M6 2021 Waiver of Report 07-09-2021WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
Name
A dress
MNU
Office Sought
Ci4 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.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 ❑ 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
THROUGH_
Sign i
Date
X 11 I ti
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 noted in writing on the prescribed
reporting date that no report is being filed.
DS -DE 87 (Rev. 06115)
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
Name
Adress
h�
Office Sought
City 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.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 ❑ 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
THROUGH
X
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.)
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. 06115)
CAMPAIGN TREASURER'S REPORT SUMMARY
n Y �� IGI
OFFICE USE ONLY
Name
RECEIVED
(2)
Address (number and at t)
JUL 0 2 2021
CITY OF BOYNTON BEACH
State, Zip Code
/ ,� , CITY CLERKS OFFICE
❑ Check here if address has changed
(3) ID Number -
(4) Check appropriate box(es):
Candidate Office Sought:_b
ti
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 46 /QL_ j!Z0'Z� To
()(_q /atL/ �l Report Type:
90riginal ❑ 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 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) tD N1qr—'
(Type name)
❑ Individual (only for IE Treasurer Deputy Treasurer
Candidate ❑ Chairperson (only for PC and PTY)
or e`ectioneering comm.)
1
x
x
Signature
0! 1110LUI c
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name DNYI Q--1 m h� (2) I.D. Number
(3) Cover Period 00 / d througlfb6 /3Q QCa_j (4) Page --L— of
(5)
Date
v (7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
Citv, State, Zip Code
(S)
Contributor
Type Occupation.
(9)
Contribution
T e
(1 0)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIra TREASURER'S REPORT — ITEMIZED )EXPNENDIITTURES
(1) Name � i � 1 � 1
Pae � of 1
(3) Cover Period �_/ O j_�l: Mth�`ough C3� /� l�� O g ------ �--
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if Expenditure
(6) Street Address & contribution to a
Sequence Com, state, Zip Code candidate) Type Amendment Amount
Number
DS -0E 14 (Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES