DS-DE 12 F3-07 Amended UrquizaFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) UISu~ i'tU
OFFICE USE ONLY
Name
(2) 27.E ~ Q.aJn Rlao ~pf
Address (number and street) ~,,
'
c
~Aiaw: I~wc~ ~ 1/1
331 3H "
a
. , cs~ iii
City, State, Zip Code "^ `~~
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: `. ~ ~ ~~J~
=~ r- - -
(4) Check appropriate box(es): ="~ -v '~
(Candidate (office sought): Coenw~; Ss ta r~~~
rn (,-r~m~~"Y~L ~~_,
~
^ 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 pq / -2g / ~~. To t~ / ~2 / ~~ Report Type ~-~-7
^ Original ®Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ 3 Z~~.o ~ Expenditures $ ~ tq ~ 12
Loans $ Transfers to Office
Account $
Total Monetary $ 3 , 2SO, of Total
Monetary $ ~~~~. ~~Z
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 70 . 0.aS.a~ $ ~ ~Z3~,33
__
(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) ~wr t~ ~.uai~D S ~---_ //
(TYPe name) °'` l~S ,~ t_. ~::11x c~/ ~-'v
Individual {only for Treasurer ^ Deputy Treasurer ^ Candidate .` ^ Chairperson (only for PC, PTY &
electioneering commun.) ~ elect;Qheering commun. organization)
(
Signature Signature ~J
DS-DE 12 (Rev. 08/04)