DS-DE 12 TR Ivor RoseFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT R
(1) ~~, ~ (~~p ~~f ~ OFFICE USE ONLY
2001 OEC -7 AM 9~ 43
Name
iM
(2) ~~ f(1 ~~ ~ CITY CLE.~~t'~ ~(=~lCr
Address (number nd street)
~ ~ a ~,I ~` -P - ~tL ~~ ~ .~ 13 ~
City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Ch k appropriate box(es):
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andidate (office sought):
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^ 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
Co er Period: From ~ / ~ / ~ ~ To ~~ / ~ / ~ Report Type
Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ~ Expenditures $ t/~~
Loans $ ~' Transfers to Office
Account $ ~3
Total Monetary $ ~ Total
Monetary $ j
In-Kind $ ~
(8) Other Distributi~ s
$
AL Monetary Contributions To Date
(9) TOT Monetary Expenditures To Date
A
L
(10) TOT
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(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) ( / " (Ty name) ~~O 2 ~ ~ S e.
^Individual {only for Treasurer ~eputy Treasurer Candidate ^ Chairperson (only for PC, PTY &
etectioneerin omRwn.) electioneering commun. organization)
X ~ X ~)r'(j'L
Signature Signature
DS-DE 12 (Rev. 08/04)
,~ ~ °~ ~.-
CAMPAIGN REASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name 1-~ [,~~~> .f,G-
(3) Cover Period ~/~_/~ through ~~/~~/~
(2) I.D. Number
(4) Page ~ of ~I
(5)
Date (7)
Full Name ($)
Purpose (9) (10) (11)
(8)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expenditure
Type
mendment
mount
~~~ .~" M~ ~~ d2
DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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