DS-DE 12 G4-07 Amended Urquiza
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) (,,;~ISQ, ~,j~ V;z~ OFFICE USE ONLY
Name ~,
- ~, ~, ,~
Address (number and street) -~' "^ ~`C1
City, State, Zip Code - ~ -
^CHECK IF ADDRESS HAS CHANGED (3) ID Number: ~.: ~ ~ -t1
•
(4) Ch ck appropriate box(es): N
~
Candidate (office sought): C~.n..;ss 1a.. (~,~,n '~," c~
^ 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/.~ / ~~,~' / L , ~7 To ,! / / / ~ / ~ Report Type *'~' ~ ~-; `
^ Original [[~(]~Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ' ~~a ,~'~ G'. ~~ Expenditures $ ~~ ~~~~ . c-~
Loans $ ~, ~- ~`, L? _ t'1> Transfers to Office
Account $
Total Monetary $ f ~~°' ~~ j~) E~(,) 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 pers on 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) t;~f ~ ~N}O~ (Typ name) /.S J /•Z(~,,
^ Individual (only for Treasurer ^ Deputy Treasurer
electioneering com Candidat ^ Chairperson (only for PC, PTY &
electioneering commun. organization)
X X `"4'a.
Signature Signature
DS-DE 12 (Rev. 08/04)
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CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
{1 y Name ~~. ~ ~ ~:' ., v r c~, (2) l.D. Number
(3) Cover Period i ~ / G~ 2 ! G' ~ through ~ ~ / ~~ / ~ (4) Page ~_ of ~__
(~
Date ('n
Fua Name (8) (9) (10) (11) (12)
(~
Sequence
Number (Last, Sa9l:, First, Middle)
Street Address a~
Ci , Sta Zi Code
Contnbutor
lkcu tion
Coutribadon
T e
In-kind
Descri 'on
Amendment
Amount
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un-Ur, is lxev. vaiusJ, SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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