Q-1 Amended
FLORIDA DEPARTMENT OF STATE, DMSION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
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(1) /l# 'f(06 (2),4-
Can idate, ommittee or Party Name 1.0. Num er
(3) /z31 AfI/JIIIA!~<nN;lfF /I1/J11Jf1 ~e/tl/ It- :33/3
Address (number and street) City ate Zip Code
o Check box if address has changed since last report
(4) Check appropriate box(es):
~andidate (office sought): (10/ (l'/J11I1'!tJ(fIII'fEj( -- 6'~df/l111
o Political Committee 0 Check if PC has DISBANDED /
o Committee of Continuous Existence 0 Check if CCE has DISBANDED
o Party Executive Committee
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o (5) REPORT 10 NTI IERS
Cover Period: ~ 01/;4. ()( To If II (11
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o Original Amendment 0 Special Ele ion Report
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Report Type: ~ '9'
o Independent Expenditure Report
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(6) CONTRIBUTIONS THIS REPORT
$ 1-, 1f::/J .dd
.
Cash & Checks
Loans
$
$ 1.-, 150 _0
I
Total Monetary
In-Kind
$
(9) TOTAL Monetary Contributions to Date
$ 2 ( 7t"O . dlJ
(7) EXPENDITURES THIS REPORT
Monetary ;2W. 7, /
Expenditures $ I
Transfers to Office
Account
$
o
Total Monetary $
(8) Other Distributions
$ J-(/J JI/
(10) TOTAL Monetary Expenditures to Date
2((). 11
$
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (55. 839.13, F .5.)
I certify that I have examined this report and it is
true, correct and complete
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x
Name of
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SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(2)I.D. Number
(
of (
(11) (12)
(4) Page
(9) (10)
Full Name
(Last, Suffix, FIrst, Middle)
Street Adcbess &
City, State, Zip Code
Contributor
(6)
Sequence
Number
Contribution In-klnd
Type Oc<:upotion Type Descrl on Amendment Amount
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CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES
(1) Name /jd,v'/ ?>RdtJ/lS (2) 1.0. Number
- (3)CaverPeriod III I~ ()f through1L~ .11
(4) Page ( of I
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Sufllll, FIrst, Middle) (add office sought if
Sequence SInlet Address & conb'lbutlon to a Expenditure
Number City, state, Zip Code candidate) Type Amendment Amount
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