DS-DE 12 Q2-11 Urquiza FLORIDA DEPARTMENT OF STATE DIVISION OF ELECLWNt. r t 'J F fl
C TREASURER'S REPORT SUMMRY
( L - 1 /.. (,r ? z u Ot9-ft iiUs d W N 1t. M 2: 06
Name
( ztf C 1 Alto Or CITY CLEWS OFF ICE
Address (number and street)
Mto•w„ &rutin F1 3315CA c7
CO
City, State, Zip Code 74
1 :Xt
E CHECK IF ADDRESS HAS CHANGED (3) ID Number: r 1
(4) Check appropriate box(es): z - Ti
[Candidate (office sought): C- cowiw• ?is?oaer (,two p T (n - <
n Political Committee ❑ CHECK IF PC HAS DISBANDED o = n
-71 N r-z
❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED
Ii Party Executive Committee r , ' .., v
E Electioneering Communication L CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From 4 / v t / tot( To 6 / 3v / zo tt Report Type Q 11
Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ 'V Expenditures $
q
Loans $ 95 Transfers to Office
Account $
P
Total Monetary $ Si Total
Monetary $ 0
In -Kind $ 0
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ # $ 5
(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) ,,,,,.d C.uv'M.N (Type name) E /4.A
NI • OR a 0i 24,_
❑Individual (only for Treasurer ❑ Deputy Treasurer Candidate [II Chairperson (only for PC, PTY & a_ .. electioneering commun.) electioneering commun organization) 242,....„...,
Signature a ! - --' Signature
DS -DE 12 (Rev. 08/04)