CAMPAIGN TREASURER' S REPORT SUMMARY

Transcription

1 CAMPAIGN TREASURER' S REPORT SUMMARY ) RCELY Name 2) 27 PALM ISLAND NW Address (number and street) FEL. ' Ole OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEPT. Check here if address has changed ( 3) ID : 4) Check appropriate box(es): v Candidate Office Sought: CLEARWATER CITY COUNCIL, SEAT 4 Political Committee ( PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) 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 Report Identifiers Cover Period: From / 26 / 8 To 2 / 08 / 8 Report : G3 v Original Special Election Report s This Report Cash & Checks $, 3, Expenditures This Report Monetary Expenditures $,, Loans $,, 00 Total Monetary $, 3, In -Kind $,, Transfers to Office Account $,,. 00 Total Monetary $,, Other Distributions 00 TOTAL Monetary s To 30, ) TOTAL Monetary Expenditures To It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, name) JAY POLGLAZE ) Certification to falsify a public record (ss , F.S.) and complete: name) Individual ( only for IE, Tre=sur- r Deputy Treasurer or electioneering comm.)/ 0 Candidate Chairperson ( only for PC and PTY) X X %' Si. nat e Signature ut iz (rcev. i SEE REVERSE FOR INSTRUCTIONS

2 CAMPAIGN TREASURER' S REPORT - ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through ) Page of ROBERT JOANNE MCINTYRE 720 STARKEY RD LARGO, FL ) In- kind ) 2) Occupation Description I CEO CHE WILLIAM FRANCES WALLACE 606 TURNER ST. I CHE JUDY, JEFFREY MITCHELL 508 BEACH DR NE ST. PETEERSBURG, FL 3370 I BANKING CHE ED & TARA ARMSTRONG 64 SANTA BARBARA DR. DUNEDIN, FL34698 I ATTORNEY CHE KEN MARKS PO BOX 2336 CLEARWATER, FL I AUTO SALES CHE JAY & LINDA POLGLAZE 522 RICHARDS AVE CLEARWATER, FL I EXECUTIVE CHE DANIEL SHOUVLIN 425 BUTTONWOOD LN LARGO, FL I RESTAURANT CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

3 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period through / / 4) Page 2 of 3 0) ) 2) BRUCE RECTOR Occupation In- kind Description WOOD THRUSH WAY PALM HARBOR, FL I CHE FRANK & LYNN DAME LEEWARD IS I C. O. O CMA CHE JOHN & JANICE DRAHEIM WINDWARD IS I CHE STEPHEN GERLACH INC REDINGTON DR. REDINGTON BEACH, FL B CHE DOUGLAS MANUFACTURING CLEVELAND ST CLEARWATER, FL B SALES CHE JOHN, STEPHANIE DORAN TR 65 VERBANA ST I CHE WILLIAM JACOBSEN 600 PACARD CT. SAFETY HARBOR, FL I HOME BLDR CHE DS DS - - DE DE!! 33 ( ( Rev. Rev. SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

4 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period / 26 / 8 through ) Page 3 of 3 0) ) 2) In- kind Occupation Description MICHAEL ANDERSON ISLAND WAY 8G I ONLINE STEPHAN MCCELLAND 5 AURORA AVE CLEARWATER, FL I CAS CONNOLLY & JAMES MCAURTHER 504 PARK AVE BELLEAIR, FL I CAS CHARLES & LOUISE ROBINSON 65 N. PINE CIRCLE BELLEAIR, FL I ATTORNEY CHE RUMBA' S GRILL 800 GULF TO BAY BLVD B RESTAURANT INK FUNDRAISER A SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ul ul J J ( ( Kev. Kev. SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

5 CAMPAIGN TREASURER' S REPORT ITEMIZED EXPENDITURES ) Name ( 2) I. D. 3) Cover Period / 26 / 8 through 2 / 08 8 ( 4) Page of 0) ) Purpose add office sought if contribution to a candidate) Expenditure 2 6 / 8 LUBRNO CREATIVE CONSULTING 920 JACKSON CT. PALM HARBOR, FL CAN ANEDOT, INC. P. O. BOX 8434 BATON ROUGE, LA70884 CAN DS DS - - DE DE 4 4 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

6 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 27 PALM ISLAND N.W. Address (number and street) Check here if address has changed 3) R JAN LY OFFICIAL RECORDS AND LEGISLATNE SRVCS DEPT. ID : 4) Check appropriate box(es): v Candidate Office Sought: CLEARWATER CITY COUNCIL, SEAT 4 Political Committee (PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) 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 Report Identifiers Cover Period: From / 2 / 8 To / 24 / 8 Report : G- 2 Original Special Election Report s This Report Expenditures This Report Cash & Checks $, 3, Monetary Expenditures 2, Loans $, 00 Transfers to Office Account Total Monetary $, 3, Total Monetary In -Kind $,,. 00 Other Distributions 00 2, TOTAL Monetary s To 26, ) TOTAL Monetary Expenditures To 7, ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F. S.) I certify that I have examined this report and it is true, correct, and complete: JAY POLGLAZE name) name) Individual ( only for IE li Treasu er Deputy TreasurerCandidate Chairperson ( only for PC and PTY) or electioneering comm.) X :_% / ARO /,.. X nat e Signature DS -DE 2 (Rf. / 3) SEE REVERSE FOR INSTRUCTIONS

7 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) DAVID Name ALLBRITTON ( 2) I. D. 3) Cover Period / 2 8 through / 24 / 8 4) Page of 0) ) Purpose add office sought if contribution to a candidate) Expenditure JIFFY REPROGRAPHICS f 6/ 8 4 S. GARDEN AVE CAN JIFFY REPROGRAPHICS 4 S. GARDEN AVE CAN JIFFY REPROGRAPHICS S. GARDEN AVE CAN B - HIVE AWARDS N. HERCLES AVE CLEARWATER, FL CAN DIRECT MAIL SYSTEMS AUTOMOBILE BLVD CLEARWATER, FL CAN 8, DIRECT MAIL SYSTEMS AUTOMOBILE BLVD CLEARWATER, FL CAN 3, ANEDOT 8 8 P. O. BOX 8434 BATON ROUGE, LA CAN DS DS - - DE DE 4 4 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

8 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / 4) Page of 2 0) ) 2) CLEARPAC Occupation In- kind Description CLEVELAND ST CLEARWATER, FL F PAC CHE, GEORGE' S VACUUM SALES S. FT. HARRISON B SALES CHE JANICE CASE PALM ISLAND N. W. I CONSULTANT CHE TIGHE QUIGLEY 2 8 P. O. BOX 666 CLEARWATER, FL I SOFTWARE CHE, ROBERT METZ MAPLE FORREST DR. CLEARWATER, FL I REAL ESTAT CHE JOE BLANTON WINDGAP DR. CLEARWATER, FL I ONLINE LYNNE FAIMALIE S. PAULA DR. # 2 DUNEDIN, FL I ONLINE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

9 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period through / / ( 4) Page of 2 0) ) 2) In- kind 2 8 ALAN STOWELL 2873 THORNTON RD. CLEARWATER, FL Occupation Description I RETIRED CHE DS -DE 3 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

10 cj CAMPAIGN TREASURER' S REPORT SUMMARY ) 2) Name 27 PALM ISLAND N. W. OFFICE USE ONLY Pr. ' A,. Address (number and street) Check here if address has changed 3) OFF( 4 _- ;:.._ ;" > ID : T+': MS L- AND T. 4) Check appropriate box(es): CLEARWATER v Candidate Office Sought: Political Committee ( PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure (IE) ( also covers an individual making electioneering communications) CITY COUNCIL, SEAT 4 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 Cover Period: From / 0 / 8 To Report Identifiers / / 8 Report : G gi Original Special Election Report s This Report Expenditures This Report Cash & Checks $ Monetary Expenditures 00 Loans $,, Total Monetary $ In -Kind $ Transfers to Office Account Total Monetary Other Distributions 00 TOTAL Monetary s To ) TOTAL Monetary Expenditures To ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F.S.) I certify that I have examined this report and it is true, correct, JAY POLGLAZE name) and complete: name) Individual ( ss'` only for IE or electioneering comm. r- - urer Deputy Treasurer 0 Candidate Chairperson ( only for PC and PTY) X took f/ X Signa r Signature DS -DE 2 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS

11 CAMPAIGN TREASURER' S REPORT - ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through 4) Page of MICHAEL J. ANDRIOLA 8 3 AMBLESIDE DRIVE BELLEAIR, FL ) In- kind ) Occupation Description 2) I CHE BRIAN AUNGST JR MIDNIGHT PASS WAY CLEARWATER, FL I ATTORNEY C$ E PINELLAS REALTORS 8 ASSOCIATION 4590 ULMERTON RD. CLEARWATER, FL B TRADE ASSOC. CHE INFI SYSTEMS, LLC CLEVELAND ST. CLEARWATER, FL B SOFTWARE CO. CHE OLGA & DEVCHAND 8 KUMBHANI 447 AMBERLY OAKS CT TAMPA, FL I CORP. DIR. CHE VENKAT DEVINENI 8 A RICHLAND LN # T CAMP HILL, PA 70 6 I PRES. INFI CHE LEELA SANYESA RAO DADI WRANGLE HILL RD. 224 BEAR, DE I PROGRAMMER CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

12 ) Name 2) 27 PALM ISLAND N. W. Address (number and street) CAMPAIGN TREASURER' S REPORT SUMMARY Check here if address has changed 4) Check appropriate box( es): O Candidate Office Sought: Political Committee ( PC) El Electioneering Communications Org. ( ECO) El Party Executive Committee ( PTY) Independent Expenditure ( E) ( also covers an individual making electioneering communications) OF OFF'' LEGS [A 3) ID : Ip4Sc 9g CLEARWATER CITY COUNCIL, SEAT 4 Check here if PC or ECO has disbanded Check here if PTY has disbanded s g r L S AND Check here if no other IE or EC reports will be filed Report Identifiers Cover Period: From 2 / 0 / 7 To 2 / 3 / 7 Report : M 2 0 Original Special Election Report s This Report Cash & Checks $, Expenditures This Report Monetary Expenditures $, 2, Loans $. 00 Total Monetary $, In -Kind $. 00 Transfers to Office Account $. 0 Total Monetary $, 2, Other Distributions 00 TOTAL Monetary s To 7, 097, 00 0) TOTAL Monetary Expenditures To 5, ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F. S.) I certify that I have examined this report and it is true, correct, and complete: name) Individual (only for IE or electioneering comm. JAY POLGLAZE f asurer 0 Deputy Treasurer name) 0 Candidate X Signature 0 Chairperson ( only for PC and PTY) SEE REVERSE FOR INSTRUCTIONS

13 ) Name 3) Cover Period CAMPAIGN TREASURER' S REPORT ITEMIZED EXPENDITURES 2 / 0 / 7 through 2 3 / 7 2) I. D. 4) Page of Purpose add office sought if contribution to a candidate) Expenditure 0) 2 / 04/ 7 CITY OF CLEARWATER 2 S. Osceola Ave. FILING FEE CAN / 08/ 7 PROFORMA INC. P. O. BOX PRINTING CINCINATTI, OH CAN / 08/ 7 DVC MARKETING 4 S. GARDEN AVE PRINTING CAN LUBRANO CREATIVE CONSULTING 26 BAY HARBOR DR. PALM HARBOR, FL SOCIAL MEDIA SERVICES CAN / 0/ 7 HOME DEPOT 2495 GULF TO BAY CLEARWATER, FL FLAGS CAN / 2 7 WALGREENS 703 COURT ST. PHOTOS CAN / 9/ 7 USPS PO 6670 CLEARWATER, FL STAMPS CAN DS -DE 4 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

14 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of 0) ) 2) PRESSMAN & ASSOC. Occupation In- kind Description EAST LAKE ROAD PALM HARBOR, FL B CONSULTANT CHE DAVID & KATHRYN YATES 40 GRANDCHAMP CIR. PALM HARBOR, FL I CEO CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

15 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name o ` "` r. irer5 2) 27 PALM ISLAND N. W. Address ( number and street) Check here if address has changed 3) DE 27 OFFICIAL_,,=` L,iI)S AND LEGISLAII' VE SWCS DEPT. ID : 4) Check appropriate box(es): v Candidate Office Sought: CLEARWATER CITY COUNCIL, SEAT 4 Political Committee ( PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure (IE) ( also covers an individual making electioneering communications) 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 Report Identifiers Cover Period: From / 0 / 207 To / 3 / 207 Report : M v Original Special Election Report s This Report Expenditures This Report Cash & Checks $, 3, Monetary Expenditures, Loans $,,. 00 Transfers to Office Account 00 Total Monetary $, 3, In -Kind $,,. 00 Total Monetary Other Distributions, TOTAL Monetary s To 6, ) TOTAL Monetary Expenditures To 3, 76, 48 ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F. S.) I certify that I have examined this report and it is true, correct, and complete: name) JAY POLG E name) Individual ( only for IE 0 T easurer 2 : uty Treasurer el Candidate Chairperson ( only for PC and PTY) or electi.' - eying comm.) X t/ X nature Signature DS -DE 2 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS

16 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period / 0 / 7 through 3 7 4) Page of 3 0) ) 2) In- kind ANGEL DELGATTO Occupation Description CAMBRIA ST # 303 I WILLIAM & BETTE CROWN 7 7 III 29 FRANKLIN CIRCLE I JOHN & JANICE DRAHEIM WINDWARD ISLAND I FRANK & TERESA HIBBARD DRUID RD. I FINANCIAL CHARLES CASTAGNA 5 7 MEDIATION, INC. 6 DRUID RD. # 52 B HARRY & SANDRA JAMIESON JASMINE WAY I RETIRED FRANK & LYNN DAME LEEWARD IS I CEO DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES VALUES

17 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period / 0 / through / / ( 4) Page of 0) ) 2) PATRICK CAREY Occupation In- kind Description SNUG IS 8 I JOHN & JANET MORTIMER CLEVELAND ST # 805 CLEARWATER, FL I RODNEY FISCHER U. S. HWY 9 N CLEARWATER, FL 3376 I DEBRA GREGORY SNUG IS I GYNETH STANLEY DRUID RD W I ATTORNEY PRESSMAN & ASSOCIATES EAST LAKE RD # 02 PALM HARBOR, FL B CONSULTANT YATES DAVID & KATHRYN JONES 40 GRANDCHAMP CIRCLE PALM HARBOR, FL I CEO DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS INSTRUCTIONS AND CODE VALUES

18 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period / 0 / 7 through / 3 / 7 4) Page of 3 3 0) ) 2) In- kind 09 7 DAVID WILCOX 3 Hyacinth Ln Occupation Description FAIRPORT, NY I INVESTOR GRANT WOOD 2807 WESTCHESTER DR. CLEARWATER, FL 3376 N I CONSULTANT PATRICIA JUCHA 763 HARBOR ISLAND I DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

19 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name 2) I. D. 3) Cover Period / 0 / 7 through / 3/ 7 ( 4) Page of 0) ) Purpose add office sought if contribution to a candidate) Expenditure COUNTRYSIDE COUNTRY CLUB / 5/ COUNTRYSIDE BLVD CLEARWATER, FL 3376 CAN THE HOME DEPOT CLEARWATER, FL CAN BOB COLMER TUSCANY TRACE # 724 PALM HARBOR, FL CAN ANEDOT 22 7 PO. BOX 8434 BATON ROUGE, LA CAN DS -DE 4 (Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

20 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 27 PALM IS N. W. Address (number and street) Check here if address has changed 3) ofr ID : NOYQ II rb OFFICIAL RECORDS AND LEGISLATIVE SRVCS DCrT. 4) Check appropriate box(es): Candidate Office Sought: Political Committee ( PC) CLEARWATER Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) CITY COUNCIL, SEAT 4 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 Report Identifiers Cover Period: From 0 / To 0 / Report : M- 0 Original Special Election Report s This Report Expenditures This Report Cash & Checks $, 0, Monetary Expenditures, Loans $. 00 Transfers to Office Account Total 0, Monetary $, Total Monetary In -Kind $,, Other Distributions 00, TOTAL Monetary s To 3, ) TOTAL Monetary Expenditures To, ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F. S.) I certify that I have examined this report and it is true, correct, name) JAY POLGLAZE and complete: name) Individual ( only for IE ^. Treasurer 0 Deputy Treasurer or electioneering comm.) D Candidate 0 Chairperson ( only for PC and PTY) gnatur / DS -DE 2 ( Rev( / 3) Signature SEE REVERSE FOR INSTRUCTIONS

21 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name ( 2) I. D. 3) Cover Period 0 / 0 / 207 through 0 / 3 / 207 ( 4) Page of 0) Purpose add office sought if contribution to a candidate) Expenditure USPS 0 3/ CLEVELnd st clearwater, fl CAN / 7 Elizabeth Pierce 325 San Blass Loop Largo, F CAN JIFFY REPROGRAPHICS S. GARDEN AVE CAN COUNTRYSIDE COUNTRY CLUB COUNTRYSIDE BLVD CLEARWATER, FL 3376 CAN ANEDOT 0 4/ 7 PO Box 8434 Baton Rouge, LA CAN OFFICE DEPOT CLEARWATER, FL CAN JIFFY REPROGRAPHICS S. GARDEN AVE CAN VISTA PRINT 275 Wyman St 0 05/ 7 Waltham, MA 0245 CAN DS DS - - DE DE 4 4 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

22 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name ( 2) I. D. 3) Cover Period 0 / 0 / 207 through 0 / 3 / 207 4) Page of 70) ) Purpose add office sought if contribution to a candidate) Expenditure 0 3/ 7 USPS 650 CLEVELnd st clearwater, fl CAN / 7 Elizabeth Pierce 325 San Blass Loop Largo, F CAN JIFFY REPROGRAPHICS 4 S. GARDEN AVE CAN COUNTRYSIDE COUNTRY CLUB 300 COUNTRYSIDE BLVD CLEARWATER, FL 3376 CAN / 7 ANEDOT PO Box 8434 Baton Rouge, LA CAN DS DS - - DE DE 4 4 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

23 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of 8 0) ) 2) In- kind Occupation Description WAYNE SHELOR 303 COUNTRYSIDE BLVD CLEARWATER, FL 3376 I RETIRED CHE ST FLORIDA MANAGEMENT DRUID RD. E. 2 B REAL ESTATE CHE ALAN BOMSTEIN DREW ST. CLEARWATER, FL I CONTRACTOR CHE ANDREW CAUDELL WOODCREST AVE I CONTRACTOR CHE BECCA KAYE I CA BRIAN AUNGST, SR BRATTLE LN CLEARWATER, FL 3376 I RETIRED CHE BRIAN YATZKAN P. O. BOX 287 GLEN ELLYN, IL 6038 I REAL ESTATE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS INSTRUCTIONS AND CODE CODE VALUES

24 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. 3) Cover Period / through / / ( 4) Page of 8 BRUCE & HEATHER BROCK WINDWARD PASSAGE 0) In- kind ) Occupation Description 2) I RETIRED CHE C. G. ELIAS & CO ENTERPRISE RD. CLEARWATER, FL 3376 B INSURANCE CHE CARDINAL DOOR & HARDWARE TH AVE N B SALES CHE CHARLES ROBINSON N. PINE CIRCLE BELLEAIR, FL I ATTORNEY CHE CLEARWATER FERRY SERVICE 65 PINELLAS ST.# 2 B FERRY CHE CONSUS GROUP, LLC P. O. BOX 4268 CLEARWATER, FL B CONSULTING CHE DAVID JELASO ROGERS ST. UNIT A I CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

25 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of DAVID LLOYD 70 BRENTWOOD DR. 0) In- kind ) Occupation Description 2) I CHE DEAN ANDRESON 2046 BRENDLA RD. CLEARWATER, FL I CHE DENIS DEVLAMING 0 TURNER ST. CLERWATER, FL I ATTORNEY CHE DONALD EWING 660 ISLAND WAY # 708 I CHE EARLE COOPER 697 MIDNIGHT PASS WY CLEARWATER, FL I CONSTRUCTIO CHE EDGAR & DELLA DAY 430 WINDWARD PASSAGE I CHE FRANK & LYNN DAME 407 LEEWARD IS I CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

26 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) LD. 3) Cover Period 0 / through / 02 / 207 ( 4 8 4) Page of GEORGE MANTZARIS CASLER WAY CLEARWATER, FL ) In- kind ) Occupation Description 2) I AUTO SALES CHE GRANT & KATHY TRIER ISLAND WAY I CHE GULF COAST CONSULTING, INC 3825 ICOT BLVD, STE 605 B CONSULTING CHE CLEARWATER, FL JAMES MARTIN P. O. BOX 392 I CHE JOHN DORAN P. O. BOX 3266 I CHE JOHN DRAHEIM WINDWARD IS. I CHE KATHRYN TEW PALM IS N. E. I RENTAL CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

27 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page 5 of 8 0) ) 2) KEN & ANN DAYTON SARASOTA RD Occupation In- kind Description BELLEAIR, FL I CHE KEN MEYER BAY MEADOW CY CLEARWATER, FL 3376 I CHE PRESSMAN & ASSOC EAST LAKE RD. # 02 PALM HARBOR, FL B CONSULTANT CHE PROFORMA N & M COMM HAZEN AVE. 434 BELLEVUE, KY 4073 B MARKETING CHE RICHARD & CINDY OWENS MIDWAY IS. I CHE ROBERT BAUER, JR S. HIGHLAND, STE C I CHE ROBERT METZ MAPLE FOREST DR. CLEARWATER, FL I REALTOR CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

28 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of 8 0) ) 2) SAM MCCLELLAND N. HIGHLAND AVE Occupation In- kind Description CLEARWATER, FL CHE THOMAS BOWERS VICTORIA DR. DUNEDIN, FL I RETIRED CHE TOMMY DUFF ISLAND WAY # 705 I CHE THOMAS MICHAELS OAK CREEK DR. CLEARWATER, FL 3376 I ATTORNEY CHE WILLIAM STURTEVANT ' P. O. BOX 472 I CONSULTANT CHE MATTHEW CRUM SCARLET OAKS DR. CLEARWATER, FL I INSURANCE CHE WILLIAM HANCOCK PINE ROAD I INSURANCE ONLINE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

29 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of 0) ) 2) ROSEMARY WINDSOR TRUST POINSETTA RD Occupation In- kind Description BELLEAIR, FL I DIR. TROLLEY CHE GERTRUDE & DAVID LITTLE CASEY JONES CT. CLEARWATER, FL I CHE TRT Management, LLC P O. BOX 743 CLEARWATER, FL B PROP MGMT CHE A CORNU LARBOARD WAY I CHE BRIAN AUNGST, JR ' 683 MIDNIGHT PASS WAY CLEARWATER, FL I ATTORNEY CHE RAY FERRARA Druid Rd, ste. 05 I CHE ALEXANDRA OF CLW BEACH P. O. BOX 3337 B CONCESSIONS CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

30 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D ) Cover Period / / through / / ( 4) Page of 8 0) ) 2) In- kind Occupation Description BAREFOOT BEACH HOUSE S. GULFVIEW BLVD. B PROP. MGMT CHE KEN & LISA HAMILTON 200 PALM IS NW I REST. OWNER CHE ROBERT & TERESSA CLARK 320 ISLAND WAY # 603 I CHE ISLAND WAY GRILL 20 ISLAND WAY B RESTAURANT INK DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

31 ) David Allbritton Name 2) 27 Palm Is N. W. Address (number and street) Clearwater, FL CAMPAIGN TREASURER'S REPORT SUMMARY LJ Check here if address has changed 4) Check appropriate box(es): 5 Candidate Office Sought: O Political Committee ( PC) O Electioneering Communications Org. ( ECO) 0 Party Executive Committee ( PTY) O Independent Expenditure ( IE) ( also covers an individual making electioneering communications) OFFICE USE ONLY Of') 207 3) ID NUIMb r\ /4 Kiii"4-'): Clearwater City Council, Seat 4 O Check here if PC or ECO has disbanded 0 Check here if PTY has disbanded O Check here if no other IE or EC reports will be filed Report Identifiers Cover Period: From 09 / 8 / 207 To 09 / 30 / 207 Report : M9 pi Original 0 0 Special Election Report s This Report Cash & Checks 2, Expenditures This Report Monetary Expenditures $, Loans Total Monetary In- Kind , Transfers to Office Account $, 0. Total Monetary $ Other Distributions 0 TOTAL Monetary s To 2, 907, 00 0) TOTAL Monetary Expenditures To 207, 00 ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F.S.) I certify that I have examined this report and it is true, correct, and complete: name) Jay Polglaze ( name) David Allbritton 0 Individual (only for IE or electioneering comm.) rer 0 Deputy Treasurer Candidate 0 Chairperson ( only for PC a TY) X ignatur DS- DE 2 (. / 3) X Signature SEE REVERSE FOR INSTRUCTIONS

32 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name David Allbritton 2) I. D ) Cover Period / / through / / ( 4) Page of 0) ) 2) In -kind Southern Cross Building Solutions, Occupation Description Inc Camelia PL B mechanical CHE Largo, FL 3377 Marshall Brett Harris Camelia PL Largo, FL I CEO, Preside CHE David Allbritton Palm IS N. W. Clearwater, FL S LOA Brian Yatzkan P. O. BOx 287 Glen Ellen, IL CHE Robert & Shirley Galatas 732 Brentwood Dr. 5 Clearwater, FL I CHE Alan Stowell Thornton RD Clearwater, FL I Retired CHE DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

33 ) Name David Allbritton CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES 2) I. D. 3) Cover Period 09 / through 09 / 30 / 207 4) Page of Purpose add office sought if contribution to a candidate) Expenditure 0) ) 09/ 8/ 207 GoDaddy 4455 N. Hayden Rd Scottsdale AZ CAN Florida Dept of State sunbiz. org CAN misc. office expense 09/ 8/ 207 CAN DS -DE 4 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

34 STATEMENT OF CANDIDATE Section , F.S.) Please print or type) OFFICE USE ONLY SEP9207 OFHCIA. ;,,,;: LEGISLAHE SkyC A.. LCi I, David Estes Allbritton candidate for the office of Clearwater City Council Seat 4 have been provided access to read and understand the requirements of Chapter 06, Florida Statutes. X Signature of Candidate 9/ 9/207 Appointment Each candidate of Campaign must file Treasurer a statement and with the qualifying officer within 0 days after the Designation of Campaign Depository is filed. Willful failure Financing to file Actthis which form is a first degree misdemeanor and a civil violation of the Campaign may result in a fine of up to $, 000, ( ss ( Statutes). )( c), ( ), Florida DS -DE 84 ( 05/ )

35 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES Section 06 02( ), F. ) PLEASE PRINT OR TYPE) RECEIVED: EP j 207 OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEP=T. NOTE: This form must be on file with the qualifying officer before opening the campaign account.. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re- Filing to Change: 2. Name of Candidate (in this order: First, Middle, Last) David Allbritton 4. Telephone 5. E -mail address 727 ) info@voteallbritton.com 6. Office sought (include district, circuit, group number) Clearwater City Council, Seat 4 8. If a candidate for a partisan office, check block and fill in 0 Write -In No Party Affiliation OFFICE USE ONLY Treasurer /Deputy Depository Office Party 3. Address (include post office box or street, city, state, zip code) 27 Palm Island N.W. Clearwater, FL If a candidate for a nonpartisan office, check if applicable: name of party as applicable: My intent is to run as a Write -In candidate. My intent is to run as a El Party candidate. 9. have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 0. Name of Treasurer or Deputy Treasurer David Allbritton. Mailing Address 27 Palm Island N.W. 3. City 4. County Clearwater Pinellas 8. I have designated the following bank as my 9. Name of Bank USAmeribank 2. City Clearwater 22. County Pinellas 2. Telephone 727 ) State 6. Zip Code 7. E- mal address Florida l I info@voteallbritton. com Primary Depository 20. Address 257 Countryside Blvd 23, State Florida Secondary Depository 24. Zip Code 3376 UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE / 8 / 207 designated above as: 26. Signet X andidate Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) David Allbritton 09 / 8 / 207 DS -DE 9 ( Rev. 0/ 0) Please Print or Name) El Campaign Treasurer X Signature Deputy Treasurer. do hereby accept the appointment mpaign Treasurer or Deputy Treasurer Rule S , F.A.C.

36 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES Section 06 02( ), F. ) PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account.. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re- filing to Change: 2. Name of Candidate (in this order: First, Middle, Last) David Allbritton 4. Telephone 5. E -mail address 727 ) info@voteallbritton.com 6. Office sought (include district, circuit, group number) Clearwater City Council, Seat 4 ED OFFICIAL RECORDS AND LEGISLATIVE SkVCS DEFT. ' OFFICE USE ONLY Treasurer / Deputy Depository Office Party 3. Address (include post office box or street, city, state, zip code) 27 Palm Island N.W. Clearwater, FL If a candidate for a nonpartisan office, check if applicable: My intent is to run as a Write-n candidate. Write -In 8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a No Party Affiliation 9. I have appointed the following person to act as my Campaign Treasurer a Party candidate. 0. Name of Treasurer or Deputy Treasurer Jay Polglaze. Mailing Address 600 Cleveland St, Ste 450, Clearwater, FL City Clearwater 4. County Pinellas 8. have designated the following bank as my 9. Name of Bank USAmeribank 2. City Clearwater 22. County Pinellas Deputy Treasurer 2. Telephone 727 ) State 6. Zip Code 7. E -ma.i address Florida, I jaypolglaze@gmail. com 0 Primary Depository [ J Secondary Depository I 20. Address 257 Countryside Blvd 23. State Florida 24. Zip Code I 3376 UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE designated above as' 09 / 8 / Signature of Candidate x Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) Jay Polglaze 09 / 8 / 207 Please Print or Name) Campaign Treasurer ( j Depyty Tre- - urer. do hereby accept the appointment DS- DE 9 ( Rev. 0/ 0) Sig '. ture. f Campaign Tr f surer Treasurer Rule S , F.A.C.