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Treasurer's Reports
CAMPAIGN TREASURER'S REPORT SUMMARY (1) Paula Melley OFFICE USE ONLY Name 4-- -< (2) 720 Mariners Way rrn Address (number and street) v7 r Boynton Beach FL 33435 co `"4 .r. City, State, Zip Code --0 .,i ❑ Check here if address has changed (3) ID Number 0000 41.1 1 (4) Check appropriate box(es) ca IN) _, bi IE Candidate Office Sought Boynton Beach City Commissioner District II ❑ Political Committee (PC) ❑ Electioneering Communications Org (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded ❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed individual making electioneering communications) (6) Report Identifiers Cover Period From 2 / 1 / 2014 To 2 / 7 / 2014 Report Type: 2014G1 ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , Expenditures $ , , 250 , 87 Loans $ , , 300 00 Transfers to Office Account $ , , Total Monetary $ , > Total Monetary $ , 250.87 In -Kind $ , (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , 300. 00 $ , 250 87 (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) 1 certify that I have examined this report and it is true, correct, and complete (Type name) Paula Melley (Type name) Paula Melley ❑ Individual (only for IE Wrreasurer ❑ Deputy Treasurer Candidate ❑ Chairperson (only for PC and PTY) or electro g comm) Al X / X aks-1— l� Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Paula McIley (2) I.D. Number 0000 (3) Cover Period 2 / 1 / 2014 through 2 / 7 / 2014 (4) Page 1 of 1 ( ( ( ( ( ( ( Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contnbutor Contribution In -kind Number City, State, Zip Code Type Occupation Type Descnption Amendment Amount 2 / 7 / 14 Paula Meiley Loal to self end, 300 720 Mariners Way L r 1 Boynton Beach FL 33435 / / / 1 / / / / 1 I 1 / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES 0000 (1) Name Paula Melley (2) I.D. Number (3) Cover Period 2 / 1 /2014 through 2 / 7 / 2014 (4) Page 1. of 1 (6) (7) ( ( ( ( Date Full Name Purpose (Last, Suffix, First, Middle) (add office sought if (s) Street Address & contribution to a Expenditure Sequence City, State, Zip Code candidate) Type Amendment Amount Number 2. / 7/ 14 Supervisor of Elections Ballot verification CAN $3.30 240 S Military Trail WPB FL 1 33415 2. / 10/ 14 City of Boynton Beach Filing Fee CAN $25.00 100 E Boynton Beach Blvd 2 Boynton Beach FL 33435 City of Boynton Beach 1`)/0 state 2 / 19/14 CAN $222.57 100 E Boynton Beach Blvd Assessment 3 Boynton Beach FL 33435 1 1 1 1 DS -DE 14 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) (a v,,1 a, -0, t e1 OFFICE USE ONLY Name ' stip Address (number and street) u) rl ± bin R e o-c h (- c-- City, State, Zip Code '2, y ?]-- ' _,'; ❑ Check here if address has changed (3) ID Number: O t) 0 0 I U. " (4) Check appropriate box(es): j��? � Candidate Office Sought t S i VI c_+ -- ( n - 4 6Y , X.,� C- "" t t 1 t /MP y, (h i ss j � f ❑ Political Committee (PC) J ❑ Electioneering Communications Org (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) El Check here if PTY has disbanded ❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From a / 8 / 1 '4 To 9, / D ) / 1 4_ Report Type: a0) 44..c a ^ ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ 556 40✓ Expenditures $ , , 333.i 9 Loans $ , • _ Transfers to Office Account $ . Total Monetary $ , / , - 0 0 —1 Total Monetary $ , , 333 . - 1 C 1 J In -Kind $ , I c7O , 11 (8) Other Distributions $ , 0 . 00 (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ / ,BSS 00 $ , , —, /tr, (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) 1 certify that I have examined this report and it is true, correct, and complete (Type name) P4 Ca 0. (` l ' LJ J (Type name) P4 (ti -( Ce_- Pie ( i ❑ Individual (only for IE Meeasurer ❑ Deputy Treasurer yaandidate ❑ Chairperson (only for PC and P or el enng com I Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Pa k./ 3 G- (2) I.D. Number 0 0 0 D (3) Cover Period 0' / 8 / 1 Li- through ?-- /;- f / 1 T (4) Page 1 of ( (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount lib Magi - c / F c ;Ii-. / /c /f( c' f;ry t,cf, A I c00 c.9 / i 6 / 1 7 .720 Nom..- 11(1/4/1. ' - Cl '3 3 0-51 , ..-tts.-- 64t--- - EL- 3 / l 1, T0fr f 1 e.� q +2e�i-iV tc.� ����t � j r C S I V Lk pe_.e.4) I~- , fl/ / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES -p CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITUR oO (1) Name l� Ct ( C-- n`l-C t i �-cJ� (2) I.D. Number JO (3) Cover Period a v ` /(' /I 1 4 through / (r_ / / I tf (4) Page C of 1 (5) ( (8) (9) (10) ( Date Full Name Purpose (s) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) Type Amendment Amount 2 /g /14- \(3M s L+�olctcA ,t - L am, G 000 N� 11t►� v /IA) � 2 � •7 vt- D,' ../ S. c' c--4 (c> 2 /W (4-/-- P o aN C ---) C/l N} W t bo ' I c t C 5✓ �e ' 2 434 Li )) 1 - f co),) -u - Pd.. C/A-1\1 liq 7 cz 3 t (rv 0 -yCi a / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Paula MeIley OFFICE USE ONLY Name (2) 720 Mariners Way w Address (number and street) '-- Boynton Beach FL 33435 t City, State, Zip Code - 00001 ° ❑ Check here if address has changed (3) ID Number ;,„, (4) Check appropriate box(es) ' ` t] Candidate Office Sought District 2 Boynton Beach City Commissioner c st tty CJ1 — 4 ❑ Political Committee (PC) ❑ Electioneering Communications Org (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded ❑ Independent Expenditure (IE) (also covers an El Check here if no other IE or EC reports will be filed individual making electioneering communications) (6) Report Identifiers Cover Period: From 2 / 8 / 14 To 2 / 21 / 14 Report Type' 2014G2 ❑ Original M Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , 1 , 550 00 Expenditures $ , , 383. 79 Loans $ , Transfers to Office Account $ , , Total Monetary $ , 1 , 550 00 Total Monetary $ , 383 79 In -Kind $ , 357 00 (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 1 850 00 $ 634 66 , , (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) Paula McIley (Type name) Paula MeIley ❑ Individual (only for IE Treasurer ❑ Deputy Treasurer ^ibindidate ❑ Chairperson (only for PC and PTY) ore oneenng Comm) T X C 6 j - X Ii ,_et fd2- Signature Signature DS - 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Paula Melley (2) I.D. Number 00001 (3) Cover Period 2 / 8 / 14 through 2 / 21 / 14 (4) Page 1 of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contnbutor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount Robert Melley Corporate ADD 357 2 / 13 / 14 I Self INK P 720 Mariners Way Filing and 5 Boynton Beach FL Service fees 33435 / / / / 1 1 / / / / DS -DE 13 (Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Paula Melley OFFICE USE ONLY Name ---► -, .4 (2) 720 Mariners Way Address (number and street) Boynton Beach FL 33435 _ City, State, Zip Code ❑ Check here if address has changed (3) ID Number 00002 cn (4) Check appropriate box(es) - ' n Candidate Office Sought District 2 Boynton Beach City Commissioner - :.. ❑ Political Committee (PC) ❑ Electioneering Communications Org (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded ❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed Individual making electioneering communications) (6) Report Identifiers Cover Period From 2 / 22 / 14 To 3 / 6 / 14 Report Type 2014G3 ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report / Monetary Cash & Checks $ 4 385 00 ✓ Expenditures $ 1 , 424 .21 ,% Loans $ , , Transfers to Office Account $ , , Total Monetary $ , 4, 385 00 — Total Monetary $ , 1 424 . 21 .J In -Kind $ , , 500 00 J (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To 7e $ 6 235. 00 r/ $ 1 , 424. 21 (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 Paula Malley e name) P Melle (Type name) (Type ) y ❑ Indroid al (only for IE easurer ❑ Deputy Treasurer .. and ❑ Chairperson (only for PC and PTY) or ele o e ng Comm ) X etc --mot x ( ...... L 4 i/ Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Paula Melley (2) I.D. Number 00002 (3) Cover Period 2 / 22 / 14 through 3 / 6 / 14 (4) Page 1 of 5 ( ( ( ( ( ( ( Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contnbutor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount First Choice HH Home CHE 2 25 / 14 1499 Forest Hill Blvd B Health 750 1 Ste 109. WPB FL 33406 2 / 25 14 John McGovern CHE 100 3929 Palladium Lake I Retired 2 Dr. Boynton Bch FL 33436 Jeff King 2. 25. 14 743 NE 12th Terrace Realtor CAS 50 3 Boynton Beach FL 33435 Korte & Wortman Law / 2. / 25. 14 2041 Vista Pkwy CHE Firm 250 4 WPB, FL 33411 B Phyllis Martini 2. / 25. / 14 501 NW 13th CHE 50 5 Delray Beach FL I Marketing 33444 2. / 25. / 14 M. Dion 2 Ridge Pointe I Self CHE Drive Unit D 50 6 Boynton FL33435 Brian Cornacchia 2. / 25. / 14 731 NE 12th Terrace 8 I Self CHE 100 Boynton Beach FL 7 133435 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Paula Melle (2) I.D. Number 00002 (3) Cover Period 2. / 22. / 14 through 3. / 6. / 14 (4) Page 2 of 5 ( ( ( ( ( ( ( Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount Lisa Noll _2. / 25. / 14 8664 Hawkwood Bay Dr Home health Boynton Beach FL I 250 8 CHE 33473 2. / 25. / 14 Ina T Zimmerman Marketing CHE 50 7536 BrieIla Dr I 9 Boynton Bch FL 33435 Integrated Med Dir. Onsite 2. / 25. / 14 Wound 1 Country Road B CHE 100 10 Consultinc Village of Golf FL 33436 2. / 25. / 14 Todd Schaufendal Pilot 533 Canal Pointe I CHE 200 11 Delray Beach FL 33444 2. 25. 14 Ann Russett Nat'l sales / / 10575 Prairie Lane 2 00 I CHE Hanover MN 55341 12 G Allen Hendricks 2. / 25. 14 / 122 SE 4th Ave I Self CHE 50 13 BB FL 33435 Jennifer Leo 3. 4. 14 / / 637 -2 NE 12th Terrace I Sales CHE 100 14 Boynton Beach FL 33435 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Paula Melley (2) I.D. Number 00002 (3) Cover Period 2. / 22. / 14 through 3. / 6. / 14 (4) page 3 of 5 ( ( ( ( ( ( ( Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount 3. / 4. / 14 Miller Land Surveying CHE 508 E Boynton Beach B 100 15 Blvd BB FL 33435 Surveying Jeff King Realtor 3./ 4. / 14 743 NE 12th Terrace #8 CAS 50 Boynton Beach FL I 16 33435 :isristina Renteria 3. / 5. / 14 158 Plantation Blvd 1 Med asst CAS 20 17 Lake Worth FL 33467 3. 5. 14 Belinda Murphy Realtor / / 760 Mariners Way I 15 CHE Boynton Beach FL 18 33435 RAR architecture Architectural 3. 5. / 14 44 Cocoanut Row Uni: 6 P Design CHE 250 Palm Beach FL B i 33480 Ed Sheinwald 3. / 5. / 14 743 NE 12th terrace Retired CHE 20 Apt 7 BB FL 33435 1 100 Realtor Association 3. 5. / 14 Of the palm beaches F PAC CHE 1000 21 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name ( 2) I.D. Number 000- (3) Cover Period ,` / 2 Z / � 7 through / / ) L (4) Page q of J ( ( ( (9) (10) ( ( Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number �/ City, State, Zip Code Type Occupation Type Description Amendment Amount 1�- u., ( h Le _- / 5 , (� Coc3 _ 4 _ N e t _ ,____, -9-. C s r 0 Z-2 t'2 - `fir 7, 1�K 1,,'S' , /q._ 6' mot'. - --- 4,-:4 ,,, .l" 1 ,,t,.. ; . rt.-- '2--? 0 0. t X36 71 , S / l� >� c - Q - i q___ C4 (1-5 'JP) Ni L.,_, ___t_ , S:"1 p io-t.,-. ____ ( ° \--1 ( ' s ions &v_., . , . - 3‘i \---' I c-i- -----( c ..k,..,_, ,' L - )s - , p„a„ --, - k.�,,.. S - . *� �i�' yA� I I �iC� 1 ` t" ! ' -' l "� S a '` S w L t I L-4 ��, --�-�` - „/ = ' 7 �� ;� / ..__ A i o - Lc , 'NISr-L_ 33y ?f ! C 2 1 CT / c-,-v 1 vy--- --ec =-) A + V” Ifs `ei-, -- k`-'it- {Y � v .__t . j.T.k CAS I 0 3, Co , (c.i• P o 1P! co. i - C \/ - DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Pk (,tj O. 1 (i -CAI (2) I.D. Number ©0 3 b (3) Cover Period ( a� ( 9 : 4 / -/ 1 (1 through 3 / (0 / 1 ( 4 (4) Page 5 - of E ( ( ( ( (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In -kind Number City, State, Zip Code Type Occupation Type Description Amendment Amount 1'8 r4 1 Z .1-F C 146 J 00 �j - # 7 _ CA / (Li LidLaSyi i cii,A1c. J I-� e- � --:� Geb cii.. otA vz /1c t____ 1. - 1 3q h vs) sc-tciiii- --r sec-r-Nv t-- - Fvtl- - ( 0,1C 1 C .1--k 2. o( 61 ' / ' rve, la- , �- - .63 9 ? c ��� ' c c l Cc ( C u�,„AA,, ✓ - c) 4, ��t 1--ii } i.y - dvr'nv____ '3",-- I g '(_, i - N1 K- 6_,,,,, L ., L , s _ ri - G° / / / 1 / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN THE SURER'S REPORT - ITEMIZED EXPENDITURES 00 (1) Name r a ) C (2) I.D. Number 0 L7 00 2 (3) Cover Period " / 2 Z / _ I') through 3 / G / 1 (4) Page I of r a — ' (5) (7) ( ( ( ( Date Full Name Purpose (Last, Suffix, First, Middle) (add office sought if (6) Street Address & contribution to a Expenditure Sequence City, State, Zip Code candidate) Type Amendment Amount Number ) \ / 7 ( L q S q'I ►-c► , tI 1 ki•-ier , *FL, 3' 117 SUQ ►- VvSoN, cA, 1e>c-t, ,_.1 pvoc.c- 2 a /(q �- �v s'- ti ',14��- - tve�_ v C 1 (� /L2, D --- u--etfro--c C(ec,v C o p t, / i<-1- i v-f N . +,..t C,c s C A.N) (DV).. p d l - Yv - ` p p � (. 1 (s p � ) Lt� 02--)--, 0 3 LA L - tom S r v, U , / / /(q �tA- , p\--t-v,°,4_ p(cs ( 1:0 - SA, L--p l,-,„, v 7 . - .e_ C -cr -- c % /1 /1 1.1 N (Q r 0 ,.s C 1.\ `3- -x.6,1 c --' V l' 1 L- Sz \ D. / l / t c./ o, ()\ "/ , 66,, r 1c. CA `- • r .-7 L),G ,-1--- PA1 r -J ( t ; 1 --c__ P "" ( i l N P DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name ra ( ,.(G. k o (2) I.D. Number 0 03 0 &"— (3) Cover Period 2- / L 2/ / V through �`E' / 1 i (4) Page )}-, of , (5) ( ( ( ( ( Date Full Name Purpose (6) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) Type Amendment Amount p ri,z)ce.?_,� f JJ ! 7( 1 P`n(e.. 4.C t-e4-- ( 7 4 }N (() 3- c o 5 . t� 1 \ f-i m - Tv ! . i 0 Los ) T- '--- ; kimf . r3 P4/L) / V/ i '/- ev-)6--e---a-)� _) 6• p t / r e--- J. UCL,----■ 65----GIL--/ 3 CU (r1-`/ r D C l �� t ) ( ,t. c :" .- 7 )� < <c - 1 ay Li 13 3 � S ���f '5 C j� O i i-H i , LA' :0- c ( A )`‘i iC) 1 C/ LA-p a ,--t-- ,_ ;-,_-),, 1 , c , (r∎ si- . s 1,-- 3/ (p//4 a > >- - -c-d ► S;c s CA id i S 61 1 c" De{ 76 "3 --- 'g --- C.7 -rc.,/ 6._ up9 ( Gpir----_ c A Nt 00 & -- ? 7 c/? DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Paula Melley OFFICE USE ONLY Name `w (2) 720 Mariners Way • Address (number and street) i a' Boynton Beach FL 33435 City, State, Zip Code ❑ Check here if address has changed (3) ID Number 00003 v1 - I _7 fi (4) Check appropriate box(es): ; ® Candidate Office Sought Boynton Beach City Commissioner District!! 17 ❑ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded ❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed individual making electioneering communications) (6) Report Identifiers Cover Period: From / / To / / Report Type 2014TR ❑ Onginal ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , 0 00 Expenditures $ 4 , 176 13 / Loans $ Transfers to Office Account $ . Total Monetary $ , • Total Monetary $ , 4 176 13 In -Kind $ , (8) Other Distributions $ . (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 6 235 00 $ 6 235 00 ✓ (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) Paula Melley (Type na` Paula Melley ❑ di • - (only for IE ❑ Treasurer ❑ Deputy Treasurer a idate ❑ Chairperson (only for PC and PTY) or =Iecb• - ng comm X X d..1 i I r; X iAL Signature . Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FO - = RUCTIONS