Waiver of M 12 Report 01-01-21'A i
(PLEASE TYPE)
2303 SW 21 st Ter
JAN 2021 3 q �Y
L�
CITY OF BOYNTON BEACH
CITY CLERK'S OFFICE
OFFICEUSE ONLY
Boynton Beach City Commission Dist. 1
Boynton Beach, i=Lw 33426
Cly State
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NOTE: This ibrm does not apply to an electioneering communications organization (ECa). fon EGO must file a report (not a
waiver) that no reportable contri ubons or expenditures were made during the reporting period (s. 106.0703(ti), t S.).
-ss
TYPE OF REPORTAppropriate s s Box s Complete Applicable Line beneath Box)
O -MER REPOPIT
Indicate[0—
Indicate report#
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f:: r. na =--
G
Q TERMINATION DRi F! SPECIAL_ ELEC720N
THROUGH 12131/2020
0110112021
Indicate report; type and t"
as applicable:
s
Signature Date
Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S)
€ olitical Committees:
Chairman and Campaign Treasurer or Deputy Treasurer (s. 106-07(5), F.S.)
F' ty Executive Committees: I
Treasurer and Chairman (s. 106229(2), F -S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or
the fftig of ft req&W report is waived- However, the Bing offer mast be rxrtik d in writing on the prescribed
reporting date that no report is ging filed.
DS -DE 87 (Rev. 06115)