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Filing Papers , CITY OF BOYNTON BEACH APPOINTMENT OF CAMPAIGN TREASURER CITY CLERK'S OFFICE AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES - 15 NOV 16 Pty 3:57 (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. N e of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip r ) .-�C /P _ar .. G. code Cl / rte- S cr 4. Telephone 5. E -mail address /3, zs, A /FC.-- e0C ( 66 /) 07c$ S 3 y/6 /d4 .e T V, C.K l ,3Y6 ey V/ .�s'i- - r -.2. o 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: y,� /�� /3Q c.c.-A_ / i r0 ❑ 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 �ampaign Treasurer ❑ Deputy Treasurer 10. N of � � � A9 Treasurer or De uty Treasurer /(® 11. Mailing Address 12. Telephone g C7 c-`- 5 fi ./ (51 ) 025,5 ( 3 w co 13. City 14 Aunty 15. State , 16. Zip Code 17. E -mail address , �-L no i '7 C ©-� l a- m_ 0.e `'GL Jed d 6 ' c r /v+ c. /� �/ -0- 18. I have designated the following bank as my 0 Primary Depository 0 Secondary Depository 19. Name of pank _ 20. Address '' L I 21. City 1 22. C unty 23. State 24. Zip Code / c5,5 UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMP • • - • - • z DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FA _ TS STATED IN IT ARE T; - . 25. Date 26. Sign- re of andid-: = el . 17 1 / Vil$ —7-47---pr.k...W,...iiiitie.... 27. Treasurer's Acceptance of Appointment (fill in the blanks-.prop i o I, . r( /1:5 , do hereby accept the appointment (Plea a Print or Type Name) designated above as: Campaign Treasurer j Depu . _ t�j�� x�- , - .I -- Date ignature • • -i• reasurer or ! - g'i•, Treasurer DS-DE (Rev. 10/10) Rule 18- 2.0001, F.A.C. •• '- OFFICE USERNLY STATEMENT OF CITY OF BE o Ft CITY CLERICS CANDIDATE (Section 106.023, F.S.) 15 NOV 16 Phi 3: 51 (Please print or type) I , 7:t_ J-7 /71 candidate for the office of Ma. �/ G / . I have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. lir.v. ■4101 _A? 410 //A/5 -4"41.4 .r.1NTR . - 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 � -1 -- ma) cn - C CS, - n C = /\ 7 �, candidate for J fTt (Print Name) fr/Q-1/0 of the City Ma or mmis i — Co s over District #) Beach, have received, read and understand the residency requirements of Article II of the Charter of the City of Boynton Beach- ' n. , are - of^Car(frdat' --- / (7/V. (Date) 11/12/2013 12:31 PM S: \CC \WP \ELECTION \Year 2014 \Information Packets \RESIDENCY REQUIREMENTS STATEMENT.doc I r r Miscellaneous Cash Receipt ` ; T Y N ` } CITY OF BOYNTON BEACH 4' T O ON .. - - E A ccountNo. . 0 01 -0000- 359 °10 ®00 $ 25.00 I P' ,. 20 ' 1 1 Received of Car/. McKoy E Address 69 Citrus Park Lane. Boynton Bpae_h , +'T, 11A16 Y For Citv Fi liner Fee to run for ayori i c l 452,9 - c Total Cd'f prtWiilt :`F De City Cleo" k 's By Miscellaneous Cash Receipt 01.Y CITY OF BOYNTON BEACH NO. O = �DCa� 0000-369-10-00 O Y TO N y B A � P Account No.- $ 259.25 . '1 Nov er 17 ,.201 Received of Carl McKoy Address 69 Citrus Park Lane. Boynton IRRaeh PT, 3.14116 For 1. % State Assessment to run for Pais; ! IFS, 'lei) i5 (UL-' ',it€ - c!1 I d D p vrent _° ' :kg-4.r ' pity Clerk's Office Dept. By 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: LANIA15� ` FIRST NAME�Mlr LE NAME AILING ADDIgSS : i, 62 ( /7 , - Li c toi--k 447, CI›, P: COUNTY: r co Ci fr NA GENCY : �� •�! - NAME OF FFICE R POS HELD OR SOUGHT : You are not limited to the sp ce the lines on this form. Attach additional sheets, If necessary. t7 rTt Z CHECK ONLY IF CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE * * ** BOTH PARTS OF THIS SECTION MUST BE COMPLETED * * ** DISCLOSURE PERIOD: 1 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 THATARE 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 1)$ ❑ DOLLAR VALUE THRESHOLDS I 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 SOURCES OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY /Fe Ar , 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] (if you have nothing to report, write "none" or "n /a ") FI)_ING INSTRUCTIONS for when and where to file this form are A � � located at the bottom of page 2. INSTRUCTIONS on who must file . thls 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 RELATES , A 1-_, PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "n /a ") NAME OF CREDITOR `/ ADDRESS OF CREDITOR /3/V L.) gAit„) . ,0-711.,.._ ,49-,,,,,,../- ,,,, O____ 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 //7 ° L ADDRESS OF BUSINESS ENTITY / PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST I IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET PLEASE CHECK HERE ❑ • SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY , Signature' -If-a or certi fi cunaeer Chapter 3 - , � ' -l e f t t in ed good public standing aco with tnt the lic Florida nsed under Bar prepared hapt47 this , or form for you, he or she must complete the following statement: Iii / � % " 1 ' prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable Date " : knowledge and belief, the disclosure herein is true and correct. i i / n// // (} CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, jnciudinq 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, retum the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. If you have nothing to report in a particular who mu st be confirmed by Appointees Local officers/employees Elects ons of the county in which they file with the wh y the Senate must file section(s). Supervisor of Elections Prior to confirmation, even if that is Tess than . section, you must write "none" or "n /a" in that permanently reside. (If you do not permanently 30 days from the date of their appointment. NOTE: reside in Florida, file with the Supervisor of the Candidates for publicly - elected local office must county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY: papers. A candidate who previously filed Form 1 because State officers or specked state employee of another public position must at least file a copy file with the Commission on Ethics, P.O. Drawer Thereafter, local officers/employees, state of his or her original Form 1 when qualifying. A 15709, Tallahassee, FL 32317 -5709; physical officers, and specified state employees are candidate who files a Form 1 with a qualifying address: 325 John Knox Road, Building E, Suite required to file by July 1st following each calendar q fY g 200, Tallahassee, FL 32303. year in which they hold their positions. officer is not required to file with the Commission or Supervisor of Elections. Candidates file this form together with their Finally, at the end of office or employment, each qualifying papers. local officer /employee, state officer, and specified 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 pp/ relieve Facsimiles will not be accented. the filer of filing a CE Form 1 if he or she was in their position on December 31, 2014. CE FORM 1 - Effective: January 1, 2015. Adopted by reference in Rule 344202(1), F.A.C. PAGE 2 C) 01 : CO MC> CANDIDATE OATH - `-' 33 NONPARTISAN OFFICE s. Q rn rs, cap. (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE C CC A .. „1 :2) (Section 99.021, Florida Statutes) (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 / ti r `� , (office) (district #) ; I am a qualified elector of ,��,,,," leALACounty, Florida; (circuit #) (group or seat #) I am qualified under the Constitution and the La of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public_e- irrtfie state, the term of which office or any part thereof runs concurrent with the fficeek; acrd - = I• ned from any office from which I am required to resign pursuant to Section 99.01F • Statutes' - rioorm I suppo - the Constitution of the United States and the Constitution of the State of Flo 'do: Vi % 5 ., l 23 All ib4"/ ( 7 ex,f,AAckorg ft 4 / r Cand• • • Telephone Number Email Address 74r I ‹roc . ec 3 Address ity State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): //A lip ,3(c () * 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): e . STATE OF FLORIDA COUNTY OF PPt L-M Be.A,pN Sworn to (or affirmed) and subscribed before me this 67 day of NOVe irY1 , 20 _ 5 . Known: &V or Y I1; Personally nature of Notary Public Produced Identification: 'Tint, Type, or Stamp Commissioned Name of Notary Public Type of Identification Produced: Y "r;', JANET M. PRAINITO *: dhl : +': MY COMMISSION # FF 142411 • ''' a EXPIRES: September22 2018 ' Bnnded Thni AIM= PAH. 1 lnri n r..ifn.c DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C. ` J Th - City :'f Boynton ,.-' :, ch ,-iii ( City Clerk's Office c `'; 100E BOYNTON BEACH BLVD �. c-)-=i* =i f� BOYNTON BEACH FL 33435.: o 0' ilej (561) 742 -6060 0 � , - n cG `�� -� FAX: (561) 742 -6090 r rncp �� r „� ' r E -mail: prainitoj @bbfl.us --1 7:a °- www.boynton- beach.org = CM --1 ox PUBLIC NOTICE -, cx TO: CANDIDATES, POLITICAL PARTIES AND OTHERS NOTICE IS HERE ' :Y GIVEN that the Logic & Accuracy (Li A) testing of the voting equipment to be used in the March 15, 2016 General Election will be held: Wednesday, February 24, 2016 © 10:00 a.m. Supervisor ;•f Elections Warehouse 7835 Central Industrial Drive Riviera Beach, Florida RECEIPT h' ,• 0 , ' - reby document- .i° - � ..aillir Sig Date Received DET' CH IF YOU AND /0 °- YOUR REPRESENT A TIVE(S) plan(s) to attend the Logic Accuracy (L wa ' ) testing on ",' ednesday, February 24, 2015 © 10:00 a.m., please detach and return the I. >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 ` o .. �� Palm Beach County yyG Q' OF PAP- - ' "� N....a -- 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 3341S SUSAN BUCHER Supervisor of Elections TELEPHONE: (561) 656 -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 25 signatures on the Nominating Petitions of CARL MCKOY for MAYOR of BOYNTON BEACH 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 CARL G. MCKOY is a registered voter in Precinct 3168, in the cs City of Boynton Beach, Florida. 0 7: 0 C7) - n` ‘s:= ■•• r" CO •"-- 1 Signed, this the 17th day of November, 2015. Q- cxy CZJ SU ' AN BUCHER SUPERVISOR OF ELECTIONS . -PAL B'Ef?�,CH COUNTY (SEAL) cY 112510360 MCKOY, CARL G DEM 3168 69 CITRUS PARK LN BOYNTON BEACH FL 33436 4/29/1962 U M 11/28/1995 11/6/2012 561 22 W CO O W CO CO CO CO .A. CITY OF BOYP.TO BEACH CAMPAIGN TREASURER'S REPOR�PiS fi41�tIFI` R FF CE (1) Carl McKoy 16 JUlo cd si'ottly Name (2) 69 Citrus Park Lane in Address (number and street) Boynton Beach, FL 33436 , City, State, Zip Code 0 111Check here if address has changed (3) ID Number: (4) Check appropriate box(es): e4.7.-- ❑ Candidate Office Sought: Boynton Beach Mayor 0 Political Committee(PC) ❑ Electioneering Communications Org. (ECO) El Check here if PC or ECO has disbanded r 171 ❑ Party Executive Committee(PTY) ❑ Check here if PTY has disbanded � 1=1 Independent Expenditure(IE) (also covers an ❑Check here if no other IE or EC reports will be filed ( 3 individual making electioneering communications) (5) Report Identifiers Cover Period: From 03 / 4,2_ / /(, To -2 / g / /L, Report Type: riginal ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , , . 0 Expenditures $ , , .3 (5, b 6 Loans $ Transfers to c `"-- Office Account $ , Total Monetary $ • D Total Monetary $ , . i(106 In-Kind $ (8) Other Distributions $ , , • (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures o D.te 00 Ar (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) Ce A, = ® j (Type name) (1&," l %A, -- ❑Individual :RI for IE 0 Treasurer C :-.• , urer 0 Candidate 'Chairperson(only •• - TY) or electio Brin: g c �nm_,l - t_ --------- 1111Pr'— ,..•% /11 --"**.-- —. ,1001K.X fes 1�► Sa" Signature �' SIo.,,,K ANL' i DS-DE 12(Re 11/1 ,...�' SEE REVERSE FOR INSTRUCTIONS '` CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES (1) Name Carl McKoy (2) I.D. Number (3)Cover Period 03/ /1 / /67 through / / (4) Page / of (5) (7) (8) (9) (10) (11) 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 21/17/ ,'//S / i a C AO— /c C7 0 "%y -4/C`3.7756 (=� zVA.---c‘ /�- Af /O, o0 //fir//6 r5-5:0 � r /7 /cc U.J 1 � r� e/7�`( /0„ 00 ( 4515 ) cJf eri � /��'j ��ry��C e /3 L�'/ tr/2 33 �3� z e- // / / / c-, cam'; tZD MI rrt c) VC) .;13 co rn DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES