12
-- -- -- -- -- -- -- -- -- -- FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Hwy. - c C' r V ,_ c c, "- . .:.... (3) 10 Number: $Awte Ro.sA CCWI m i 5.-5 /l)lIH'? R D"stRic t s D Check if PC has DISBANDED D Check if CCE has DISBANDED (5) REPORT IDENTIFIERS 1--1 I a.K To 2- I L.J?-. I CJ 8 Report Type D Special Election Report D Independent Expenditure Report (7) EXPENDITURES THIS REPORT Monetary Expenditures $ , -- -ll Transfers to Office Account $ , , Loans $ , , Total Total Monetary $ -- -- Monetary In-Kind $ Other Distributions (8) $ , , (10) TOTAL Monetary Expenditures To Date (9) TOTAL Monetary Contributions To Date $ , 5 ,OCJ tf- . 8?? $ , , .500· on (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (55. 839.13, F.5.) I certify that I have examined this report and it is true, correct and complete. I certify that I have examined this report and it is true, correct and complete. Name of IE.Candidate o Chairman (PC/PTY Only) Name of o Treasurer Deputy Treasurer X 89v\.. 1,,0£) . Signature Signature (1) S B i.ce R andidate, Committee or Party Name (2) (e) OtJD ChUMYC kLA Address (number and street) PAC E. City, State: Zip Code D Check box if address has changed (4) Check appropriate box(es): Candidate (office sought): D Political Committee D Committee of Continuous Existence D Party Executive Committee Cover Period: From 4- I L D Original D Amendment (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ OS-DE 12 (Rev. 08/03) 77

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Page 1: OFFICE USE ONLY S i.ce R - votesantarosa.com · CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name llN ,58L 1£f2 (2) 1.0. Number _ (3) Cover Period !f.-/.Li: / J2..8..-through

-- -- -- --

-- --

---- -- --

FLORIDA DEPARTMENT OF STATE, DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY

OFFICE USE ONLY

Hwy. ~ - ~ c C' r ~

V,_ c c, "- . .:....

(3) 10 Number:

$Awte Ro.sA CO~J!Jtv CCWI m i 5.-5 /l)lIH'? R D"stRic t s• D Check if PC has DISBANDED

D Check if CCE has DISBANDED

(5) REPORT IDENTIFIERS 1--1 I a.K To 2- I L.J?-. I CJ 8 Report Type

~ D Special Election Report D Independent Expenditure Report

(7) EXPENDITURES THIS REPORT

Monetary Expenditures $ ,

-- ~'tJ:2. -ll

Transfers to Office Account $ , ,

Loans $ , ,

TotalTotal Monetary $_'J!sL'oM'~ -- -­

Monetary $-'~'~'-8L In-Kind $_'----L'~.3Ll

Other Distributions(8) $ , ,

(10) TOTAL Monetary Expenditures To Date (9) TOTAL Monetary Contributions To Date

$ , 5 ,OCJ tf- . 8??$ , ~O , .500· on

(11) CERTIFICATION

It is a first degree misdemeanor for any person to falsify a public record (55. 839.13, F.5.)

I certify that I have examined this report and it is true, correct and complete. I certify that I have examined this report and it is true,

correct and complete.

Name of IE.Candidate o Chairman (PC/PTY Only)

Name of o Treasurer ~ Deputy Treasurer

X 89v\.. 1,,0£) XSJ~ ~A~~. SignatureSignature

(1) ~OJ1J S B i.ce R andidate, Committee or Party Name

(2) (e) OtJD ChUMYC kLA Address (number and street)

PAC E. ~L 3~52! City, State: Zip Code

D Check box if address has changed

(4) Check appropriate box(es):

~ Candidate (office sought):

D Political Committee

D Committee of Continuous Existence

D Party Executive Committee

Cover Period: From 4- I L D Original D Amendment

(6) CONTRIBUTIONS THIS REPORT

Cash & Checks $_,~,Dfltl·JUJ

OS-DE 12 (Rev. 08/03)

77

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CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS

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