Termination Report 05-10-2022CAMPAIGN TREASURER'S REPORT SUMMARY
(1) 1: 11 fN,rl - — ROUSE ONLY
Name �.
(2) vt k f Ikm , �Lotkj) MAY 1.0 2022
._
Address (number and street)
r� C fl C +A , f l 3'-3 L.I 3 CITY OF BOYNTON BEA
City, State, Zip Code CITY CLERICS OFFICE C&
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
}'Candidate Office Sought: i fi (10t_ t -(lSs 10 n) r VZ .c- D i 51-V i CF 3
❑ 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
7 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 / /20 22 To 'S / j u / 20 L2 Report Type: T rL
Lv_""'Origmal ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ Dv Expenditures $ 200 13
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 X12. 2-0 $ 1s X12. z�
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839,13, F.S.)
I certify that have
examined this report and it is true, correct, and complete
(Type name), l� �- f � � � � �L f r--l LQUt 2 >v (TYP ame) � ( �i 1 )A (Q�� 1L L
❑ Individual (only for IE Treasurer ❑ Deputy Treasurer Candidate t Q Chairperson (only for PC and PTY)
or electioneering comm.) V
Signature Signature
DS-DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name L , t. jj L ri ill P. -f � j . j C.L1 j� � (2) I.D. Number
(3) Cover Period _3_/ —q-1 ` L)23through 5 /_10/MVZ (4) Page __ 4 of 9
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(8)
(9)
(10)
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Date
Full Name
Purpose
(Last, Suffix, First, Middle)
(add office sought if
Sequence
Street Address &
contribution to a
Expenditure
Number
City, State, Zip Code
candidate)
Type
Amendment
Amount
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DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name - , .{ it, Ft t\ K- 0 1
t l C u
i i IL� t,
(2)
I.D. Number
(12)
Amount
(3) Cover Period / Z.y
/ l .1_
through 5 /10
/ Z,Z
(4) Page of
(7)
Full
Date Name
t6) (Last, Suffix, First, Middle)
Sequence Street Address &
Number City. State, Zip Code
(6)
Contributor
Type I Occu ation
(9)
Contribution
Type
(10)
In-kind
Description
0 1)
Amendment
(12)
Amount
(iL101LI) fV0
�t�lty ,/tea $�—t1Cir
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DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES