E-4
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
~AtV 18/iP7l57E Ftey~ /<'
(2) #3o~ IV E. Qo II1C
Ad~s}number and street) ~
~I() M- ft:- '3370 ~
City, State, Zip Code
o CHECK IF ADDRESS HAS CHANGED
(4) Ch8A;k appropriate box(es):
~Candidate (office sought):
tJ Political Committee
o Committee of Continuous Existence
o Party Executive Committee
o Electioneering Communication
4
(1 )
OFFICE USE ONLY
(3) 10 Number:
M WcO~
o CHECK IF C HAS DISBANDED
o CHECK IF CCE HAS DISBANDED
o CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFteRS
Cover Period: From ~ / 9JL / ~ To ~ / 0&/ / 10 Report Type E. - 4
Original 0 Amendment 0 Special EJection Report 0 Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
g Monetary f:r
Cash & Checks $ Expenditures $
Loans $ Gr Transfers to Office t7
I:r Account $
Total Monetary $ Total 6.
Monetary $
In-Kind $ (;?
(8)
Other Dist~butions b
(9) ;OTAL Mon~ontributions To Date
(10)
TOTAL Monetary Expenditures To Date
$ 7i{?:" fq
(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, I certify that I have examined this report and it is true,
correct, and complete. correct, and complete.
(Type name)
o Individual (only for
electioneering commun.)
(Type name)
Treasurer 0 Deputy Treasurer Wcandidate
o Chairperson (only for PC. PTY &
electioneering commun. ganization)
xIX
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OS-DE 12 (Rev. 08/04)
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'S REPORT - TEMIZED EXPENDITURES
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(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if Expenditure
Sequence Street Address & contribution to a
Number City, State, Zip Code candidate) Type
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
".--
(1) Name Jerrrv 8fJ1:0 S7c ~~~
d- 3
(2) 1.0. Number
(3) Cover Period I :;Jc; I/O through 17 I/O (4) Page of
(5) (7) (8) (9) (10) (11 ) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number lCitv. State, Zio Code Tvpe Occupation Tvpe Descriotion Amendment Amount ./
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OS-DE 1;'(Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES '\\\,
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