Filing Papers Miscellaneous Cash Receipt NO 99147
CITY OF BOYNTON BEACH
L ArE o �
bLACH ~TON 0�P
Account No. 09iH=aQfr MO6 S OF ICE
', ,,f H! QM I I: f1 $ 262.19
^2--000:1-•369--10-00 , 20
Received of MALCOLM D. GROPPER
Address 44 ISLAND DRIVE BOYNTON BEACH, FL 33436
For 1% FILING FEE TO RUN FOR COMMISSIONER — DISTRICT I ON
MARCH 12, 2019
Dept. CITY CLERK'S OFFICE By
Miscellaneous Cash Receipt
No. 92140
CITY OF BOYNTON BEACH311 t of BL
Account No. 01-0000-369-10- O,w ` l 4110, 2n
$ 25.00
, 20
Received of MALCOLM D. GROPPER
Address 44 ISLAND DRIVE BOYNTON BEACH, FL 33436
For CITY FILING FEE TO RUN FOR COMMISSIONER —DISTRICT I ON
DT rrEITCT
MARCH 12, 2019
Dept. CITY CLERK'S OFFICE By
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_ Palm Beach County
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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) 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 33 signatures on the Nominating Petitions of MALCOLM D. GROPPER
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 MALCOLM D. GROPPER is a registered voter in Precinct 4050,
in the City of Boynton Beach, Florida.
Signed, this the 20th day of December, 2018.
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- SUSAN BUCHER c3 c
SUPERVISOR OF ELECTIONS ,�
PALM BEACH COUNTY
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(SEAL)
FORM 1 STATEMENT OF 2018
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: c_';) �..1-c.
Gropper, Malcolm Dennis17- . .
MAILING4slands Dr `�
4 rTt c..
G> ;70
Boynton Beach, FL 33436 Palm Beach
CITY: ZIP: COUNTY:
NAM OFENCY: (p
NAME A Commission, District 1, City of Boynton Beach rn
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
City Commissioner
You are not limited to thyspace on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IFLlit CANDIDATE OR [J 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(gust check one):
0I'! DECEMBER 31,2018 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(must check one):
❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR a 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 SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
Charles Schwab& Co San Francisco, CA • Dividends& Interest
Charles Schwab& CO San Francisco, CA IRA Dostributions
Social Security Austin. TX
Retirement benefits
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"Na")
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") FILING INSTRUCTIONS for when
and where to file this form are
44 Island Dr, Boynton Beach, FL 33436 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 1,2019 (Continued on reveres 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 ENTITY TO WHICH THE PROPERTY RELATES
Stocks & Bonds Various Publicly Traded Companies
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"nia")
NAME OF CREDITOR ADDRESS OF CREDITOR
Charles Schwab Bank PO Box 985605, El Paso , TX 79998
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"Na")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY
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
PART G—TRAINING
For elected municipal officers 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
SI nater , If a certified public accountant licensed under Chapter 473,or attorney
s Ilk , in good standing with the Florida Bar prepared this form for you,he or
�' she must complete the following statement:
I, , prepared the CE
�: Akin ♦ 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 Si..ned:
/7/9/z.67/9 CPA/Attomey Signature:
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
form to that location.To determine what category your position falls MULTIPLE FILING UNNECESSARY:A candidate who files a Form
under,see page 3 of instructions. 1 with a qualifying officer is not required to file with the Commission
Local officers/employees file with the Supervisor of Elections or Supervisor of Elections.
f of cer in they permanently reside. (If you c not WHEN TO FILE:Initially,each local officer/employee,state officer,
permanentlyftheuye in which tIle with the Supervisor of the county and specified state employee must file within 30 days of the
where your agency has its headquarters.)Form 1 filers who file with Appate inohis whoor her mustappointment or of the beginning Seate of mustoile priormeno
the Supervisor of Elections may file by mail or email. Contact your Appointees that confirmedssthan by the days from datee ftheir it
Supervisor of Elections for the mailing address or email address to confirmation,even if is 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 lFinanty, file a finalm l yment.e form (Form 1F) (Finalin 60 days of
your completed form and any attachments as a pdf(do not use any o avian Financial Interests)or employment. Filirelieveng a CE Form 1F igStatement
other format)and send it to CEForml@le state.fl.us. o not file by filew inhis
does rimposition
on the filer r filing a. Form 1
both mail and email.Choose only one filing method. Form 6s will noif the filer was in his or her positron on December 31,2018.
be accepted via email.
CE FORM 1-Effective:January 1,2019. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER
I I 'f OF B(YQ I I Otl BEACH
CITY CLEPIK'5 OFFICE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
i3 NOV2r'i 1151
(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
1.9HECK APPROPRIATE BOX(ES):
i►' 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
code)
C AL
4. Te��lepho%neJ� �l
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
My intent is to run as Write
a -In candidate.
8. If a candidate fora 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.
Q. I have appointed the following person to act as my ® Campaign Treasurer ® Deputy Treasurer
Name of Treasurer or Deputy Treasurer
11. Mailing Address
"7'/"''7` �a�i. I G`I/ e_
12. Telephone
( )
13.ity
14. County
15. State
16. Zip Code
17. E-mail address
18. Khave designated the following bank as my Primary Depository ® Secondary Depository
19. Name of Bank
,---O '7 1
20, Address
Z -,7E?
21. City
22..�County
23. State
24. Z�ipi Code
UNDE4 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
A g^an
I
-` D / Y
27. Treasurer's Acceptance of Appointment (fill in the blanks and ched/k-tKe appropriate block)
1,
v'� , do hereby accept the appointment
(Please Print or Type Name)
isignated above as: Campaign Treasurer Deputy Treasurer.
rw
Date Signature of 4711�,0901reasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) / Rule 1S-2.0001, F.A.C.
I
CANDIDATE OATH —
NONPARTISAN OFFICE
(no not use this form if a Judicial or School Board Candidate)
Teck box only if you are seeking to qualify as a
write-in candidate:
❑ Write-in candidate
Ct `r<< 1F GC o ri i ON BEACH
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
13HON 29 fiij If = 51
OFFICE USE ONLY
(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 boxE]. (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 &::�2 ' _�
(Office) (District #)
I am a qualified elector of �,viy• 1 19441501 44.:f ,8e4e-,'kounty, 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 office
I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes;
- d 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): /%Z`�IIz Qd
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 (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
iL,/,g%z coGM D
re of Candidatl�j ,/,/,I Telephone Number Email Address
,x,,,7V,/ , /*, _--41,
Address City
STATE OF FLORIDA
COUNTY OF I A-1 Rt B646I
Sworn to (or affirmed) and subscribed before me this '1
day of OU &M IL- , 20/8- .
fsonally Known: or Produced Identification:
rab of Identification Produced:
DS -DE 30290 AAV. 11AjY
State
ZIP Code
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
l P ?VB . PAMELA BLANCHARD
*. MY COMMISSION # GG 239854
Po ` EXPIRES: August 16, 2022
• r ....•
FOE a.�. Bonded Thru Notary Public Underwriters
Rule 1S-2.0001, F.A.C.
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of 1
o�FIcFfu§E oNLY S'FACH
UTP( CI_E:,RK'S OFFICL
18Nl0V29 A M I I : 5 1
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
OY
Signatvr'e of? didate 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 (05111)
I,
,,, 41 . i ze C, C'- 4-" -,
candidate for
(Print Name)
6 ne I of the City
(Mayor/Commissioner ® District #)
of Boynton Beach, have received, read and
understand the residency requirements of Article II
of the Charter of the City of Boynton Beach.
(Date)
2/15/18
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