DS-DE 12 Campaign Treasurer's Report Summary F4-07 Correctedit c c~-=e ~(
FLORIDA DEPARTMENT OF STATE DIVISION OF~;~G~li9~~ F
CAMPAIGN TREASURER'S REPORTS ~A~~~~
{~) ~IAibU` ~ , ~~slt~uT~rofmr~r~a~~a~a~s f ~~tirs 200i~/c~8.~s~hbr~.'~58
Name ~ ~~
Address (number and street)
_ ~ttkiu~ Px~trG ~L X139
City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: ~- WSJ ) $ ~Z
{4) Check appropriate box(es):
^ Candidate (office sought):
,Political Committee ^ CHECK IF PC HAS DISBANDED
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED
^ Party Executive Committee
^ Electioneering Communication ^ CHEGK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS `~'1~,p~
Cover Period: From ~O / ~~' /~ 7 To )( / O ~ / ~ Report Type ~~
[Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ((~, ~, ~~ Expenditures $
Loans $ Transfers to Office
Account $
Total Monetary $ Total
Monetary $
In-Kind $
(8) Other Distribution
(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) f-Fl~le-bN R~S~)U~ (Type name) ~~~~ ~~SuIGK.
Individual (only for Treasurer ^ Deputy Treasurer ^ Candidate ~ Chairperson (only for PC, PTY &
electioneering common.)
~ electioneering common. organization)
X
~2,A~ X >~r1
Signature Signature
DS-DE 12 (Rev. 08/04)
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
alb ~ r I~~ ~y ~~~ v0 2 II.D. Number ~~~
(1) Name ~ I;~~''~' O
.~~ n_..__ o.._:..a I/~ ~ 1 Q / T `7 thmunh ~~ l !~ I / PJ ~7 /41 Paae ~ of
~..
(5)
Date - -
(7)
Full Name -
(8) -
(g) -
(10)
(11)
(12)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address ~
Ci ,State, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
Amendment
Amount
Ca va.~o.v r t`
i i ov~!~~--, 1k 7 1
~ ~
i i
i i
~ ~
1
/ /
DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES