DS-DE 12 Campaign Treasurer's Report Summary F4-07____- _____ ~-JJ~2~__-
DS-DE 12 (Rev. 08!04)
A DEPARTMENT OF STATE DIVISION OF ELECTIONS
PAIGN TREASURER'S REPORT SUMN~I~`P'~ F
~ ~~~" _ ~1~i1dS~°N~'~ 12~ 29
street
~, , L .~3 l3 g
HAS CHANGED (3) ID Number:
c(es):
.Ight):
^ CHECK IF PC HAS DISBANDED
uous Existence I_I CHECK fF CCE HAS DiSBAivDED
imittee
nunication ^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
~U ~ ~ (5) REPORT IDENTIFIERS ~~ _ ~ -~ -
~ ~~
~
~
'
Report Type
l ~'~ / `
/~ / ~
~ To
~
nt ^ Special Election Report ^ Independent Expenditure Report
5 REPORT (7) EXPENDITURES THIS REPORT
Monetary 1
Cash & Checks $~~ o-s-~ . o-~ Expenditures $ r(/",
Loans $ Transfers to OfFce
Account $
Total Monetary $ Total
Monetary $
In-Kind $
butio
(8) Other Dist
~
~
(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 l 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 co
lete.
~( y~
(TYPe name) ~V ~.'1 V ~- i ti' 1 ~ ~
Type name) z ~`~~' ~ ~~ ~ Lxs
Individual (only for Treasurer ^ Deputy Treasurer ^ Candidate Chairperson (only for PC, PTY &
electioneering mun. ,- 'e tioneering commun. organization)
X 'r /~ -•
Signature - - Signature
~~~ ~ ~ ~
N TREASURER'S REPnORT -ITEMIZED CONTRlBUT10NS
:..erJ~--~~-YC~~, ~~ '1-vIJ~ V6 2 /I.D. Number ~~~
~)
/ ?~ / U ~~ +hrnunh /i / ;^ / / r :~' (dl Pane / of i
(7)
(Name (8) (9) (10) (11) (12)
c, First, Middle)
Address &
te, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
Amendment
Amount
o
D 1
~~S ~
~/~~~
~~
~~
rl
c~
D/ ~
'y'i ~ 7 /
/ /
I I
/ /
DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~~.~~r