DS-DE 12 Q1-07 Amended UrquizaFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) ~~ ~~ ~~~ OFFICE USE ONLY
Name
(2) zz7 ar ewn_ A1i~ +Ar
Address (number and street)
M~a~i Qtwc.~t ~~1 33i3A c; ~
-? ~ ~q
`"
City, State, Zip Code -n
^ CHECK IF ADDRESS HAS CHANGED ,-- c~ ;~~
(3) ID Number:
~~t
(4) Check appropriate box(es): ~`: r
Candidate office sou ht : `~~ ~ ~'
^ Political Committee ^ CHECK IF PC HAS DISBANDED .~~ N _;
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED ~ N
cn
^ Party Executive Committee
^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From pl / pl / p~ To ~~ / ~{ / O~ Report Type Q I
^ Original ~Arnendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ Expenditures $ Ict7.OG _________
Loans $ ZS, (~~ Transfers to Office
_ Account $
Total Monetary $ Total
_ Monetary $ lu?,
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 2~, r~DO $ IA?~o0
(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) p~.,$G~.. J~6jJ/ ZGC.. (Type name) /`~ l•SGtr /~(~~ j 2~
^ individual (only for ^ Treasurer ^ Deputy Treasurer ^ Candidate ^ Chairperson (only for PC, PTY &
electione mun.) electio ring commun. organization)
X ~/
/~
Signature Signature
DS-DE 12 (Rev. 08104)