DS-DE 12 -1 S. Berke FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER°.S REPORT SUMMARY
(1) �je"e-4.t OFFICE USE ON�Y
Name
4, / / --i _C_
Ave,-
C_j
Address (number and street) r c a f
A4/�1, oq-4 , FL 3 3
City, State, Zip Code
Cn
❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es):
Cn
Candidate office sought): / •Q �-Gt`"L'
❑ 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 / / To 6 / 3� / /3 Report Type
❑ Original 5;-Am"'e n d m e n t ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ D Expenditures $
Loans $ 1�S'J, 00,3 - Transfers to Office
Account $
Total Monetary $ �s 0 O Total
Monetary $
In-Kind $ b
(8) Other Distributions
$ C)
(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. (1, correct, and complete.
(Type name) �ut- v� (Type name) "r6A,/C /
❑Individual(only for Q<reasurer ❑Deputy Treasurer andidate ❑Chairperson(only for PC,PTY&
electioneering commun.) lectioneering commun.organization)
X X
Signature Signature
DS-DE 12(Rev.08/04) l F 3
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name ILA -c/- 2 I.D. Number
(3) Cover Period / / l through 6 / 30 / /3 (4) page .0-- of 3
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last,Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-kind
Number /City,State,Zip Code Type Occupation Type Description Amendment Amount
gel.,
riv, 57. (od vue
�p
M(6ti1��
3
C=
l J., 9sl
y
DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
� 0 � 3
CAMPAIGN TRgASI)RER'S REPORT- ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number
(3)Cover Period /�_/ through / 3 (4) Page of 3
(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
c—j T
�i
i
i
DS-DE 14(Rev.08103)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 3
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