M11 2021 Report 12-10-2021WAIVER OF REPORT 10 202 --��
(Section 106.07(7), F.S.)
(PLEASE TYPE)
OFFICE USE ONLY
Name Office Sought
Address City State Zip Code
'Candidate rl Political Committee® - i Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report (not a
waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.).
❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
ONTHLY REPORT rj PRIMARY ELECTION GENERAL ELECTION OTHER REPORT TYPE
Indicate report # Indicate report # Indicate report # Indicate report type and #
as applicable:
Mj 80, P G
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
_i 4- ( LQ-- D-1 THROUGH 10 ` 2 1 '- a6 a I
X '-J
Signatu
Signature
�-94--1-0--a,(
Date
Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account (no funds expended or
received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS -DE 87 (Rev. 06/15)
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) 1 1— 8
c
Name—�------- ----_
ST
Address (number and street)
City, State, Zip Code
LJ Check here if address has changed
(4) Check appropriate box(es):
E't andidate Office Sought:
Political Committee ;PC)
OFFICE USE ONLY
(3) ID Number:
❑ Eiectioneering Communications Org. (ECC) ❑ Check here if PC or ECO has disbanded
El 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)
Cover Period: From 4 It l
Original ❑ Amendment
(6) Contributions This Report
Cash & Checks $
(5) Report Identifiers
To L t / 3 V / 2 ( Report Type: r--1 1 i
❑ Special Election Report
(7) Expenditures This Report
Monetary
. Expenditures
Loans $ ,
Total Monetary S ,
In -Kind $ ,
(9) TOTAL Monetary Contributions To Date
S a1 SS � oc)
Transfers to
Off ce Account $
Total Monetary $
(8} Other Distributions
$
(10) TOTAL Monetary Expenditures To Date
7f I
(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) Q�JCS �I'l,` u + + �, _
(Type name) �e.��nc A� W'��(A.e
or Ilectio ee (only for l reasurer ❑ GeputY reasurer C .a�e Chairperson (only for PC and PIV)
or electioneering comm,) `�
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
!!��__�
(1) Name lc'�&-" l.J r'c � i (2) I.D. Number
(3) Cover Period) P / 2 t through) 31 / 90 (4) Page— of
(7) (8) (9) (10) (11)
Date Full Name Purpose
(s) (Last, Suffix, First, Middle) (add office sought if 'Expenditure
Sequence Street Address & contribution to a
Number
City, State, Zip Code I candidate) Type Amendment Amount
i
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