DS-DE 12 Urquiza Q3-12 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUM . ARY
"7Z-.CA OFFICE USE ONLY
1411 OCT
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Address (number and street) V r
3-S13CA
City, State, Zip Code
❑ CHECK IF ADDRESS HAS CHANGED (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 -7 / / To C / 7 Report Type 1-z'-�Z
Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ Expenditures $
Loans $ c6 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
$ 000) $
(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) -���,�;r C.�L�►nb (Type name) 9 I,6�9 d lJ/ZL�
❑Individual (only for Treasurer ❑Deputy Treasurer YfCandi Chairperson(only for PC,PTY&
electioneering commun.) electioneer' commun.organization)
Signature -' !�— Signature )
DS-DE 12(Rev.08/04)c--
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