M9 2021 Report 10-08-2021CAMPAIGN TREASURER'S REPORT SUMMARY
Name
(2) rj [ 3 r,'j, Lk__� a Add 6'T-
Address
'r
Address (number and street)
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
M- andidate Office Sought: �\
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
Cover Period: From I j
Tr Original ❑ Amendment
(6) Contributions This Report
Cash & Checks $
Loans $
Total Monetary $
In -Kind $
OFFCEASE ONLY
R _EMI
OCT 8 2021
ePBER O E H
CITY CLERKS FC
(3) ID Number:
❑ 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
(6) Report Identifiers
j To 0/ / -C) Report Type: r A 61
❑ Special Election Report
(9) TOTAL Monetary Contributions To Date
$, o .�
(7) Expenditures This Report
Monetary
Expenditures $ t ��1, E� . lI
Transfers to
Office Account $ ,
Total Monetary $ ,
(8) Other Distributions
$ 1 1
(10) TOTAL Monetary Expenditures To Date
$ ) _
(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 examinned�t its rep or; and it is true, correct, and complete:
(Type name) 0�� (TYpe name)
[:1 Individual (only f r IE �i reasurer ❑ Deputy Treasurer ❑ Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
n.
X 17
Signature
X
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name — r—c4 r-- Q f1 -T— (2) I.D. Number
(3) Cover Period / I a. 6 through (4) Page of
(5)
(7)
(8)
(9)
(10)
(11)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address &
Purpose
(add office sought if
contribution to a
Expenditure
(6)
Sequence
Number
City, State, Zip Code
candidate)
Type
Amendment
Amount
` til �'"'�
�I -7i
<4 <+
2 2
CAAerf—
y�
CiAr�
1231
7
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES