DS-DE 2
CONTRIBUTIONS RETURNED
(Section 106.07(4)(b), F.S.)
(PLEASE TYPE)
OFFICE USE ONLY
This report applies only to contributions received by any candidate, committee, or organization but returned
to the contributor before being deposited in the campaign account.
Candidate Committee or Organization
Full Name:
Full Address:
Full Name and Address of Contributor: Full Name and Address of Contributor:
Amount of Contribution: $ Amount of Contribution: $
Date Received: Date Received:
Date Returned: Date Returned:
Full Name and Address of Contributor: Full Name and Address of Contributor:
Amount of Contribution: $ Amount of Contribution: $
Date Received: Date Received:
Date Returned: Date Returned:
I CERTIFY THAT I HAVE EXAMINED THIS REPORT AND IT IS TRUE, CORRECT AND COMPLETE.
Type or Print Name of Candidate, Treasurer or Chairman
X
Signature
DS-DE 2 (Rev. 07/10)