M9 Report 10-05-2021CAMPAIGN TREASURER'S REPORT SUMMARY
r OFFICE
FRECEIVEDISEONLY
-
Name
Address (number/land street) OCT 5 221
-kill � � `• �' C
-" CITY OF BOYNTON BEACH
City, State, Zip Code , 3 r^
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
.Candidate Office Sought:
❑ 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 I 1 I� To Report Type:
D4 Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $ , f 70C)o
Monetary
Expenditures $ ,
r�
Loans $
Transfers to f
Office Account
Total Monetary $
Total Mono ry $ ,
In-Kind $
(8) Other
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Mone E p"difures To Date
$ r ,L0 .0 o
$ --- --
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that 1_ have examined this report and it is true, correct, and complete:
(Type name) ��!"45 �U%�n'( �' (Type name) ( h01*0',6U 0-0mi/1-re
❑ individual (only for IE ❑ Treasurer [Deputy Treasurer 12�candidate ❑ Chairperson (only for PC and PTY)
or e'ectioneering comm.)
x x
Signature Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
2
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name P (2) I.D. Number
(3) Cover Period q / I l 2Gy/ through l3 O 12-0-2-1 (4) Page of 2,-
(5) (7)
(8)
(9)
(10)
(11)
(12)
Date Full Name
(6) i (Last, Suffix, First, Middle)
Sequence Street Address &
Contributor
Contribution
In-kind
Number City, State, Zip Code
Type Occupation
T e
Description
Amendment
Amount
q
1 % 20 21
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DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name ThorlgS /;b�ny t e (2) I.D. Number
(3) Cover Period / j / UV through l 30 1 (4) Page 2' of 2—
(5)
(7) — -- (8) - (9) (10) (11) (12)
_ Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State, Zip Code Type 1 Occupation Type Description Amendment Amount
1 'n Al 1�0� d MWIV -T Nom ft
21 vy Sr,1�Ps�'f3s nRy� C lea, Dv
prIUP: 3 z
VA- Pl,o f 13 o
LIPp v; C NSA
2' V vq sorvHans pwAO
or T 77*11el -Al
IF.
sin 4 62
10371 �o t -�— C yo,00
1C
-739 / YLjJ, vim'
33q
-T""*f'v�rv�tlhv T
�( , Z�P2( cNgsi Amar ov,-s LW
Z 14 frj1011/
a 33�
Alf
F —#100,Ob
writ;h9-0A rJ_
z
�°3111 t
q1 2,0* Hvz
31408
DS -DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES