DS-DE 12 Q4-12 EUrquiza FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SiUMM, #1Ft1C
a OFFICE USE ONLY
Name 2013 JAN -7 PM 2. 0 9
(2) ZZq- le QZvo AA o CITY CLERK'S OFFICE:.
Address (number and street)
�L1,erA c)
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
3l
Cover Period: From tc> / t / Zol2 To It / / ZoIZ Report Type Q+ - tZ
MI/Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
� Monetary
$
Cash & Checks Expenditures $ az'gCA
Loans $ Transfers to Office
Account $
Total Monetary $ p1 Total
Monetary $ 1ZL,a CA
In-Kind $
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ C)0 $ IZZ • GG1
(11) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
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 I c, cd U (_C'Vw0S (Type name) /S 14 J/ZC
❑Ind ividual(only for Treasurer [—]De,uty Treasurer EiVcandidate ❑Chairperson(only for PC,PTY&
electioneering commun.) lectione g commun.organization)
X X
Signature Signature
DS-DE 12(Rev.08/04)
1
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name ISc% Or q 0'z a (2) I.D. Number
(3) Cover Period 40 Z through 12 / �,O / IL (4) Page of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix,First,Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
C7V%f- T;nc-n etx9,4d �utrtla�S
tl ►q t2 qd t(o SC- A,��,�s►�,.� 44.
Pe�r�laM� �e °I-4 ZOZ
DS-DE 14(Rev.08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES