DS-DE 12 F2-09 BowerFLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMM Y_
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(1) OFFICE USE ONLY
Name 2004 QCT -2 PM 2~ 43
(Z) I~rZ- ~~~-~~~c~~~c c~r~r cat rr:°~ o~ ~_ ~cF
Ad r (num rand stree
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City, State, Zip ode
^ CHECK IF ADDRESS HAS CH NGED (3) ID Number:
(4) Check appropriate box(es): _
Candidate (office sought): ~ ~ ~~
^ 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 O~ / ~Z / ~ To ~ / ~~ / ~ Report Type 2,-
(~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THlS REPORT
Cash & Checks $ ~~ ~~ ~ O~ Monetary
Expenditures $
Loans $ _ Transfers to Office
Account $
Total Monetary $ 7i~ rj ~ ~ ~ Total
Monetary $
In-Kind $
(8) Other Distributions
(9) TOTAL Monetary Corrtributions To Date (10) TOTAL Monetary Expenditures To Date
$ ~~ S a , oca ~ ~3t~D ~ a p
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a ublic 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 plete.
~ correct, and lete.
(TYPe n \ ~~ (TYPe name) ~ 6~
^Ind' for Treasurer ^ Deputy Treasurer ,Candidate ~ ^ Chairperson (only for PC, PTY 8
e .) • orgarwzation)
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DS-0E 12 (Rev. OSlo4) a
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(1) Name
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CAIYIPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
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(3) Cover Period ~ \ t ~7i t d~ through (~ t ~ l O J {4) -Page ~ ofi
(5)
Date (7)
Full Name (8) (9) (10) (11) (12)
(6)
Sequence
Number (Last, Suffoc, First, Middle)
Street Address &
State, Code
Contributor
T O "on
Contribution
T
In-kind
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Amount
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DS-DE 13 (Rev. 081'03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
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