DSDE12 Campaign Treasurers Report Summary
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) OFFICE USE ONLY
Name
(2)
Address (number and street)
City, State, Zip Code
Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
Candidate Office Sought:
Political Committee (PC)
Electioneering Communications Org. (ECO) Check here if PC or ECO has disbanded
Party Executive Committee (PTY) Check here if PTY has disbanded
Independent Expenditure (IE) (also covers an Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From / / To / / Report Type:
Original Amendment Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Expenditures Cash & Checks $ , , . $ , , .
Loans $ , , . Transfers to
Office Account $ , , .
Total Monetary $ , , .
Total Monetary $ , , .
In-Kind $ , , .
(8) Other Distributions
$ , , .
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , . $ , , .
(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, correct, and complete:
(Type name) (Type name)
Individual (only for IE Treasurer Deputy Treasurer Candidate Chairperson (only for PC and PTY)
or electioneering comm.)
X X
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
Instructions for Campaign Treasurer’s Report Summary
(1) Name: full name of the candidate, political committee, party executive committee, electioneering
communications organization, or individual making an independent expenditure or electioneering
communication.
(2) Address: the full address or post office box, city, state, and zip code.