M10 2021 Report 11-09-2021CAMPAIGN TREASURER'S REPORT SUMMARY
(1) '&X',Xa r� L."� OFFICF 1SEgQQ LY
Name�.;,,;
(2) �-if:3 sT
Address (number and street)
City, S ate, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
andidate Office Sought: `✓v-� /4
❑ 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)
(6) Report Identifiers
Cover Period: From / / To / / Z ( Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary _
Cash & Checks $ Expenditures $ , j_�
Loans $ 4-P, 1) D p 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
$ ? �5`� _ eta c� $ _-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 I have examined this re7ort anjd. it is true, correct, and complete:
(Type name) 9-^1 L r' Q ' ,Q v��1� (Type name
� _ (Yp ) � d W .
❑ Individual (only for IE 4!?Treasu Deputy Treasurer SJ -candidate ❑ Chairperson (on for PC and PTY)
or electioneering c m.)
ti
XX
Signature Signature
DS -DE 12 (Rev. 11/13) S& REVERSE FOR INSTRUCTIONS
CAMPAI N TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name s r' , `fes _ (2) I.D. Number
(3) Cover Period /,6 / t / c-:) ( through / / (4) Page of
(5)
Date
(s)
Sequence
Number
(7)
Full Name
j (Last, Suffix, First, Middle)
I Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Ex
Expenditure
P
Type
(10)
Amendment
(11)
Amount
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1)' Name 13'x" d-+AI'&�)riy 1..1 (2) I.D. Number
(3) Cover Period � D / f / through (4) Page of
(5)
Date
(6)
Sequence
Number
(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
f0 l 2`1
tC Fc
x713 tc- W �•��
61T
Lf'00 -W
I
i
I
DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES