M12 2021 Report 01-10-2022CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Ty Penserga OFFICE USE ONLY
Name RECEIVED
�
(2) P.O. Box 742831
JAN, 10 2022
Address (number and street) _'L_5
Boynton Beach, FL 33474 CITY OF BOYNTON BEACH
City, State, Zip Code CITY CLERKS OFFICE
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
Q 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 To I Or- / / O!DX, Report Type: MI
[ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ �_ , ®- O'D
Expenditures $ Q O d
Loans $ , , �%
Transfers to
Office Account $
Total Monetary $ , ,,bo • O-0
Total Monetary $ ® o
In -Kind $ , , .00
(8) Other Distributions
$ O Od
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
$
$ ;a9.
(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 0 Treasurer ❑ Deputy Treasurer ❑r Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X
Signature Sign
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
(1) Name T
(3) Cover Period
12/01/2021 - 12/31/2021
(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
I Managing
Dir. /
Real
Estate
(9)
Contribution
Type
CHE
(10)
In-kind
Description
(11)
Amendmeni
(12)
Amount
$ 500.00
(6)
Sequence
Number
12/02/2021
Hall, Robert
1499 SW 21st
Boca Raton, FL 33486-0000
1
12/10/2021
Business Leaders United for Boca
Raton
1800 N Dixie Highway
Boca Raton, FL 33432-0000
F
Political
Committe
e
CHE
$ 1000.00
2
rhis form is based on DS -DE 13 (Rev. 11113) Adjutant Workshop, Inc. - Campaign ToolBox
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Ty Penserga (2) I.D. Number 00000
(3) Cover Period
12/01/2021 - 12/31/2021
(4) Page 0 of 0
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a candidate)
(9)
Expenditure
Type
(1 0)
Amendmen
(11)
Amount
(6)
Sequence
Number
Nothing to report on t
is form
This form is based on DS -DE 14 (Rev. 11/13) Adjutant Workshop, Inc. - Campaign ToolBox