Filing Papers
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
~ITY 9F BOYNTON BEACH
CIT'r CLERK'S OFfiCE
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(PLEASE PRINT OR TYPE)
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
I2iI Initial Filing of Form Re-filing to Change: 0
2. Name of Candidate (in this order: First, Middle, Last)
o
4. Telephone
(flar )0 (j J~ 670; b VidoCr "5,=>?.Qml...ac. (<Y'\
6. Office sought (include district, circuit, group number)
Treasurer/Deputy 0 Depository 0 Office 0 Party
3. Address (include post office box or street, city, state, zip
code) J< (P I }./or-1 L.. Po-. / ;v-. P r f U Q...
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7. If a candidate for a nonpartisan office, check if
applicable:
e3I My intent is to run as a Write-In candidate.
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
o Write-In ~ No Party Affiliation
o
Party candidate.
9. I have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
cJ. (p I lYortA ;g j/"\ 0;-( U(( g~
13. City 14. County
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~ Campaign Treasurer
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Deputy Treasurer
18. I have designated the following bank as my
19. Name of Bank
12. Telephone
IfJ(7A,~~t\ f( S ~ q S) (r~/) b c 1-61 ero
15. State 16. Zip Code 17. E-mail address
rL 35(/5
CH} Primary Depository
o Secondary Depository
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23. State
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24. Zip Code
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20. Address
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.
25. Date
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$ 201/
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 11 e:.+O,r U h" ~ ( / N () a ~0j , do hereby accept the appointment
(Please Print or Type Name)
designated above as:
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. Date
ID Campaign Treasurer
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Deputy Treasurer.
OS-DE 9 (Rev. 10/10)
Rule 15-2.0001, F.A.C.
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NOMINATING PETITION
We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH, do
hereby nominate:
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to be a candidate for CITY COMMISSIONER - DISTRICT II of the City of Boyrn:On:;;~
Beach, Palm Beach County, Florida, for the term: .:. ....,~
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MARCH 2011
to
MARCH 2014
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pursuant to the Charter and Ordinances of said City.
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NAME (Signature)
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!, the undersigned, $ CbL 1), ~ 6 \~ IJj
, do solemnly swear
(or affirm) that I am duly qualified to hold office under the Charter and Ordinances of the
City of Boynton Beach, Florida, and I do hereby accept the foregoing nomination as a
candidate for the office of Mayor for the City of Boynton Beach, Florida.
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Sworn to and subscribed before me at Boynton Beach, Florida, this
7~
day
of 4.t.k-7
A.D. 201_.
Received at the City Hall in Boynton Beach this 7"'aay of '::;1-~-
2011at 5-!~S ~.M.
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FORM 1
STATEMENT OF
FINANCIAL INTERESTS
2010
,ease print or type your name, mailing
address, agency name, and position below:
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FOR OFFICE
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NAME OF OFFICE OR POSITION HELD OR SOUGHT:
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P. Req. Code
You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF ~ CANDIDATE OR
o NEW EMPLOYEE OR APPOINTEE
"BOTH PARTS OF THIS SECTION MUST BE COMPLETED"
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR. WHETHER BASED ON A CALENDAR YEAR OR ON
A FISCAL YEAR PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one)'
II DECEMBER 31, 2010 QE 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (must check one)'
:l COMPARATIVE (PERCENTAGE) THRESHOLDS QE II DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person]
(If you have nothing to report, you must write "none" or "n/a")
1\ IV
PART B __ SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person]
(If you have nothing to report. you must write "none" or "n/a")
NAME OF NAME OF MAJOR SOURCES
BUSINESS ENTITY OF BUSINESS' INCOME
fi
ADDRESS
OF SOURCE
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PART C -- REAL PROPERTY [Land, buildings owned by the reporting person]
(If you have nothing to report, you must write "none" or "n/a")
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FILING INSTRUCTIONS for
when and where to file this form
are located at the bottom of page 2.
INSTRUCTIONS on who must
file this form and how to fill it out
begin on page 3,
OTHER FORMS you may need
to file are described on page 6.
CE FORM 1 - Eftecllve January 1 2011 Refer \0 RUle 34-8 202(1) FA C
(Continued on reverse side)
PAGE 1
PART D - INTANGIBLE PERSONAL PROPERTY [Stocks bonds certificates of denosd etc 1
(If you have nothing to report. you must write "none" '!! ' nia"';
TYPE OF INTANGIBLE: -I BUSINESS ENTin rrJ, WHICH THE PROPERTY RELATES
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PART E - LIABILITIES [Major debts]
(If you have nothing to report, you must write "none" or "n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
~. t/ II
PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions In certain types of bUSinesses]
(If you have nothing to report, you must write "none" or "nla")
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NAME OF BUSINESS ENTITY tIft
ADDRESS OF BUSINESS ENTiTY
PRINCIPAL BUSINESS ACTIV,TY
POSITION HELD WITH ENTiTY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0
SIGNATURE (reqUired)~ .~ tJ -./ DATE SIGNED (required):
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FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form. Including If you were mailed the form by the COmlntSSlon Initially, each local officer/employee state
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer. and specified state employee must
sheet (pages 1 and 2) for filing. your annual dfsclosure filing. return the form to file within 30 days of the date of hiS or her
that locatfon. appointment or of the beginning of employ-
If you have nothing to report in a particular Local officers/employees file with the Supervisor ment Appointees who must be confirmed by
section, you must write "none" or "n/a" In that of Elections of the county In which they perrna- the Senate must file prror to confirmation even
section(s) nently reside !If you do not permanently reSide ,f that IS less than 30 days from the date of their
In Florrda. file with the Supervisor of the county appointment
Facsimiles will not be accepted. where your agency has Its headquarters, Candidates tor publicly-elected iocal office
NOTE: State officers or specified state employees must file al the same time tr'pv file their
MULTIPLE FILING UNNECESSARY: file with the Commissfon on EthiCS PO Drawer qualifying papers I
Generally, a person who has filed Form 1 for a 15709. Tallahassee "L 32317-5709 physical Thereafter. local officers/employees. state I
calendar or fiscal year is not required to file a address 3600 Maclay Boulevard. Soulh SUfte officers, and specified state employees are
second Form 1 for the same year However, a 201 Taiiahassee i"L 323-12 reqUfred to rile oy juiy i st follOWing eacr
candidate who previously filed Form 1 because Candidates file this 10rtll lOgether witt, theu calendar year 1'1 which they hold their PoS!-
of another public position must at least file a copy qualifying papers 1Ion~,
of his or her original Form 1 when qualifYfng fo determine what category your pOSition Finally, at the end of office or employment
falls under, see the "Who Must File" Instructions each local officer/employee state officer, and
on page 3 specified state employee is required to file a
final dfsclosure form (F orm 1 F I wlthlll 60 days
:Jf leaving office or employment I
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CE FORM 1 - Effective January 1 2011 Refer to Ru!e 34-820211 F /::" C'
PAGE 2
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031777
ACCT. NO.
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Miscellaneous Cash Receipt
CITY OF BOYNTON BEACH
Account No. 001-0000-369-10-00
Received of
Victor Norfus
No. 72694
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$ 25.00
February 8,
,20~
Address 261 NORTH PALM DRIVE. BOYNTON BEACH~ FL 33435
For City Filing Fee to run for City ~~~~~on, District 2, on
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March 8, 2011.
Dept. City Clerk's Office
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Miscellaneous Cash Receipt
CITY OF BOYNTON BEACH
Account No. 001-0000-369-10-00
Received of VICTOR NORFUS
No. 72693
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$ 226.00
February 8,
,20 11
Address 261 NORTH PALM DRIVE, BOYNTON BEACH FL 33435
For
on March 8, 2011.
1~ State Assessment Fee to run for?€~~sioner, District 2,
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OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
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candidate for the office of Co M n) I 's J I 0 I) €-J () I'} j (' ). ( 1 /.)
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed.--,WiI!f . J
failure to file this form is a first degree misdemeanor and a civil violation of the Can'lpa
Financing Act which may result in a fine of up to $1,000, (55. 106.19(1 )(c), 1 06.265(1 ),~Ion .
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