M10 2021 Report 11-10-2021CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Ty Penserga OFFICE USE qH Y
WL
Name � W
(2) P.O. Box 742831 Wt u=
Address (number and street),
Boynton Beach, FL 33474
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑✓ Candidate Office Sought: Mayor, City of Boynton Beach
❑ 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 (O / 3 / c�110.14 Report Type: M (O
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ , 350. 00
Expenditures $ , 4 . f] 0
Loans $ 0 010
Transfers to
Office Account $ 0 00
Total Monetary $ , 3 Sb 00
Total Monetary $ , qCf a r] 0
In -Kind $ 0 00
(8) Other Distributions
$ , , 0 00
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$ ,15 , rl1�l . as
$ q8
(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:
(Type name) Kim LeeBove (Type name) Ty Penserga
❑ Individual (only for IE ❑r Treasurer ❑ Deputy Treasurer ❑� Candidate ❑ Chairperson (only for PC and PTY)
or electioneering com .)
X
Signature Signature It/7-
IDS-DE
DS -DE 12 (Rev. 11/13) _ SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name T
(3) Cover Period
10/01 /2021 - 10/31/2021
(2) I.D. Number 00000
(4) Page
1 of 1
(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
10/01/2021
Perlman, Jeff
971 Delray Lakes Drive
Delray Beach, FL 33444-0000
I
Real
Estate
CHE
$ 250.00
1
10/21/2021
Penserga, Nelson
213 Terrace Rd
Saint Michael, MN 55376-0000
I
CHE
$ 100.00
2
10/26/2021
Horwitz, Grant
2645 Executive Park Dr. Suite 689
Weston, FL 33331-0000
I
Real
Estate
CHE
$ 500.00
3
10/30/2021
Penserga, Marivic
4315 Key Lime Blvd
Boynton Beach, FL 33436-0000
I
Health
Care
Services
CHE
$ 500.00
4
B oy -I•Tt_tt
BEACH
MOW
This form is based on DS -DE 13 (Rev. 11/13) Adjutant Workshop, Inc. - Campaign ToolBox
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name T
(3) Cover Period
10/01/2021 - 10/31/2021
(2) I.D. Number 00000
(4) Page
1 of 1
(5)
(7)
(8)
(9)
(10)
(11)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Purpose
(add office sought if
contribution to a candidate)
Expenditure
Type
Amendment
Amount
(6)
Sequence
Number
10/01/2021
Tracey Benson Photography
Photography Services
MON
$ 387.50
101 Lone Pine Ln
Palm Beach Gardens, FL 33410-
0000
1
10/01/2021
Anedot
Online Donation
MON
$ 10.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
2
10/21/2021
Anedot
Online Donation
MON
$ 4.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
3
10/26/2021
Anedot
Online Donation
MON
$ 20.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
4
10/30/2021
Anedot
Online Donation
MON
$ 20.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
5
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CL.I :,'
t.,10
Ch '21. 1: 3P1*1
This forth is based on DS -DE 14 (Rev. 11/13) Adjutant Workshop, Inc. - Campaign ToolBox