TESTIMONIAL FOR PUBLIC OFFICERS
(Section 111.012, F.S.)
Date testimonial is to be held:
Name of officer in whose honor or on whose behalf the testimonial is to be held:
Persons in charge of the testimonial:
CONTRIBUTIONS
Date
Donor Name & Address
Description of In-kind
Donation
Amount
Page _____ of _____
Form DS-DE 61 (Rev 10/06)
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