E-3 Treasurers Report
s (nurn --.)
f) On
City, $,ta ,Zip Code
o CHECK IF ADDRESS HAS CHANGED C
(4) Check appropriate box(es):
~candidate (office sought): . [)
o Political Committee
o Committee of Continuous Existenc
o Party Executive Committee
o Electioneering Communication 0 CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS f1.-.-
Cover Period: From J-2- 1 11-1 Lr To -1Q 1 JR 1 ~ Report Type
riginal 0 Amendment 0 Special Election Report 0 Independent Expenditure Report
ARTMENT OF STATE DIVISION OF ELECTIONS
N TREASURER'S REPORT SUMMARY
() ,.r J OFFICE USE ONLY
JVe
N
(1 )
::0
-..1:,,,,
(2)
-"-
"
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
3/ ,:)OD Monetary ~ 7- j,;: tof
Cash & Checks $ Expenditures $
(
Loans $ Transfers to Office
Account $ 6~
Total Monetary $ Total 6r
IS Monetary $
In-Kind $
(8) Other Distributions
$
(9)
TOTAL Moneta~~tributions To Date
$ /~. OI'tJ?r
I
(10)
TOTAL Monetary Expenditures To Date
$ S; C):J.f, OcZ
it is true,
/X
Signature
OS-DE 12 (Rev. 08/04)
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name Nt2- 1"'1 e IJ e ~ 0 S'S
(3) Cover Period '0 1 {I tJ through / 1 0
(5) (8)
Date
(9)
(4) Page
(10)
(11 )
Contribution In-kind
Descri tion Amendment
CH~
Cf/1
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of bZ
(12)
~AMPAIGN TR:SU'?)R'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name r) d r (Ct\. l\ 0 S-.s (2) I.D. Number
b I \ II 0 q- through [) 1- (4) Page d- of
(7) (8) (9) (10)
Full Name
(Last, Suffix, First, Middle)
Street Address &
Cit ,State, Zi Code
(i H~IY\ H lLL .-v ~
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D J;)~ J ol <~rII t~,~~~ :IS ~.
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(3) Cover Period
(5)
Date
DS-DE 13 (Rev. 08/03)
In-kind
Descri tion
Amendment
\')\;;4li "J-
l dPe~~
wel\cs-l~
~,~~
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
cZ
(11 )
(12)
Amount
J[SJlf}
IS
PAIGN EASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name e!. ~ .s- (2) I.D. Number
(3) Cover Period 1.12-1 fl;~rOUgh JJ-1.-12L1 n (4) Page /
~ m ~ ~
Date
(6)
Sequence
Number
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Purpose
(add office sought if
contribution to a
candidate)
Amendment
Expenditure
Type
tl 'al-K ~ ;c-S'r I
l () 00 Ifp ;tI~ Jllrte
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DS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of3
(10)
(11)
Amount
11 d S:J'.J
RER~S..REPORT -ITEMIZED EXPENDITURES
(1) Name 0 J (2) I.D. Number
(3) Cover Period -fo-J~~hroU9h .D-J2.1E (4) Page ::2.. of--3
(5) (7) (8) (9) (10)
Date
(6)
Sequence
Number
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
u- ~. f ()~l ~E;:...-vl C e
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'1?Ii~~ (3e~I.( pL3JL/::? '-
DS-DE 14 (Rev. 08/03)
Purpose
(add office sought if
contribution to a
candidate)
Expenditure
Type
~+aMp5 '-PIS
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SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Amendment
(11)
Amount
zq- 02 rc;
~11
~
5_.$76
REASjJRER'S REPORT - ITEMIZED EXPENDITURES
o s:-.s (2) I.D. Number
/nthrOUgh-JJ_L!2L~ (4) Page _'-=S of-S
(1) Name
(3) Cover Period ~
(5)
Date
(6)
Sequence
Number
DS-DE 14 (Rev. 08/03)
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8) (9) (10) (11)
Purpose
(add office sought if
contribution to a Expenditure
candidate) Type Amendment Amount
fdrk~e B
&:J ~-)o,,_
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(?I\t.jot ,J
~
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
C) 0-1
CO ::=4 -<
City,
o CHECK IF ADDRESS HAS CHANGED
(4) . Check appropriate box(es):
~Candidate (office sought):
o Political Committee
o Committee of Continuous Existence
o Party Executive Committee
o Electioneering Communication
O:J
N
(1 )
OFFICE USE ONLY
-0
:x
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~ ~"'-:1-
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(2)
N
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(3)
11
b eclc~
o CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
I q (5) REPORT IDENTIFIERS
Cover Period: From -lilt li t 0 '} To ~ t () I t 0 't- Report Type E 3
o Original 'f2g Amendment 0 Special Election Report 0 Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash & Checks $ 3 s-{) 0
{
Loans $
Total Monetary $ 3( 5/J ()
In-Kind $ (S
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures
$
~ I ~ 03.3'f
Transfers to Office
Account $
Total
Monetary
$
b b () 3,31-
I
(
(8) Other Distributions
$
(9)
TOTAL Monetary Contributions To Date
$ I eJ/ 9-9CJ. 00
(
(10)
TOTAL Monetary Expenditures To Date
$ G! 9- 5 1-- ':f-d-
(
(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 e amined this report and it is true, I certify that I have examined this report and it is true,
correct, and com l jJ correct, and comp . I
r c:Yle ,luS'S Ve,V)e
reasurer DDeputy Treasurer
/l~ x..-//
Signature
OS-DE 12 (Rev. 08/04)
INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Type full name of candidate, political committee, committee of continuous existence, party executive
committee, or individual or organization filing an electioneering communication report.
(2) Type the address (include city, state, and zip code). You may use a post office box.
If the address has changed since the last report filed, check the appropriate box.
(3) Type identification number assigned by the Division of Elections.
(4) Check one of the appropriate boxes:
Candidate (type office sought - include district, circuit, or group numbers)
Political Committee
Committee of Continuous Existence
Party Executive Committee
Electioneering Communication
If PC or CCE has disbanded and will no longer file reports, check appropriate box.
If individual or organization will no longer file electioneering communication reports, check appropriate box.
(5) Type the cover period dates (e.g., From 07/01/03 To 09/30/03)
Enter the report type using one of the following abbreviations (see Calendar of Election and Reporting
Dates). If report is for a special election, add "S" in front of the report code (e.g., SG3).
Quarterly Reports General Election Reports
~1~~i:~~1:::J~ !it~~~~~~
Primary Reports
32"d Day Prior............................... ................ .......... ......... F1
1~t~~~yp~~~r.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ~~
Check one of the appropriate boxes:
Original (first report filed for this reporting period)
Amendment (an amendment to a previously filed report)
Special Election Report
Independent Expenditure Report (see Section 106.071, F.S.)
90-Day Termination Reports (Candidates Only)
Termination Report ..... ... ...... ...... ..... ........ ..... ..... ............. TR
(6) Type the amount of all contributions this report:
Cash & Checks
Loans
Total Monetary (sum of Cash & Checks and Loans)
In-kind (a fair market value must be placed on the contribution at the time it is given)
(7) Type the amount of all expenditures this report:
Monetary Expenditures
Transfers to Office Account (elected candidates only)
Total Monetary (sum of Monetary Expenditures and Transfers to Office Account)
(8) Type the amount of other distributions (goods & services contributed to a candidate or other committee by
a PC, CCE or PTY).
(9) Type the amount of TOTAL monetary contributions to date (parties keep cumulative totals for 2 year
periods at a time (e.g., 01/01/02 -12/31/03). Candidates keep cumulative totals from the time the
campaign depository is opened through the termination report).
(10) Type the amount of TOTAL monetary expenditures to date (parties keep cumulative totals for 2 year
periods at a time (e.g., 01/01/02 -12/31/03). 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 & candidate must sign)
PC report (treasurer & chairperson must sign)
CCE report (treasurer must sign)
PTY report (treasurer & chairperson must sign)
Electioneerinq Communication report (individual or orqanization's treasurer & chairperson must sign)
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 OS-DE 13, 14, 14A and 94. The Division will summarize all
reDorts submitted for each reDortina Deriod and for the filer to date.
RER'S REPORT - ITEMIZED EXPENDITURES
(2) J.D. Number
(4) Page ---1-- of
(5) (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
DEL /60
()f+iee l>epof;;, b\vej{)feJj~dc, ~}S
:20D 'fJ'~i4~flVe
{3o~ n10h /!erlC~ LPYcl
().ft;:~e~rrq-- A 6nVe!o~ efe.. ) S
d&o f/. fJ,~~s}J1Ve.
& f\~1 fL ]st;,
<Ii
DEL
~r> D $ Lf(S''f
OS-DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT. ITEMIZED EXPENDITURES
(1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or
party executive committee (PTY).
(2) Type identification number assigned by the Division of Elections.
(3) Type cover period dates (07/01/03 through 09/30/03). (See Calendar and Election Dates for appropriate cover
periods.)
(4) Type page numbers (e.g., 1 of ~).
(5) Type date of expenditure (Month/DaylYear).
(6) Sequence Number - Each detail line shall have a sequence number assigned to it. Sequence numbers are to be
assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and
sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer.
This method of unique identification is required for responding to requests from the Division and for reporting
requirements.
For example, a 01 report having 40 expenditures would use sequence numbers 1 through 40. The next report
(02), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended 01
reports would begin with sequence number 41 and on amended 02 reports would begin with sequence number 31.
See Amendment Type instructions below.
(7) Type full name and address of entity receiving payment (including city, state and zip code).
(8) Type purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the
candidate). PLEASE NOTE: This column does not apply to candidate expenditures, as candidates cannot
contribute to other candidates from campaign funds. However, PCs (supporting candidates), CCEs and party
executive committees contributing to candidates must report office sought (Section 106.07, F.S.).
(9) Enter Expenditure Type using one of the following codes:
DESCRIPTION : CODE
----------------------------------~----------------------
Disposition of Funds (Candidate) j DIS
I
Monetary ! MON
Petty Cash Withdrawn i PCW
I
Petty Cash Spent j PCS
Transfer to Office Account j TOA
Refund i REF
(10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the
reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data.
The sequence number for expenditures with amendment type "ADD" will start at one plus the number of
expenditures in the original report. For example, amending an original 01 reports that had 75 expenditures, means
the sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD"
expenditure would have sequence number 39.
To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment
type on a line with the sequence number of the expenditure to be corrected. In combination with the report number
being amended, this sequence number will identify the expenditure to be dropped from your active records. On the
next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus
replacing the dropped data. Assign the sequence number as described above.
(11) Type amount of expenditure.