M12 2021 Report 01-10-2022CAMPAIGN TREASURERS REPORT SUMMARY
(�) �0�Yj`}(�,$ �TUfl�'1 U4ME ONLY
�^ CITY OF BOYNTON BEACH
CITY CLERK'S OFFICE
City, te, Zip Code
❑ Check here ff address has changed (3) ID Number.
(4) Check appropriate box(es): t2
[R'Candidate Office Sought {ave. &jT AVN Ct-t CGr>!rrtmS . r Dr
❑
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 12 1 01 21 To 12 ,31 21 Report Type: M2
® Original ❑ Amendment ❑ Special Election Report-
(6)
eport(6) Contributions This Report (7) Expenditures This Report
Monetary
Cas & Checks $ 1 ,105-.62 F�endifimes $ ,877 32
Loans $ Transfers to
Office Account $ ,
-Total Monetary $
Total Monetary $ ,877 .32
In-IGnd $
(8) Other Distributions
$
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
2 , 450 - 52 $ . 1— , 116 • .��
(11) Certification
R Is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
1 certify that I have examined this report and it is true, coned, and complete:
r
(Typename) —rho`TViVAn_ (Type name)b�i)'1�
❑ Individual (mq for IE 29 Treasurer ❑ Deputy Treasurer WrewdWate ❑ Ctcakprsson (only for PC and PTY)
or decoonwft convn.)
x x
Signature Signature
DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
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CAMPAIGN TREASURERS REPORT — ITEMIZED CONTRIBUTIONS
• (11) Name Iy O 0AW; � U(kk O (2) I.D. Number
2( rough I. 2 3 l Z, (4) Page ` Of
(S) Cover Period th
12 f 0 l ! —
(B) (9) (10) (11I (12)
(s) m
Deb FtA Name
(B) (L=% SUft Fisk M'ddis) Con hubr Contribution In-kind
eooe
SequSbeet Address & IurrnsmrN Amount
Number cftv. Stets Code T on
121 0515 p� Lj ,,# UO' co�, libel()
11-1 6% 11,k e L lr� v�+Ng
,,q 4,,
-50.2 0 m
DS4)E 13 (Rev.11H3) SEE REVERSE FOR 5137TRUCTIONS AND CODE VAILIJES
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CAMP,IGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(t) Name
(3) Cover Period l /-R through f Z / 5k/ Z l
(2) I.D. Number
(4) Page of
(S)
Date
Is)
Sequence
Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City,, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(g)
Expenditure
Type
(10)
Amendment
(11)
Amount
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DS -0E 14 (Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES