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Polglaze, Jay - Seat 3FLORIDA DEPARTMENT OF STATE �VISION Of ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Jay Edwin Polglaze Name (�) 522 Richarda Avenue Addr,ess (number and street) Clearwater, FL 33755 City, State, Zip Code ❑ CHECK IF ADDRESS M14S CHANGED OFFICE USE ONLY ,m �� . �� FEB 1 �� 2G�2 � , : �..;,, ,,.,4, _,� . {3} fD N .:�`�'W .�.t;�..; � � (4) Check appropriate box(es): 0 Candidate (o�ce sought): Clearwater Ci.ty Council Seat #3 ❑ Potitical Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HA8 Di36ANDE0 ❑ Party E�cecutive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER E4ECTIONEERING COMMUNICATION REPORTS 1MLL BE FlLED (5) REPORT IDENTIFIER� Cover Period: From io 1 i/ aoii To 2 / i6 / 2oiz Report Type � [�] Originai ❑ Amendment � Speaal Eledion Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash 8 Checks Loans Total Monetary in-Kind $ 4,230.00 $ 14.ia (7) EXPENDITURES THIS REPORT Monetary . E�Bttditur8s $ 3, 064 :30 TransFers to Office Account $ $ 4 � 244 .18 TOtel Manetary � 540.00 {9) TOTAL Moneiary Contributions To Date $ 4,244.18 $ � �� 3.064.30 (8) Other Distributions $ Z.i�9.se (10) TOTAL Monetary Expendi#ures To Date $ 4,a44.ie (1t) CERTIFtCAT10N It is a flrst degree misdemeanor fo� any tson to falsffy a pubik record (ss. 838.13, F.S. I certify that i have examined this report and tt is true, 1 certify that 1 have e�amined this report and it is tcue, correct, and complete. correct, and complete. (Type name) William Sturtevant (Type name) ❑Individual {oniy for Trsasurer De ut T rer OCandidate e oommun.) Signature Sign #u_ D8-DE 12 (t�ev. 08/04) �_ Jay Edwin Polglaze ror pc, Prr a . organization) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name Jay Edwin Polglaze (2� I.D. Number 3 Cover Pe�iod 10 l 1 � 2 011 through 2� 16 � 2012 4 Pa e � of � (�) �� 9� �� 12� Date Futi Name (6) (Last, Suf%c, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number C' State Zi Coda 7 Occu tion T e Descri tion �°�m°� Amount Crabby Bills B Rest. �,g 500.00 10 � 7 �2011 37 Causeway Blvd Clearwater Beach, FL 33767 1 Donald Chandler I �E 35.00 10 � 14 �011 609 Richards Ave Clearwater, FL 33755 2 Paul Kuhne Z � 100.00 10 � 17 2Q11 7080 River Country Dr Safety Harbor, FL 3 34607 Nancy Currey I � 100.00 10 � 18 �011 534 RiChard�, CT Clearwater, FL 33755 4 Mark Quirny I �g 100.00 10 � 18 �2011 1405 Ridge Ave. Clearwater, Fl 33755 5 Nor�is Smith g Video 200.00 10 � 19 ?�011 26g Mayfair Ave Palm Harbor, FL 34683 6 Frank Dame I � 100.00 10 20 011 � � 407 Leeward Island Clearwater, FL 33767 7 John Duxberry I CHE 50.00 10 � 20 �011 225g Clairborne Dr Clearwater, FL 33755 8 ..�� DS-0E 18 (Rev. Oat03) SEE REVtfcat rvrc ��vrs � Ru�. � w�,w w.�+..�..,... .�,........ CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Jay Edwin polglaze (2� I,D. Number 3 Cover Period 10 / 1 1 2 o i i th�gh 2� 16 � 2 o i 2 4 Pa e 2 of 5 i5) c�) ��) (9) i�o) t»� ��> pate Fuil Name (6) (Last, Suffa, Firsi, Middle) Sequence Street Address 8 Confibutor Contribution In-kind Nurnber C" State Zi Code T e Occu t�n T Descri tion �e^d►►,ent Amount Nicholas C. I Realtor CHE 150.00 10 � 24 �2011 pritsch 1310 Gulf Blvd. 8-D 9 Clearwater, FL 33767 0 Katherine Jones I Ina. � 250.00 10 � 24 �011 575 S. Hercules Ste 604 Clearwater, FL 10 33764 Diane Nelsan Z � 50.00 10 � 24 2911 2833 Chancery Lane Clearwater, FL 33759 11 John Doran I � 50.00 10 � 24 �011 PO Box 3266 Clearwater, FL 33767 12 Anthony Granese B � 100.00 10 � 24 �2011 1014 Drew St Clearwater, F1 33755 13 John Dunn I Health CHE 200.0 10 � 24 ?�Qil 1884 Oak Forest care Clearwater, FL 33759 14 10 24 2O11 Joanna Siskin I � 25.00 / / 121 N Crest Clearwater, FL 33755 15 Michelle Gallagher I CHE 25.00 10 � 24 �011 401 Cleveland St Ciearwater, FL 33755 16 DS-DE 13 (Rev. OBJOB) $EE REVERSE FOR INSTRUCTION3 AND CAD� YAi.uCS3 CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Jay Edwin Polglaze (2) I.D. Number 3 Cover Pe�iod �' ° / 1 � a o 11 through 2� 16 � 2 012 4 Pa s 3 of � c5� m c8� c9� cio� c„> c1z} Date Fult Name (8) (Last, Suffix, First, Middie) Sequence Street Address 8� Co�tributor CoMribution In-kind Number C' State Zi Code T Oxu ation T Descri ' �e"dm� Amount Doug Wiliiams I � 25.OQ 10 � 24 �2p11 2544 Frisco Dr Clearwater, FL 33764 17 Brian Aungst, Jr I Attorney CHE 250.00 10 � 24 �2011 2633 Brattle Lane Clearwater, F1 33761 18 Rochelle I Q.� 100.00 10 � 24 2Q11 Kuroghlian 1821 Springwood Cir 19 Clearwater,FL R3 Sales inc. g � 100.00 10 � 24 �011 1449 Court St. Clearwater, FL 33756 20 1Cimberly MeGaEfrey Y �g 100.00 10 � 24 � O11 2322 St. Gharles Dr Clearwater, FL 21 33764 Grant Wood I Real CHE 150.00 10 � 24 ?�011 15462 GulE Blvd Estate #802 Mgt. Madeira Beach, FL 22 33708 10 Jenny Esno I Media Ci�ifi 150.00 � 24 �011 1201 Bay Dr. Belleair Bch, FL 33786 23 Brian Aungst I CHE 100.00 10 � 24 �011 2633 Brattle Lane Clearwater, FL 33761 24 D8-0E 13 (Rev. 08/0S) SEE REVERSE FOR INSTRUCTK3NS AND CODE YALUE8 CAMPAIGN TREASUFtER'S REPORT - ITEMI2ED CONTRIBUTIONS (1) Name Jay Edwin Polglaze (Z) (.D. Number 3 Cover Period �� / 1 / 2 fl 11 th„�gh 2 � 16 � 2 012 4 Pa e 4 � 5 c5� m c8� c9� c�o� ci�� c12� Date Futt Name (6) (last, Suffoc, First, Middle) Sequence Street Address & Contributor Gontribution In-kind Nurr�er C' State Zi Code T Occu tion 7 Descri tion �� Amount Carl Opper I Q� �.00.00 10 � 2.� �2011 705 Shady Lane Clearwater, FL 33764 25 Advantage Group B CHE 100.00 10 � 24 �011 2555 Lnterprise Rd Ste Z1-3 Clearwater, FL 26 33763 The Census Group g � 100.00 10 � 24 2911 pp Box 4268 Clearwater, FL . 33758 27 �OwBe`� B Tech CHE 500.00 10 �� plx 601 Cleveland St Clearwater, FL 33755 28 Maryce Garber I � 20.00 10 1 24 �2011 1234 Grove St. Clearwater, FL 33755 29 Islan:d Way Grill g INK 500.00 10 � 24 �011 2o Island way Clearwat�r, F1 33767 30 10 2 26 O11 ��rd I � 50.00 / / Fensterwald III 337. Cleveland St Clearwater, FL 31 33755 R. B. Swick I CHE 50.00 10 � 28 �011 831 Peggy Ray Dunedin, FL 34698 32 DS-0E 1S (Rev. Q8t03) SEE REVERSE FOR INSTRUCTIONS AND CODE VAI.UES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRtBUT10NS (1) Name Jay Edwin Polglaze (2) I.D. Number 3 Cover Period 1 o / 1 � 2 o i i through 2� 16 � 2 012 4 Pa e � of 5 (5? c�') ($) (9) i�o) (�+) i�Z) Date Full Name (6) (Last, Suffa, First, Middle) Sequence Street Address 8 Contributor Contribution In-kind Number C' State Zi Code T Occu tion T Des ' tion �e�ma^� Amount D-Mar General B CHE 100.00 10 � 31 �2011 Contracting 1453 S. Martin Luther King 33 Clearwater, FL 33756 0 Ed Armatrong I Att4rney CHE 200.00 10 � 31 �U11 1614 Santa Bax'bara Clearwater, FL 34698 34 Jay Edwin Polglaze I LOA 14.18 2� 14 2912 522 Richards Ave Clearwater, FL ��•/� � 33755 h�� S 1 1 / / J / / / / / DS-0E 78 (FZev. 08J03) SEE REVERSE FOR tNSTRUCTIONS AND CODE YALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name say Edwin Polglaze (2j I.D. Number (3) Cover Pertod 10 / 1 � 2 0 � 1��h 2� 16 � 2 012 t4� Pa$e 1 � 6 (s� (7j t8) t91 t��1 (��) Dilte FuN Ns�me Purpose �s� (L.ast, Suftix, First, Middle) (add otf'ke sought if Sequence stroet Addresa 8� contribution to a �pQ�diture Number City, State, Zip Coc� candidate) TYPe ,4mendment Amoun! City of Clearwater Filing Fee MON $2gg,2g 10 9 11 112 S. Osceola Clearwater, FL 33755 1 US Postmaster Stamps MON $gg.00 10 3 1 100 S. Belcher Clearwater, FL 337865 2 Island Way Grill Campaign MON $350.00 10 24 11 20 Island Way kick-off Clearwater, FL 33767 Party Hvspitality 3 WTX.com Web site MON $�.gp 11 14 il Bloomingdale, NJ 07473 hosting 4 Kyle Polglaze Web site MON $350.00 11 29 li 522 Richards Avenue design Clearwater, FL 33755 � 5 City of Clearwater Petition MON $30.00 12 8 11. 112 S. Osceola Avenue verification Clearwaker, FL 33755 fee 6 Turner Print•ing Company Letterhead, MON $388.41 7�2 9 11 829 Belleair Road business Clearwater,FL 33T56 cards, misc. printing 7 WIX.com Web site MOM $g.�p 12 12 11 �loomingdale, NJ Q7473 hosting 8 DS-0E 14 (Rev. 08/03j SEE REVERSE FOR INSTRlJCT10NS AND CODE VALUES CAMPAIGN TREASURER'3 REPORT — ITEMIZED EXPENDITURES (1) N8R18 Jay Edwin Polglaze (Z) I.D. Number (3) Covsr Pertod 1� / 1 � 2 o i l through 2 / 16 � 2 012 �a� Page 2 p� 6 is) �� (gl (el (�ol (��) 08te Full Nams purpose �g� (Last� Suffix, First, MWdle) (add otfice so 3equence s�et Addr+�ss � contribution t�o a� �Penditure Number CitY, $�te� ZiP Code candidatej TYPe Amendment Amount USAmeeriBank Monthly MON $10.00 12 30 11 161'7 Gulf to Bay Maintenance Clearwater, FL 33755 Fee 9 WIX.com Web site MON � 90 1 �. a Bloomingdale, NJ 07473 hosting 10 Nauti Nancy's Thank you MON 1 28 12 70o Eldridge Street reception for $1,500.00 Clearwater, FL 33755 campaign eupporters il USAmeriBank Monthly MON $10.00 1 31 12 161'7 Gu1f to Bay Maintenance Clearwater, FL 33755 ia WIX.com Web site MON $9.90 2 � 12 Bloomingdale, NJ 07473 hosting 13 Crabby Bill's REF DIS $135.66 2 4 12 37 Causeway Blvd. Clearwater Seach, FL 33767 14 Dpnald Chandler REF DIS $9 85 Z 4 12 609 Richards Ave Clearwater, FL 33755 15 Paul Kuhne REF DIS $2g.13 2 14 i2 �080 River Country Dr. Safety Harbor, FL 34607 16 L7�iJt 74 (It@V, uwua� 3EE REVERSE FOR fN8TRUCTION3 AND CODE VALUE8 CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Jay i3dwin poiglaze (2) I.D. Number (3) Cover Period 10 � 1� 2 011 through 2/ 16 � 2 012 �4) Page 3 of 6 �g� (7) (8j (8) (10) (11) Date pW� �� p�� 6� (Last, Suf�x, First, Mlddle) (add office sought if ��n� Street Addreas & coMributio� ta a Expenditure Number City, State, Zip Code candidate) TYPe Amendment Amount Nancy Currey REF DZS �2g.13 2 14 12 534 Richards, CT Clearwater, FL 33755 17 Mark Guirny REF DIS $28a13 2 4 2 1405 Ridge Ave Clearwater, FL 33755 18 � Norris SmiCh REF DIS $56.26 2 14 12 269 Mayfair Ave Palm Harbor, FL 34683 19 Framk Dame REF Dis $28,13 2 14 12 407 Leeward Island Clearwater, FL 33767 20 John Duxberry REF DIS $14.06 2 4�2 2258 Clairborne Dr Clearw8ter, FL 33755 21 Nicholas C. REF DIS $42.19 2 4 12 Fritsch 1310 Gulf Blvd 8-D Clearwater, FL 22 33767 Ka�rine Jones REP DIS $70.33 2 4�,2 575 S. Hercules Ste 604 Clearwater, FL 23 33764 Diane Nelson REF DIS $I4.06 2 14 12 2833 Chancery Lane Clearwater, FL 33759 • 24 DS-0E 14 (Rev. 0&/03} SEE REVERSE FOR iNSTRUCTiON3 AND CODE VALIJES CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES (1) NBme__ Jay Edwin Polglaze (2� �.D. Number (3) Cover Period 1° � 1 � 2 0� 1 through 2 � z 6 � 2 012 (4) Page 4 ot 6 Date �� (91 t�Q) (1'�) Full Name pu� �Q� (Last, SuRix, First, Middle) (add oftice sought if gequence Street Address � contribution io a Expenditure Number CitY� State, Zip Code candidatej TYI� Amendmsnt Amount John Doran REF DIS $14.06 2 14 I2 PO Box 3266 Clearwater, FL 25 33767 Anthony Granese REF DIS s2g.13 2 ,� 2 1014 Drew St Clearwater, FL 33755 26 JOhn Dunn REF DIS $56.26 Z 14 12 1884 Oak Forest Clearwater, FL 33759 27 Joanna Siskin REF DIS $7.03 Z 14 12 121 N Crest Clearwater, FL 33755 28 Michelle Callagher REF DIS $7.03 2 4 �,2 401 Cleveland St Clearw�ter, FL 33755 29 Doug Williama REF DIS $7.03 2 4 12 2544 Frisco Dr Clearwater, FL 33764 30 Brian Aungat, Jr REF DiS $70.33 2 4 12 2633 Brattle Lane Clearwater, FL 33761 31 Rochelle Kuroghlian REF DiS $2g.13 2 14 12 1821 Springwood Cir Clearwater, Fl 33755 32 tJ3-UC lq (KSV. Uif/Y3) �E REVER3E FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REP�RT — ITEMI2ED EXPENDITURES (1) Na1'1't@ Jay Edwin Polglaze (2) I,D. Number (3) Cover Perlod 10 � 1 � 2 011 �rough 2 / 14 � 2 012 �4) Page 5 Of 6 (si �7) (8l i�l (1�) (11) Date Ft�ll Name p�� g) (Last, 8uffix, Pirsk Middie) (add office so ff Sequence Street Address 8 contributian t��o a Expenditurs Number City� St�te, Zip Code candidate) TYi� Anwndment Amount RS Sales, inc. REF DIS $2g.13 2 14 12 1449 Court St Clearwater, FL 33 33756 Kimberly McGaffrey REF DIS $28.13 2 4 2 2322 St. Charles DR Clearwater, E+'L 33764 34 Grant Wood REF DIS $42.19 2 14 1,2 15462 Gulf Blvd #802 Madeira Beach, FL 35 337Q8 Jenny Esno REF DIS $42.19 2 14 12 1201 Bay Dr. Belleair Bch, FL 33786 36 • Brian Aungst REF DIS $28.13 2 4 12 2633 Brattle Lane Clearwater, FL 33761 3� Carl Opper REF DIS $28,13 2 4 12 705 Shady Lane Clearwater, FL .33764 38 Advantage Group REF 1�IS $28.13 2 4 12 2555 Enterprise Rd Ste 11-3 Clearwater, FL 39 33763 The Census Group REF DI3 $28.13 2 14 12 PO Box 4268 Clearwater, FL 33758 40 uca�vc �� rtev. �anl�j SEE RE1/ERSE FOR INSTRUCTIOMS AND CODE VALUES CAMPAtGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name _ Jay Edwin Polglaze (2) I.D. Number (3) Cover Period 1� / 1 � 2 01 i through 2 � 16 � 2 o i 2 �4) Page 6 of 6 �51 �� (8I (9) (��) (111 Date F�� (g� (Last, Suifix, First, Middle) (add offlce sought if Sequsnce s�t �d� � contribution to a �xpenditure Number City, State, Zip Code candidate) fYPe Amendme�t Amount KnowB4 REF DIS $�35.66 2 14 12 601 Cleveland St Clearwaker, FL 41 33755 Maryce Garber REF DIS $5.62 2 4 2 1234 Grove St Clearwater, FL 33755 42 Bernard REF DIS $14.06 2 14 12 Fensterwald IIT 331 Cleveland St Clearwater, FL 43 33755 R. B. 5wick REF DIS $14.06 2 14 12 831 Peggy Way Dunedin, FL 34698 44 D-Mar General REF DIS $28,13 2 4 12 Contracting 1453 S. Martin Luther King Clearwater, FL 33756 45 Ed Armstrong REF DIS $56.26 2 4 12 1614 Santa Barbara Clearwater, FL 34698 46 U3iJC 74 (K@V. u�nrs) gEE REVERSE FOR lNSTRUCTIONS AND C�OE VALUES FLORIDA pA T" T OF STATE DIVISION L;A : CAMPAIGN P '"° _7 d Ja Edwi Palcglaze .. Name to chart e ue �`�ii -66111 I LEA#I ` ' , Address number and street) L TL Clearwater, FL 33755 A„ k City, State, Zip Code .,rw< <, E] CHECK ir ADDRESS HAS CHANGED (3) ID Number. / ( Check appropriate )a Candidate (office sought): Clearwater City Council Seat #3 Political Committee Q CHECK IF PC HAS DISBANDED Q Committee of Continuous Existence Q CHECK IF CCE HAS DISBANDED Pa ecuti e Committee Electioneering Communication HECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WtLL BE FILED PORT IDENTIFIERS Cover Period: From 15 / 2011 To 9 l 30 i 2011 Report Type Q3 C ri in i 0 Amendment F-1 Special" Election Report Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT" ( EXPENDITURES THIS REPORT Monetary Cash & Checks $ 100. 00 Expenditures 0 . 00 Loans $ 0 . 00 'transfers to Office Account 0 . 00 Total Monetary $ 1-00 .00 Total Monetary $ 0 . 00 In-bind $ 0 . 00 - Other Distributions 0 . 00 ( TOTAL Monetary Contributions To Date 1 TOTAL Monetary Expenditures To Date x,00 . 0 C E ( )CERT I ICATION It is a first degree misdemeanor for any parson to falsify a public record(s s. 839.13, F.S.) I certify that t have examined this report and it is true, I certify that I have examined this report and it is true, correct, and cornplete. correct, and complete. (Type name) William Sturtevant (Type name) Jay Edwin laze []Individual(6n€y R Treasurer Deputy'Treasurer 0 candidate F_�Chair rson[o for FCC PTY& election,-er ng com tin) e6prtion ring co organization) inattare `� ir�at re -[� t Ie�.4k9ltB CAMPAIGN TREASURER"S REPORT- ITEMIZED CONTRIBUTIONS (1) Name Jay Edwin Polglaze (2) I.D. Number N/A J3) Cover Period 9 15 1/ 2 01- Mrough 9 1 30 j 2011 (4) Page Of (5) (7) (8) (9) (1 0) (1 t) (1 2) Date Full Name (6) (Last, Suffix,First, Middle) Seqwence Street Address& Contributor Contribution In-kind Number City, State,Zip gode T a Occupation Type Descri tion Amendment Amount _ ,Jay Polglaze cas 100.00 9 22 12011 522 Richards Ave Clearwater, FL 33755 t T -n rn rn Cn 09-DE 13(Rev.OW03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASUREWS REPORT- ITEMIZED EXPENDITURES (1) Name Ja Erjw.L1-1 P0191aze (2) I.D. Number N/A (3) Cover Period 9' / 15 / 2 01 s through 9 30 1 2011 (4) Page 1 Of 1 (5) (7) (8) (9) (10) Date Full Name Purpose (6) (Last,Suffix,First, Middle) (add office sought if Expenditure Sequence Street Address& contribution to a Number City, State,Zip Code candidate) Type Amendment Amount z one �0.00 C=) rn rn < r,nr- M rn M C�> z z z z z DS-DE 14(Rev. 48103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES