DS-DE 12 Q2-12 Urquiza FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUM�"� R V
(1) I S� ZO�F.��FLEMEP#LI
Name 46
(2) -L-L T C 2,,,a I k CITY CLERK'S OFF ICF
Address (number and street)
A&M" &"C)o I t=1 33t3G
City, State, Zip Code
❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Ch
❑ck appropriate box(es):
Candidate (office sought): CO Ss;oV� �Yo0-P =
❑ 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 / / Zp IE To 6 / Report Type
E4 Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ c6 Expenditures $
Loans $ (�, Transfers to Office
Account $
Total Monetary $ Total
Monetary $
In-Kind $
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ $
(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) G—L,.,,C� �,to�O.S (Type name) ,G pl/S 4
F-1 Individual(only for ZTreasurer ❑Deputy Treasurer Ercandidate ❑Chairperson(only for PC,PTY&
electioneering commun.) election ring commun.organization)
Signature Signature
DS-DE 12(Rev.08/04)