CAMPAIGN TREASURER' S REPORT SUMMARY. City Council. 5) Report Identifiers. 7) Expenditures. Monetary Expenditures. Office Account.

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1 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 006 Magnolia Dr. Address (number and street) Check here if address has changed 4) Check appropriate box(es): Candidate Office Sought: Clearwater Political Committee ( PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) 3) City Council OFFICE USE ONLY IDN ral; ' f( Seat 5 S DE 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 / / 208 To / / 208 Report : G Original Amendment Special Election Report Contributions This Report Expenditures This Report Cash & Checks $,, Monetary Expenditures Loans $,, Transfers to Office Account Total Monetary $,, Total Monetary In -Kind $,, Other Distributions TOTAL Monetary Contributions To 3, ) TOTAL Monetary Expenditures To 3, ) 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) and complete: name) Individual ( only for IE 0 Treasurer Deputy Treasurer 0 Candidate Chairperson ( only for PC and PTY) or electioneering comm. Signatur Sig ure I X DS -DE 2 ( 7ev. / 3) SEE REVERSE FOR INSTRUCTIONS

2 CAMPAIGN TREASURER' S REPORT SUMMARY ) c tl PP,ISY Name 2) 006 Magnolia Dr. Address (number and street) Check here if address has changed 3) f I `' a 2z A OFFHCH ': EC,Mr s AND LEGISLAI krie S \... i D[: j ID : NA 4) Check appropriate box(es): Candidate Office Sought: Clearwater Political Committee (PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) City Council Seat 5 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 / / 207 To 2 / 3 / 20 7 Report : D2 Original Amendment Special Election Report Contributions This Report Expenditures This Report Cash & Checks $,, Monetary Expenditures, Loans $ Transfers to Office Account Total Monetary $, Total Monetary In -Kind $,, Other Distributions TOTAL Monetary Contributions To 3, ) TOTAL Monetary Expenditures To 3, ) 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) and complete: name) Individual ( only for IE 0 Treasurer Deputy Treasurer 7 Candidate Chairperson ( only for PC and PTY) or electioneering comm.) X,, 67- vt/ Signature Signat i r. X 6(,,,,,, DS -DE 2 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS

3 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name ( 2) ID. NA 3) Cover Period 2 / / 207 through 2 / 3 / 207 4) Page of 0) ) Purpose add office sought if contribution to a candidate) Expenditure Amendment Amount City of Clearwater 2 / 5/ S. Osceola Ave. Election Fees CHE Griffin Productions P. O. BOX 34 Advertising Indian Rocks, Beach FL CHE 695 THE UPS STORE 2 23/ 07 6 S. FT. Harrison Rental CHE 5 2 ZIP Printing S. Lincoln Ave. Ste. C Printing CHE City of Clearwater S. Osceola Ave. Copies CHE City of Clearwater S. Osceola Ave. Signature Verify CHE Zip Prining 2 / S. Lincoln Ave. 28 Printing CHE DS -DE 4 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

4 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. NA ) Cover Period / / through / / ( 4) Page of 0) ) 2) Contributor Contribution In- kind Occupation Description Amendment Amount Funk, John 006 Magnolia Dr. S Bus. Owner CHE, Repper, Mary Peterson Camp Brooksville, FL I Bus. Owner CHE 00 2/ Chenault, Michelle 468 Mandalay Ave. Clearwater, FL I Realtor RCT / Zayas, Ricardo 0800 US Highway 9 Unit 4 Pinellas Park, FL I IT Tech. RCT / Funk, John 006 Magnolia Dr. S Bus. Owner RCT 9. 4 DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

5 CrFcp4, ;:, CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 006 Magnolia Dr. Address (number and street) Check here if address has changed 3) or,fitremiff LEGSD,,,;,, ID : NA AND DEPT. 4) Check appropriate box(es): Candidate Office Sought: Clearwater Political Committee ( PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) City Council Seat 5 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 / / 207 To / 30 / 207 Report : M Original Amendment Special Election Report Contributions This Report Cash & Checks $,, Expenditures This Report Monetary Expenditures Loans $,, to Transfers Office Account Total Monetary $,, Total Monetary In -Kind $,, Other Distributions TOTAL Monetary Contributions To 2, ) TOTAL Monetary Expenditures To 2, ) 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) and complete: name) Individual ( only for IE 2 Treasurer Deputy Treasurer Q Candidate Chairperson (only for PC and PTY) or electioneering comm.) X l /? Oi - Signature / X?;(,' Signatur V. i- DS -DE 2 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS

6 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name 2) I. D. NA 3) Cover Period / / 207 through ) Page of Arnold, Yankee 48 George Rd. Tampa, F Contributor Contribution 0) In- kind ) 2) Occupation Description Amendment Amount I Pastor CHE 50 GRACE, Tom Belleview Blvd Belleair, FL I Attorney CHE 00 MURPHY, Jerry MANDALAY AVE. CLEARWATER, FL I Army Officer CHE Shapiro, David 308 Hickory Lane Largo, FL I MD CHE Beach Tran Clearwater LLC 373 Drew St. Clearwater, FL B APR Transit CHE KELLY, MARTIN D. 45 Sandy Lane Clearwater, FL I AuthorWriter CHE FUNK, BRIANA 0800 US Highway 9 Unit 4 Pinellas Park, FL I Optician CAS 40 DS -DE 3 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

7 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name JOHN FUNK 2) I. D. NA 3) Cover Period / / 207 through / / ( 30 20: 2 2 4) Page 0) ) 2) Contributor Occupation Contribution In- kind Description Amendment Amount Wentworth, Glenna 2227 BARN BLVD. CLEARWATER, FL I COUNSELOR CHE 25 DS -DE 3 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

8 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name ( 2) I. D. NA 3) Cover Period / / 207 through / 30 / 207 4) Page of 0) ) Purpose add office sought if contribution to a candidate) Expenditure Amendment Amount / 2/ 207 THE UPS STORE 6 S. FT. HARRISON CLEARWATER, FL PRINTING CHE / 0 / 207 ONE STOP PRINTING 867 GULF TO BAY BLVD. CLEARWATER, FL SIGN/ PRINTING CHE / THEUPS T. STORE 6 S. FT. HARRISON CLEARWATER, FL PRINTING CHE / DS -DE 4 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

9 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 006 MAGNOLIA DR. Address (number and street) CLEARWATER, FL, Check here if address has changed 3) 0Qf fempyly itc,, C / tj NOV 207 OFFICIAL RECORDS AND LEGISIATINE SINCS DEPT. ID : NA 4) Check appropriate box(es): Candidate Office Sought: Clearwater Political Committee (PC) Electioneering Communications Org. ( ECO) Party Executive Committee (PTY) Check Independent Expenditure ( IE) ( also covers an individual making electioneering communications) City Council Seat 5 Check here if PC or ECO has disbanded 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 0 / 3 / 207 Report : M0 Original Amendment Special Election Report Contributions This Report Expenditures This Report Cash & Checks $,, Monetary Expenditures, Loans $,, Transfers to Office Account Total Monetary $,, Total Monetary In -Kind $,, Other Distributions, TOTAL Monetary Contributions To 2, 0 0) TOTAL Monetary Expenditures To, ) Certification It is a first degree misdemeanor for any person to falsify a public record (ss , F. S.) certify that I have examined this report and it is true, correct, and complete: name) name) Individual ( only for IE fl Treasurer 0 Deputy Treasurer 7 Candidate Chairperson (only for PC and PTY) or electioneering com Signa f Al DS -DE 2 ( Rev. / 3) Cx Signatu SEE REVERSE FOR INSTRUCTIONS

10 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name JOHN FUNK 2) I. D. NA 3) Cover Period 0 / through / ) Page of Contributor Occupation Contribution 0) In- kind Description ) Amendment 2) Amount 0/ Funk, John 006 Magnolia Dr. s Bus Owner CHE 500 0/ Beach, Dan 262 Druid East Clearwater, FL I Barber CHE Funk, John Magnolia Dr. s Bus. Owner CHE, 000 SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ut ut is is ( ( rcev. rcev. SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

11 CAMPAIGN TREASURER' S REPORT - ITEMIZED EXPENDITURES ) Name ( 2) I. D. NA 3) Cover Period 0/ / 207 through 0 / 3 / 207 ( 4) Page of Purpose add office sought if contribution to a candidate) Expenditure 0) Amendment ) Amount 0/ 2 / 20i a Supervisor of Elections 35 Court St Clearwater, FL IT Data CHE ; /. Roberts Printing 2049 Calumet St Clearwater, FL Printing CHE / / Supervisor of Elections 35 Court St. Clearwater, FL IT Data CHE / 5 / 207 d PH Media 0800 US Hwy 9N # 4 Pinellas Park, FL Website CBE / 24/ 20') a Computerized Results MAILER SERVICE 4420 Manhattan Ave. Tampa, FL 3364 CHE / 2420 CI POSTMASTER C/ O Computerized Results 4420 Manhattan Ave_ Tampa, FL 3364 POSTAGE CHE DS DS - - DE DE 4 4 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES

12 CAMPAIGN TREASURER' S REPORT SUMMARY ) Name 2) 006 Magnolia Dr. Address (number and street) Check here if address has changed 3) OFFICE USE ONLY RECEIVED NOV OFFICIAL RECORDS AND ivcs DEPT. IDIticTIVF 4) Check appropriate box(es): SI Candidate Office Sought: Clearwater Political Committee (PC) Electioneering Communications Org. ( ECO) Party Executive Committee ( PTY) Independent Expenditure ( IE) ( also covers an individual making electioneering communications) City Council Seat 5 Check here if PC or ECO has disbanded Check here if PTY has disbanded here if no other IE or EC reports will be filed 0 Check Report Identifiers Cover Period: From 9 / 4 / 207 To 9 / 30 / 207 Report : M9 Original Ei Amendment Special Election Report Contributions This Report Cash & Checks $,, Expenditures This Report Monetary Expenditures Loans $ to Transfers Office Account Total Monetary $,, Total Monetary In- Kind $,, Other Distributions TOTAL Monetary Contributions 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, and complete: name) name) Individual ( only for IE NI Treasurer Deputy Treasurer GI Candidate Chairperson (only for PC and PTY) or electioneering comm.) / X, I, / 6e, C x Signature ' Signatu," DS -DE 2 ( Rev. / 3) SEE REVERSE FOR INSTRUCTIONS

13 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name JOHN FUNK 2) I. D. NA 3) Cover Period through 9 / 30, 207 4) Page of 0) ) 2) Contributor Contribution In- kind Occupation Description Amendment Amount Funk, John 006 Magnolia Dr. S Bus. Owner CHE 500 9/ Funk, John 006 Magnolia Dr. Clearwater, F S Bus. Owner INK P. O. BOX DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE REVERSE FOR FOR INSTRUCTIONS INSTRUCTIONS AND AND CODE CODE VALUES

14 ,_ CAMPAIGN TREASURER' S REPORT SUMMARY ) Campaign Fund oficoruse otio i : w Name 2) 006 Magnolia Dr. Address (number and street) g 207 i. r,-, ` :, LE; LL», L..,. y D Check here if address has changed ( 3) ID : na 4) Check appropriate box(es): NI Candidate Office Sought: Clearwater City Council Seat 5 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 9 / 4 / 207 To 9 / 30 / 207 Report : M9 Original Amendment Special Election Report Contributions This Report Cash & Checks $,, Expenditures This Report Monetary Expenditures $,, Loans $,, 0.00 Transfers to Total Monetary $,, In -Kind $,, Office Account $,, 0 00 Total Monetary $ Other Distributions TOTAL Monetary Contributions To ) TOTAL Monetary Expenditures To It is a first degree misdemeanor for any person ) Certification to falsify a public record (ss , F.S.) I certify that I have examined this report and it is true, correct, and complete: name) name) Individual ( only for IE F4 Treasurer Deputy Treasurer or electioneering comm.) GI Candidate Chairperson ( only for PC and PTY) Signature DE 2 ( Rev. X Sig re SEE REVERSE FOR INSTRUCTIONS

15 CAMPAIGN TREASURER' S REPORT ITEMIZED CONTRIBUTIONS ) Name JOHN FUNK CAMPAIGN FUND 2) I. D. NA 3) Cover Period 9 / 4 / 207 through ) Page of 0) ) 2) Contributor Contribution In- kind Occupation Description Amendment Amount Funk, John 006 Magnolia Dr. S Bus. Owner CHE 500 9/ Funk, John 006 Magnolia Dr. Clearwater, Fl S Bus. Owner INK P. O. BOX DS DS - - DE DE 3 3 ( ( Rev. Rev. / / 3) 3) SEE SEE REVERSE REVERSE FOR FOR INSTRUCTIONS INSTRUCTIONS AND AND COD COD bb IL IL ^ ^ u, rrr COT COT I 20I

16 STATEMENT OF CANDIDATE OFFICE USE ONLY Section , F. S.) Please print or type) JOI7n/ GC. ni candidate for the office of CL Pfd r u i 6o / c L- s - have been provided access to read and understand the requirements of Chapter 06, Florida Statutes. x / Signature of Candidate z3) ate 2_n/ 7 Each candidate must file a statement with the qualifying officer within 0 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $, 000, ( ss ( )( c), ( ), Florida Statutes). DS ḎE 84 ( 05/ )

17 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES Section 06.02( ), F. S.)'( ry PLEASE PRINT OR TYPE) C' - j NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY. C)-IECK APPROPRIATE BOX( ES): l' Initial Filing of Form Re- filing to Change: Treasurer / Deputy Depository Office Party 2. Name of Candidate (in this! order: First, Middle, Last) 4. Telephone d i-i n/ 22 s4q, 3 6f r,, N k 5. E -mail address 446, kksgy,,/,,,, row 6. Office sought (include district, circuit, group number) tv GC rtl G L- Sc-oo 3. Address ( include post office box or street, city, state, zip code) % D c3 6 %r) A tr_ r OL/ A Di- 375-Z GLe rw i ` L 3 7. If a candidate for a non artisan office, check if applicable: My intent is to run as a Write- In candidate. 8. If a candidate for a artisan office, check block and fill in name of party as applicable: My intent is to run as a Write -In No Party Affiliation J Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 0. Name of Treasurer or Deputy Treasurer Thh,i yu., /c. Mailing Address / 3. City c> 0 6 ma / V v* 0r 6- r k,. p r en 4. County nvp / // as 5. State F Zip Code 337C-6 2. Telephone 7. E -ma I address 02 5, 9-3,x. y ric2f a_ cam- v,) /cqy 4ao. Cc,. i 8. I have designated the following bank as my [ Primary Depository Secondary Depository 9. Name of Bank! 69 /- 7t 30d 2. City e e / / c-. Ai 3Luifs 22. County Ai ' e //' ' 20. Address 7/ cl Ai / G/eS 44 Pi. 23. State FLT - d,v 24. Zip Code 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 Signature of Can : te S7- e: l 6 e,-- ) V 2 2 (/ 7 x -% 27. Treasurer's Acceptance of Appointment (fill in the bl -f% s and check the appropriate block) I, D /, V ) z, A)' -, Please Print or Name) do hereby accept the appointment designated above as: Er Campaign Treasurer puty Tre surer. Sefre"-, 6 / DS -DE 9 ( Rev. 0/ 0) y 20/ 7 x ature of Campaign Treasurer or Deputy Treasurer Rule S , F.A.C.

CAMPAIGN TREASURER' S REPORT SUMMARY. 5) Report Identifiers. Monetary. Transfers to Office Account. Total Monetary. 8) Other Distributions

CAMPAIGN TREASURER' S REPORT SUMMARY ) Tom Keller Name 2) 707 Algonquin Dr. Address ( number and street) Clearwater, FL 33755 Check here if address has changed 3) 9 lref', EB 2. I20 Y OFFICIAL RECORDS