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Filing Papers APPOINTMENT OF CAMPAIGN TREASURER CITY OF BOYNTON BEACH AND DESIGNATION OF CAMPAIGN CITY CLERIC'S OFFICE DEPOSITORY FOR CANDIDATES 16 SEP 29 PH12: ?R (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 akiECK APPROPRIATE BOX(ES): Initial Filing of Form Re-filing to Change: (] Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name /D andida a (int 's order. irst, Middle, Last) 3. Address (include post office ors eet;ci , state, zip code) a i 6 ii c i 4. Telepho e P . E-mail addr ss (5 / ) r c �► C-3 C 3`6Office sought (inP3/0-ig-3 e district, circu. ,"grou number) 7. If • candidate for a nonpartisan office, check if applicable: flS 1 c- 0)1541� ❑ My intent is to run as a Write-In candidate. 8. If a candidate for a p isan 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 Er Campaign Treasurer ❑ Deputy Treasurer 10. Name o Treasur or yly s rer jr ,/ L 11. Mailin dre s / 12. Telephone M L Jf/ / DI( )? -Q14. u ty 1 St to 16. Zip .ode 17. E-mail address „)(,,, 4, rh_o, ihX C-0/1 1 . I ave designated the follow'n bank as myPrimary Depository Secon ary Depository g 9 ❑ ❑ 19. :..- of Ba 20. Address P Ft&A,-/ ' 21. ' it/ 74 pty 23.,g/t5 �' 24. I. •de/ ovil 1rH ( f UNDER PEN: IES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTME► •' CAMPAIGN REASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T ' - S S • IN IT A- UE. .„0„.?, 25. D 2.. ignature of f <•• :ate ,,,4,4, // x ,. 27. Tr s eA Ac ept c o pointme t (fill I bl-nks an. - - the a-•ropriate %lock) 1 1 ( , do hereby accept the appointment eas int or ype N me) designated ab•ve - V Campaign Treasure ,epu reasur:r. / X / /� / , /L' > ,� 1 Date( ..g - u • C- -•-'= Treasurer • Deputy Treasurer DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) Nrei( 4,1 candidate for the office of i)V have been provided access to rea and understand the requirements of Chapter 106, Florida Statutes. c)c ( c Can4i. -te 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 N r'Q7 c) ® --=Cry 4(6 I, , candidate for offrii, ',Print me) 1SS Na/ of the City (Mayor/Commissioner— District#5 Beach, have received, read and understand the residency requirements of Article II of the Charter of the City of Boynton Beach. del. ,.''A.- -4 ._ ( ire b 'andi iF I, fir 176 (Date) 11/12/2013 12:31 PM S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc