M10 Report 11-09-2021CAMPAIGN TREASURER'S REPORT SUMMARY
OFFICEfUSF �JLY
Name
(2) _)/0 G Ave.. 4,2r- 70 NUS u v Z021
Address (number and street)
L� n ,f%r ani c ._�L�"s=1.— �3 3 !"171' OF I30YP TON PEACI
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Chick appropriate box(es):
Candidate Office Sought: 'r .� i 5+ r t L o AGR r4 1 s 5
❑ 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 / ` / j To b / 3 t I f Report Type: m ld
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
$ DU
Monetary
Expenditures $
Cash & Checks �C ,000
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.)
certify that I have examined this report and it is true, correct, and complete:
, +
(Type name) or; + l :' .. . :: I /' (Type name) A ✓; t Hv
❑ Individual (only for IE ❑ Treasurer [("Deputy Treasurer P'Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X J X
Signature Signat re
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
f
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name de
(2) I.D. Number
(3) Cover Period /D / / / Z/ through /d / 91 / Z/ (4) Page I of /
(5) (7)
Date _ Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address &
Number City, State, Zip Code
(8)
Contributor
Type Occupation
(9)
Contribution
T e
(10)
In-kind
Descri tion
(11)
Amendment
(12) —.
Amount
l2Z /21
ti vy►'L b rt t o (Y
q�566c',��t��s.of
p, e. Vox 735
J - over 3ge 0%_
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t i0i ;
x RG t�
—
I I
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES