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M5 2021 Campaign Treasurer's Report 06-04-2021CAMPAIGN TREASURER'S REPORT SUMMARY i OFFICE USE ONL Name RECEIVED !� � � Address (number a street JUN 0 4 2021 0 33'3 CITY OF BOYNTON BEACH City, tate, Zip Code ri1v r." PRIGS OFFICE ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑ Candidate Office Sought: y ❑ 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 0,To C)�S l3 d 1 ReportType: ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Cash &Checks $ Monetary Expenditures $ 13 Loans $ Transfers to Office Account $ Total Monetary $ b� Total Monetary $ In -Kind $ f (8) Other Distributions $ (9) TOTAL Monetary CTntributions To Date (10) TOTAL Monetary Expenditures To Date $ ran . o� $ A31D (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: ,^ t� f"' n 1 pU Ll � � (Type name) � I 1 -(Type narn� ❑ Individual (only for IETreasurer [IDeputy Treasurer Candidate [IChairperson (only for PC and PTY) or ele eenng comm.) is X Signature Signature DS -DE 12 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS _- (1) Name (3) Cover Period(n /.C -A �� through ©8 /'31 (2) I.D. Number / MZQ, (4) Page _ of I (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Contributor Type Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number I I DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Re CAMPAIGN TR UT'S REPORT - ITEMIZED EXPENDITURES (1) Name i 'L` (2) I.D. Number (3) Cover PeriodUJ / ®� through oS /'31 (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 T yP Type (10) Amendment (11) Amount (6) Sequence Number DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) 1' J j . me (2) ,-6ddress (number City, rte, Zip Code ` ❑ Check here if address has changed (4) Check appropriate box(es): Candidate Office Sought ❑ Political Committee (PC) ! ❑ Electioneering Communications Org. (Eq ❑ Party Executive Committee (PTY) �����((( ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) OFFICE USE ONLY RECEIVED :e JUN 072021 SEACH (3) ID Nurr%Ter.j ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed (5) Report Identifiers Cover Period: From 0S ! I / 2 0q -To 1 Report Type: Original 0 Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks Loans I Total Monetary In -Kind (7) Expenditures This Report Monetary Expenditures $ , 13-. $ Transfers to Office Account $ , $ - d� Total Monetary $ . $ , (9) TOTAL Monetary CTntributions Two Date $ (8) Other Distributions $ , , (14) TOTAL Monetary Expenditures To Date $ , t13U (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that t have examined this report and it is true, correct, and complete: q Rype nam4? A� pWIZ 1 � � \ (Type name) � 1 Z i (�5� F1 Individual (ordy for IE Treasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) oreering comm.) �� &�\ X X Signature Signature DS -DE 12 (Rev.11113) SEE REVERSE FOR INSTRUCTIONS