DS-DE 12 G4-13 Elsa Urquiza FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
Name /
(2) 07
Address (nu er and street)
µi
p d
City, State, Zip Code
❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Check appropriate box(es): -
[Candidate (office sought): C0/V/V 'S'si'o�c _ �rQdJ/�
❑ 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 2, / 3 To IC) A3 Report Type 6 3
❑ Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ ,�SD, oy Expenditures $ /p.' 900. 6
Loans $ 0" _ Transfers to Office
Account $
Total Monetary $ 3,55 49 Total
Monetary $ /0/ y09', X-J9
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) j� 4, (Type name)
❑Individual(only for ®Treasurer [:]Deputy Treasurer Candidate ❑Chairperson(only for PC,PTY&
electioneering commun.) electioneering commun.organization)
X - X , .
Signature Signature
DS-DE 12(Rev.08/04)
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name /V,, v (2) I.D. Number
(3) Cover Period JD //a through /0 / 31 / 1-3 (4) Page of
(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
to / c2S / /3 FISO4d
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.30
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10 / /7 113 (A)A
DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES /
CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
(1) Name '�/s� deez J,'2-ot— (2) I.D. Number
(3) Cover Period ry l /a / through /U / 3/ / 6 (4) Page of
(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 Typ e Occupation Type Description Amendment Amount
F® p
33 -3
,r.
DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
S
-CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES
(1) Name 1, (2) I.D.Number
(3)Cover Period through (4) Page of
(5) (7) l8) (9) (10) (111
Date Full Name Purpose
(Last,Suffix,First, Middle) (add office sought if
(6) Street Address& contribution to a Expenditure
Sequence City,State,Zip Code candidate) Type Amendment Amount
Number
�-z 677;s %1-7-7
i 3
le, 13�211
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i 2 i A-1
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DS-DE 14(Rev.08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN ASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name 5� (2) I.D. Number
(3)Cover Period�d / o� / /.3 through /O (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
/i
lr
r'
fr'
I
DS-DE 14(Rev.08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
� Elsa Urquiza
X227 E Rivo Alto Dr I'
Miami Beach,FL 33139 7 I 0•S• POSTAG
I►1111 P E
III AID
1111
uror III
rs II MI
Nov
rusia,srerES I '
1000 11 11 111 1/It AMOUNT
33139 sup�b
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