Filing Papers APPOINTMENT OF CAMPAIGN TREASURER `'I ' r Li du`r ti Li bEACH
AND DESIGNATION OF CAMPAIGN CIT .Y CLERK'S OFFICE
DEPOSITORY FOR CANDIDATES 19
(Section 106.021(1), F.S.) ,IAN -7 r � : 9
(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: Ej Treasurer/Deputy (l Depository 0 Office 0 Party
Y
2. Name of Candidate(in this order: First,
Middle, Last) 3. Address (include post office box or street, city, state, zip
// ` -/t1 /Pea/'ea/ ()e-
fie code) /
G' sIl' Lf/�l1 re),-/d / / " ��(� -� �i.-! 7 7`4 /7/tf
4. Telephone 5. E-mail address
8 /� c�
(�I�t
, d-HP S Cc,c,i/'7`G'l'(-'_c�,�.��'/d��S7•Ct?/,; 47 e- j�r� L'_/7 ��-/L-/',
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
c1 L.5 j-ri c:_,t applicable:
0 0 m all 1 5 S to e_r '(1r-r- ❑ 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
0 Write-In Er No Party Affiliation 0 Party candidate.
Q. I have appointed the following person to act as my E Campaign Treasurer 0 Deputy Treasurer
' Name of Treasurer or Deputy Treasurer/
C OLIr //ane TOC/�-f'/
/iiL ' ei
11. Mailing Address 12. Telephone
/ 5 7M /Gem
( )
13. City i 14. County 15. State 16.Zip Code 17. E-mail address
/3
j / 74 /041 /'ter/in,�c-, /- 33-2.f3,5
18. I have designated the following bank as my 0 Primary Depository 0 Secondary Depository
19. Nam of Bank A 20.Address
Etc/
21. City 22. County 23. State 24. Zip Code C
edit, &n.C l L PAL i.Ptit 71/ /e / c&rP fais4-/L 3
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 f Can/dida/ttei
�
27. Treasurer's Acceptanceptfof Appointment (fill in the blanks and check the appropriate block)
I, C 6)",I-l ein II- ,M6"anC PIL/ 7)e , do hereby accept the appointment
(Please Print or Type Name)
,signated above as: Campaign Treasurer 0 Deputy Treasurer.
/ •• `-t . 4U/.9 X a.7#7 ,-,__,
tDate Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE;tO P QlJ.L'd i UN BEACH
STATEMENT OF ell CLERK'S OFFICE
CANDIDATE 19 JAN -7 AM 10: 9
(Section 106.023, F.S.)
(Please print or type)
A-04 t re__
candidate for the office of G 417)l,'5-5-1 n01e` �� /, . f ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x c I / /,
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(05/11)
RESIDENCY REQUIREMENTS
-'
-,
(_ -<C:
c_)
rn
=,* u;
o�
I, C n 24(1/ail /1A11)2-z-1 candidate fore Pi
(Print Name)
G
1'1 C o on ; s S � o v� � � _Er 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.
ditt
(Signature of Candidate)
II
(Date)
11/12/2013 12:31 PM
FILENAME \p S:\CC\WP\ELECTION\Year 2017\CANDIDATE INFORMATION CD\4. Residency Requirements\RESIDENCY
REQUIREMENTS STATEMENT.doc
CANDIDATE OATH -
NONPARTISAN OFFICE Jil i CITY c( EFcf r l �''� �ACH
'S OFFICE
(Do not use this form if a Judicial or School Board Candidate)
19 jii -7 AMM. 4n
leek box only if you are seeking to qualify as a
write-in candidate:
E Write-in candidate
OFFICE USE ONLY
Candidate Oath
7 (Section 99.021(1)(a), Florida Statutes)
I, oar,"// moi, le'Qa/ i /'e,
(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 49,17/17 i �.5/C....' 4 - A7451417 e.--,71 11/ ,
(Office) (District#)
f,i f '1-_ ;I am a qualified elector of 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;
'Ind 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): /10/ 7 S cj_ 9
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as maybe used by persons with disabilities(see instructions on page 2 of this form):(Not applicable to write-in candidates.]
9 51 c- e/'/ ?reJ/ —'.I //.
X Alai (�tAtar
( 4 e3 “4.1-9
Signature of Candidate Telephone Number Email Address
r/9 ,-7d .27Y ' P/eZ ,e3,.y %7/9 5 ,, A , /G 5 : it 3
Address City State ZIP Code
STATE OF FLORIDA
���.
Signature of Notary Public
COUNTY OF ,v,---/7/77 L:3�'C'2 Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to or affirmed)and subscribed before me this G ' , a t ANN MEDINA
Notary Public,State of Florida
day of 1_, , 20 l 9. $ �„
.— Commission,/GG 30107
y "�`o My comm.expires Sept.13,2020
l �rsonall Known.: or Produced Identification:/�
Type of Identification Produced: fL.be•
DS-DE 302NP(Rev.11117) Rule 1S-2.0001,F.A.C.
0 '�I'i 'i iii- BLi i'i !uii p`ALti
CFI Y CLERK'S OFFICE
WAIVER OF REPORT
(Section 106.07(7), F.S.) n FEB l i All I l : FF,
(PLEASE TYPE)
OFFICE USE ONLY
L.1
°II tr-4. R VI 4+- Lill C -- CA'1(,
Name Office Sought
ki gi(9)i. hv) l&-B14/1 -F1-- :3- ft5i-
ddress City State Zip Code
Candidate L Political Committee ❑ Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a
waiver)that no reportable eontnbutions or expenditures were made during the reporting period(s. 106 0703(6),F.S).
n Check here if address has changed since last report J-Ch here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
MONTHLY REPORT 7 PRIMARY ELECTION [1 GENERAL ELECTION ❑ OTHER REPORT TYPE
Indicate report# Indicate report# Indicate report i Indicate report type and#
as applicable:
M P 0
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
THROUGH r-e/i 21/7
X ( j.1.1/ / g / %� --
.- ,r./' r Date
Sig :tune rr
x ----
• Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman(s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has g been no activity int a aed ccount ti tt((no funn the ds expended or
received)the filing of the required reportrescribed
ris
date that no report d. However, the is being filed.
r be Heti!
DS-DE 87(Rev.06/15)