DS-DE 12 TR GroszFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
Name
(2) ~~~~ (~ C7 ~ ~l , i'i~ /~'/~ 1008 JAN 28 AM I! ~ 09
Address (number and street)
L ~': i ~~ ' v Lt ~ i ~ i..
City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
Jc.~~
^ Candidate (office sought): ~~~rn
~~/'S j~s-r/C'_- ~iJ"~ t
~
,
^ Political Committee ^ CHECK IF PC HAS DISBANDED
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED
^ Party Executive Committee
'.~ tiirr~;mrn~~c~Ta~~r~t, ~ "IfFItiF(O(~iIHII~R®il~ill
(1;79N1f [ID'q~l I~Zt~ V41~ iiliu E Fl lt®
(5) REPORT IDENTIFIERS
Cover Period: From ~ / ~ 1 / ~!~ ~~ To ~ / ~ l Q~ Report Type ~~
Q~Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ --- ~ ~ -- Expenditures $ ~ ~~ ~~_S_ ~L~
Loans $ Transfers to Office
Account $
Total Monetary $ _ ~~~ Total
Monetary $ ~ ~ ~~
In-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) ~ ~ ii/,/ /.`~ ~/~ (~•`~ Z, (Type name) (Jl ~ ~/
^~dividaaHtoniy so~' ^ Treasurer ^ Deputy Treasurer ^ Candidate Chairperson (only for PC, PTY &
et~~ioaeeang~oarmua~~ a~tftasra~irre~cran~mun:~ o7c~trfz~icr )
X ~
~~L?~ X "' o
'
Signature ~ ,
Signature
DS-DE 12 (Rev. 08/04) ~ / U~
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
(1) Name ~ / ~~.~~~ (Q/'~J `Z (2) LD. Number
(3) Cover Period ~ / ~ / -~ through ~ / !~ ~r / ~~ ~' (4) Page ( of
(5)
Date (~)
Full Name (8) (9) (1 ~) (1 ~) (~ 2)
(6)
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
/ /
r
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
~ ~ l~
CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name~~ ~d/-~'~ /~1~~'f ~- (2) I.D. Number
(3) Cover Period ~~//~2 through ~/~/ ~',~ (4) Page of
(5)
Date (7)
Full Name (8)
Purpose
h
if (9) (10) (11)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code t
(add office soug
contribution to a
candidate) Expenditure
T e
Yp
Amendment
Amount
~
~rrf `l~Jl,~,
DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ~~
~~