Filing Papers Miscellaneous Cash Receipt 't"0,„
0�
No. SP152
CITY OF BOYNTON BEACH ACF
t� ct}� ,'•�S �F4 SCE o t11' C ` TpN
Account No. 001.-0000-369-4,9790 : dig •
$ 262.19
, 20
Received of MICHAEL FITZPATRICK
Address 175 SW 2ND STREET BOYNTON BEACH, FL 33435
For 1% FILING FEE TO RUN FOR COMMISSIONER — DISTRICT III ON
MARCH 12, 2019
Dept. CITY CLERK'S OFFICE By
Miscellaneous Cash Receipt
CITY OF BOYNTON BEACH No. 9215 :;
111' OF B1 ; , 1 'r' BE n U
OFrIC'"Le-
•ON O
Account No. 001-0000-369-1 g0-0E
$ 25.00
, 20
Received of MICHAEL FITZPATRICK
Address 175 SW 2ND STREE! BOYNTON BEACH, FL 33435
For CITY FILING FEE TO RUN FOR COMMISSIONER — DISTRICT TIT ON
MARCH 12, 2019
Dept.CITY CLERK'S OFFICE By
CANDIDATE OATH —
NONPARTISAN OFFICE jl �1r
(NIoil BEACH
(Do not use this form if a Judicial or School Board Candidate) i 1 "4ti OFFICE
.leck box only if you are seeking to qualify as a r13
As] 1 0
write-in candidate: V ID: SR
El Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a),Florida Statutes)
I, fil'ckcae1I Fi'4 2.p Q+,f, ic..�
(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 D. (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 1) e" bt}a vt 16r,,a. C" L `)fi dam bt •'roit, J"7
(Office)
/1 1 (District#)
;I am a qualified elector of 1'a 1 I/14. .c 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
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;
and 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): 112. / II / q6
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.]
I/14 Et k L F / -2, p A Tru k.
Xe iI.L `r )56 / -- 632— 15 �'
7 ? �� �z. � -.��wlp7 ®for,f.
Signature of Candidate 1 C mTelephone Mumber Email Address
175" S w kat ST 6,c, c w40 L,1 6e4c,L PL 333
Address City State d 5
Code
STATE OF FLORIDA
?kill
'L� eSig ure of NotCo mPublic
esionCOUNTY OFPrint,Type,or Stamp Commissioned Name of Notary Public below
Sworn to(or affirmed)and subscribed before me this I D Queenester Nieves
day of_ 3 n.C*dj ,20 I q 494:47% Notary ester States Florida
/ Queenester Nieves
`ersonaly Known: or Produced Identification: ✓ +� Ex Commission 22 210021
�i�A� Expires 07!1612022
Type of Identification Produced: 1 I Uri ckt -DA;VQ.... I j ce-A-S R.
DS-DE 302NP(Rev.11117) "• ..,
Rule 18-2.0001,F.A.C.
FORM ! STATEMENT OF 2018
Pin"if"iv IV*ru°t"I".mai". FINANCIAL INTERESTS 1 FOR OFFICE USE ONLY:
didniss,vinoy name,arld 0.41tion b•low:
I LAST NAME--FIRST NAME--MIDDLE NAME.
Fitzpatrick Michael Martin
wiLiga ADDREsa
175 SW 2nd Street
CITY
ZIP - COUNTY
Boynton Beach 33435 Palm Beach
NAME QPAGENC.Y
City of Boynton Beach
Ty:
NAME OF OFFICE OR POSITION HELD OR SOUGHT
City Commission, District 3
:Tr —r-r-
c-).>
rri
You aro not lintllati kr the opium on So.Moo on this Wm.Attach additional•Aolta.It eimiamnini. C)
=T.
CHECK ONLY IF (ji CANDIDATE OR 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(must check one)'
DECEMBER 31,2018 QB U SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPONTAIII-E 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 at 511 DOLLAR VALUE THRESHOLDS
PART A-PRIMARY SOURCES OP INCOME (Moor sources of Income to the reporting person•See Instructions)
(If you hive nothing to report,write"none"or"nil")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
Reg ions Bank PO Box 1687; Birmingham, AL 35201 FF Pension
US Government Washington Social Security
PART I- SECONDARY SOURCES Of INCOME
Nisior customers,clients,and other sources of income to businesses owned by the reporting person-See instructional
(if you hove nothing to report,write"none"or"Ws")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
N/A
PART C-REAL PROPERTY (Land,buNdIngs owned by the reporting person-Se*instructions)
(If you have nothing to report,write"none"or"Ala") FILING INSTRUCTIONS for when
and where to file this form ere
101 SW 4th Ave; Boynton Beach, Fl 33435 located at the bottom of page 2.
INSTRUCTIONS on who must file
237 N Deer Isle Rd; Deer Isle, ME 04627 this form and how to fill It out
begin on page 3.
CF Foam I-!So*,, Andy ,0111
(0••••••••in myna*won
PnOE
incorporated of reload*.4'1 344 20211),F AC
PART 0--INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions)
(I you have nothing to report,write"none"or"nfa"j
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
See attached
111111111111111111111111111111111111111111111.1111111111111111111111....1
PART E—LIAIIUTIE$ (Major debts-Sae Instructions(
(If you hire nothing to report,writs"none"or"Nab
NAME OF CREDITOR
See attached ADDRESS OF CREDITOR
11111111111111111111111111111.1111111
PART F"-INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions In certain
(E you have nothing""rt
nlport;write"none•o►"rva~► BUSINESS ENTITYht of businesses-See Instructions]
OF BUSINESS ENTITY N 1 BUSINESS ENTITY S 2
None
ADDRESS OF BUSINESS ENTITY
POSITION HELD WITH ENTITY
11111111111111111111111111111
I OWN MORE THAN 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST IIIIIIIIIIIIIIIIIIIIIIIIIIIII
-�
PART O—TRAINING N•t - . .I . .I- I I -I- -s
For*Meted municipal officers required to complete annual ethics training pursuant to section 112.3162,F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH 0 ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
El
■ e ; ► C ► ; 61
Signature:
in pool standing with the Florida if a certified public accountant
licensed under Chapter 473.or attorney
she must prepared this form for you,he or
' complete the following statement;
•
I,
.+/. Form 1 in aocordan0e with Stolon 112.9145 F prepared the CE
instructions c the rd form.Upon Florida Statutes,and the
Date Signed:
disclosure herein Is true asonatllt krw�Nedpt and belief,the
J A l , c9 l �? CPArAttomsy signature
v 1 Date Signed:
F'It.[NG jfNQTR 1 TlOfiT�
If you were mailed the form by the Commission on Ethics ora County Candidates file this form together with their Illi
Supervisor of Erns for your annual disclosure filing, nature the rep paper.
form to that location. To determine what category your position falls I with a Lta FILING UNNECESSARY:inot required
A candidate who fuer a Form
under,see papa 3 of instructions: 1 with a visor yi officer is not
Local officers/employees or Supervisor of Elections, nsquired to file with the Commission
's ployees fde with the Supervisor of Elections
of the county In Which they ppeermanently reside, (If not WHEN TO FILE:Initially, each local officer/employee,state officer,
permanently reside in Florida, fib with the Supervisor of°u mount and specified state employee must file within 30
where your agency has fit headquarters,)Form 1 filers who fib ` date ofrehis or her appointment or of the beginning days
oy°m.n
the Supervhcx of Elections may file by moil or email: Contact your A� tees who must be confirmed byy the Senate mus�le
Supervisor of Elections for the mailing address or email address to confirmation,even if that is less than 30 days from the date ofitheU
use. •. ,• it J,, t.stn . tI 'in!, ..•i ,.r ,i.,H. 1 ,i_ confer t tion
arignila
Candidates must Mie at the same time they file their qualifying
t Mrd state employeas who file with the papers,
State officers or a
Commission on Ethics may Mie by mail or small. To file by mail, T
tend the completed form to PO. Drawer 15109, Tallahassee, FL hold r'rap, file by July 1 following each calendar year in which they
3231Y-bTOg; physical address: 326 John Knox Rd, Bldg E, Ste 200, positions.
3230-5709 FL si32sal To file with oe CommissionKnoxR email, sign Finally, tile a final disclosure form (Form 1F) within S0 days of
Talahasseyour
err l and to any E attachmentschas a pdt(do not use any leaving inan a!nteror ests)employment Filing relieve theof filing al CE Form 1
o• e u . ,,.and send
. �; t
. eg.state.fi.us. rep
• pticap -d a amai,
' ,i `'� ii is. I... Form ds no if the filer was in his or her position on December 31,2018.
♦.Farm 1.@ir.U'v. JWW}�!�,1,200)
airs 2
Inti, .gp 01' M 244 XVIII.F A G.
cx
Form 1 Statement of Financial Interests 2018
Addendum
For Michael Fitzpatrick
Part D Intangible Personal Property
Checking Account PNC Bank
Checking Account Wells Fargo Bank
Checking Account Bar Harbor Bank &Trust
DROP account Boynton Beach Firefighters Pension Plan
Retirement account Florida Retirement System
Part E—Liabilities
Juan Mocci 2833 SW 4th Street, Boynton Beach, FL 33435
PNC Bank 1520 S Federal Hwy; Boynton Beach, FL 33435
Wells Fargo Bank 1600 S Federal Hwy; Boynton Beach, FL 33435
t
c
of
CO
Fri
fyPd`
g .. Palm Beach County
4 pF Pp y
240 SOUTH MILITARY TRAIL
WEST PALM BEACH, FL 33415
POST OFFICE BOX 22309
SUSAN BUCHER WEST PALM BEACH, FL 33416
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 30 signatures on the Nominating Petitions of MICHAEL MARTIN
FITZPATRICK for CITY COMMISSIONER, DISTRICT 3, 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 MICHAEL MARTIN FITZPATRICK is a registered voter in
Precinct 7186, in the City of Boynton Beach, Florida.
Signed, this the 4th day of January, 2019. 2
r-
,,Zzoct/r.
o ;Y
SUSAN BUCHER
SUPERVISOR OF ELECTIONS E. �
PALM BEACH COUNTY �•
' -�
:n
m�
(SEAL)
APPOINTMENT OF CAMPAIGN TREASURER
;{ }U; E3li Y i U BEACH
CLE:RI(' S OFFICE
AND DESIGNATION OF CAMPAIGN
CI i Y
DEPOSITORY FOR CANDIDATES
1 I\a 20 PIS ' - 4
(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. Name/ of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
ml c,k a 21 m c.r-I'1 el P; � z joc&V' i ck
code) 17 S .S L-D a
o + ovt R e
4. Telephone 5. E-mail addressQ
ii
-�t+2peirer-L 7(
3 3V35
G I -al. Ce_-L,\
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
Q oy vL� bh t3 e4�� C: Y Coves ,vl, �5 1% 3
applicable:
❑ My intent is to run as a Write-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
F❑ Write-In E] No Party Affiliation ❑ Party candidate.
a. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
Na
Te of Treasurer or Deputy Treasurer
o5�rtt��Z1�
11. Mailing Address
12. Telephone
911
1(-541 )
13. Qity
'ICUfNioN�Pl.
14. County
)991n bow
15. State
T)_1
16. Zip Code
331135
17. E-mail address = ,
ffOE66LoXG • &9W
18.1 have designated the following bank as my [ Primary Depository ❑ Secondary Depository
19. Name of Bank
PNC a �t, (c
20. Address
/ 5 Zo $ . e�2 enc 1 ��
21. City
Q oy ✓1. �vK.
22. County
I",t Q, e 4e, L,
23. State
rL.
24. Zip Code
33 c/
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. Signature of andidate -.
O &1O(9
a
x11
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, SOMM;F, AEF
do hereby accept the appointment
(Please Print or Type Name)
�signated above as: 29 Campaign Treasurer ❑ D Tre urer.
Date Deputy Treasurer
DS -DE 9 (Rev. i0110) / Rule 1S-2.0001, F.A.C.
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
A,e mS�+�-,-�
Cli {�f' f3 T'fi(Ci i BEACH
A R
CII I CLEP%K S OFFICE
AND DESIGNATION OF CAMPAIGNDEC
10 PM 2; 9 4
DEPOSITORY FOR CANDIDATES
(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`"��am��e of Candidate (in this order: First, Middle, Last)
3. Address (include post office b-ofx� or street, city, state, zip
/ - ic�,&l &- --�ZrJ4i�vYG�
code) / %S
o y n 1,o Art J 3�
4. Telephone
5. E-mail address
-`��r°w-I-WI-L-W,
7g
Cf m
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
���h �, _j �p ems. ` 4 a`S�
l
applicable:
is to Write-in
❑ My intent run as a 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. 1 have appointed the following person to act as my ❑ Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address
12. Telephone
13. City
14. County
15. State
16, Zip Code
17. E-mail address
18. 1 have designated the following bank as my IN Primary Depository Secondary Depository
19. Name of Bank
rt, L
20. Address
d G m o S. -jTe A&VV&
21. City. 22. County
V1l, O `f ✓l,- ,o 10ao-I Vr L
23. State
FL
24. Zip Code
3 , q36 -
3b`UNDER
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIJ TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
14
25. Date
26. Signature of andidate
9' c 2 a► S
4 7-;
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer ® Deputy Treasurer.
X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
9 December 2018
Mike Fitzpatrick
175 SW 2"d Street
Boynton Beach, FL 33435
561-632-9578
To: Boynton Beach City Clerk office
Subject: Location of Campaign Bank Account
Hi Judy,
When I filled out and submitted the DS -DE 9 form I listed PNC bank as my designated bank.
When I went there to open my campaign account, they refused to open an account without an IRS
Employer Identification Number.
Therefore I went across the street to the Wells Fargo bank to open the campaign account. They were
also squirrely about the lack of an EIN, but ended up opening it using my 2016 campaign account as a
template.
I do not know which form to show this change. To be on record of the change I am writing this note and
filled out the appropriate information on a second DS -DE 9. If I need to do something else, please let me
know.
Sincerely,
N 77
J�/r
Mike Fitzpatrick
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
Ci'I9FffCg«WS�Fr ,L[ACH
CITY CLERK'S OFFICE
'13 NOV 20 Pik 1= 44
candidate for the office ofg � o� e� y (�,�„� 1� �'s 3
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X m A) v,2,9 t
Signature of Candidate 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)
RESIDENCY REQUIREMENTS
of Boynton Beach, have received, read and
understand the residency requirements of Article II
of the Charter of the City of Boynton Beach.
(Signature of Candigfe)
�o /idv '�-c9 l�
(Date)
2/15/18
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENTAOC
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, candidate for
(Print Name)
69 1 5s 1 o kle f �
� %s�' � � �+ 3
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.
(Signature of Candigfe)
�o /idv '�-c9 l�
(Date)
2/15/18
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENTAOC