M10 Report Amendment 12-01-2021CAMPAIGN TREASURER'S REPORT SUMMARY
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Lz� �t�
OFFIGF 1 �9�LY
Name
(2) a -I-1 .5Ul27 L441/
0E,C Q 1 7.0?,l
Address (number and street)
40, f/1 -&G, /'� c - j, , fi J 3 )4
City, State, Zip Code
['{;
❑ Check here if address has changed
(3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought: 5(%h _�_S��GIn_ _� ��SSI (7ht� 1-1117)7-17"�1
❑ 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 (I E) (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 To
Report Type:
❑ Original 0 Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash &Checks $ 33 ��
Monetary
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
$ , Z,XOI_.U6
$ i
(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) d �s �y�`%/�`
(Type name) _7)w !_ � C -L"13'
❑ Individual (only for IE ❑ Treasurer Deputy Treasurer
❑ Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X-1YY'"�-v -
X
Signature
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS