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Filing Papers APPOINTMENT OF CAMPAIGN TREASURER 'I pit L ' i'� ' BEACH ( AND DESIGNATION OF CAMPAIGN ' 's r E fti';", , OFFICE DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) 1 J � 1 1 `® (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): e Initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy 0 Depository 0 Office 0 Party 2. N59 e of Candidate(in • order: First, Middle, Last) 3.Address (include post office box or street, city, state, zip ` `� �' \ C.b,r( code) V3 .1 /4 L-) --- 4. Telephone 5. E-mail address ( 10 ) 6I 3°8 D- _ -e�c� ��te t-mc., >L•C ti r1-^ 0y/6'-'or 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if applicable: s k c 1c, T2) ❑ 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 0 No Party Affiliation ID Party candidate. II QI have appointed the following person to act as my E Campaign Treasurer El Deputy Treasurer C. J. Name Treasurer or Depu asurer 1NP , ICAC( AC1 11. Mailing Address I <=Y1-- 12. Telephone 3 I (0 11\Y -) 1 fAue_ - (9 ) 60/ 3a8� . City 14. Cpunty 1 tate 16.Zip Code 17. E-mail address MittDP L� 6 L 3 3LI 3 k real tti 1.44-.C)Na ►-ral z . 18. I have designated the following bank as my 0 Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address WO SV- ,� 1 (0c_ . :. c-J 1.7 1 City 22. County 23. State 2 Zip Code N$01- 0cM ( ' 35313 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 1 26. Sign re of Candidate • \ \ 5 ao1 X w, ) 1 ' 1 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) r I, I .� iJ ) ,,'c ,( E-10 , do hereby accept the appointment (Please Print or Type Name) yignated abo e as: p Campaign Treasurer Deputy Treasurer. N \\ C 1 d-t)1 q X ,(,/lv („CL V t CAL AlL0,4-0 Date Signa e of Campaign Treasurer or Deputy Treasurer 1 DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C. CANDIDATE OATH — ;I Bt, , ` i Uii BEACH NONPARTISAN OFFICE ('i Ca ER {,'S OFFICE (Do not use this form if a Judicial or School Board Candidate) JAN I5 AM ( i Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, C.- .1100 1fi OcC ACI (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 C:_j -c1 `--0 rek(71 IS 5 i* C%( 3 (Office) (District#) ; I am a qualified elector of \ 1 tY\ I -,eac J 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): I 0(4 (p 7 2 ( f2 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 may be used by persons with disabilities(see instructions on page 2 of this form):[Not applicable to write-in candidates.] golf t X (1,1/1,g1 �0 C�kLa�13)4 )� j't iSreatwsi-i- a'�`�1 /PodSignature of Candate Telephone Number Email Address 31kp ivA) f31- 7-313 Address City State ZIP'Code STATE OF FLORIDA St�ll Q/zJ'�Q- iic ' '")��0' b� fN �uli Signature o otary b e COUNTY OF CPA-1(Y\ uA Print,Type,or Stamp Commissioned ame of Notary Public below: Sworn to(or affirmed)and subscribed before me this 1154 nO rru�r. C►7HEKINECHErsRrcUBErttiuN (y o MY COMMISSION I GG 000932 day of 4 a /_ , 20 1 g i 4 a EXPIRES:dun.12,2020 "Are,0,ct Mod TMs Binet Notify Services Personally Known: or Produced Identification: Type of Identification Produced: A" 1 DS-DE 302NP(Rev.11/17) III Rule 1S-2.0001,F.A.C. RESIDENCY REQUIREMENTS RIP� c c c-rAd candidate for (Print Name) 01-1 rY\Orl 1 c � b ;� ii, �► c1 - 3 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. el*co lam' (Signature f Can. date) (►gate) 11/12/2013 12:31 PM S:\CC\WP\ELECTION\Year 2017\CANDIDATE INFORMATION CD\4. Residency Requirements\RESIDENCY REQUIREMENTS STATEMENT.doc STATEMENT OF -1cT 'Fy cFFa§ `Y CANDIDATE � 10: 14 E 13 J -I � Al, (Section 106.023, F.S.) (Please print or type) , f Nfl IJI C er 0 ��5 ick candidate for the office of E. j �,� iSS i ©moa 3 . have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. • 4„usr,20.,,, yis )ciq Signattire of Candidate D to 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)