Filing Papers MATERIAL FOR CANDIDATES
YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, WE HAND YOU THE
FOLLOWING:
1. Qualifying Information & Municipal Election Schedule
2. ' Dates to Remember
3. ✓ Form DS -DE 9 Appointment of Campaign Treasurer and Designation of Campaign Depository for
Candidates (8/03) — TO BE SIGNED AND RETURNED TO CITY CLERK
4. ✓ Residency Requirements (To be filled out and returned to City Clerk)
5. ✓ Form DS -DE 84 Statement of Candidate & copy of Chapter 106, Florida Statutes (Must be filed with
City Clerk within 10 days after filing Appointment of Campaign Treasurer)
6. ✓ State of Florida Election Laws - Chapters 99, 105 & 106 (2012)
7. ✓ Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
8. ✓ Directions for Posting Temporary Political Sign
9. ✓ City Commission District Map
10. ✓ Part I Charter, Article VII. Elections — City of Boynton Beach �--
11. ✓ Part II Code of Ordinances — Chapter 2 Administration, Article III. Elections - = T
12. ✓ Poll Watcher Form & FS 101.131 — "Watchers at Polls" c - n
c r
13. ✓ Candidate Handbook for Candidates
14. ✓ Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets
15. ✓ Petition Form - Candidate for Commissioner — TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF
ELEC. I IONS AND RETURNED TO CITY CLERK DURING QUALIFYING
16. 40 Form 1 Statement of Financial Interests 2009 —,TO BE FILLED OUT, SIGNED & RETURNED TO THE
CITY CLERK DURING QUALIFYING 6
17. L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.) t it-Ot CLOCAL r
18. Loyalty Oath - Oath of Candidate (DS -DE 24B)— TO BE RETURNED TO CITY CLERK DURING
QUALIFYING R�" IQ L
:n:i:tig:atur
Signed
,�. `in . Pit_bw„);„t,
et M. Prainito, MMC
Clerk
October 18, 2012
S:\CC \WP \ELECTION \Year 2013\MATERIAL FOR CANDATES.doc
L EACH
r ' r - r - I
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN ; 007 23 (,F; 9: 03
DEPOSITORY FOR CANDIDATES
(Section 106 021(1), F S )
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re -filing to Change p Treasurer /Deputy ❑ Depository ❑ Office ❑ Party
2 Name oo Candidate (in this order First, Middle, Last) 3 Address (include post office box or street, city, state, zip
OKY 1 I in 11L.{-‹ code) g sa -y LArvc.: .
4, Telephone 5. E -ma'I address 1j0 �- 134 t rt_ - 33 \j3 1D
(Vol )V�3 _(►9ta �,�,;, a
6 Office sought (include district, circuit, group numb 7. If a candidate for a nonpartisan office, check if
racr(1 3)t (- oisiR1( ap
CAl
f � 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
❑ Wnte - In ❑ No Party Affiliation ❑ Party candidate
9 I have appointed the following person to act as my cfr Campaign Treasurer ❑ Deputy Treasurer
10 Name of Treasurer or Deputy Treasurer
2 dre 4 d f s /�CA/,y •'a S c. /'.&-�, /$, 11 Mailing 12 Telephone
`� 33 r 5 ci e e - �. , 6= ( 4-'/) 7 3‘ 3.t
13 City 14 County 15 State 16 Zip Code 17. E -mail address
BarikeIN [3Eck\ ?,,,c, 13EAG FL 33 416 - /2,c/r,v- /.Z P 0'/4 az,G •j'
18. I have designated the following bank as my IZ Primary Depository E] Secondary Depository
q 19 Name of Bank 20 Address
w Q f l ) cq CaN\Ir6K INti T
21 City 22 County 23 State 24, Zip Code
N lei V , FL.cz -InA ' 3 3 '4 C
UNDER PENALTIES OF PERJURY, 1 DECLARE THAT 1 HAVE READ THE FOR- • OING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND T THE FACTS STATED IN IT ARE TRUE.
25 Date j / 26 • � :Cie o andi a
/`a! w" //v
X C� �--1
27 Treasurer's Acceptance of Appointment (fill in the blanks an check the appropriate block)
-'" , I, 73r .tom -d Sd "3, c r i. , do hereby accept the appointment
(Please Print or Type Name)
designated above as Campaign Treasurer ❑ Deputy Treasurer
/ o/ /- v/ X .--- __- - - ---- O
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.
STATEMENT OF
CANDIDATE '' Or:: 23 f.:1 9: 03
(Section 106.023, F.S.)
(Please print or type)
1 , 0F\N l a 1 ,
candidate for the office of CC'XY1(`DIMIOr\J SL_
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X Lifil6 Z/1
Signature o Candidate 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. 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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS -DE 84 (05 /11)
RESIDENCY REQUIREMENTS
' c)
c
MEaWR , candidate for
(Print Name)
GOMCC11M 1 c — S - A - 4 of the City
(Mayor /Commissioner — District #)
Beach, have received, read and understand the
residency requirements of Article II of the Charter of
the City of Boynton Beach. OVA
Lys— k
(Signature of Candidate)
C-'6 9 1+) (10
(Date)
9/27/2012 11:03 AM
S: \CC \WP \ELECTION \Year 2013 \RESIDENCY REQUIREMENTS STATEMENT.doc
4, �OF F4 0
• eCAAL $q 1%
`): Palm Beach County
°f_ ^�
T Pp01' 240 SOUTH MILITARY TRAIL
WEST PALM BEACH, FL 33415
POST OFFICE BOX 22309
WEST PALM BEACH, FL 33416
SUSAN BUCHER
Supervisor of Elections TELEPHONE• [561) 656 -6200
FAX NUMBER: C561) 656 -6287
WEBSITE. www.pbcelections org
CERTIFICATION
I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do
hereby certify that the 40 signatures on the Nominating Petition for CITY COMMISSION,
DISTRICT NO. I of DAVID T. MERKER, marked with a check, are registered electors
within the municipal limits of the City of Boynton Beach, according to the registration
records on file in this office.
This is to further certify that DAVID THEODORE MERKER is a registered voter in
Precinct 4050, in the City of Boynton Beach, Florida.
Signed, this the 14th day of November, 2012.
na
1
S i SAN BUCHER
SUPERVISOR OF 'ELECTIONS "'o
s
PALM BEACH COUNTY, FLORIDA �; CO
rn
(SEAL)
NOMINATING PETITION
We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2 -42,
City Code of Ordinances), do hereby nominate:
fr DANi Is3 - 1 1 ., ME-R WE r 1 .,
to be a candidate for City Commission, DISTRICT NO. I City of Boynton Beach, Palm Beams
County, Florida, for the term:
MARCH 2013 to MARCH 2016 - `'
pursuant to the Charter and Ordinances of said City.
SIGNATURE ADDRESS
' ' '' ! C' vt - PT Ail/ 1 Ft 334 3 G
__.- „„,,e ; , 4 ,.. f .,-, --- SY-4 .-ef(/'(- eet-*if ?'14
O Th j/ 1 ".` A-1/-- ' le 1 JJ u/U' k I X c 41.,-(-4-sLis33,t3i
, -_f - _, -/,444...4//(;.Q.e,..4„,..A. A 2 --f ' A 4 r tA4v4 OtWio tiyiiir- A .›)Y.3 4
("2,, / Z i ( 172 nt 50 c) 74174 ....K5-‘
6 Th 7--------...., pidc,Ac2_ ..., 0 ‘;',? c
E c i -- N if: : :)7, J ...., Al,e / 6k-- I 0 ;e:.)--e j- z ' ' ._) Fe,- 1\-1,, _A____ fjAA-N I: 4i ,1 1 ' '-' \ i .')_,
`` if) frrei (k L'r 3 1 D q-r 4 l
Er' l Li f ' . a 0 2.- • 51 .,b S 4 id- L
�r �- ,�'
1 J U fQ i 1 •14(x ., ► �� n i _I
I s il A tri 4+ a 4 , �
Afe)-:,
a ' / 7 /Ati i. Lff iii ttititSrAtyndYkk 21/Kutie
@) /I i t - , ,-- 6(
G f
4 / 1 Ailo('M�� S La IS /3 3 3
f 1r `T -� , A ,os b /sfsk,� - vc 33
b , I i Jinn >11 c .: 'All: (, - ‘
E .0 (...,,/ , „,„_ ? I ii„,t_ac.,„,„/, LA; P.-/?1,
L , / / ! 7 1� tea l// / � 3 �� / J 33'/3 Kr
/
Cl-,) f ' .ffs 3 ; i L p � s cis6
co, m '
ie L- L N, .72va -u � , 3 ioJ 1 '+ 0t T Pc�ynin. Wiz) t /-/
1--- ' 4Q- 4...C -f ( eX/J '):3 ( 0 6 ) - ) i z . * e "
'2,-2' Al li _ , , i ,s , , ✓ /J hi 64 7 '4-Te PA 7 7;,‘ A
1- - ‘ *,, '' 8 174-4 /9d/Zi 543
/ 141 /30}//0"0 x.91
8 "_:,.,_..._.;";-:;:,,, y.,.„ w .. no,) ' A . r A - 4
G _ J ; " ) \ $-_ , A , . -./ 6 (,,, --- ce_,_-1.et-,Ist_ 0.6,..c__
-P i • 1. 7 ' 3
1 — / , \ 3 (v s L. 3 h -A 1.1
r . .f„:„ , _,___„ - 7_, ,, Y -- K - 4,7 -- ,/,,,,: el, ,o.: y47 c'
• / -3 ""275 14 O n .�-O'
C /tit /ZJ (? Ca- -t-..
e fi iv73i7leL
,E__;)) " 11 _23- e he fr'9
ar
Wo-e--6 r
c t. , _ -f .« 7 -- 4—F') -1` 4-Its 3 Y3(
n G ' '-- v5 ' A 'W.40 \I q 8,-i_.,,i-d
........7"446.,,A ' 6 ---- , 47_ 3 ',3 L7,36
6( 11
.� 7, r ,4 (4,,,,
- _OM •„:Al A ., _, _ '
���- ��L s)-
())&4 L . 3313 , tRA (51 10144,2..5-3v.A
(--- draL,,,,er g, `, /. °`' 1 w 1e-nt. /5.11 3436
Lt - 4 4 , , �i ' r ,
4 - < - - .9 3 X34
,L,„_, 3 7 , ,—}U4t , L,L A , 3 ?kt
6) , (--/ / // / k�i
c 7 ti ;
(L ) ' 00." �� (c ' f : ' - 7 C - c0 -(
t-tv Pr , , , !, ./ 6 / ao nx--
t- v" . 1 - .4_44.4. _ ./..... t(11' l 4
€) _pr,„ �/ ,�- a - n
/
NOMINATING PETITION
We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2 -42,
City Code of Ordinances), do hereby nominate:
1.Dm r�
to be a candidate for City Commission, DISTRICT NO. I City of Boynton Beach, Palm Beach
County, Florida, for the term:
4 --
MARCH 2013 to MARCH 2016
pursuant to the Charter and Ordinances of said City. c y
c,
r-- '�
S NATURE , ADDRESS
SCO - 0 , f - ' ' ar/ i
A. r i
C7!) 7�.t<, 1 6 / el Oi .33Y3C
6,i C_ : 9' f Ai - id'f . Y ,5" C 50,1-0 Z
C ' ' 7,et. „,6,-- c � �--- -
t ----------4eQc- ___, /1,07 S i
€ IiAMuLiff 11.01M•A., - - L3,
6 ) ,5- (----/---,---2--/ 5
1 ,. : � . l / _ -73 , o ,s ;, Q }- 4
dP
C' G , UV_ / f; s ' t- ' 3 q 5 (,
moti ,, .„) - fi -, / P - - ,,2 5 y i /V \ ' '
_, ' . �''� r? ; r' 4 7)11 e��_ 4 '7-v; -Y-
� L'1 ..{ y 5 5 Y(
CC'S- 5' 9 7 i
Y,J.° "IN 3 3 3 3i el/ 6 (t(W
yi) " -- T w'-. 1 ------- V d___Ck/A1,3 Z _3 3
______ i Ai ,..... " 0 „,,,, , i
G-ii) Ara , gi dotiAtAkkdt La-elte-
-`l\ - "Abb. 2_ au (4 e 0 '' Z..,fl -
17 IWIP 1 '21 c-,,,,„4. &I.
-,
, -____---*,..., k i / ,
. ...:, 6.2_ c's.s/6.4-t-,>.
/
NOMINATING PETITION
We the undersigned, duly qualified voters of the CITQF BOYNTON BEACH (Sec. 2 -42,
City Code of Ordinances), do hereby nominate:
Dm ‘T) -- T. ‘\
,,
.,
a
::,
to be a candidate for City Commission, DISTRICT NO. I City of Boynton Beach, Palm Beach
County, Florida, for the term: -
MARCH 2013 to MARCH 2016
pursuant to the Charter and Ordinances of said City. H
SIGNATURE ADDRESS
- 7 ,: e- 3 3 // F5, i 1,9-, ,g
E il) ditz/i6 E. z , t , 9 ' # >4-?..ta 4
) iF-/1 r a u�
r .I.,. .......__/ Ita...�_ b") e I op
-) 1 # ,
, 4.- e c 74 ak>'50-7
&) A441/4=1 _:/ si- , ;'(- :4 --- . 7--- ..1
f /
6 / Ldo6-- i,y
�, -7100 aitx 129 l
E t , R A ( e 177 4 Y f ,,ewTh ,mod 4e, 3/ ...,.../4:-C-9 CA_ ,
,),_
,,,,,) ,,_ c3 ; r/ ry\ 02 6 / 44/F
S 4 b%2 / 7GrBR/ &)v-F
! ' T i 7
7.17 V
(4 d ry? 14 �� 3(0,3i f .,�lo o. 1� r ,� �n r
� lia ._ _.� . �1L g vt7e Dive e, B fry ,0-34
n 2 W a Lt 9 S L. ,k) Ps '3 `f 3"
r .4\1‘/N, v-U-A---A-- \<(" Cv ,,,‘Ii(1,--i•N ,
‘*•
0
I, the undersigned, DP . t Q t ' � ,L�L , 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 At -Large for the City of Boynton Be. c , lorida.
V
Sworn to and subscribed before me at Boynton Beach, Florida, this ! 5 day of
� Vern ber A.D. 20 t a, .
Yin • PAza.i....„±z)
Received at the City Hall in Boynton Beach this l i 4 day of No ve 6e,r
A.M.
20 la. at 11'37
c, pr„iAja-
City Clerk
\ 4:
� v
tir
j \shrdata \ccAwp \election \nominating petition doc
Pr— _
Miscellaneous Cash Receipt ?
No.
CITY OF BOYNTON BEACH
j
o
9'
O N
Account No. 001-0000-369-i0-o
$ 222.57
oanuaiy 29. ,20 1 3
Received of David Merker
Address 8 Southport Lane #D, Boynton Beach, FL 33436
For 1% State Assessment to run for Commissioner Ln Ui.trict 1
on March 12, 2013
Dept. City CLerk's (Alice B
Miscellaneous Cash Receipt 0"?
CITY OF BOYNTON BEACH No.
0 \
Account No. 001-0000-369-10-00
$ 25.00
January 29. ,2012_
Received of David Merker
Address 8 Southport Lane fa, Boynton Beach, FL 33436
For City Filing Fee for District I City Commission seat for
March 12, 2013 election
Dept. City Clerk's Ot f iee By
FORM 1 STATEMENT OF 2012
Please print or type your name, mailing FINANCIAL INTERESTS
address, agency name, and position below FOR OFFICE USE ONLY:
LAST NAME -- FIRST NAME -- MIDDLE NAME
PYEk liacz. DNV 1 D THOOoiz.c
MAILING ADDRESS
ES SOUTT:3 ),ANr-- i=h D c __ ,f'^C
v Tc'�N Benc. H 334 3 6 P u 3t �1 la,
N3 r `W
CITY ZIP COUNTY '.0 r CD
NAME OF AGENCY �1
n7 !
-lop
NAME OF OFFICE OR POSITION HELD OR SOUGHT j
2
You are not limited to the space on the lines on this form Attach additional sheets, if necessary.
CHECK ONLY IF ❑ CANDIDATE OR ❑ 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
EITHE
ust check one)
DECEMBER 31, 2012 OR ❑ 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) CHECK THE ONE YOU ARE USING
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF SOURCE SOURCES DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n /a ")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] FILING INSTRUCTIONS for
(If you have nothing to report, you must write "none" or "n /a ")
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.
■
CE FORM 1 - Effective January 1 2013 Refer to Rule 34 -8 202(1) FA c (Continued on reverse side) PAGE 1
PART D — INTANGIBLE PERSONA) PROPER T `" t .1`, '_K5 i ;i1;,' - Itilit,atc r I , , r
If you have nothing 10 report, you i -.° <r wi io "norty ' • ' r'E
TYPE OF INTANGIRI_t_ i UuSINESS EN1ITt TO WHICH [HE PROPERTt - LATF; r
-,, \ _ 1 r 1 " ,, , . __ _._ ______ __ _ _ - - __ - - - 4
....... .. .. .. .. _ _. .... ....._ _ _ ___.."
PART E — LIABILITIES [Major debts - See instructions] [
(If you have nothing to report, you must write "none" or ' "n /a ")
1
NAME OF CREDITOR ADDRESS OF CREDITOR [
IN O1 Ls ---t- ____ _ __ ___ _ . . ___. _
-4- _ _ ._ 1
---1
1
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions rn certain types of businesses See instructions
(If you have nothing to report, you must write "none" or "n/a"1
BUSINESS ENTITY # i BUSINESS ENTITY # 2 BUSINESS EN I I I Y # ;;� _ __
NAME OF BUSINESS ENTITY
TEA I I 1
ADDRESS OF BUSINESS ENTITY N,_ ~~ _
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY 14 C' L,-= ?a "
I OWN MORE THAN A 5%
,;±
INTEREST IN THE BUSINESS
NATURE OF MY i
OWNERSHIP INTEREST 1 1
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE F
SIGI URE (required): DATE SIGNED (required):
V
FILING INSTRUCTIONS
WHAT TO FILE: WHERE TO FILE. WHEN TO FILE,
After completing all parts ,f this form "1 you were mailed the form by the Ccninussio , nitially, . J, irfIce empluyc-
including signing and dating it, sena back on Ethics or a County Supervisor of Elections ,tate office ,,,r 50ecif,e. state employee
only the first sheet (pages 1 and 2) for filing roi your annual disclosure +ding ( trin it -- nus till within 30 days _' `he :farm
form to that location nis or her appointment or of the beginning
If you have nothing to report in a panicuiar Local officers/employees file with the .)1 employment Appointees who must he
section, you must write "none" or "n /a" in that Supervisor of Elections of the county in onfirmed by the Senate must file prior to is
section(s) which they permanently reside (If you do not onfirmation even f that ei less than 31
permanently reside in Florida, file with the days from 'he oat(' f them appointment
NOTE: Supervisor of the county where your agency Candidates tot publicly elected local office
MULTIPLE FILING UNNECESSARY has its headquarters) -lust file at thr same time they file their
Generally, a person who has filed Form 1 State o or specif state employees � uahf y rn g p arser t
for a calendar or fiscal year is not required file with the Commission on Ethics, P O Thereafter , ocai officers /employees, state
to file a second Form 1 for the same year Drawer 15709, Tallahassee FL 323 ufOcers and specified state employees
However, a candidate who previously filed Candidates file this form together with thei are required rc fife by July 1st following
Form 1 because of another public position qualifying papers each calendar year ,r- which they hold their
must at least file a copy of his or her original positions I
Form 1 when qualifying To determine what category your position falls F at the end of office or employment
under, see the "Who Must File" Instructions on each local officer /employee, state officer and
page 3 specified state employee is required to file a
'inal disclosure form ( Form 1F) within 60 days
Facsimiles will not be accepted. of leaving office , -,mployr�3ent however
filing a GE Form jF (Final Statement 01
Financial Interests' does not relieve the filer
df filing a CE Forn s he or she was in their
position on December 31 20t
CE FORM 1 - Effective January ' 201 Refer ; 4 , 34 -0 202 i ` 4 ,
',TY OF IOYNTUN BEACH
CANDIDATE OATH — "; ` r C'LERK'S OFF!CE
NONPARTISAN OFFICE 13 JAN 29 PM 12: Oa
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
•---) (Section 99.021, Flonda Statutes)
D I L fl 1 i&
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT' - NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of 0JM m rV 13% t C } Z , 1 ,
(office) (district #)
' ; I am a qualified elector of PAL - BE County, Florida;
(circuit #) (group or seat #)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or
elected, I have qualified for no other public office in the state, the term of which office or any part thereof runs
concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to
Section 9 012, Florida Statutes, and I will support the Constitution of the United States and the Constitution of the
State o F rida
►' ✓1 Cf ( C\-"1-Cf\ k-11) ( ) e cAV ∎ mes Scr I Its orti'IC d cOt`n
Signature of Candidate Telephone Number Email Address
9 cn Zt >! oN 0zf\) B i L, 3 � 3L,
Address City State ZIP Code
Candidate's Florida Voter Registration Number (located on your voter information card) ` %S I '} c l 3 r 1 _
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form)'
STATE OF FL IDA
COUNTY OF P t3\
Sworn to (or affirmed) and subscribed before me this c I day of , 20 13 .
(1 r
Personally Known or . �✓
ignature of Notary Public
Produced Identification nnt, Type, or Stamp Commissioned Name of Notary Public
NOTARY PUBLIC-STATE OF FLORIDA
Type of Identification Produced, Janet M. Prainito 1.
,'-',. ;Commission # EE028433
`Expires. s P. 22, 2014
i P n rrrorr •r, *vrtr unATir\f. on TWC
DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C.
FORM IX AMENDMENT TO FORM I
STATEMENT OF FINANCIAL, INTERESTS .. L . ,..ffil: OF ELIC I DNS
LAST NAME - F•RST NAME MIDDLE 4AMF . . • . e ^ : a,, c:yCr 1 . YU ct *r'' 1; ♦ THIS FORM 1% AMENDS THE FORM t t tryci, item Apt t • 2
e a �- t } {m interests) ! FILED FOR THE YEAR �> 1
NIA,Lt'.c::+CCCPC.rr 'A LM BEAN { COLA T , F4
-,, - • DURING THAT YEAR 1 HELD OR WAS A CANDIDATE FOR. THE
=osi - noel O ._ ,„ y I l/ c.rr )5.1 \
•
d I '. '. ..il 3 $ • s L 16'411...1s1 13t :1 . WITH THIS + VERt4FAt NTAL AGENCY _ T
CO ,,- .TICA COLD
MANNER OF CALCULATING REPORTABLE INTt"RFSTS
PRIOR TO 2001 THE ' iftESHOLDS FOR REPORTING FINANCIAL INTEP.E SLrc*'REC.OLPARATPiE LSSJALLY WAD ONPERCENTAt:',E
VALJES $EGti%NING N 2Z al THE. LEO"SLA tJ.3 EO rL:ER3 TN: OPTION CF WANG RE =CRTINC, THRESHCLDS'HAT APE ABSC..LTE
DOLLAR VALUES t;r;t, N .trsieto•'t:. for ce..rthi d:.: P, EASE ' BH t VVNE'NE§ THiS ST,4TTNEY' REF: F. TS E THEE (must check nne)
0 COMPARATIVE (PERCENTAGE) THRESHOLDS
vR
DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME :MaJot tc,trcas t,t „tC, .M." ci> 1hr , or: , ' Y• Fc's - ++t ;'re n +trAons!
■lt y ou have, natiung to report, IOU roust write `c=one" of "r „`
•
hAAML OF raO,JRC V:) ». DFSCF off ' i ::T },JRCE:S
OF Id;COME ADI'JR!= ;; t PRINCIPAL BUSINESS A:. :":T
N11.1111111 IMMIILIIIII
di w ,
PART B -- SECONDARY SOURCES OF INCOME ' - Si.:..
;ktaist Cu&tern. , okettt£ anti other 48UfC8:, *I inter t' zG ^13tfCS C+cFS ty We "e et!r-ry F S^' Zee , oit , ..3 , 1 -
11t you have nothing to loon you must write' Pork.' ur "Yef i')
'3AMML OF A.WE OF M! OR SOURCES ADCRE:S ” PRINCIPAL RJSINESS
P c". L^.+'' '1ESCS NC(ME 1 ..* SOURCE t AC ;v1TYC,F IRO s
III ��
iiii PART C — REAL PROPERTY (-anti buiotoga sAanra by Me ±oporarg pon - San , nstructions 7
'ir you have nothing to report, you must writ* " nt rte" ar r• 1
PART D -- INTANGIBLE PERSONALPROPERTY ' rY:• U0.^C; teefft,- .V4*;r,+ t",epn5..rv.:tr .cw3 1 ^ oTUrt.xt13.1
• 1F you have nathtnn to report you must write "none" or "n-a 1
yPE OF ir`-NC P § ti. 1FY. 1� :v Ai -. ,^,N "HE P LR RE, TEZ
_____ -_ _ .— . -__ _ -_ � S . Q t ::-\ 1 Ja
w l �`D AL_.t - _s,, • : .+•k „ - •s I-1 V�, _
1 •r -n:,. •,�..-- -• - - -; -'sham- -
(continued on ve a velei '1 PAGE, I
PART E - LIABILITIES Walo c=••b• • 7. -..,'..
/If you inufg nothing fn rgpoif yat/ rtitiSf T4t.2 " rialfi ' Or .* iv.) 'I
NAME OF OR i-ttIOR Arti:sett,S0 C.IP.EDITOP
.„ " •-
i g * : •
I
- - .
•• - .. - ... ,
PART F - INTERESTS W SPECIFIED BUSINESSES IC.>,..nemt to -,, ty./..-,(IwIl, n o-rta n =yoe/.. at ho:::,o:›ozeY Cke ;rising...UFA
sif you have flatfoot; to report, voc, must *oft matte c•t
NAME. Of 1
ENIITV
BLISANES.S. BA. 'ES s
aiIti
.SaS
ADoR ass OF rt I
Fi . .
. -- - ........_ ..________
PqiNCIPAL BUSINESS '
AC. TiVITY t —
POSITIO' ftEL 3 i
... i 1 ' — --...„-- . — .. --- ---
) oyyty thofiE THAN A Sva i 1
' • • ' l'OES.li — i I
,— — —
NATURE OF Ms/
OWNERSHIP NR E3 I
FART 0 - EXF OF CHANGES
' -
--- —
— — -----
IF ANY OF PARTS.A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ij
SIGNATUR -; ! t
DATE SIGNED:
i -,
0 . ‘ • 1 1 \ \ , \ ,i, - Clid)e. r2, 1. IS
-, ,
F11,1'SG INSTR 'CIFICYNS:
WHERE TO Fit E. sr ?..ffl oftirorq" ni r.,elesriftorl .:7,7t4* omplopoos' QUESTIONS
Return the tam to tots oat w ?au fuNi Name. , ....1 - w".1 be f fen , fro Cis .on a^ Aintq t for a the utttsm Laws may be
thz Fr' 1 that yori, lie sox - jog ta amend flet....o . 0 1.■.. "n e. r,..)ror-coatr on f.er Ne,..1
.: -c7C3 zorp e Cr:.1 15 'a t4nttsscn Fionlyj
Luca/ officers abvuici fra,/f: tlfga with t te
32117-570S totopho•te afal. 488 7E64
Sopefviaflr of Eloct of the r..oJrty rt 'At cr (... -a ,:trt hooc '''i ed 11 F'ZT '
the) achrafleotty rettea ;0 rytt d-ci r,"-t
7/ fogtfks ," Pritta than V.O 'ME
Steper /50r Of th county gato...c your ogoncy Pisd
As head. Jorte:5
INSTR t FOR ('()N1PI_ETING FORM 1 X:
INTRODUCTORY INFORMATION - Tor: ci r--rr PARTS A through F:
NAME. DISCLOSURE PERIOD NAME OF POSITION aect NAME - LZ: Ef.34 "21 C C' C ..7.0m t:i r, tt -:•,, r-te . ..r.o.
OF AGENCY Uoe rho '.....an r- ..t:: =..-n ,'-„; r,,-,; /,..;.. Ps2 ." 1 )1.1, Ot`t!: - t.. 1...:.1 • • - y,,,o ...,,,40,1 ft, 1
you are !...eeKros tc, rt-r o-.1 ,,t,- ,.,,, r., - ;,,I..-teit-0,.t ..Ov.r. 4 -, 4, 1 - J1.... , <II
MAILING AGGRESS '.. se your c.4"n1 rrnorq ac1.1
MANNER OF CA LCULMING REPORTABLE +NTERESTS 7.."1"•.t.t•
ow le) au: certeu)orct3 la ifla typc of ti"*E4.'?1.7 ffis, uott f sr .."<.• PART G:
crIg+na Fe/-r I yOu ,e0 seeIow to wrenc
1 ..t 1 rorro - o e rpfvr... t ct 1.ot. are mons;
..1.000■011.1 -
PAGE 2
C
� N
? y
7 C
•
m C/
c- O G
Z - tc
c
c 3' G
N n
O c6 sc
' wh
03 03 3'
oo � a
j
w o w
CAI
0)
c1R2ST CLASS
'� ri ;
ON/Tt
dm; Sim
r x d
n -
hJ0
0