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M4 2021 Waiver of Report 04-29-2021WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) I� Rv �� 1. �fict itn Name N�. Ad ess APR 2-9 2021 CITY OF BOYNTON BEACH CITY CLERK'S OFFICE /q ! ad�m OFFICE USE ONLY IIIA Office Sought 33q-30 State Zip Code Candidate ❑ Political Committee ❑ Party Executive 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.&). ❑ 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 [j PRIMARY ELECTION ❑ GENERAL ELECTION El GENERAL 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 Au,,L THROUGH [I 30 IM Signature ate 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.) 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) CAMPAIGN TREASURER'S REPORT SUMMARY (1) _ OFFICE USE ONLY Wam &t e remm (2) ...r^ (umber aA street)[ APR 2.6.202?L� Address �7 JGM W OF BOYNTON BEACH City, Otatie, Zip Code CITY CLERKS ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): andidate Office Sought soliticalCommittee (PC) ❑ Electioneering Communications Org. (EC ) ❑ 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 (D� / O To (/ -3Q / Aqj Report Type: ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , Expenditures $ , Loans $ Transfers to Office Account $ Total Monetary $ Total Monetary $ In-Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expe ditures To Date $ $ •� (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) 1 certify that I have this report and it is true, correct, and complete: `examined j (Type name) V��^ �- (Type name) ❑ Individual (only for IE Treasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) or elec#ioneenng comm.) X Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS 110 CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name M 1D —T—. MLM11 C� (2) I.D. Number (3) Cover Period �/�_ through_/3O / ���. (4) Page f of _ (g) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (g) Expenditure Type I (10) Amendment (11) Amount (6) Sequence Number DS -0E 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name_ �� (2) I.D. Number (3) Cover Period (::tf / C) I / ab� t through of /,10 / l (4) Page Of (5) j Date (6) Sequence Number f (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Contributor Type Occu tion (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount 1 1 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES