DS-DE 12 F2-07 Amended UrquizaFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ~~ Jto~caa OFFICE USE ONLY
Name
(~) Z-2~' ~ Q~rO ~1o Q~
Address (number and street)
N
City, State, Zip Code ""~ ~
^ CHECK IF ADDRESS HAS CHANGED ~--= '~'
(3) iD Number: r~ -;~
(4) Check appropriate box(es): %:. -v .~-,~
Candidate office sou ht ~ (m, 'YC `~` ~ '~"i
^ Political Committee ^ CHECK IF PC HAS DISBANDED N --'
^ 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 ~ / ~~ / o~ To o~i / ~_ / y~ Report Type _ }2-a~
^ Original [Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ 1,ppp Expenditures $ Z ~~p.4i
Loans $ Transfers to Office
Account $
Total Monetary $ ~, QpU Total
Monetary $ ZIRdo 4~
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ b~
~A~'•oo $ zl ~ Sao . 61
,
(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~ ~~ ~ a ~ r-- ~,-,
(Type name) ~"" ~ ,~ ~f~~~l ~ ~`~~~
Individual (only for QTreasurer ^ Deputy Treasurer ^ Candidate ^ Chairperson (only for PC, PTY &
electioneering commun.i ~~"~~,, electi~ieering common. organization)
Signature Signature r r
DS-DE 12 (Rev. 08/04)