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M11 2021 Report 12-06-2021CAMPAIGN TREASURER'S REPORT SUMMARY (1)burflctn& rf(_uir'e-) Name Address (number and sf et) 4V1f-DVA 8eGCti , FC �3 y 95 S City, State, Zip Code ❑ Check here if address has changed (4) Check appropriate box(es): OFFICE USE ONLY 11 0 E 0 6 2021 11,41�S- C'tF54YNTON BEACH - (3) ID Number: 116andidate Office Sought: 0.1 N Con] MESS l 0 t el' ❑ Political Committee (PC) tST r 10- 3 ❑ 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 / D j / 2,021 To I 1 / 3a / Z02,1 Report Type: r1 j ) [Original El Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , , 1517 • r Loans $ , , Total Monetary In -Kind $ (9) TOTAL Monetary Contributions To Date $ Aso. =' (7) Expenditures This Report Monetary Expenditures $ '� 2 00 Transfers to Office Account $ , Total Monetary $ (8) Other Distributions $ , , (10) TOTAL Monetary Expenditures To Date $ , , l`L 0 0 (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: f (Type name) rlfc, ►ell I isICQUI (C, (Type name)C(��Jr' lc°tndA- rkoui i'e, ❑ Individual (only for IE tfTreasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) or electioneering comm.) 'Iyt X *(04, Signature Signature DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name u rkIcx Ilcd - tic,Qui (c, (2) I.D. Number (3) Cover Period / 10t /232-t through l t / 30 / ` OZI (4) Page (5) (7) (8) (9) (10) Date Full Name (6) (Last, Suffix, First, Middle) '( of I (11) (12) Sequence Street Address & Contributor Contribution In-kind Number City, State, Zip Code Type Occupation Type Descri•tbn I Amendment CoUfftalid t rlc-gUfy-e �dvelrh fob uJhiSP>@Y�YIo�P�YI fid., go�rt�-vn l3euch 5 CH E Fl 33-135 9"tldiaet 6oenb-er 32/40 IzOge Ln. Boq 0 Dyl C H E Z. 3:3z435 i t , n / 21 Lucia McWW & 9uden 1- 50(o w hl-s?erim ?i1fln CNE DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Amount .sem 15© CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name CQU(�J(,{, r1C(' u ' rb (2) I.D. Number (3) Cover Period I I / O 1 / 2021 through H / ?�O / ZOa) (4) Page _ 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 AMT -rust- Ban k- 127 con. 56Ave &oy -on (each I F -L 33%12�O �� ck. rned Chu CAO CA t J 11 2 2 i M1-ruSf- f a i r r2-7 N C.on� r-fSs hoe • "Viton Beach , r t 3:397k Q e-h.c r ne d Che�t<- ->r 2 DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES