25/2007 Cooke, Bill Office Clerical MON $ 350.00 P.O. Box 432591 Miami, FL 33243-0000 000012 10/26/2007 The Connection Consultants, Inc. phone system MON $ 555.00 11501 N.E. 11th Place connection Biscayne Park, FL 33161-0000 000013 10/26/2007 Karlton Investment Group, Inc. Expense MON $ 177.72 Suite 2 reimbursement 1800 Sunset Harbour Drive Miami Beach, FL 33139-0000 000014 10/26/2007 Karlton Investment Group, Inc. Expense MON $ 285.58 Suite 2 reimbursement 1800 Sunset Harbour Drive Miami Beach, FL 33139-0000 000015 10/26/2007 Universal Parking, LLC parking reimbursemen MON $ 24.00 1800 Sunset Harbour Drive Miami Beach, FL 33140-0000 000016 DS-DE 14 (Rev. 08/03) Atltutant ~ottware -campaign i wioux CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 3of4 ~5) (7) (8) (9) (10) (11) Date Full Name (6) (Last, Suffix, First, Middle) Purpose Sequence Number Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure Type Amendmen Amount 10/26/2007 Unger, Zahava Office Clerical MON $ 150.00 4101 Pine Tree Drive Miami Beach, FL 33140-0000 000017 10/26/2007 Rosenstein, Erica Office Clerical MON $ 45.00 4584 Alton Road Miami Beach, FL 33140-0000 000018 10/26/2007 Schoenwetter, Karen Office Clerical MON $ 85.00 13580 SW 67th Avenue Pinecresit, FL 33156-0000 000019 10/26/2007 Kovalesky, Anna Office Clerical MON $ 40.00 P.O. Box 630771 Miami Beach, FL 33140-0000 000020 10/26/2007 Reyes, Elizabeth Office Clerical MON $ 55.00 7703 Camino Real Miami, FL 33143-0000 000021 10/26/2007 Schoenwetter, Maria Office Clerical MON $ 232.09 13580 SW 67th Avenue Pinecrest, FL 33156-0000 000022 10/26/2007 Sarao, Maricey Office Clerical MON $ 342.50 836 85th Street Miami Beach, FL 33140-0000 000023 10/26/2007 West, Dorothy Office Clerical MON $ 310.00 Apt 1510 6959 Collins Avenue Miami Beach, FL 33140-0000 000024 DS-DE 14 (Rev. 08/03) Adjutant Software -Campaign ToolBOx ~~-~'~ ~Z ~ (s CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 4of4 (5) (7) (8) (9) (10) (11) Date Full Name (6) (Las[, Suffix, First, Middle) Purpose Sequence Number Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure Type Amendmen Amount 10/26!2007 Baquero, Miguel Office Clerical MON $ 896.00 14874 SW 56th Terrace Miami, FL 33193-0000 000025 10/26/2007 Baquero, Miguel Reimbursement MON $ 92.70 14874 SW 56th Terrace Miami, FL 33193-0000 000026 10/26/2007 An-Image Signs and Printing Signs and Printing MON $ 2,311.20 #5 8200 W. 33rd Avenue Hialeah, FL 33018-0000 000027 10/30/2007 Campaigns That Matter, Inc. Advertising MON $ 7,142.00 Suite 708 407 Lincoln Road Miami Beach, FL 33139-0000 000028 10/31/2007 MV Almer Productions Advertising MON $ 1,035.00 P.O. Box 398685 Miami Beach, FL 33239-0000 000029 10/31/2007 5th and Ocean Productions Advertising MON $ 1,750.00 # 302 1370 Washington Avenue Miami Beach, FL 33139-0000 000030 10/31/2007 50 Blue, LLC Printing/Advertising MON $ 15,037.25 7525 SW 54th Ct Miami, FL 33143-0000 000031 10/31/2007 Schoenwetter, Maria reimbursement MON $ 125.00 13580 SW 67th Avenue printing/mailing Pinecrest, FL 33156-0000 000032 DS-DE 14 (Rev. OS/03) Adjutant Software -Campaign Toott3ox ~~-G~ C 3 ~ ~S, CAMPAIGN TREASURER'S REPORT -ITEMIZED DISTRIBUTIONS THIS FORM APPLIES TO POLITICAL COMMITTEES, COMMITTEES OF CONTINUOUS EXISTENCE AND PARTY EXECUTIVE COMMITTEES ONLY. (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 0 of 0 ~5) Date (7) Full Name (8) (9) (1 0) (11) (6~ Sequence Number (Las[, Suffix, Firsl, Middle) Street Address & City, State, Zip Code Purpose (add office sought if contribution to a candidate) Related Expenditures Amendmen Amount Nothing to report on t is form DS-DE 14A (Rev. OS/03) Adjutant Software -Campaign TooiBOx PA~~E ~ y d~-ls CAMPAIGN TREASURER'S REPORT -FUND TRANSFERS (1) Name Ed Tobin (3) Cover Period 10/13/2007 - 11 /01 /2007 (2) I.D. Number 00000 (4) Page 0 of 0 (5) Date (~) Name of Financial (8) (9) (10) (11) (6) Sequence Number Institution Street Address & City, State, Zip Code Transfer Type Nature of Account Amendmen Amount Nothing to report on th s for DS-DE 94 (Rev. OS/03) Adjutant Software -Campaign ToolBox ~ll~ ~s ~ 1~