M9 Report 10-05-2021CAMPAIGN TREASURER'S REPORT SUMMARY
`
( 1 ) nR'7
1Name
(2) S/u � 0Ct,A.v AVQ. , AP7 •37O
Address (number and street)
G City, State, Zip Code
OFRFIICE# ONLY
5 2021
Cf OF BOYWON CITY CLERKS OFFIE BEACH � 33 f w
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
3 Rn D.,
[Candidate Office Sought: �fd/h�:.Si;a,-�f r7/+,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 Uq l l ZI To Uo 1 Z i Report Type:
+[Original ❑ Amendment ❑ Special Election Report ---�—
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ 3 , out . o o Expenditures $
Loans $ I G u o u Transfers to
Office Account $ •
Total Monetary 3 go a o
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: r
(T BS) K. (Type name) I'L7Af l -r
❑ Individual (only for IE U-rreasurer ❑ Deputy Treasurer 8 -'Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X X
Signature l Signature
DS -DE 12 (Rev.11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name ar i �-L ec ✓l. _ (2) I.D. Number _ _-
(3) Cover Period q / I I through q / 36 / 2 I (4) Page I of /
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number Cit State, Zip Code Type Occupation Tvpe Descri tion Amendment Amount
p 56M; ro
/Z1 0 S f;d� t7 000.00
Ccrt r` ��
-7739NW ts'rc c l� t
/ 6 u i%c 3oLst
IF-
1z
LVX
Z S �evvlWp v.ywt -
/ 13/ Z! Loft �e
-. ?735 N W i�tbS1"� 5 � CO \006!00
WL
330 t t,o i i i
-
q / 13 /Z1 735 taw I�tc. 1�.e�.�. C ��, X0000°
330t1a
q/ / 7 / Z 1 �/Yla�� t i e AC'Q -"
^-t. e11_(3 --A � CL- oo. as
3.��a5
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name M o t i f He oje-t-*� (2) I.D. Number
(3) Cover Period I / 1 / Z l through 1 / 3 0 / 7-1 (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
P
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES