M12 2021 Report 01-10-2022CAMPAIGN TREASURER'S REPORT SUMMARY
(1) -F k( Qh/W E ONLY
Name S
(2) "71 --S Pi LD JAN 10 2022 VrY""
dress (number and street) �L-S
®jF I e) It -4 �L?;, -3-3 Q3Sr CITY OF BOYNTON BEACH
--f CITY CLERK'S OFFICE
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑ Candidate Office Sought: $-y--N Aq ® F
❑ 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 Report Type:
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Cash & Checks $
Monetary
Expenditures $
Loans $
Transfers to
Office Account $
Total Monetary $ , ,
Total Monetary $ L-}, F o) .
In -Kind $
(8) Other Distributions
$ , ,
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
,. o c�
$
(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 thi ort and it is true, correct, and complete:
(Type name) l�_�FC �L �`GL w�+tT'`t{ \ (Type name) se r f-t-La'-La'a W t-, C. i
❑ Individual (only for IE ❑ Treasu er ❑ De uty Treasurer ❑ Candidate ❑ Chairperson (only for PC and PTY)
or electioneering c
Signature Signature
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIG TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name —,•-i ` f-1 k i (2) I.D. Number
(3) Cover Period / / j 12' through 1A / I �r l ( (4) Page of
(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
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
C) 4s
l --27 a
Cr-
S
C -low
1� .�1 2�
DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES