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Filing Papers I A PPOINTMENT OF CAMPAIGN TREASURER CITY OF B�YN SACM CITY' CL�R �(S 4FFtCE AND DESIGNATION OF CAMPAIGN I DEPOSITORY FOR CANDIDATES 15 SEP — AM 8' 5 (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: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip lr w. P� fit ■ (L € J I;rh - cod e / o S w 7 � L r v ,�/. Z T 4. Telephone 5. E -mail address a0 , j2o / +►r / F4- 'g 3`?3S ( ) 699 -3832 -Set ,,,.Q.,. /I /1 , .1 c_ Mat. car.... 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if 647ti - 1 CI4y Co i"-+ la' applicable: ❑ 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 ❑ Write -In ❑ No Party Affiliation ❑ Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer i r0. Name of Treasurer or Deputy Treasurer a v,„ a 8 /4 i al ot-e 13 r re 11. Mailing Address 12. Telephone 7/ Co S Lt. 2741, "r - vezxeo__ (s6 r ) 6Q7 -3270 13. City 14. County 15. State 16. Zip Code 17. E -mail address �/� ?v► , r Ci/ ^ r 1 Ol (r✓1 f ,, _ a f t au �Cl NnA� i f i ✓l � K�r i / L• - 18. I / have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address - 7 — 0 IS0-4/4C / C O ( GA. 121e-, A loPael-- 13') Vi 21. City 22. County 23. State / ill 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 TED IN IT ARE TRUE. 25. Date 26. Signatur- - • idate l ( C 1 X 4 27. Treasurer's Acceptance of Appointment (fill in t' •- •I -nks and ch eck the appropriate block) I, G /�)C,� j` ® r or. , do hereby accept the appointment (Please Print or / ype Name ( ype Name) iesignated above as: Cli Campaign Treasurer • r .., reasurer. I e i/ fC 7 1c X. Date ig 1- ,{ e • Camp-'. reasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. CITY OF BOYN T O i BEACH APPOINTMENT OF CAMPAIGN TREASURER CITY CLERK'S OFFICE AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES 15 SEP -:$ AN 9:10 (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): r Initial Filing of Form Re- filing to Change: El Treasurer /Deputy ❑ Depository 0 Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code) w ` - € . 4 , yo , ..Sari / ,( g ( ,� � , r-� '3341‘.3T 4. Telephone 5. E -mail address �°�'"7 (6( ) 495,g fxry A),A.a_ Gec. f 6. Office sought include distric circuit, group number) 7. If a candidate for a nonpartisan office, check if � applicable: C ✓`0*--ray" 0 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 p Write -In El No Party Affiliation El Party candidate. 9. I have appointed the following person to act as my 0 Campaign Treasurer r - Deputy Treasurer 10. Name of Treasurer or Deputy Treas arer ph 68 (Q SJ1 ►ass w.:tv, 11. Mailing Address 12. Telephone 7 (0 3 (9-r7 i t, TeAl,r,� f ..s 1 „ (56 ( ) G _. a7,s' 13. City 14. County 5. State 16. Zip Code 17. E -mail address I rot r � L W fort r-e- 'ter 6)(e ?a40 o y 2 M 18. I have designated the following bank as my n Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address r) 11 f6t5 i LA/ A,,,,,,ha ges ad 21. City 22. County 23 State 24. Zip Code i„,4„,„ a sza-d- -Poi (1..., Acez,c,A Pt, 3 4 ' 7 ' a -- 6 ' UNDER ENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR ^ `POINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS : , TED IN IT ARE TRUE. 25. Date 26. Signatur- - r. idate C e g Zj X r 27. Treasurer's Acceptance of Appointment (fill in t (lav s and check the appropriate block) I, Lam" rp ,/ ",2 3 Q /e J y -oo " , do hereby accept the appointment (Please Print or Type Name) designated abov as: El Campaign Treasurer iriA Deputy Treasurer. Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. 1 1 _ RESIDENCY REQUIREMENTS v.-J(7-e- , candidate for (Print Name) (a Pin ‘,.•, a. 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. • f (Signature of Candidate) (Dat — & 9:7,7 C T) r cn C7 CA _*7 � rn D +I rnn 11/12/2013 12:31 PM S: \CC \WP \ELECTION \Year 2014 \Information Packets \RESIDENCY REQUIREMENTS STATEMENT.doc r OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) I , "6 :ct , hrtra_.5 ) , Pt) ell et-e) P roLke , candidate for the office of C.1 } - y ' gg dvid- have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X if / cr/ / r `ignature of Candidate a te 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. 106.19 106.265(1), Florida Statutes). LO :8 WV 6- d3S SI. 33I33O S.UZI3]13_ A113 DS -DE 84 (05/11) 1-13V38 N0T:NA08 30 A113 MATERIAL FOR CAN J 'DATES YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, I 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 INDICATING YOUR / INTENT TO RUN. 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 - Intent ) 6. State of Florida Election Laws - Chapters 99, 105 & 106 7. / Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees 8. «./ Directions for Posting Temporary Political Sign 9. / City Map and District Maps -urn(/' "� -< C , 10. ✓ Part I Charter, Article VII. Elections - City of Boynton Beach rn 11. ✓ Part II Code of Ordinances - Chapter 2 Administration, Article III. Elections zra. 6 ca m 12. / Poll Watcher Form & FS 101.131- "Watchers at Polls" ® 13. ,✓ Public Campaign Financing Handbook 147 14. ," Candidate Petition Handbook 15. °V Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets 16. Petition Form - Candidate for Commissioner - TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF ELECTIONS AND RETURNED TO CITY CLERK DURING QUALIFYING 17. / Form 1 Statement of Financial Interests 2014 — TO BE FILLED OUT, SIGNED & RETURNED TO THE CITY CLERK DURING QUALIFYING 18. q � L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.) 19. / Loyalty 0- - Oath of Candidate (DS - DE 24B) — TO BE RETURNED TO CITY CLERK DURING QUAL Y RECEIVED : Candidat= :ig aturf. Date i 9 ned' 4 1) • Pk . net M. Prainito, MMC City Clerk 5/26/2015 3:33 PM S: \CC \WP \ELECTION \YEAR 2016 \Information Packets \MATERIAL FOR CANDATES.doc i ::ai'... .:: - 1-.... s r..i:.v -.^r r . " ,. tiu,.. a.- :' :l • •- .- .`- ".. v..- ^- ... f .:...re =� ::i -. ry ' �? V O,c Miscellaneous Cash Receipt No. CITY OF BOYNTON BEACH - _ P TON 6 - _ Account No. 001 -- 0000.369 ®10 -00 $ 25.00 1 ,20 - Received of James Michael Brake Address 710 SW 27th Terrace. Boynton BEorpca 33435 Date 1it.10 /.15 01 R Mipt no, 5211 For City Filing Fee to run for Co i f ±b ' . District q - �O L cl l { '��iyrien E. 2 � `t j March 15, 2016. De p t . City .Clerk's Office B Miscellaneous Cash Receipt 01 " °, ° 8 ' CITY OF BOYNTON BEACH - No.r . - ~TON - Account No. 001 -- 0000 - 369 °10 ®00 $222,57 . , 20 Received of James Michael Brake Address 710 SW 27th Terrace Boynton B , 33435 Date; 11/10/15 'u�1: R ceipt no SOS $: 1 % State Ass -essme: ,t t. _ ,, r �` spo- - n; - p4 { For ..rt _, ,l ; 1.-: 4' . ;: - on March 15, 2016. ��: _ Dept. City Clerk's Office By The City of a:3oy { c � . _ -e -- c tr' City Clerk's Office r = � � 100 E BOYNTON BEACH BLVD c I t r Y :� BOYNTON BEACH FL 33435 0 V-7-7-!---N-=:---7-7-1 (561) 742 -6060 v' l FAX (561) 742 -6090 'l'� o „� E -mail: prainitoj @bbfl.us — m a www.boynton - beach.org ° _ D V ' NOTICE 9 F,m TO: CANDIDATES, POLITICAL PARTIES AN i OTHERS s NOTICE IS HEREBY GIVEN that the Logic & Accuracy (L:°: Y \,) testing of the voting equipment to be used in the Larch 15, 2016 General Election will be held: Wednesday, February 24, 2016 @ 10:00 a.m. Supervisor of Elections Warehouse 7835 Central Industrial Drive Rivia- ra Beach, Florida RECEIP oft is <s ice is hereby documented: /7/. /7/ 6 iic ig t re Date DETACH IF YOU AND /OR YOUR . E .'RESENT: TIVE(S) plan(s) to attend the Logic & Accuracy (L ) testing e n Wednesday, February 24, 2015 @ 10:00 a.m., please detach and return the l • =er portion of this notice to the City Clerk. Signature #Attending S: \CC \WP \ELECTION \YEAR 2016 \Information Packets \L&A Testing Public Notice - For Candidate's Signature.doc Catch a Wave, Catch a Fish, Catch Your Breath - Breeze Into Boynton Beach America's Gateway to the Gulfstream C7 CANDIDATE OATH — o `� c ,, NONPARTISAN OFFICE r°' co (Not for use by Judicial or ` o C A I School Board Candidates) ; OFFICE USE Ws= OATH OF CANDIDATE (Section 99.021, Florida Statutes) I, James M Brake (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 Boynton Beach Commissioner , 3 (office) (district #) ; I am a qualified elector of Palm Beach 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 off : I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Flo '• -, Statutes; nd I will support the Constitution of the United States and the Constitution of the State of Florid . nature of Candidate Telephone Number Email Address 71 SW 27th Ter Boynton Beach FL 33435 Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 11 1766010 " 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): [JEYMZ] [BREYK] STATE OF FLORIDA COUNTY OF PALM Be I Sworn to (or affirmed) and subscribed before me this 10 day of NOVery1 6er , 20 15 . Personally Known: or - / / ( ° PiLat444.4.L' • nature of Notary Public Produced Identification: nnt, Type, or Stamp Commissioned Name of Notary Public Type of Identification Produced: Y ,.;�tih•"• JANET M.PRAINI7O i*1. MY COMMISSION # FF 1 .2411 I ' -P EXPIRES: September 2. • 2018 'hof Rnndad Th...►,,.._ n. DS -DE 25 (Rev. 5/11) Rule - 2.0001, F.A.C. FORM 1 . STATEMENT OF 2014 Please print or type your name, mailing . FINANCIAL INTERESTS I FOR OFFICE USE ONLY: address, agency name, and position below: LAST NAME -- FIRST NAME — MIDDLE NAME : G'3 Brake James M —4. Cre MAILING ADDRESS 710 SW 27th Ter Boynton Beach 33435 Palm Beach rcp CITY : ZIP : COUNTY : NAME OF AGENCY : W, — 4"1.7Cxf City of Boynton Beach s Fir", NAME OF OFFICE OR POSITION HELD OR SOUGHT :. Commissioner for District 3 You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF lA 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 EITHER (must check one): DECEMBER 31, 2014 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE 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, write "none" or "n /a ") NAME OF SOURCE SOURCES DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS - PRINCIPAL BUSINESS ACTIVITY The Menswearhouse 11295 Legacy Place, 33410 retail sales Coidwell Banker 362 Ave, 33426 real estate sales 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 none . PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "n /a ") FILING INSTRUCTIONS for when and where to file this form are none 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, 2015 (Continued on reverse side) PAGE 1 Adopted by reference in Rule'34- 8.202(1), F.A.C. PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] - (If you have nothing to report, write "none" or "n /a ") -\ "" - ° - TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELAYS ;= .;..4. none C ;. - .0= : cam r ..0 "`' fri PART E — LIABILITIES [Major debts - See instructions] — 0 ' (If you have nothing to report, write "none" or "n/a") =- ' -„ ® Q NAME OF CREDITOR ADDRESS OF CREDITOR rn tom.. r' ?, Education Services P.O. Box 7051, Utica NY 13504 t ' rnn. PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or "n /a ") • BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY none - ADDRESS OF BUSINESS ENTITY 1 PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST c IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNAT RE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or Signature: / attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. Date - d: . 4_71/f(( CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: i WHEN TO FILE: After completing all parts of this form, including If you were mailed the form by the Commission initially, each local officer /employee, state officer, signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file prior to , section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they 30 days of irrn the n date e of l thei is Ie ntment • section(s). permanently reside. (If you do not permanently . reside in Florida, file with the Supervisor of the Candidates for publicly - elected local office must NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY: papers. State officers or specified state employees A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer Thereafter, local officers /employees, state of another public position must at least file a copy 15709, Tallahassee, FL 32317 -5709; physical officers, and specified state employees are of his or her original Form 1 when qualifying. A address: 325 John Knox Road, Building E, Suite required to file by July 1st following each calendar candidate who files a Form 1 with a qualifying 200, Tallahassee, FL 32303. year in which they hold their positions. officer is not required to file with the Commission Finally, at the end of office or employment, each or Supervisor of Elections. Candidates file this form together with their local officer /employee, state officer, and specified qualifying papers. state employee is required to file a final disclosure ' To determine what category your position falls form (Form 1 F) within 60 days of leaving office or under, see the "Who Must File" Instructions on employment. However, filing a CE Form 1F (Final page 3. Statement of Financial Interests) does otot relieve, the filer of filing a CE Form 1 if he or she was in Facsimiles will not be accepted. their position on December 31, 2014. CE FORM 1 - Effective: January 1, 2015. - PAGE 2 Adopted by reference in Rule 34- 8.202(1), F.A.C. `,`P FUAL 'Pj =s Palm Beach County O C1, 4 4 4 ' -�" 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 ] 858 -6200 FAX NUMBER: [561 ] 656 -6287 WEBSITE: www.pbcelections.org CERTIFICATION I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 40 signatures on the Nominating Petitions of JAMES BRAKE for BOYNTON BEACH CITY COMMISSIONER, DISTRICT 3 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 JAMES MICHAEL BRAKE is a registered voter in Precinct 4054, in the City of Boynton Beach, Florida. Signed, this the 9th day of November, 2015. c?= �c. c-) SUS BUCHER SUPERVISOR OF ELECTIONS `t) - te r PALM-BEACH COUNTY ° r . (SEAL) \ ; r �S J :11 CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statzles - If all requested information on this form is not completed, the form will not be valid as a Candidate Pek o ' o . ka..rt V if) 64yr& I k the undersigned, = r- .is ered voter (print name as it appears on your voter information card) in saidstate and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] LIJ Nonpartisan 151 No party affiliation El Party candidate for the office of ,- - Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD1YY) B 1 4-5 all isT City County State Zip Code 26im-7oo cl3cft PALM c e+E-Acti "S `R Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voted Rule 1S-2.045, F.A.C. DS-DE 104 (Eff. 09/11) c-f-1 gz.) - g (z1 cz . "ti •st"" C,ey ■ CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida St test - If all requested information on this form is not completed, the form will not be valid as a Candidate Petitio fo m. X } fC ! �\ the undersigned, a registered voter (print name as it appears on your voter information card) v , in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party. affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address e r Q (MM/ D/YY) 'O ;• ('✓ � '^1�Y�IC% J1Ve /,?' //if 7 City County State Zip Code 107 44 105. Signature of Vot- Date Signed (MM /DD/YY) I [to be comp) ted by Voter] _ dr 1 a Ac /is- Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) l s • CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida atute 5 - If all requested information on this form is not completed, the form will not be valid as a Candidate Petit on &rm. 4 74,/ the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) /V 0 -7-5firx_ City County State Zip Code Signature of Voter Date Signed (MM /DD/YY) [to be complete by Voter] ii/ae? Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11 ) t om +- 71 ) ate' 7 ciltzs Ts! '� n CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition J 1, Di bora f 1A-rm a >1 the undersigned, a registered voter r 1 . (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number. Address '130 SW 021 Tarr&c' (MM /DD/YY) 1 1 Z-1 d QCz_ City County State Zip Code Tibiecton r-l) P& ryt FL- 33$35 Signature of Voter Date Signed MM /DD/YY 9 g ( ) [to be completed by Voter] AU /4/ / 0 /415 Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) ti rr- "a C r , . -, ._ LI Ili CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for . C the undersigned, a register d rote (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Re istration Number Address � , (MM /DD/YY) ��/ld &19 7 ✓ 50 I �, w I 9P ) 4 4 ,.4j Co y . State Zip Code , 3 1p -4 Signature oar. er Date Signed (MM /DD/YY) [to be complet d by Voter] (41, r 1O( 90 /l6 Rule 1S -2.1 • , . DS -DE 104 (Eff. 09/11) . N cr r 8 CSs ("4 LI -0 yy .�" t CANDIDATE' PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statu ( 1'; 7 - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo ® / d FA05t` the undersigned, a registered voter s (pri t name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary /General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) 93/ (S4) .00? City County State Zip Code , , y41Po,r) /74 %/f y4 gi' rt Signature of Voter Date Signed (MM /DD/YY) [to be completed by Voter] 1/c0 /C Rule 1S -2.04 .A.C. / DS -DE 104 (Eff. 09/11) r ® `€7 z: C3'! "" d cz CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . 0 - the undersigned, a registered voter (print n me as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] D Nonpartisan No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address / 1I 42X l F City County State Zip Code Signat'i re of Voter Date Signed (MM/DDIYY) [to be completed y Voter] ■•■IiiMA (07;0 1 5 Rule 1 2.045,M_M DS -DE 104 (Eff. 09/11) v . / ST :; rel Pte' • CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida St tut sJ - If all requested information on this form is not completed, the form will not be valid as a Candidate Are itisr f I, 1/1 c the undersigned, a rec istered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan El No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/Y) /' J 0 le sc&Q ) 1v Grp City Cour Sta Zip Code 0/4-i Signature of Voter Date Signed (MM /DD/YY) [to be complete by Voter] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) r4,9 rrr • r. tv t Ca C73 = • 1 CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. - R D b1 / lit it c7( the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) I I I ( (oS f 3 q 1 S W --1 to City County State Zip Code y - al* aea4 ('L 33`f33 Signature of Vot Date Signed (MM /DD/YY) / < [to be completed by Voted / 3 0% Rule 1S- 2.045, F.A. . DS -DE 104 (Eff. 09/11) C: > r r. czz " a at ' - cr CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. i / - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statu s - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition bi : . I, ,`l' (lU `elp the undersigned, a eg - -1 voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) g / / eto 2, ( g- ( co so ek., s---d, tee) a , J C leo( Coun ty State r Zip Code I P'd �$ ✓� C � t C— l (/ 2 ? kt;:c Signature of Voter Date Signed (MM /DD/YY) [to be completed by Voter] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) L % �7 '° - e`a SZI CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute 1 - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo iNa w1 R S _c t ltcc�, m�.l the undersigned, a registered voter l� S (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) ®Y /13 /HO �� � S ca 21+ Why City County 2 State Zip Code 20 ) C,v-rJ4 3611-c l Penan L � F 3 L 3 Signature of ter Date Signed (MM /DD/YY) 1 [to be completed by Voter] l 0` '3o1 Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) czz ea": G' CZ • c cc. r i�i S CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Stat e J - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition or . yr, Fj ( -4 s the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 1g No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/ D/YY) l S� Th 0 "1 I8I 1 City n ( County State Zip Code frt 3 3 L( 3 3° Signature of Vot r Date Signed (MM /DD/YY) [to be completed by Voter] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) l-° (I3 e Lui x 1.3.. fr. +4} • CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for candidate. [Section 104.185, Florida Statut J - - If all requested information on this form is not completed, the form will not be valid as a Candidate Petit f /� � the undersigned, a r gi tered oter (print name as it .'rears on your voter in ormation card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 Y Y (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address sw City County State Zip Code &D yiV rrti 6 AC(- Vt L I - Fe - ttC H FL 334/e,4 Signature of Voter Date Signed (MM /DD/YY) (0 [to be completed by Voter] • a 100 ✓ ,3 Ley 5 Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09111) , CD to u• 2' CD - CD C tii — ¢ Cri CANDIDATE PETITION ' Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statu - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition f m. 1 4 1 f /e d the undersigned, a registered voter 7 ! ('print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan FA No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) ke /RP 9/ 0 City County State Zip Code -_ 6y t&# v i J ��� . ��'�( )4ew� f�! Signature of Voter Date Signed (MMIDD/YY) Zi = [to be completed by Voter] # Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) w w CANDIDATE PETITION A--, Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes} - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo m. - - /3 I, /� D C �,l � � .(/ v � the undersigned, a registered voter rf, (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary /General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth r Voter Registration Number Address (MMbD !) let V S / 1) 1 1 / 6 State Zip Co� I 3 1 Sig re of Voter Date Signed (MM /DD/YY) [to be comple ed by }toter] a 37/5 Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) I Zr.; 1 ..0 -s- 2 6: iii �.! . °° s)i - w - G 'J CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statut sJ - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . I, Pif a1V 2i� the undersigned, a registered voter (print name as t appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party; candidate for the office of Boynton Beach Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) -54s 4144 • 1— City County State Zip Code Signature of Voter Date Signed (MM /DD/YY) [to be cleted by Voter] 4/ Rule 1S- 2.045, F.A.C. f DS -DE 104 (Eff. 09/11) . tFs m' . EL_ 4 �s l CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition hp, / t0 -- m ,� I, Iii --a c E , K/2. L / 19N the undersigned, a regi to d vot (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address / dr (MM/D 9.16". CP a RI Vi6i2) ' 2jeJv z` City County State Zip Code TOVAMW --- E/9 - an Pnl-M ZE/90 Ai . - L-- 33 V3 Signature of oter Date Signed (MM /DD/YY) ,./ ,ezie„:". _ [to be co plete by Voter] ,14441-- Rule 1S-2.045, F.A.C. // DS -DE 104 (Eff. 09/11) to fir P _.I 4.. ) . -7 t <, t + C,..1 rt - -, CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition f I, J a ^\ 1 �° �� v ' � the undersigned, a r gist red voter (print name as it / appears o your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan El No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Numb Address (MM /DD/YY) 3 69/ 04 3 G 1 h -(LS vN e, 1r L City County State Zip Code / d 1J C PA r*1 a C J-- 3 z J V3 6 Signature of Vot Date Signed (MM /DD/YY) [to be completed by Voter] > - 3 . Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) h 1 — t a c i 1 li - - CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Sta ' to - If all requested information on this form is not completed, the form will not be valid as a Candidate P • on 7 . m. e 11 a 4 the undersigned, a reg stered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary /General Election Ballot as a: [check/complete box, as applicable] Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) City Co ty State Zip Code 'r_ytp,(Actl Alt (8 l'ea 3 Signature of Voter — Date Signed (MM /DD/YY) [to be completed by Vote,] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) } 1 ?z.. J 44,1 c CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute - If all requested information on this form is not completed, the form will not be valid as a Candidate Petiti fo I, S if L vp, a, 4 Ty -ir the undersigned, a r gis voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan o No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth , or Voter e 'station Number Address 3 f f (MM /DD/YY) ! U 4/-4--- 3/7 Cit County State Zip Code b Uri gri 9 �( � _ C 3 Signature o , ot_V Date Signed (M /DD/YY) [to be com leted by Vote ) , . k%V.7— I 6 Rule 1S -2.045 F.A.C. D -DE 104 Eff. 09/11 t 09/11) y Pw to C fC C'3 j- CC Z a. N C1? CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -.If all requested information on this form is not completed, the form will not be valid as a Candidate Petition I, �I (41 / - p � ��� the undersigned, a regis er d vote (Jf (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address �� (MM /DD/YY) co z 3� l � -7d d r `' 1 ,-- lJ r1��5 /'lr City County G � - Sta e Zipode 2 -4' (p Signature 1� Signature of Voter Date Signed (MM /DD/YY) e -,_ [to be completed by Voter] -ffAirv.„-/ Rule 1S- 2.045, F.A.C.( DS -DE 104 (Eff. 09/11) C r � - • ` , - z ESJ N ' CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Stat es] - all requested information on this form is not completed, the form will not be valid as a Candidate P titio ; / If Prm) i I, . A • k 1/ L 1 the undersigned, :registered voter � (prinf name -s it a•pears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth r ii Voter Registration Number Address ( M/�� `P /1,21 r l 5 `i 67 4 ! �i�_- -r' City County S tate r ' Zip Code I196 i2--)6 7 Signature of Voter ` Date Signe ( M /DD/YY) k [to be com let by Voter] 1S- 2.045, F.A.C. !- Rule DS -DE 104 (Eff. 09/11) , r` „i_ L`I' - C) hw Li 66 -{ C_ Cy7 COi CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for I the undersigned, a registered voter � j- 1 (print name a if appears on your oter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan FA No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address y C� �j( (MM /DD/YY) (i_� O 1 /� L 1 c C� City County State Zip Code ?al) ra9fark h L K Signature of Voter Date Signed (MM /DD/YY) r [to be cr pl te3y ote Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) 1 5 - � CrIo f„ r ■ CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes it - If all requested informatio on this form is not completed, the form will not be valid as a Candidate Petition fo 7, . _____) 1, it a 0 i a _ the undersigned, a registered voter print name as it - ppears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] E Nonpartisan o No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD S 18 .BZ i , i $ai 2-1,S 723 -5 Li 2 i' ls City County State Zip Code 6 opi e ' PA 1 Q om-- r �' 3'.A Signature of Vot Date Signed (MM /DD/YY) - 1 [to be complet d y Voter] 2. — . j ji 6 K Rule 1S- 2.045, F.A.C. DS-DE 104 (Eff. 09111) 40 Cam. Crs a L ar r 4 Cr; ±..1t -.. tea " CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo I, , /re,,,,y /� the undersigned, a registered voter n ot name as it appears on our vo er information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) fi //5 io.,4/3/6a -- 7oa 5 &O c ?, 7 Pi Ci � County State Zip Code o /I yl % 6 1 (ni (5 f 33 3- L.1 Signature of Voter Date Signed (MM /DD/YY) _ [to be completed by Vo et] �� Rule 1S -2.045 F.A1 DS -DE 104 (Eff. 09/11) V 4t+ J CD Lii r 1 - J CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida St ute - If all requested information on this form is not completed, the form will not be valid as a Candidate P do • `• rm. 6 the undersigned, a registered voter L D O l O f -e_5 1 I221n .5c. i SS- �IVYIG, `1 (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary /General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan A No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or oter Registratio�umhef Address (MM /DD/YY) _ /' // 7 (, g 9 1 i f '110 5 b() ,2--7 —7 , City County State Zip Code 00i n +on ( 3-ea:e-A Pa /kri 3.e--a-c ) F2-- 3 3 X35 Signatur , • • Date Signed (MM /DD/YY) — [to be completed by Voter] —.AI''' * -■1111e -- /1/63/1 5 Rule 1S- 2.045, F. . DS -DE 104 (Eff. 09/11) t3. J w :a L. c...) C ) _ ,,, ,' 0) ✓- , •' lc- Lf3 �,j ----- . CVO'.. ,- CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the will not be valid as a Candidate Petitio fo yd the undersigned, a r:;gis ered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) — 1) _ 51.1 30 c���� v� l � ire s Dom, City County State Zip Code r .G.6%," vd-Die,7 6-2zzet fec(1-x Signature Voter Date Signed (MM /DD/YY) [to be completed by Voter] 1 I i1/43 Rule IS-2.045, F A.C. DS -DE 104 (Eff. 09/11) I - Cf'°: • r r tom$ M tom ' .»: C 4,E t/? am a cis CANDIDATE PETITION Notes :. - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statu es - If all requested information on this form is not completed, the form will not be valid as a Candidate Petitio fo m. 1, T . P Sb'\ \ the undersigned, a registered voter (print Name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) c�2� 2 0 - lR 52— me ( S\f■ Ci County State Zip Code 334 3J0 Signa • re • f Voter Date Signed (MM /DD/YY) [to be completed by Voter] 3 2 01.5 Rule 1S- 2.045, .A.C. DS -DE 104 (Eff. 09/11) Lo w t IOC W LS CL CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for; I, 1/1/1/1-4s41'- % the undersigned, a registered voter (print name as it appears on yd r voter information card) jr[, -k 14.r,vea - e in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) CS 1/ -9/ --Z- CI 4- 2, (--,14-1"-r q City County State Zip Code ,..„) Signature of Voter Date Signed (MM /DD/YY) ,�- ----"' [toe completed by Voter] Rule 1S- 2.045, F.A.C. DS-DE 104 (Eff. 09/11) ; Cr7 p a.. y c* 1a # — f C CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested i formation on this orm is not completed, the form will not be valid as a Candidate Petition fo 1, / t, f the undersigned, a r , is ered voter (p t -nn- as it - • • . ars on your voter formation card) in said state and county, petition to have the name of Ja es Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] 0 Nonpartisan 'J No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) /d 3` VI 81 4 6,1i 0 ...,I", 4 / ' / pz Co �y St Zip Code ,xii./ (LI 5 3 y3 s 3‘00 Signature o •t Date Signed M /DD/YY) i i [to be compl ed by ' oterl ii Rule 1S -2.04 DS -DE 104 (Eff. 09/11) !— 'i .. LtJ a C1. :-7 !z_ 1 , . c) °: CD , LU C J r" CO CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition o m. I, Aiyisli. ` the undersigned, a regi t• (prin / AJ.44 ) name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan IS No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /pD/Y/1f) Cit County State Zip Code Az 0 n gear,ii Wair) ika . 2-- JA95 Signat._ e of Voter Date Signed (MM /DD/YY) [to be com leted by Voter] ��__ r L / !� d /I4. e Rule 1S- 2.045, F.A.C. / DS -DE 104 (Eff. 09/11) ■ C CO ,-:-- 4- _i? f_1s CZ S @:e— C D d G3 1 :i Cr) t.:.J (.'3 u- a- cam= 41 ip i CANDIDATE PETITION , Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. 1 - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo I, l�tv4 ff// p �- the undersigned, a registered voter (print name as it abpears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address .0)1 { r (MM /DD ) ' v1�-l�k Ci County State Zip Code fu4014 P •G- ?4LP4 13 - 1. 3t-f 35 Signature of V� Date Signed (MM /DD/YY) / • [to � e co mete by Voter] 1 - Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09111) r ,=) ' 1.4._ ta,i C" J ti , , lc t.ti .J kL c=. N €lid i L . CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. t/ - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition f I, c lE AL5d mo., the undersigned, a registered voter D (print naPne as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan ID No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/ D/YY 0(0 OS Fl b 1 k _ City County State Zip Code l bOINTOO &Al . ?B‘ k 2'34,14, Signature of Voter Date Signed (MM /DD/YY) / 94411 7 1 efr friell:/‘ [to be completed by Voted Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) p'r cr C3 co . 1:11 J Q • > C!? } A CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . I, y I rG�„ �v/{, wt g rown the undersigned, a registered voter 1, , (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) 2-O Z Sw lei `4 _ 5+ 2 / DM/ 7Y City County State Zip Code h y 04-4. liStyk A. P Pic, lG & 3 3 Y3 f' Signature of Voter Date Signed (MM /DD/YY) / , , [to be completed by Voter] it - 0 — Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) 1 yam .. _ L:1 a. r J G:1 0r t -,- t'? C. a' ■ r, v 3 . Lu - a „1 , C CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition orm.. the undersigned, a registere voter print name as it appear on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) /Q/ /9/ 7e76 s 2 7 4 City County State Zip Code 0e7 rdfril 3-2a0it- /om �3 c/ 3.S Signature of Voter Date Signed (MM /DD/YY) [to be co pleted by Voter] // Rule 1S- 2.045, F A .. DS -DE 104 (Eff. 09/11) • C k c 1 eot, C'� 1t1 a 3 • ' 0- N O w CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Stat to - If all requested information on this form is not completed, the form will not be valid as a Candidate Peio o . as•A /-'( 1 i iJ < .J the undersigned, regi tered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ' ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) �`oa_n LS'Z1NS�d�� City Co Stat Zip Code /C5611ArnTh Uri /66dC-H 33 4 7‘S Signature of Voter Date Signed (MM /DD/YY) Ad-c/\. [to be completed by Voted l/ ° Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) co CD C") Ta 1 . C 1 6s d N Cf_ • CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. '! - It is a crime to knowingly sign more than one petition for a candidate., [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . I, - t _Y)6 ` L f the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan i0 No party affiliation ❑ - Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) 5 $ 501s ,S / c i t iou2f Co my State Zip Code it7TA) 6626,CE un 6mcH 33c-t33" Signature of Vo Date Signed (MM /DD/YY) [to be completed by Voter] s - Age Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) LI C!6 t.L: 6L- CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petitio fo 1), I, powuls S7L "Iv Gk-/Q6 the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan FA No party affiliation ❑ Party candidate for the office of , Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) 5 o15 S6- . I D Vf� �� — �0 kJ' gounty State Zip Code bcl, v /- ,i-i p , c.)-1 r= t 33 g3-s- Signature of Vot. Date Signed (MM /DDM() I / `O4 /a [to be completed by Voter] /� 1 / Rule 15- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) _ ,.e'e r " - -- - Cy 1: C :F% , ,, la..! r :rW� ta»d 7 CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition f � C ���Fc rzsTAn� a the undersigned, a regist vote (print name as it appears on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan IN No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) 3t�V Sw y rz -og- � as9 4 9- / City County State Zip Code 1C1 ?ACM j35ACi4 FL 33 - /'s Signature of oter Date Signed (MM /DD/YY) - [to be completed by Voter] /1-5 -?oil Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09111) Ltd � 1 Cw : s L) i 'i to CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . the undersigned, a registered voter 1 v (J (print name as it a p ars on your voter information card) in said state and county, petition to have the name of James Brake placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑ Nonpartisan 0 No party affiliation ❑ Party candidate for the office of Boynton Beach City Commissioner District 3 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or V ter Registration Number Address (MM /DD/YY) \ (I„ I �� /� , Of © fq (J J lid 7 � City County State Zip Code Y1 I rk lir Bead 33`135 Signature of Vote Date Signed (MM /DD/YY) [to be c mpl ted by Voter] 1 9 11 Rule 1S- 2.045, F.A. DS -DE 104 (Eff. 09/11) . I rn C:5 C ) i p Ga us sr, l