M6 Report 07-07-2021CAMPAIGN TREASURER'S REPORT SUMMARY
(1) r t -j a t-[ i r c c kT— OOFCFIICEEDUSE ONLY
FEE
Name ��++
(2) 1'3 A4• a �� �7 JUL 0 7 2021
Address (number and street) ri
CITY OF BOYNTON BEACH �;SI
1 %
City, State, Zip Code CITY CLERK'S OFFICE
❑ Check here if address has changed (3) ID Number.-
umber(4)
(4)Check appropriate box(es):
1?(!andidate Office Sought: C�
❑ 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 I % I -1 To l 3 C) I j Report Type: "-t �.
[Original El Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
0
Cash & Checks $
Expenditures $
Loans $
Transfers to
Office Account $ ,
Total Monetary $ >
Total Monetary $ ,
In -Kind $ >
(8) Other Distributions
$ •
(9) TOTAL M�'onetaryContributions To Date
(10) TOTAL Monetary Expenditures To Date
L
(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
4
�
(Type name) �1�1 r , Y�1 `oma (Type nameZ� CES l__CC�_
❑ Individual (only for IE er ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC a 'd PTY)
or electioneering .)
�ommf
x` ry
Signature Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name PD e -`1--i U r- j U'> T- < '-� k -, (2) I.D. Number
(3) Cover Period _i� ' / / through (0 3a I ab (4) Page 1 of
(5)
Date
(7) (8)
Full Name Purpose
(Last, Suffix, First, Middle) (add office sought if
Street Address & contribution to a
City, State, Zip Code candidate)
(9)
Expenditure
p
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
4ez Il
e_
3 7�c
'C3cu�,
IP Yeks
fe
r4-
Y 5
CA-+
q 4,60
DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES