DS-DE 12
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) OFFICE USE ONLY
Name
(2)
Address (number and street)
City, State, Zip Code
Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
Candidate Office Sought:
Political Committee (PC)
Electioneering Communications Org. (ECO) Check here if PC or ECO has disbanded
Party Executive Committee (PTY) Check here if PTY has disbanded
Independent Expenditure (IE) (also covers an Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From / / To / / Report Type:
Original Amendment Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Expenditures Cash & Checks $ , , . $ , , .
Loans $ , , . 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
$ , , . $ , , .
(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, correct, and complete:
(Type name)
(Type name)
Individual (only for IE Treasurer Deputy Treasurer Candidate Chairperson (only for PC and PTY)
or electioneering comm.)
X X
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
Instructions for Campaign Treasurer’s Report Summary
(1) Name: full name of the candidate, political committee, party executive committee, electioneering
communications organization, or individual making an independent expenditure or electioneering
communication.
(2) Address: the full address or post office box, city, state, and zip code.
Check the box if the address has changed since the last report filed.
(3) ID Number: identification number assigned by the filing officer.
(4) Check the appropriate box(es).
(5) Report Identifiers
Cover Period: the dates this report covers (i.e., From 1/1/15 To 1/31/55). Important: use the appropriate
cover period dates as published by the filing officer.
Report Type: refer to the filing officer’s calendar of reporting dates for the correct codes to be used for
each reporting period. If report is for a special election add “S” in front of the report code (i.e., SG3).
Check one of the appropriate boxes:
Original: first report filed for this reporting period.
Amendment: must summarize only contributions/fund transfers and expenditures/distributions being
reported as additions or deletions. Read instructions for sequence numbers and amendment types on
the back of Forms DS-DE 13A and 14A.
Special Election Report: Important: once a special election report is filed, the entity is required to file all
remaining reports due for the special election.
(6) Contributions This Report:
Cash and Checks: total amount for this reporting period.
Loans: total amount for this reporting period.
Total Monetary: sum of Cash and Checks and Loans.
In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period.
(7) Expenditures This Report:
Monetary Expenditures: total amount of monetary expenditures for this reporting period.
Transfers to Office Account: total amount transferred to an office account by elected candidates only.
Total Monetary: sum of Monetary Expenditures and Transfers to Office Account.
(8) Other Distributions: the total amount of goods and services contributed to a candidate or other
committee by a PC, ECO, or PTY.
(9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date.
Candidates keep cumulative totals from the time the campaign depository is opened through the
termination report.
(10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date.
Candidates keep cumulative totals from the time the campaign depository is opened through the
termination report.
(11) Type or print the required officer’s name and have them sign the report:
Candidate report: treasurer and candidate must sign.
PC report: treasurer and chairperson must sign.
PTY report: treasurer and chairperson must sign.
ECO report: organization’s treasurer must sign.
IE or EC report: individual must sign (this applies when an individual acts alone to make these
expenditures)
AMENDMENT REPORTS: An amendment report summary should summarize only
contributions, expenditures, distributions, & fund transfers being reported as additions or
deletions. Read the instructions for the sequence number & amendment type fields on
the back of forms DS-DE 13, 14, 14A and 94.