No Boss Mayor ClearwaterCAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
OFFICE USE ONLY
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has changed (3)
(4) Check appropriate box(es):
❑ Candidate Office Sought:
ID Number:
0 Pohtical Committee (PC)
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
• Electioneering Communications Org. (ECO)
1 Check
■ Party Executive Committee (PTY)
• Check
• Independent Expenditure (IE) (also covers an 11
Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 11 / 02 / 18 To 11 / 16 / 18 Report Type: TR
Election Report
1 Original ■ Amendment • Special
(6) Contributions This Report
Cash & Checks $ , ,
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 5 , 124 . 53
Loans $
to
$ , .
Total Monetary $ •
$ , 5 , 124. 53
In -Kind $ -
(8)
Other Distributions
$ , , .
(9) TOTAL Monetary Contributions To Date
$ , 92 , 096 . 00
(10)
TOTAL Monetary Expenditures To Date
$ , 92 , 096 . 00
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
■ Individual (only for IE GI Treasurer ■ Deputy Treasurer
■ Candidate 13 Chairperson (only for PC and PTY)
or election ring coram_)
X(V
1- ,
Signature
Sigriature
DS -DE 12 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(1) Name (2) I.D. Number
(3) Cover Period
11 / 02
/
18 is
through 11 / /
18 (4) Page
1
of
1
(5)
Date
(7)
FUII Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
/
/
/
/
/
/
/
1
1
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(2)113. Number
(3) Cover Period 11 02 18 through 11 / 16 / 18 (4) Page 1 CO
1
(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
11/07/18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater,
Loan Repayment
1
FL 33759
DIS
5000.00
11 07 18
/ /
Friends of the Clearwater Library
100 N Osceola Ave
Clearwater, FL 33755
contribution
DIS
124.53
2
/ /
/ /
/ /
/ /
1 /
/ 1
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) No Boss Mayor Clearwater
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
['Check here if address has changed
(4) Check appropriate box(es):
❑ Candidate Office Sought:
OFFICE USE ONLY
e... iw
NOV 052018
OFFICIAL RECORDS AND
kEGISL4TI'/E SVCS DEPT
(3) ID Number:
✓❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
0 Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
❑ Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 10 / 20 / 18 To 11 / 1
❑✓ Original
/ 18 Report Type: G7
0 Amendment 0 Special Election Report
(6) Contributions This Report
Cash & Checks
Loans
Total Monetary
In -Kind
$ , 26,030. 00
$ , 26 , 030. 00
(7) Expenditures This Report
Monetary
Expenditures $ , 26, 914 . 83
Transfers to
Office Account $
Total Monetary $ , 26 , 914 . 83
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date
$ , 92 , 096 00
(10) TOTAL Monetary Expenditures To Date
$ 86 , 971 . 47
(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) Danielle Dahlberg
❑ Individual (only for IE ['Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X
Signatttre
DS -DE 12 (Rev. 11/13)
(Type name) Elizabeth Rawlins
❑ Candidate
+❑ Chairperson (only for PC and PTY)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
' CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(3) Cover Period
10/ 20
/
18 11
through
1
(2) I.D. Number
18 1 1
/ (4) Page of
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
10
/
24
/
18
ICMA
777 N. Capitol
Suite 500
Washington, DC
St, NE
20002
B
prof. assoc.
CHE
26000.00
1
11
/
1
/
18
Jan Hagenbuckle
608 Mariva Ave
Clearwater, FL
33755
I
CHE
30.00
2
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(3) Cover Period to / 20 / 18 through 11 / 1 / 18
(2) I.D. Number
(4) Page
1
of
1
(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
(70)
Amendment
(11)
Amount
(6)
Sequence
Number
Michaels #9432
Buttons
10)/20 / 18
33561 US Hwy 19 N
Palm Harbor, FL 34684
MON
14.45
1
10 25 18
Beth Rawlins Inc
Social media
/ /
2845 Chelsea Place S
Clearwater, FL 33759
MON
1348.75
2
Beth Rawlins Inc
Direct Mail
1029 18
2845 Chelsea Place S
/ /
Clearwater, FL 33759
MON
23452.97
3
Beth Rawlins Inc
Digital advertising
10 29 18
2845 Chelsea Place S
/ /
Clearwater, FL 33759
MON
1250.00
4
Beth Rawlins Inc
Social media
10 31 18
2845 Chelsea Place S
/ /
Clearwater, FL 33759
MON
846.66
5
Wells Fargo Inc
Bank Fee
10/ 3 18
420 Montgomery St
1
San Francisco, CA 94104
MON
2.00
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Beth Rawlins, Inc.
Tenacious Problem Solving
2845 Chelsea Place S. • Clearwater, FL 33759
RECEIVED
1O1
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT.
i
�na;iiial4111/1 Yid
i
UMllED STATES
PDSruLSERYI[E0
7018 1130 0001 1507 9750 ?n23
U.S. CM LETTER E PAI.
CLEARWATER, FL;
33763
AMOUNT
R2303510 -33(1
/e0..‘1/Ine2.4,‘:e. ea -1/
ez.Jt/
0 e/ci aJfr-r
7fY- 77r,
33 Se --4745- 9)��Ji,'�11�1Ji1'Jl'liJ1JJ��J'I�IIl1111"il'J11I�,J��,1,/)1�'J1"J
_1
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
OFFICE USE ONLY
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address
(4) Check appropriate box(es):
❑ Candidate Office
has changed (3)
Sought:
ID Number:
✓ Political Committee (PC)
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
❑ Electioneering Communications
❑ Party Executive Committee
❑ Independent Expenditure
individual making electioneering
Org_ (ECO)
■ Check
(PTY)
• Check
(IE) (also covers an
■ Check
communications)
(5) Report Identifiers
Cover Period: From 10 / 13 1 18 To 10 / 19 1 18 Report Type: G6
❑ Special Election Report
1 Original ❑ Amendment
(6) Contributions This Report
Cash & Checks $ , , 100. 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 260. 00
Loans $ , , •
to
$ , , .
Total Monetary $ , , 100. 00
$ , , 260. 00
In -Kind $ , , 2 . 89
(8)
$
Other Distributions
, ,
(9) TOTAL Monetary Contributions To Date
$ , 66 , 066 . 00
(10)
TOTAL Monetary Expenditures To Date
$ , 60 , 056 . 64
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
■ Individual (only for IE O Treasurer IN Deputy Treasurer
• Candidate
0 Chairperson (only for PC and PTY)
r_.5--,a,z,...-
or eleclio ring comm.)
,e,„,.i,,e-•
Signature
S' ure
DS -DE 12 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(1) Name (2) I.D. Number
10
13 18
(3) Cover Period / /
10
through
19 18
1
(4) Page of
1
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
10
/
18
18
/
Anita McClelland
715 N Highland Ave
Clearwater, FL 33755
I
CAS
50.00
1
10/
18
/ 18
Samuel McClelland III
715 N Highland Ave
Clearwater, FL 33755
I
CAS
50.00
2
1019
/
18
1
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
B
Consulting
INK
copies
2.89
3
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(3) Cover Period 10 /
13 / 18 through 10 / 19 / 18
(2) I.D. Number
(4) Page
1
of
1
(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
Tme
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
10j/19/18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
Phone calls
1
MON
260.00
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
OFFICE USE ONLY
UCT Z4 261?
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has changed (3)
(4) Check appropriate box(es):
❑ Candidate Office Sought
ID Number:
✓ Political Committee (PC)
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
❑ Electioneering Communications Org. (ECO)
■ Check
❑ Party Executive Committee (PTY)
• Check
• Independent Expenditure (IE) (also covers an
❑ Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 10 1 6 / 18 To 10 / 12 / 18 Report Type: G5
Election Report
1 Original ❑ Amendment ■ Special
(6) Contributions This Report
Cash & Checks $ , 16, 950. 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 29 , 822. 32
Loans $ , •
to
$ , , .
Total Monetary $ , 16 , 950. 00
$ , 29 , 822. 32
In -Kind $ . •
(8)
Other Distributions
$ , , .
(9) TOTAL Monetary Contributions To Date
$ 65 , 966 _ 00
(10)
TOTAL Monetary Expenditures To Date
$ 59 , 796 . 64
(11) Certification
It is a first degree misdemeanor for any person
1 certify that 1 have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
• Indivi • ual (city for IE El Treasurer ■ Deputy Treasurer
■ Candidate GI Chairperson (only for PC and PTY)
or el - ... - - ring conwn.)
(t--
[ e'
J4 1 .- 6 ,�1.�
# 4 1
Signature
S ature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(3) Cover Period
10/ / 6 18
through
(2) I.D. Number
10 / 12 / 18 1
(4) Page of
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
10
/
8
/
18
ICMA
777 N. Capitol St, NE
Suite 500
Washington, DC 20002
g
prof.
assoc.
CHB
16800.00
1
10
/
12
/
18
Peter Cranfield
1956 Sandra Dr
Clearwater, FL 33764
I
CHE
50.00
2
10
/
12
/
18
Communications Worker
of America - Local
3179
2165 Sunnydale Blvd
Suite M
Clearwater, FL 33765
B
prof.
assoc.
CHE
100.00
3
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater (2) l.D. Number
(3) Cover Period 10 / 6 18 through 10 / 12 18
(4) Page
1
of
1
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
A
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
TYPe
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
10/
11/
18
Beth Rawlins Inc
2845 Chelsea Place 5
Clearwater, FL 33759
Mail
MON
23191.07
1
1011
/
/
18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
Digital Ads
MON
6631.25
2
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Beth Rawlins, Inc.
Tenacious Problem Solving
2845 Chelsea Place S. • Clearwater, FL 33759
11111111Latir-Av451r►, IIIII1••.
I ( I III VIII � �'' ���: .
j.i
7018 1130 0001 1507 8203
I�.
(1a,671
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(40'44a -2a -7-'6-z/, ,a3159- 97$1,
33755--5 1 0 5'99 '1I1'11'1IIIIUU1,111"IIJI'11'IIi11111111I111II,+I111I1.1"1 II1
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1023
33758
UC P TACE PA!
CLEARWATER, FL
k3763
MOUNT18
$3.95
R,*303S 102684 II
- rt
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
oFF E USE ONLY
OCT I t 2018
r.ia. _ ` ;-
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has changed (3)
(4) Check appropriate box(es):
❑ Candidate Office Sought:
I
ID Number:
✓ Political Committee (PC)
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
❑ Electioneering Communications Org_ (ECO)
■ Check
❑ Party Executive Committee (PTY) ❑ Check
❑ Independent Expenditure (IE) (also covers an
■ Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 9 / 29 / 18 To 10/ 5 / 18 Report Type: G4
Election Report
✓ Original • Amendment ■ Special
(6) Contributions This Report
Cash & Checks $ , , 125.00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 0 . 00
Loans $ , , •
to
$ .
,
Total Monetary $ , , 125 00
$ , 0 . 00
In -Kind $ , , 150 . 00
(8)
Other Distributions
$.
(9) TOTAL Monetary Contributions To Date
$ , 49 , 016 00
(10)
TOTAL Monetary Expenditures To Date
$ , 29 , 974 • 32
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
• Individual (only for IE D Treasurer • Deputy Treasurer
• Candidate GI Chairperson (only for PC and PTY)
or electioneering comm.)
X I4u /r
X6 ,_.5-XL/7.�.4.":1
Signature
Sig re
DS -DE 12 (Rev.11113)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
9
(3) Cover Period
29 18
/ through
10/ 5
(2) I.D. Number
18
1
/ (4) Page of
1
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
FUJI Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
10
/
1
/
18
Patricia Smith
105 Sunburst Ct
Clearwater, FL 33755
I
CHS
25.00
1
10
/
1
/
18
Richard Brant
913 Jeffords St
Clearwater, FL 33756
I
CHB
50.00
2
10
/
1
/
18
Julianne Anderson
1101 Flushing Ave
Clearwater, FL 33764
I
CHB
50.00
3
10
/
3
/
18
Louis Betz & Assoc.
Pp Box 274108
Tampa, FL 33688
B
consulting
INK
phone #s
150.00
4
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
1
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(2) I.D. Number
(3) Cover Period 9 / a9 / 18 through 10 / s / la (4) Page 1 of 1
ag
(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
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
OFFICE USE ONLY
Received
OCT 0 4 2018
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
❑ Candidate Office Sought
(3)
ID Number:
City Manager's Office
❑ Check
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
1 Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
• Check
❑ Independent Expenditure (IE) (also covers an
■ Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 9 / 15 / 18 To 9 / 28 / 18 Report Type: G3
Election Report
✓ Original ❑ Amendment • Special
(6) Contributions This Report
Cash & Checks $ , 40 , 901 . 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 26 , 081 . 98
Loans $ , -
to
$ .
,
Total Monetary $ , 40 , 901 . 00
$ , 26 , 081. 98
In -Kind $ , , 2 . 89
(8)
Other Distributions
$.
(9) TOTAL Monetary Contributions To Date
$ , 48 , 891. 00
(10)
TOTAL Monetary Expenditures To Date
$ , 29 , 974 , 32
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
■ Ind' '. - (only for IE O Treasurer • Deputy Treasurer
■ Candidate GI Chairperson (only for PC and PTY)
or ele �, • comm.)
Signature
Sigrfature
DS -DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
9
(3) Cover Period
15 18 9 28
(2) I.D. Number
18
1
/ through / / (4) Page of
3
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
ICMA
9
15
18
777 N. Capitol St, NE
/
/
Suite 500
1
Washington, DC 20002
B
prof. assoc.
CHH
40000.00
Betty Walsco
918
18
2 S. Aurora Ave
/
/
Clearwater, FL 33765
2
I
CHE
15.00
Raymond Dube
921
/
,
18
829 Bay Esplanade
Clearwater, FL 33767
3
I
retired
CHB
100.00
Richard Claxton
9
21
18
2009 Seton Dr
/
/
Clearwater, FL 33763
4
I
CHE
10.00
E. Fields Puckett III
9
2518
2425 Summerlin Dr
/
/
Clearwater, FL 33764
5
I
CHS
6.00
9
25
18
Douglas Williams
2544 Frisco Dr
/
/
Clearwater, FL 33761
6
I
CHS
25.00
David Jaye
9
25
18
2856 Shady Oak Ct
/
/
Clearwater, FL 33761
7
I
CHE
50.00
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
9
(3) Cover Period /
15 18
/ through
9 28
(2) I.D. Number
18
2
/ (4) Page of
3
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, Slate, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
Robert Rice
9
25
18
1057 Chinaberry Rd
/
/
Clearwater, FL 33764
8
I
CHB
100.00
Peter Vosotas
925
18
Pp Box 16057
/
/
Clearwater, FL 33766
9
I
Retired
CBE
200.00
Rita Garvey
9
26
18
1715 Estelle Dr
/
/
Clearwater, FL 33756
10
I
Retired
CHE
100.00
JoAnne Larsen
9
26
18
1640 Midnight Pass Way
/
/
Clearwater, FL 33765
11
I
CHE
100.00
Carl Schrader
9
26
18
1541 S. Fredrica Ave
/
/
Clearwater, FL 33756
12
I
CPA
CHE
100.00
Rosemarie Kibitlewski
9
26
18
1506 W. Virginia Ln.
/
/
Clearwater, FL 33759
13
I
CHE
25.00
Damon Hostetler
9
/
26
/
18
107 N. Cirus Ave
Clearwater, FL 33765
14
I
CHE
20.00
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(3) Cover Period 9 / 15 / la through
(2) I.D. Number
9/ 28 18
/
(4) Page 3 of
3
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
9
1
28
/
18
Sarah Josuns
3235 San Bernadino St
Clearwater, FL 33759
I
CFE
50.00
15
9
/
28
/
18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
B
consulting
INR
copies
2.89
16
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(3) Cover Period 9 / 15 / 18 through
9 / 28 / 18
(2) I.D. Number
(4) Page
1
of
1
(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
Beth Rawlins Inc
Mail
9 / 21/
18
2845 Chelsea Place S
Clearwater, FL 33759
MON
11672.69
1
9 27
18
Michaels #3715
Buttons
/ /
11643 W Hillsborough Ave.
Tampa, FL 33635
MON
24.61
2
Beth Rawlins Inc
Mail
928
18
2845 Chelsea Place S
/ /
Clearwater, FL 33759
MON
11507.68
3
Beth Rawlins Inc
Social Media
9 28
18
2845 Chelsea Place S
/ /
Clearwater, FL 33759
MON
375.00
4
Beth Rawlins Inc
Digital Ads
9
18
2845 Chelsea Place S
/28 /
Clearwater, FL 33759
MON
2500.00
5
Welts Fargo Inc
Bank Fee
9/ 28 ,
18
420 Montgomery St
!/
San Francisco, CA 94104
MON
2.00
6
/ /
/ /
DS -DE 14 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
OFR D
SEP 20 ZON
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DFPT
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has changed
(4) Check appropriate box(es):
❑ Candidate Office Sought:
(3)
ID Number:
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ■
Check
❑ Party Executive Committee (PTY) ❑ Check
❑ Independent Expenditure (IE) (also covers an
■ Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 9 / 1 / 18 To 9 / 14 / 18 Report Type: G2
Election Report
19 Original ❑ Amendment ❑ Special
(6) Contributions This Report
Cash & Checks $ , 1, 640. 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , 3,841 . 75
Loans $ , 5, 000. 00
to
$ .
Total Monetary $ , 6, 640. 00
$ , 3 , 841. 75
In -Kind $ , , 902. 89
(8)
Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date
$ 7 , 990 . 00
(10)
TOTAL Monetary Expenditures To Date
$ , 3, 892 . 34
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify
and complete:
(Type
a public record (ss. 839.13, F.S.)
name) Elizabeth Rawlins
❑ Candidate
Sig
• Individual (only for IE 0 Treasurer ■ Deputy Treasurer
O Chairperson (only for PC and PTY)
or ele ring comm.)
X
/.....Are:/_._/.....Are:/_.__ , `
Signature
ature
DS -DE 12 (Rev.11113)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
9
1
(3) Cover Period
18
through
9 14
/
(2) I.D. Number
18
1
2
/ (4) Page of
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
9
3
18
Beth Rawlins Inc
2845 Chelsea Place S
/
/
Clearwater, FL 33759
1
B
Consulting
IAA
5000.00
Beth Rawlins Inc
94
18
2845 Chelsea Place S
/
/
Clearwater, FL 33759
2
B
Consulting
INK
Video
900.00
Patricia Vassar
94
/
18
/
2256 Glenmoor Rd N
Clearwater, FL 33764
3
I
CNS
100.00
Nicholas Fritsch
9
5
18
1310 Gulf Blvd,
/
/
Apt. 8D
4
Clearwater, FL 33767
I
CHB
100.00
Beth Rawlins Inc
9
11
18
2845 Chelsea Place S
/
/
Clearwater, FL 33759
5
B
INK
copies
2.89
Palm Pavilion of
9
11
18
Clearwater
/
/
10 Bay Esplanade
6
Clearwater Beach, FL
B
Resturant
CNS
1000.00
33767
Norene Marlow
9
/
11
18
/
1315 Ranchwood Dr
Clearwater, FL 33764
7
I
Retired
CHS
200.00
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(1) Name
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
9
(3) Cover Period / 1
(2) I.D. Number
18 914 18 2 2
through / / (4) Page of
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
9
/
12
/
18
City Cycle & Supply
Company
127 N MLK Jr. Ave.
Clearwater, FL 33755
g
Bicycle shot'
CHS
100.00
8
912
/
/
18
Marita Lynch
1618 Tuscola Rd
Clearwater, FL 33756
I
Nurse
CHS
100.00
9
9
/
12
/
18
Barbara Fisher
201 N Hillcrest Dr
Clearwater, FL 33755
I
CAS
40.00
10
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater (2) I.D. Number
(3) Cover Period 9 / 1 / 18 through 9 / 14 / 18
1
(4) Page of
1
(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)
Amendment
(11)
Amount
(s)
Sequence
Number
9
/
4 /
18
Prints 2 Go
24129 US Hwy 19 N
Clearwater, FL 33763
Printing
MON
90.95
1
9
/
9
/
18
Michaels #3715
2631 Gulf to Bay Blvd
Clearwater, FL 33759
Buttons
MON
23.54
2
9/
/ 13
18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
Brochure
MON
1205.95
3
91
/
!
18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
Yard Signs
MON
2521.31
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
TIRE
OFFICIAL RECORDS AN`:;
LEGISLATIVE SRVCS OFPT
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
(3)
ID Number:
• Check here if address has changed
(4) Check appropriate box(es):
❑ Candidate Office Sought:
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
1 Political Committee (PC)
■ Electioneering Communications Org. (ECO)
■ Check
❑ Party Executive Committee (PTY) ❑ Check
■ Independent Expenditure (IE) (also covers an
■ Check
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 8 / 24 / 18 To 8 / 31 / 18 Report Type: G1
Election Report
✓ Original ❑ Amendment ■ Special
(6) Contributions This Report
Cash & Checks $ , , 350. 00
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , 50 . 59
Loans $
to
$ .
Total Monetary $ , , 350. 00
$ ,
In-Kind $ , , 111. 17
(8)
Other Distributions
$ , , •
(9) TOTAL Monetary Contributions To Date
$ , 1 , 350 . 00
(10)
TOTAL Monetary Expenditures To Date
$ , , 50 . 59
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify a public record (ss. 839.13, F.S.)
and complete:
(Type name) Elizabeth Rawlins
■ Individual (only for IE 17 Treasurer 0 Deputy Treasurer
0 Candidate EJ Chairperson (only for PC and PTY)
X %
or electio i - 4 comm.)
X dr,
Signature
Sigrfature
DS -DE 12 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(1) Name (2) I.D. Number
(3) Cover Period
8 / 24 / 18 18
through 8 / 31 / (4) Page
1
of
1
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
Doug Kelly
8
29
18
PO Box 5751
/
/
Clearwater, FL 33758
1
I
CAS
50.00
Kelly Kelly
829
/
/
18
PO Box 5751
Clearwater, FL 33758
2
I
CAS
50.00
John Doran Tr.
829
/
/
18
65 Verbena St.
Clearwater Beach, FL
3
33767
I
Attorney
CHS
100.00
Beth Rawlins Inc
8
30
18
2845 Chelsea Place S
/
/
Clearwater, FL 33759
4
B
Consulting
INK
Website
111.17
Donna Dennis
831
18
223 Island Way,#4B
/
/
Clearwater, FL 33767
5
I
CHB
50.00
Steve Curtis
8
31
18
709 Bruce Ave.
/
/
Clearwater, FL 33767
6
I
Retired
CHB
100.00
/
/
DS -DE 13 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater
(3) Cover Period 8 / 24 / 18 through
8 / 31 / 18
(2) I.D. Number
(4) Page 1 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
(1 0)
Amendment
(1 1)
Amount
(8)
Sequence
Number
8
/
28/
18
Harland Clarke
15955 La Cantera Pkwy
San Antonio, TX 78256
Checks
MON
50.59
1
/
/
/
/
/
/
/
/
/
/
/
/
/
/
DS -DE 14 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT
(1) No Boss Mayor Clearwater
SUMMARY
pFF10EUSE ONLY
t
Name
(2) PO Box 16552
Address (number and street)
Clearwater, FL 33766
City, State, Zip Code
❑ Check here if address has
(4) Check appropriate box(es):
❑ Candidate Office Sought:
changed (3)
ID Number:
✓ Political Committee (PC)
here if PC or ECO has disbanded
here if PTY has disbanded
here if no other IE or EC reports will be filed
❑ Electioneering Communications
❑ Party Executive Committee
❑ Independent Expenditure (IE)
individual making electioneering
Org. (ECO)
• Check
(PTY) ❑ Check
(also covers an
1 Check
communications)
(5) Report Identifiers
Cover Period: From 8 1 11 1 18 To 8 / 23 18 Report Type: P7
Election Report
✓ Original ❑ Amendment • Special
(6) Contributions This Report
Cash & Checks $ , , •
(7) Expenditures
Monetary
Expenditures
Transfers
Office Account
Total Monetary
This Report
$ , , .
Loans $ , 1 , 000. 00
to
$ , , •
Total Monetary $ , 1 , 000. 00
$ ,
In-Kind $ , , 46. 00
(8)
Other Distributions
$ , , .
(9) TOTAL Monetary Contributions To Date
$ , 1 , 000 . 00
(10)
TOTAL Monetary Expenditures To Date
$ , 0 . 00
(11) Certification
It is a first degree misdemeanor for any person
I certify that I have examined this report and it is true, correct,
(Type name) Danielle Dahlberg
to falsify
and complete:
(Type
a public record (ss. 839.13, F.S.)
name) Elizabeth Rawlins
0 Candidate
X
■ Individual (only for IE GI Treasurer t Deputy Treasurer
El Chairperson (only for PC and PTY)
or ele comm.)
X id(Y-14-tee
..)..d-tie-VZ.Xre):-/-
Signature
Sigrre
DS -DE 12 (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS
(1) Name
CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS
No Boss Mayor Clearwater
(3) Cover Period 8 /
11 / 18 8
through /
(2) I.D. Number
23 18
1
(4) Page of
1
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In-kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
8
/
21
/
18
11
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
0
Consulting
LOA
1000.00
1
8
/
21
/
18
Beth Rawlins Inc
2845 Chelsea Place S
Clearwater, FL 33759
B
Consulting
INK
PO Box
46.00
2
/
/
/
/
/
/
/
/
/
/
DS -DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name No Boss Mayor Clearwater (2) I.D. Number
(3) Cover Period 8 / 11 / 18 through
8 / 23 / 18
(4) Page 1 of 1
(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
/
/
/
1
/
/
1
/
/
/
/
1
/
/
1
DS -DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
STATEMENT OF ORGANIZATION
OF POLITICAL COMMITTEE
(PLEASE TYPE)
OFFICE USE ONLY
1. Full Name of Committee
//a muss o r aVzi2C�7�I'
Telephone
7a 7
797-9333
Mailing Address (include cit , state and zip code)
/: a. 6 e issez
a?waii-- ,G 337 , - 65-5;2
Street Address (include city, state and zip code)
a8 y5. Ghe,/. a ,P/a.c�
( .1e/AG e,i'' /L- 33 759
2. Affiliated or Connected Organizations (includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization
Mailing Address
Relationship
/Va.,
3. Area, Scope and ^Jurisdiction of the Committee
(t to �%/.��(274, r/o/ / O -
/
4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.)
/ ,k1-/ :e1 6,,m2/// / aqaIIS7L G//?Qa. kr/n D7��� 0Vern/WO
5. Identify by Name, Address and Positio4S, the Custodian of Boots and Accounts (include tfeasurer's name)
Full Name
Mailing Address
Committee Title or Position
,-N ina eef/ Jia.ctilln.s
/J4r/.e/% 0c-ilbe7
o?, y,5 G!e/.€a. /2/act .S
G/,ea, Wa-f,Gr FL 33 759
"aoy i /0/o ehaat Vr
/Q/11Pa./ 'c4- 333,5"
c aid-,
j�..easur�,er
/290tf 7;:ea surer
y
DS -DE 5 (Rev. 06/11) - Rule 1S-2.017
(continued on reverse side)
6. List by Name, Address and Position, Other Principal Officers, Including Officers and Members of the
Finance Committee, If Any (include chairman's name)
Full Name
Mailing Address
Committee Title or Position
n/a
7. List by Name, Address, Office Sought and Party Affiliation Each Candidate or Other Individual that this
Committee is Supporting (if none, please indicate)
Full Name
Mailing Address
Office Sought
Party
8. List Any Issues this Committee is Supporting: Nevi e �l / /�, G
List Any Issues this Committee is Opposing: --enq /7 is yd7- i4 GIe `-To 742 r- "k7 aP
pp VIOu.grivneil7L
9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party
/7/-
10. In the Event of Dissolution,ion,What Disposition will be Made of Residual Funds?
Pr, n d3 0 / C.-_,,r€r ,L 6r el y
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository & Account Number
Mailing Address
al.zls /1V169
.2,572 i1/. 4-1W n ,&x /eel
i-i6w .er; / 337 /
12. List all Reports Required to be Filed by this Committee with Federal Officials and the Names, Addresses
and Positions of Such Officials, If Any
Report Title
Dates Required to be Filed
Name & Position of Official
Mailing Address
/=orm 897h
r- 6. 990 or / i'' Z
asrnepeh
a..S re Lr�
�i
_---z-,/e...5
D� del-; Mr
X020/
STATE OF //p 77 .07,4_, /7/ %%e-//GLS COUNTY
I, ,2� Za 6tT/ /7a_ll)/i./'1.S , certify that the information in this Statement of
Organization is complete, true and correct.
X/j//XiL4 r //�a/9
G 4 I
Signature of Chairman of Political Committee Date
DS -DE 5 (Rev. 06/11) - Rule 1S-2.017
page 2
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR
POLITICAL COMMITTEES
(Sections 106.011(1) and 106.021(1), F.S.)
CHECK APPROPRIATE BOX:
OFFICE USE ONLY
Original Appointment of Treasurer
,
Reappointment of Treasurer ❑ Deputy Treasurer
1. Committee or Organization
ND IYO,iS A1'. ekart,
2. Telephone
(7 7) 7 9 7 - 93,33
3. Name of Treasurer or Deputy Trea6urer 4. Email (optional)
19/1//e14 /)a. /her
5. Telephone (optional)
( )
6. Mailing Address U
, fox /7502 ('/earyva FL- 33 76'—4S-"o7
7. Street Address
9D 2 9 cAe/a/on eAa /Or i2mpa. FL. 3J35
8. The following bank has been designated as the
gi
Primary Depository ❑ Secondary Depository
9. Name of Bank
VIA Ca4ge
10. Street Address
02a4 /V /�c/%%%Gf °11�J,'Da7�i /e I
11. City
d'eni}4.12I.
12. State
f
13. Zip Code
33710/
14. Signature of Chairman
Xi��.af.
15. Name of Chairman (Print or Type)
F/ ZetZ e � /2/v//> u
Camnaian Treasurer's Acceptance of Aonointment
I, /34 ? /;eik Da_d //J / 6tr , do hereby accept the appointment as
(Please Print 9'type)
treasurer or deputy treasurer for No /v,_5_5' ,) pr e'7 J%w a .
(Com ttee or Organization)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE
c2a/ eX h
41/Zo 74 o
CAMPAIGN
TRUE.
TREASURER'S
,
Date Signature of Campaign Treasurer or Deputy Tre rer
DS -DE 6 (key. 7/10)
REGISTERED AGENT
STATEMENT OF APPOINTMENT
(Section 106.022, F.S.)
OFFICE USE ONLY
viOriginal Appointment ❑ Change of Appointment
Address
111 Change of Mailing Address ❑ Change of Physical
Registered Agent and Office Information
Name E/ i Za-6&Mi %?CLLt)/I �{'� ,S
T lephon
707 77 97_v3,33
Street Address
a8V-5-- G/e/s.,a. )7/ace- S.
CityState
C_/irGr1de r
�L
Zip Code
33759'
Mailing Address
/7D dox /o%5-3-,?
City
(Wed raaO ,e r.
State
PL
Zip Code
.337_ -Ss�
I accept this appointment and confirm that I am familiar with and accept the ob igations of the position as set
forth in Section 106.022, F.S. I also understand that I may resign this appointment by executing a written
statement of resignation and filing it with the applicable filing officer.
,./.•1/4 S'/a-7.d g 1. oD74 �D18
ature of Registered Agent Date
Former Registered Agent and Office Information (for changes only)
Name
Telephone
Street Address
City
State
Zip Code
Committee or Organization Information
Name of Committee or Organization
/V gD,.S /%%Dr Cyd 2i -thr
Street Address
P/a c-e S
7) 797-9333
?Ilh on,?6Wc/s��
City,State
Ceariv 74) -
PL..
Zip Code
33759
/ ' f
07D, at70/d'
_./ate"-S-
S -:nature of Chairperson
/z426e-ROW // n ,.sgz
Printed Name of Chairperson Date(
Form DS -DE 41 (revised 6111)
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR
POLITICAL COMMITTEES
(Sections 106.011(1) and 106.021(1), F.S.)
CHECK APPROPRIATE BOX:
OFFICE USE ONLY
❑ Original Appointment of Treasurer ❑ Reappointment of Treasurer l Deputy Treasurer
1. Committee or Organization
/a /3Ocss /i% 6ded4a)2i'c��''
2. Telephone
(7027) 797-93,3,3
3. Name of Treasurer or Deputy treasurer 4. Email (optional)
E/ za 4e Raw/,i-
5. Telephone (optional)
6.Mailing Address
P/3ax /,SS�7�'/earzva �r F/ 3,3764— .c5:5",:2
7. Street Address
a7 NS- eAt ea- F/ae6 J. /wthK L 33759
8. The following bank has been designated as the 1 Primary Depository
I.
Secondary Depository
9. Name of Bank
t)i`/s Fay o
10. Street Address
,25-,25-1,0�/V 1 9ti/�/- ,ee4le!
11. City
(,/& wayur
12. State
fz_.
13. Zip Code
3376 /
14. Signature of Chairma
X 0/��i/
15. Name of Chairman (Print or Type) /
�Ci// G: t/ 6e /?t l / nL
Camoaian Treasurer's Acceptance of Appointment
I, Z. // Z 1 /?al.1)/Yl Li , do hereby accept the appointment as
(Please Print or T pe)
treasurer or deputy treasurer for d i(/off A� Qr eze,}a,/ey-- •
Y �
/
(Cornmittee or Organization)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
eX.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 6 (Rev. 7/10)