Q4 - 2009
OfflefJ of the CIty Clerk
b:Of) CJ7V /-/0.-10
(1 )
':T~f\tV
Name
(2) ~ 3D,? AJt:" 4 I\~
Address (number and street)
/~o1 JW.~ 1}(L FL ) 373\-
City/State, Zip Code
o CHECK IF ADDRESS HAS CHANGED
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
13 A I" Uf (,~ fVt2'l~ l- l{ , OFFICE USE ONLY
(3)
10 Number:
(4) Check appropriate box(es):
I)j.Candidate (office sought):
o Political Committee
o Committee of Continuous Existence
o Party Executive Committee
o Electioneering Communication
Mf\~~
CHECK IF PC HAS DISBANDED
o CHECK IF CCE HAS DISBANDED
o CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From ~ I ~ I ')vo1 To ~ I ~ I 2,,"01 Report Type S '3
Original 0 Amendment 0 Special Election Report 0 Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
& Monetary ~
Cash & Checks $ Expenditures $
Loans $ 1; Transfers to Office
!?-
Account $
Total Monetary $ {j Total 4?
Monetary $
In-Kind $ t(?-
(8)
Other Distributions
$
9
(9) TOTAL Monetary ontributions To Date
$
(10)
TOTAL Monetary Expenditures To Date
$ 76L, ~~ ~~
f)~
(11 ) CERTIFICATION
It is a first degree misdemeanor for any person to falsify a public record (55. 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)
[Kcandidate D Chairperson (only for PC, PTY &
, " electioneering commun,/ganizatiOn)
X :r;~l < ,.}..;--{-;;~~/~ It t
Signature / 'J; I
Treasurer D Deputy Treasurer
.f,.
OS-DE 12 (Rev. 08/04)
(1) Name
""'''i'');-if~{~
5:00 cnV {I J
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (IQ/,()~
::'~f\;J /, frf71)1 t. ~"vt:L ~ (2) 1.0. Number
~:;
(3) Cover Period 10 / J 1~7 through J L / I 12.l'D~ (4) Page J 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 Tvpe Occupation Type Description Amendment Amount
'I. 1//
/ /
,
-, /
/ /
I /
I I
'.
I / , ''.\
\
, "\\"""\'
/,,/' " "
/ / I \
'''-\
r'\
/ / \
.'
"
,
/
/ / , ,
OS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES '\
(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 /
City, State, Zip Code candidate) Type Amendment Amount
Number //
/
/ / /
\" /
"
'-.-"" /
,~ l/
'\." ,
"""'" /'
/ / '\ ,..'
.\
\''\.
"
"- //
\.,
\"'.
/ / "-..
~',
"',
"
"
'.
'\
\'.
"-
"
/ /
"'\~
~" .
/ /
\'\
/ / \,
\
\
'\
"
\
/ '\
/ / \
\
, \
\
, \
/ / \
\
OS-DE 14 (R~. 08/03)
(4) Page
f
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
U~'& O'l .~~ ~tt;\I
oBi'
I of J
'\
\.