Termination (TR) Report 09-03-2021CAMPAIGN TREASURER'S REPORT SUMMARY
OFFffig,0EI?NLY
( Name
2) ��� SEP 0 3 2021
Address (number aqd str et}�
CITY OF BOYNTON BEACH
City, te, Zip Code r7�• 1, i CITY CLERK'S OFFICE
�C b
❑ Check here if address has changed(3) ID Number
(4) Check appropriate box(es):
Candidate Office Sought: _
❑ Political Committee (PC) J
❑ 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 _
�
I To /31 / �,(' 2„ ( Report Type
Cover Period: From l (Q�L l
riginal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $
Expenditures $
+�--1-
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) t y 10 4 `,lb (Type name) DWI) fl W
❑ Individual (only for IE Treasurer ❑ Deputy Treasurer Wandidate ❑ Chairperson (only for PC and PTY)
orele eering comm.) ry
Signature Sig ature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMP�N TREA RtR'S REPORT — ITEMIZED EXPENDITURES
(1) Name (2) I.D. Number
(3) Cover Period 06 / 4 /,Qb (4) Page �I of
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
Dv 0-T, c� �,
Ge-'�
c
, d �
t
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES