Filiing Papers CIJY 9FFEJ9qACZA(AViqH
STATEMENT OF CITY CLERK'S OFFICE
CANDIDATE 16 DEC I 4 Ph3: P.8
(Section 106.023, F.S.)
(Please print or type)
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candidate for the office of 4,upii1 .5,,/a4?2_ 2. ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X OPT /
Signature of Candid- - 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)
1
- RESIDENCY REQUIREMENTS
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4 I QUO -�� I , r candidate for
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(Print Name)
g¢Gi 2 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.
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(Signature cf Candidate)
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(Date)
11/12/2013 12:31 PM
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc
APPOINTMENT OF CAMPAIGN TREASURER CITY OF BO YNN TON BEACH
AND DESIGNATION OF CAMPAIGN CITY CLERKS OFFICE
DEPOSITORY FOR CANDIDATES 16 KW —3 PH 1o: 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 p Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Woodrow Lewis Hay code)
427 N. W. 5th Ave.
4. Telephone 5. E-mail address Boynton Beach, FL 33435
(561 ) 732-9484 woodrowhay@msn.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
City Commissioner, District 2 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 Q Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Woodrow Lewis Hay
11. Mailing Address 12. Telephone
427 N. W. 5th Ave. ( 561 ) 732-9484
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Boynton Beach Palm Beach FL 33435 woodrowhay@msn.com
18. I have designated the following bank as my ❑X Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
IBERIABANK 1101 North Congress Avenue
21. City 22. County 23. State 24. Zip Code
Boynton Beach Palm Beach Florida 33426
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Signatur of Candidate �
11-3-2016 X f-jj
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
Woodrow Lewis Hay , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑X Campaign Treasurer Deputy Treasurer.
11-3-2016 X
Date Signature of Camp-..n Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER CII Y OF BOY/t1Ti) { �t
CITY C.ERiyS DFF CE4H
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR ICANDIDATES 16,NQV_3 P(Section (1), F.S.) . R
(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):
0 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
Woodrow Lewis Hay code)
427 N. W. 5th Ave.
4. Telephone 5. E-mail address Boynton Beach, FL 33435
(561 ) 732-9484 woodrowhay@msn.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
City Commissioner, District 2 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 E Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Woodrow Lewis Hay
11. Mailing Address 12. Telephone
427 N. W. 5th Ave. ( 561 ) 732-9484
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Boynton Beach Palm Beach FL 33435 woodrowhay@msn.com
18. I have designated the following bank as my ❑X Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
Bank America 100 N. Congress Ave.
21. City 22. County 23. State 24. Zip Code
Boynton Beach Palm Beach Florida 33436
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Signatur of Candidate
11-3-2016 X 17
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
Woodrow Lewis Hay , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer Deputy Treasurer.
11-3-2016 X
Date Signature of Campaig Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.