Filing Papers Miscellaneous Cash Receipt ` Y 0,t•
No. 92145
CITY OF BOYNTON BEACH
O
4.~TO N
Account No. 001-0000-369-10-00
$ 262.19
,.20
Received of JUSTIN KATZ
Address 1353 VIA DE PEPI BOYNTON BEACH. FL 33426
For
1% FILING FEE TO RUN FOR CO vomr`- 1D�SsTRI(yT I ON
313d0 , % .
MARCH 12, 2019 H3V38j 'I)
Dept. CITY CLERK'S OFFICE By
ter. z x to ,
Miscellaneous Cash Receipt 6`t" � �,
CITY OF BOYNTON BEACH N O' 9 O
to
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Account No. 001-0000-369-10-00
$ 25.00
,.20
Received of JUSTIN KATZ
Address 1353 VIA DE PEPI BOYNTON BEACH, FL 33426
For CITY FILING FEE TO RUN FOR COSKIISfia0iiElta itaiSTRI-CT I ON
MARCH 12, 2019 J01JJ0 S.`1w)11 All:)
Dept. CITY CLERK'S OFFICE By
CANDIDATE OATH —
it t Y U,t 8tr Yiy r` �� tjE�tiCtf
NONPARTISAN OFFICE CITY CL � K,S OFFICE
(Do not use this form if a Judicial or School Board Candidate)
.ieck box onlyyou are seekingto �� JdN �$ P 4: f ,
if qualify as a
write-in candidate:
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
1 (Section 99.021(1)(a), Florida Statutes)
I, .'---SVA 3- c \2CA*2..
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of J 10`c 1 t,k \ C ii- Qv�►�1 tiwi
(Of )t liiT v .,(5<o<1,-, (District#)
I am a qualified elector of cbcb C Th 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 I
have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office
I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes;
qnd I will support the Constitution of the United States and the Constitution of the State of Florida.
Candidate's Florida Voter Registration Number(located on your voter Information card): 1 I � 3 t21?0
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as may be used by persons with disabilities(se inst ctions on page 2 of this form):(Not applicable to write-in candidates.]
c...,_ .,
X j
\(.
( (5‹I) ra -T. 0 4 0 i -81. h-i--1-1-,,-4 -a—tnrA, , ei)no/(6."---
Sigelk:f !date Telephone Number Email Address
137'3 ())d A- �Ep ; ry %L- fL »N 26
Address 1'
4000m.,..iiim
ZIP Code
STATE OF FLORIDA
Ic
(�i� 1I Signature• • Public
d'{
COUNTY OF ' 'i'y. 0(4-` Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me this`61.'1 ,,PRYPo6z, SHAYLAS.ELLIS
= ;...
�� * �_j *MY COMMISSION#GG 031774
day of ti Jr'lN�� n 7, 2 0 ,n, '"Ilio` EXPIRES:September 19,2020
Irsonally Known. or P. �a e 4 entice 9'Far ry Boned Thry Budget Notary Services
I -type of Identification Produced: ..DS-DE 302NP(Rev.11117) Rule 1S-2.0001,F.A.C.
Compound Last Names
If your last name consists of two or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to
check the box, your name will be listed with the name appearing last on the line. Example: John Jones Smith—If the last name has
no hyphen and you do not check the box,the last name on the ballot would be"Smith". If you check the box, your last name woul
be listed on the ballot as"Jones Smith." If you have a hyphen within your last name,the last name would be listed as"Jones-Smith.
Guide for Designating Phonetic Spelling
of Candidate's Name for Audio Ballot
1. Use tables below.
2. Use upper case for"stressed"syllables. Use lower case for"unstressed" syllables.
3. Use dashes (-)to separate syllables.
4. Add any notes such as rhyming examples, silent letters, etc.
Vowels
Stressed Vowel Sounds Unstressed Vowel Sounds
EE (FEET)feet uh (SO-fuh)sofa(FING-guhr)finger
I (FIT)fit
E (BED) bed
A (KAT) cat(KAD)cad
AH (FAH-thur)father(PAHR) par
AH (HAHT) hot(TAH-dee)toddy
UH (FUHJ)fudge(FLUHD)flood
UH (CHUHRCH) church
AW (FAWN)fawn _Certain Vowel Sounds with R
U (FUL)full AHR (PAHR) par
00 (FOOD)food ER (PER)pair
OU (FOUND)found IR (PIR) peer
O (FO)foe OR (POR) pour
El (FEIT)fight OOR (POOR) poor
Al (FAIT)fate UHR (PURR) purr
01 (FOIL)foil
YOO (FYOOR-ee-uhs)furious
Consonants
B (BED) bed R (RED)red
D (DET) debt S (SET)set
F (FED)fed T (TEN) ten
G (GET)get V (VET) vet
H (HED)head Y (YET)yet
HW (HWICH) which W (WICH) witch
J (JUHG)jug CH (CHUCRCH) church
K (KAD) cad SH (SHEEP)sheep
L (LAIM) lame TS (ITS)its(PITS-feeld) Pittsfield
M (MAT)mat TH (THEI) Thigh
N (NET) net TH (THEI) Thy
NG (SING-uhr) singer ZH (A-zhuhr) azure (VI-zhuhn)vision
P (PET)pet Z (GOODZ) goods(HUH-buhz-tuhn) Hubbardston
Examples of Phonetically Spelled Names
NAME ON BALLOT PRONOUNCED AS
Mishaud mee-SHO('d'is silent)
Jahn HAHN(rhyme:fawn)
Beauprez boo-PRAI(rhyme:hooray)
Maniscalco man-uh-SKAL-ko
Tangipahoa TAN-ji-pah-HO-uh
Monte. Mahn-TAI
I Tanya • TAWN-yuh(not TAN)
DO riot submit this'page to the filing officer.
DS-DE 302NP(Rev. 11/17) Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT OF 2018
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LA T N ME--F ST NAME-- DLE NAME y.:
M�ILIN ADDRESS: V ;"')
t�7
?)(ctiAct
1l�i �ki ,CITY r/ ZIP: COUNT: �• 7
,,,,..:
NAME OF AGEN '
f51
NAMV OF OFFICEORPOSITION HELD(t SOUGHT: P n
S) t �1v 1 -' C��- �' rn'
1'1�!!t? r'r. =
You are not limite to the space on the lines on th{ form.Attach additional sheets,if necessary.
CHECK ONLY IF CANDIDATE OR jJ 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
YEAOR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITH ust check one):
DECEMBER 31, 2018 OR U 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(must check one):
❑ 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"nla")
NAME OF SOURCE SOURCE'S V DESCRIPTION OF THE SOURCE'S
O 9OF INCOME ��� rpt ADDRESS�D•7J / PRINCIPAL BUSINESS ACTIVITY
)t '-iv'lLi-.. ;36i dlfQ� +�[- vi J 1h1A)1 10.Arlrrit(�P,)1 y
QccL . a _. 71y 5 rie ct` rrl:e rikb i i.` Vk/ kI�
Ci)‹: 1A41 NI-i c - 3366 �- 'Ul It '3)cIv q 1idV Ci 5T<lislist' -1 /w.,
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
14 1111 N I1's. 14 //4
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
,, located at the bottom of page 2.
lb-3 £JJ 0� 4/ 1�4/\, ' ,�L 5 312,x.
/ F�{,) J f INSTRUCTIONS on who must file
,3143•E'
'�, 5' I' ''i 59 iN 't iC h I 3:31435 this form and how to fill it out
1 / {/ I iJ�'/ f' / begin on page 3.
CE FORM 1-Effective:January 1.2019 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1),FAC.
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_, y
NESS ENTITY TO WHICH THE PROPERTY RELATES
(
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
MINT Irv? l�Y'i i 'Y �, \ ( t 7 /e 41 it Lob I VPI 'U 3 s S
PART F—INTERESTS IN SPECIFIEDBUSINESSES [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
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY t ' J
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G—TRAINING
For elected m icipaiofficers required to complete annual ethics training pursuant to section 112.3142,F.S.
I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
Signatur • If a certified public accountant licensed under Chapter 473,or 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 Signed:
j < - CPA/Attomey Signature'
(
id611
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls
under, see page 3 of instructions. 1 with qualifying officer is not required to file with the Commission
or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not 1Y
permanently reside in Florida, file with the Supervisor of the county anddate of hisspecioord herate employee must thee beginning
30 days of the
where your agency has its headquarters.) Form 1 filers who file with Appointees who must beappofmnft or of e Senate of mustide prior
the Supervisor of Elections may file by mail or email. Contact your that is less than by the days from datee ofith it
Supervisor of Elections for the mailing address or email address to confirmation, even if less 30 from the of their
use. Do not email your form to the Commission on Ethics, it will be appointment.
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter, file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200,
Tallahassee, FL 32303. To file with the Commission by email, scan Finally,lngofficefile a finalemployment.disclosure form (FormF 1F) F within(Final Statement dof
your completed form and any attachments as a pdf(do not use any o Fipag torq s*.).dcesFiling a CE Form 1F iler of filing
g
other format)and send it to CEForm1@leg.state.fl.us. Do not file by if t �t11 riWasstitrhi'or li �so rtibnlon Deceeve the fmber 31,018. Form 1
both mail and email. Choose only one filing method. Form 6s will not
be accepted via email.
3ai��� c a = ITO A ' H
by reference in Rulve: e 34.8 .2020 N3' —38
),F.A.C. j .�, -�
1. � �,I v PAGE 2
Incorporated
F (4 OF FSO
(., , i 1 i Palm Beach County
lv,!'OF ri
240 SOUTH MILITARY TRAIL
WEST PALM BEACH, FL 33415
POST OFFICE BOX 22309
WEST PALM BEACH, FL 33418
SUSAN BUCHER
Supervisor' of Elections TELEPHONE: (5613656-6200
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 32 signatures on the Nominating Petitions of JUSTIN KATZ for CITY
COMMISSIONER, DISTRICT 1, FOR THE CITY OF BOYTON 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 JUSTIN KATZ is a registered voter in Precinct 3187, in the City
of Boynton Beach, Florida.
n--
,f,) :77;--(
Signed,
-Signed, this the 8th day of January, 2019. i-„ -`,
1 4
s--- r-MI
2e,t,00/n I
C3 71'
Vis,.z.
C? Cly ;
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SUSAN BUCHER r eco
SUPERVISOR OF ELECTIONS
v m c`->
PALM BEACH COUNTY
(SEAL)