DS-DE 12 F4-07 Amended UrquizaFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ~'~ ~r4 v, zu OFFICE USE ONLY
Name r- ^~
(2) zz.~ v Q;~o A1~o tQr~
Address (number and street) ~~~} ~ r~
M~«„ l~a~ 1rl 33t~~ --
~ ~
City, State, Zip Code -~
^ CHECK IF ADDRESS HAS CHANGED .~.
(3) ID Number: ~
(4) Check appropriate box(es): _
-- w
-
dCandidate (office sought): Ce~:SS~o~ ; ~'
(tro~~ -~ ~
^ 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 tb / ~~ / n~ To ~~ / ~_ / o~ Report Type ~q..o-~.
^ Original ['Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ bS~ Expenditures $ 1°t , 56~.~
Loans $ Transfers to Office
Account $
Total Monetary $ ~~ Total
Monetary $ IQ ~ S6~ vai
In-Kind $
(8) Other Distributions
$
(S) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 77 , had. o~_ $ 'tZ , no+4.4 2
(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 re rt and it is true,
correct, and complete. correct, and compl to
(Type name) ~,,,o,r~ (.ow}~~ (Type name) '~ ~.5~' ~ (~
^ Individual (only for ®Treasurer ^ Deputy Treasurer ^ Candidate Chairperson (only for PC, PTY &
electioneering commun.} ele ion ring commun. organization)
X i~ X
Signature Signature
DS-DE 12 (Rev. 08/04)