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Campaign Treasurer's Reports
i Y OF BOYNTON BEACH - 11v r►_ERIK'S OFFICE WAIVER OF REPORT (Section 106.07(7), F.S.) 13 JUL 32 PM 2: 40 (PLEASE TYPE) OFFICE USE ONLY Dr Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Boynton Beach, FL 33436 Address City State Zip Code © Candidate ❑ Committee of Continuous Existence I I Electioneering Communication Organization ❑ Political Committee Party Executive Committee ri Check box if address has changed since last report ❑ Check here if PC, CCE, or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION ❑ January ❑ 32nd day prior ❑ 46th day prior ❑ April ❑ 18th day prior ❑ 32nd day pnor © July ❑ 4th day prior ❑ 18th day prior ❑ TERMINATION REPORT ❑ October ❑ 4th day prior ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF March 1, 2013 June 30, 2013 THROUGH • X , ) r 13 l• a S 08/01/13 Signature Date X b r B ) a ( ' 08/01 /1 3 Signature ) Date SIGNATURES REQUIRED FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Committees of Continuous Existence and Electioneering Communication Organizations: Treasurer (s 106 04(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 04/13) ' J `WWY OF QOYNTON BEACH WAIVER OF REPORT Cl I" RFC (Section 106.07(7), F.S.) 13 OCT -8 PM 1: 13 (PLEASE TYPE) OFFICE USE ONLY Dr Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Boynton Beach FL 33436 Address City State Zip Code © Candidate ❑ Committee of Continuous Existence ❑ Electioneering Communication Organization ❑ Political Committee ❑ Party Executive Committee I I Check box if address has changed since last report ❑ Check here if PC, CCE, or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION ❑ January ❑ 32nd day prior ❑ 46th day prior ❑ April ❑ 18th day prior ❑ 32nd day prior ❑ July ❑ 4th day prior ❑ 18th day prior ❑ TERMINATION REPORT © October ❑ 4th day prior El SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF June 1, 2013 September 30, 2013 THROUGH X �) L � �/� � -- 10/08/13 Signature �V� Date X I) I RL6L4/i Signature Date SIGNATURES REQUIRED FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Committees of Continuous Existence and Electioneering Communication Organizations: Treasurer (s 106 04(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 04/13) The City of Boynton Beach City Clerk's Office i (f >''s - 100 E BOYNTON BEACH BLVD BOYNTON BEACH FL 33435 (561) 742-6060 FAX: (561) 742 -6090 E -mail: prainitoi@bbfl.us www.boynton-beach.org BY CERTIFIED MAIL 7011 2970 0001 8395 5059 November 14, 2013 DR PIOTR BLASS 113 WEST TARA LAKES BOYNTON BEACH FL 33436 Re: Campaign Treasurer's Report Covering Period October 1- October 31, 2013 Dear Dr. Blass: Pursuant to FS 106.07(8)(a)(b), you are hereby notified that you failed to file your Campaign Treasurer's Report, Report Code 2013 M10, for the period October 1 through October 31, 2013. The report was due in my office by the close of business at 6:00 p.m. on Tuesday, November 12, 2013. Please be advised that a fine is being assessed for late filing of the report. In accordance with the Florida Statute stated above, the fee for late filing is $50 per day for the first three days, and thereafter, $500 per day for each late day, not to exceed 25% of the total receipts or expenditures, whichever is greater, for the period covered by the late report. Once the report is received, I will determine the number of days late and assess the fine accordingly. Please contact this office at your earliest convenience. Very truly yours, CITY OF BOYNTON BEACH ��r , , WI et M. Prainito, MMC City Clerk S \CC \WP \ELECTION \YEAR 2016 \MAYOR \Piotr Blass \Late Filing of Report for 10 -01 -13 thru 10 -31 -13 doc Catch a Wave, Catch a Fish, Catch Your Breath - Breeze Into Boynton Beach America's Gateway to the Gulfstream F 6tlYNIi> escA,6 WAIVER OF REPORT E ' `'` °r 'CI (Section 106.07(7), F.S.) 13 DEC -9 PM 4: 04 (PLEASE TYPE) OFFICE USE ONLY PIOTR BLASS MAYOR - CITY OF BOYNTON BEACH Name Office Sought 113 WEST TARA LAKES BOYNTON BEACH, FL 33436 Address City State Zip Code ta Candidate ❑Political Committee ❑Electioneering Communications Organization ❑ Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) el MONTHLY REPORT ® PRIMARY ELECTION ❑GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M 10 - 2013 P G as applicable: ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF OCTOBER 1, 2013 THROUGH OCTOBER 31, 2013 X P,jir @to q i 2ot Signature D X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified +n writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) ,}F ft 1 1fiBEA WAIVER OF REPORT (Section 106.07(7), F.S.) 13 DEC -9 PM 4' Oh (PLEASE TYPE) OFFICE USE ONLY PIOTR BLASS MAYOR - CITY OF BOYNTON BEACH Name Office Sought 113 WEST TARA LAKES BOYNTON BEACH, FL 33436 Address City State Zip Code El Candidate ❑ Political Committee FElectioneering Communications Organization ® Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) igi MONTHLY REPORT IT PRIMARY ELECTION GENERAL ELECTION [OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # as applicable: M 1 1.2013 P G ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF NOVEMBER 1, 2013 THROUGH NOVEMBER 30, 2013 X D r eiotr Bk64/ ,DPI Z / O/3 Signature Date X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) )v WAIVER OF REPORT (Section 106.07(7), F.S.) 14 JAN -3 AM 9: 00 (PLEASE TYPE) OFFICE USE ONLY � aro - Dr. Piotr Blass Mayor Name Office Sought 113 Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code El Candidate ❑ Political Committee [l Electioneenng Communications Organization ® Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ea MONTHLY REPORT 1 .i PRIMARY ELECTION ❑GENERAL ELECTION OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M 2013 -M12 P G as applicable: ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF October 1, 2013 THROUGH December 31, 2013 X � otir IJ (ck 01 -07 -14 Signature Date X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106.0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) Y c'i 80 r 4 WAIVER OF REPORT (Section 106.07(7), F.S.) 14 FEB -4 PH 5' 20 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Boynton Beach, FL 33436 Address City State Zip Code is Candidate n Political Committee ❑Electioneering Communications Organization ri Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) II MONTHLY REPORT ❑ PRIMARY ELECTION EGENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M -1 P G as applicable: 2014 M -1 El TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 01/01/14 THROUGH 01/31/14 X r (? V` ❑ a February 4, 2014 Signature Date X y r t 1 t g ,.r 1 Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) 'itY €F fp;; 'Vii`',$ I WAIVER OF REPORT F.. (Section 106.07(7), F.S.) 4 BAR 1 1 PPS 5: 31 (PLEASE TYPE) OFFICE USE ONLY i D i � r l h iI 0 S c 6( 1 ` /- f3 i Name Office Sought i 1 - 3 1)/ , l vck Bo y vl iL) 0 LF I s -?`1. - Address City State Zip Code Candidate ❑ Committee of Continuous Existence ❑ Electioneering Communication Organization ❑ Political Committee L Party Executive Committee ❑ Check box if address has changed since last report ❑ Check here if PC, CCE, or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION ❑ January ❑ 32nd day prior ❑ 46th day pnor i� ❑ Apnl ❑ 18th day prior ❑ 32nd day pnor 0 14 -M-9, ❑ July ❑ 4th day pnor ❑ 18th day pnor ❑ TERMINATION REPORT ❑ October ❑ 4th day prior ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF Fd k ) 2 0 4 THROUGH a y �� i,A 11) C 1 ) 1 X 1pir Pidr I IL 1-'6 ii,20q Signature Date X Signature Date SIGNATURES REQUIRED FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Committees of Continuous Existence and Electioneering Communication Organizations: Treasurer (s 106 04(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 04113) WAIVER OF REPORT r""- (Section 106.07(7), F.S.) 14 APR 17 AM 10: 00 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code Candidate Political Committee ]Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) PI MONTHLY REPORT PRIMARY ELECTION GENERAL ELECTION EOTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M 2014 -3 P G as applicable: 2014 -3 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF March 1, 2014 THROUGH March 31, 2014 X r ft ()I V ilvvd /u 2 vl Signature Date X v Ft Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) r)r PT �� L A �c e yo WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) OFFICE USE ONLY D r 6,C(:.kcs Name Office Sought i X ) E F E 5 3 4 Address City State Zip Code Candidate Political Committee ❑Electioneering Communications Organization d ❑ Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) Of MONTHLY REPORT PRIMARY ELECTION ❑GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M P G as applicable: ao i4 M - ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF a JL) 2 12I / THROUGH , _ l u _7 V X - ) V /6PAA 1 c 20 11 Signature ate X t� C 0 1r 4 14 - 2 v Signature Date REQUIRED SIGNATURES FOR: Candidates: :3 y ..'1Y Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S) Political Committees: n ' Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S) —s: �k. Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S) Fr Party Executive Committees: 1 40 Treasurer and Chairman (s 106 29(2), F S) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) WAIVER OF REPORT , (Section 106.07(7), F.S.) 14 JUN - 4 Ail 10: 15 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code El Candidate Political Committee nElectioneenng Communications Organization ® Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) E MONTHLY REPORT PRIMARY ELECTION ❑GENERAL ELECTION ®OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # as applicable: M 2014 M -5 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF May 1, 2014 THROUGH May 31, 2014 0 0 /4 Signature Date X r--- l U r) / (AS �L1 ` (,) Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) WAIVER OF REPORT (Section 106.07(7), F.S.) 14 JUL -7 AM 10: 1 7 (PLEASE TYPE) OFFICE USE ONLY V) I a_ss y Name Office Sought Tec va 66,0 3 ? fo yvt { R 3436' Address City State Zip Code Candidate Political Committee ❑Electioneering Communications Organization Party Executive Committee Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT PRIMARY ELECTION ❑GENERAL ELECTION OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M P G as applicable: ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF l/lQ. J ) 2 V L 4 THROUGH jal4d 7 l 014 X t) r BUQAJ1 O Signature Date X V E D y g4eem Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11/13) �-C� D gL C I- L CAS E WAIVER OF REPORT (Section 106.07(7), F.S.) 14 AUG -8 AM { I : 33 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code 0 Candidate fl Political Committee ❑ Eiectioneenng Communications Organization Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT n PRIMARY ELECTION ®GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M -7 P G as applicable: 2014 M - 7 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF July 1, 2014 THROUGH July 31, 2014 X r ek ir" Cg,62,0 E Signature u [date X D P ' Signature yr, Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code la Candidate ® Political Committee riElectioneenng Communications Organization El Party Executive Committee ❑ Check here if address has changed since last report l i Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT ® PRIMARY ELECTION GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M _g P G as applicable: 2014 M - 8 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF August 1, 2014 THROUGH August 31, 2014 X , ) r Pt 0 t r *Bht,uin _c,p4' 4 1 Signature Date X D/ pi � ,,, r- C S. p1 q, 20/4 Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in wnting on the prescnbed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) 'QTY OF WAIVER OF REPORT (Section 106.07(7), F.S.) 14 OCT -8 PH 1: O (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code 0 Candidate ❑ Political Committee ❑Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report E. Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ISMONTHLY REPORT ® PRIMARY ELECTION ❑GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # G as applicable: 2014 M -9 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF September 1, 2014 THROUGH September 30, 2014 X 7 P Oc 2 `� Signature Date 1 c gto4 or g/ 2 0 1 Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) F WAIVER OF REPORT (Section 106.07(7), F.S.) 14 NOV 12 PM 3:50 (PLEASE TYPE) OFFICE USE ONLY Dr Piotr Blass Mayor Name Office Sought 113 West Tara Lakes Drive Boynton Beach, FL 33436 Address City State Zip Code is Candidate ❑ Political Committee ❑Electioneering Communications Organization ❑ Party Executive Committee ❑ Check here if address has changed since last report ❑ Check here if PC or ECO has DISBANDED and will no longer file reports TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT I 1 PRIMARY ELECTION GENERAL ELECTION ❑OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M _1 P G as applicable: 2014 M -10 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF October 1, 2014 THROUGH October 31, 2014 X j (jay, z ?r2I1 Signature Date X 1 ,o,V1 /Uw I z 0 /4 f Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s 106 07(5), F S ) Electioneering Communications Organizations: Treasurer (s 106 0703(4)(c), F S ) Party Executive Committees: Treasurer and Chairman (s 106 29(2), F S ) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed DS -DE 87 (Rev. 11/13) n � a � T O I a , C fi�, OF � } r � PT �E� WAIVER OF REPORT L``` Or (Section 106.07(7), F.S.) 15 APR -6 PM 2: 15 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code ra Candidate Political Committee Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) is MONTHLY REPORT pi PRIMARY ELECTION ❑GENERAL ELECTION r OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # as applicable: 2015 - M - 3 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF March 1, 2015 THROUGH March 31, 2015 X gto,4,4 Aprd 6 2.19/1 Signature Date X D v 676evo A Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11113) `ICY CF = YH ( .BEACH r WAIVER OF REPORT 1:11K 'S OFFICE (Section 106.07(7), F.S.) 15 MAY -5 PH 2: (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code is Candidate ❑ Political Committee Electioneering Communications Organization E Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT ® PRIMARY ELECTION 5 GENERAL ELECTION 5 OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M - P G as applicable: 2015 - M - 4 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF April 1, 2015 THROUGH April 30, 2015 x r lO J ZOOS Signature ( Date X 0 l M Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11/13) WAIVER OF REPORT i .(Section 106.07(7), F.S.) ` 15%jup PH 1 5 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought • 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code Candidate Political Committee Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT PRIMARY ELECTION GENERAL ELECTION OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M -5 P G as applicable: 2015 -M -5 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF May 1, 2015 THROUGH May 31, 2015 x D F 0 r B LasS 1 2 Signature Date x P( , ' / ),(// 'Jan(' / zo Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11/13) CITY OF BOYNTON BEACH WAIVER OF REPORT CITY CLERK'S OFFICE (Section 106.07(7), F.S.) 15 JUL 13 AM 11: _07 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code ✓' Candidate Political Committee II Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) IS MONTHLY REPORT ❑ PRIMARY ELECTION GENERAL ELECTION OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M - P G as applicable: 2015 - M - 6 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF June 1, 2015 THROUGH June 30, 2015 X r Etam ja-66/4 zois Signature Date X D v` lq 2 O( Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11/13) CITY OF BO YN TON BEACH CITY CLERK'S OFFICE WAIVER OF REPORT (Section 106.07(7), F.S.) 15 AUG 17 An IQ: t 3 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code Candidate Political Committee Electioneering Communications Organization ri Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT 7 PRIMARY ELECTION II GENERAL ELECTION [OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M P G as applicable: 2015 -M -7 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF July 1, 2015 THROUGH July 31, 2015 X �— I' /l A� J� 16,2d� Signature " Date x ci l /o/c Signature ate REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11113) CITY OF BOYNTON BEACH WAIVER OF REPORT CITY CLER}C'S'OFFICE (Section 106.07(7), F.S.) 15 OCT -7 AM ICI; n0 (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 • Address City State Zip Code E Candidate Political Committee Electioneering Communications Organization III Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) I MONTHLY REPORT E1 PRIMARY ELECTION ® GENERAL ELECTION • OTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # M "g P G as applicable: 2015 - M - 9 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF . September 1, 2015 THROUGH September 30, 2015 X J V` (t66114 /o/7//3 Signature Date X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) • Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11/13) CSTY 0t E30 YN QN BEACH �ETY C✓rK'S OFFICE WAIVER OF REPORT (Section 106.07(7), F.S.) 15 SEP ,I 6 AM 11: (PLEASE TYPE) OFFICE USE ONLY Dr. Piotr Blass Mayor At -Large Name Office Sought 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code ✓Candidate 1111 Political Committee ';, Electioneering Communications Organization Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ✓ MONTHLY REPORT 111 PRIMARY ELECTION LGENERAL ELECTION nOTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # as applicable: M - 8 P G 2015 - M - 8 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF August 1, 2015 THROUGH August 31, 2015 X 7). r WA4 /J 20 Signature Date X � y /` IT/ Z ( Signature e REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. • DS -DE 87 (Rev. 11/13) 4, WAIVER OF REPORT (Section 106.07(7), F.S.) - ® c, (PLEASE TYPE) r t ° OFFICE USE ONLY t V Ca (4) 8 Dr. Piotr Blass Mayor At- Large cig Name Office Sought •v 113 West Tara Lakes Drive Boynton Beach FL 33436 Address City State Zip Code �✓ Candidate Political Committee Electioneering Communications Organization ❑Party Executive Committee ❑ Check here if address has changed since last report. ❑ Check here if PC or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ✓ MONTHLY REPORT I I PRIMARY ELECTION ❑GENERAL ELECTION nOTHER REPORT TYPE Indicate report # Indicate report # Indicate report # Indicate report type and # as applicable: M -10 P G 2015 -M -10 ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF October 1, 2015 THROUGH October 31, 2015 X D v - 3(42&1 Signature Date X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Electioneering Communications Organizations: Treasurer (s. 106.0703(4)(c), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 11 /13) 1 CAMPAIGN TREASURER'S REPORT SUMMARY ' ( O V" P i 0 r IS l S c OFFICE USE ONLY Name ( l.f .-.. (--) -4 Address (number and street) I 0 �nt)IA R "a21 ) i 3436 .. 2 Da Cr, City, State, Zip Code ❑ Check here if address has changed (3) ID Number : .. c (4) Check appropriate box(es): �. co C Office Sought: ' '" l a yov a--f L a i/ ,. . ❑ 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 f/ / 0 1 / is To it / 30 / 15 Report Type: M_ fl ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , • Expenditures $ , 2'q _.0 Loans $ , 3 000 / Transfers to Office Account $ , , Total Monetary $ Total Monetary $ Z , (26/100) 1 In Kind $ , , (8) Other Distributions $ , . (9) TOTAL Monetary Contributions To Qa e (10) TOTAL Monetary Expenditures To Date $ , ; _(__;,0V $ , , 2g4 . C /o I (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that l 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 Dr Pidr BI CLss x )r Pioiv Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS P 1 ' (1) Name V r Q( glacc (2) I.D. Number (3) Cover Period i l / Oil / IS through / / 3 O / 16 (4) Page a of 3 ( ( ( ( (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount 1/ / 12_ l B Dr RUNS AK Mud,. L 3 0 , . ( 0 - 2 _ / A _ C.3 1.17 C� t Z7 3 / ,qZ T1t 7 / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name D V is n > (2) I.D. Number (3) Cover Period /1 / 01 / 6 through 1/ / % �i (5" (4) Page .3 of 3 (5) ( (8) ( ( ( Date Full Name Purpose (s) (Last, Suffix, First, Middle) (add office sought If Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) Type Amendment Amount (t 14 0-. P (k 25 (9 ,_o__ V .-el_ t( rip 86 A C - fth- CK 2 gi ( (,) 0 Cictt Q._ a g2g.44,4 1 / / = CJ1 .,.,,,t -< • c • c� tit 7.Z ci) 8 ca = c3: co �m / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES I 113 West Tar lakes Drive Boynton Beach Fl 33436 I WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) Candidate NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). Indicate report # M -10 Dr. Piotr Blass Mayor at Large 12/01/2015 REQUIRED SIGNATURES FOR: Name Office Sought Address ❑ Political Committee ❑ Party Executive Committee tr TERMINATION REPORT Signature Pi Signature Check here if address has changed since last report. Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT n PRIMARY ELECTION ❑ GENERAL ELECTION n OTHER REPORT TYPE Indicate report # Indicate report # P G NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF THROUGH SPECIAL ELECTION OFFICE USE ONLY CITY OF BOYN I UHI BEACH CITY CLERK'S OFFICE 16 JAN -4 AM 8:45 City State Zip Code 12/31/2015 Indicate report type and # as applicable: /20(6 Date Date Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 06/15) ° Candidate I WAIVER OF REPORT (Section 106.07(7), F.S.) Indicate report # M .� REQUIRED SIGNATURES FOR: DS -DE 87 (Rev. 06/15) (PLEASE TYPE) OF or 13] S v // Y Name 1 L jctva.Lak,') Address NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). Check here if address has changed since last report. Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) t MONTHLY REPORT n PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 44 3/)Z016 x Dr Piofr Sicts j 27, 20 /6 Signature Date x D p M 27 2016 Signature y Date Political Committee ❑ Party Executive Committee Indicate report # P TERMINATION REPORT SPECIAL ELECTION THROUGH CI I Y OF BC li i ON BEACH CITY CLERK'S OFFICE 16 JAN 27 PM2 :39 OFFICE USE ONLY Office Sought V 3/ (9 yob goa-c � D City State Zip Code Indicate report # G Indicate report type and # as applicable: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) Dr Pi Oir )`• yOr Candidate Name G13 tx/v hv � Address City ❑ Political Committee ❑ Party Executive Committee Indicate report # Indicate report # Indicate report # M P G -I ❑ TERMINATION REPORT ❑ SPECIAL ELECTION 'p OFFICE USE ONLY Office Sought �( 3343 cf State Zip Code NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). F7 Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION ® GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report type and # as applicable: NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 2014 THROUGH r 12 Z01 x �V Rict.c F.. 25 , ?Nth Signature Date X Dr Pi.(, - fin VAPI F.-JZf 20 Ca, Signature Date Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. REQUIRED SIGNATURES FOR: DS -DE 87 (Rev. 06/15) Candidate WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) Dr T31ce,ss Name Address NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). ❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION Indicate report # Indicate report # M P REQUIRED SIGNATURES FOR: CITY OF BO YH ION BEACH CITY CLERK'S OFFICE 16 MAR -4 PH 4 :S4 OFFICE USE ONLY City State Zip Code ❑ Political Committee ❑ Party Executive Committee ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report # G ❑ TERMINATION REPORT ❑ SPECIAL ELECTION Office Sought Indicate report type and # as applicable: NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF Pei J 1 2 D (IQ THROUGH FM.10 ) 2 0 1 6 X � V R cc. v& L, 4Iz 016 Signature Date / X F 1)) 1/0t, 4) 2 - 0 /6 Signature Date Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 06/15) WAIVER OF REPORT (Section 106.07(7), F.S.) y 5 W, b ill( Candidate Indicate report # M (PLEASE TYPE) 4 Name REQUIRED SIGNATURES FOR: Address City ❑ Political Committee NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.). Check here if address has changed since last report. Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box) ❑ MONTHLY REPORT ❑ PRIMARY ELECTION Indicate report # P X ( 9,i ( A/ l'' 1 Signature X t , 112/0 Signature Indicate report # G TERMINATION REPORT SPECIAL ELECTION /c 7/o? U I � THROUGH l —4 OFFICE USE ONLY 'p M yG Office Sought ❑ Party Executive Committee I 33E13( State Zip Code ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report type and # as applicable: NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 2//o /62o ca, /it 20 �Jlll Date CD - Ft OD rrl Candidates: Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees: Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Party Executive Committees: Treasurer and Chairman (s. 106.29(2), F.S.) Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 06/15)