E-2
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FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICE USE ONLY
(1)
Name
(2)
Address (number and street)
City, State, Zip Code
o CHECK IF ADDRESS HAS CHANGED
(4) Check appropriate box(es):
o Candidate (office sought):
o Political Committee
o Committee of Continuous Existence
o Party Executive Committee
o Electioneering Communication
(3) 10 Number:
o 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 01 / ~ / /0 To ~ / ()4 / 10 Report Type E-~
Original 0 Amendment 0 Special Election Report 0 Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
9- Monetary Cz
Cash & Checks $ Expenditures $
Loans $ ~ Transfers to Office ~
~ Account $
Total Monetary $ Total 6,
6- Monetary $
In-Kind $
(8) Other Distributions c9--
$
(9) ;OTAL Monetary ~~Vions To Date
(10)
TOTAL Monetary Expenditures To Date
$ 7~~' W
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(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)
Dlndividual (only for
electioneering commun.)
(Type name)
Treasurer 0 Deputy Treasurer ~andidate
o Chairperson (only for PC. PTY &
electioneering commun. or anization)
OS-DE 12 (Rev. 08/04)
x
x
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name 7~ 1bJ1-r::fYs76 ~~~2) I.D. Number
(3) Cover Period /[}-~ / through fl- /
(5) (7) (8) (11)
Date Full Name
(6) (Last, Suffix, First. Middle)
Sequence Street Address & Contribution In-kind
Number Cit . State, Zi Code T e Desen tion Amendment
(12)
Amount
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
-::J2CAMPAIG.)I TREASU~R'~OR~IZ&D EXPENDITURES
(1) Name t:59J,tJ e>jtt77isa...... ~ /<'(2) I.D. Number
(3)COVerperiodL~~thrOugh >>- /~-.L!2.. (4) Page I
(
4
of I
,
(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 C' , State, Zip Code candidate) Type Amendment Amount
OS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES