M11 2021 Report 12-10-2021CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Ty Penserga�
OFFIe USE ONLY
Name
� �ICZWr\
(2) P.O. Box 742831
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 1 I ®( / , Qj_j To
11 130 / c 03,1 Report Type:
Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $ Q
Monetary
Expenditures $ , ' 3Y3� .43
Loans $ , 0 0 ()
Transfers to
Office Account $ 0 .00
Total Monetary $
Total Monetary $ 3�6 . 43
In-Kind $
(8) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date
(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.)
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
❑r Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X 4X
� �?
Signature
Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name T
(3) Cover Period 11/01/2021 - 11/30/2021
(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)
A.mendmen
(12)
Amount
(6)
Sequence
Number
11/02/2021
D'Almeida, Arthur
105 E Palmetto Park Rd
Boca Raton, FL 33432-0000
I
Attorney
CHE
$ 1000.00
1
11/19/2021
Tipton, Kevin Cho
230 NE 4th St Apt. 1606
Miami, FL 33132-0000
I
Nurse
Practition
er
CHE
$ 500.00
2
11/29/2021
Kupperman, Jayne
61 Midwood Lane
Boynton Beach, FL 33436-0000
I
CHE
$ 50.00
3
11/29/2021
Hanvivatpong, Amanda
9701 West Lake Court
Boca Raton, FL 33434-0000
I
CHE
$ 100.00
4
r
This form is based on DS -DE 13 (Rev. 11/13) Adjutant Workshop, Inc. - Campaign ToolBox
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Ty Penserga (2) I.D. Number
(3) Cover Period
11 /01 /2021 - 11/30/2021
(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
Amendmeni
Amount
(6)
Sequence
Number
11/02/2021
Anedot
Online Donation
MON
$ 40.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
1
11/11/2021
Palm Beach County Human Rights
Sponsorship
MON
$ 1000.00
Council
P.O. Box 267
West Palm Beach, FL 33402-0000
2
11/19/2021
City of Boynton Beach
City Filing Fee
MON
$ 25.00
100 E. Ocean Avenue
Boynton Beach, FL 33435-0000
3
11/19/2021
City of Boynton Beach
State Assessment &
MON
$ 241.23
100 E. Ocean Avenue
Petition Certification
Boynton Beach, FL 33435-0000
4
11/19/2021
Anedot
Online Donation
MON
$ 20.30
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
$ 6.60
5
11/29/2021
Anedot
Online Donation
MON
1340 Poydras Street, Suite 1770
Processing Fee
New Orleans, LA 70112-0000
6
I
This form is based on DS -DE 14 (Rev. 11/13) Adjutant Workshop, Inc. - Campaign ToolBox