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