Egerton Bell Papers OFFICE.USE,O CN
STATEMENT OFcEr
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
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candidate for the office of D ' s ;c )1. C ►r7rn ISSA •
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
d -, b— o
Signature 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(05/11)
i Ui BU r,i 1 tiN BEA
RESIDENCY RE UIRE
M
. JENTS
I. 1 J �; IG.
I, j c m P S � , candidate for
(Print Name)
Co 0101 on ar Q15 -�- ( �- 2, 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.
(Signature of Candid e)
1
G
(Date)
11/12/2013 12:31 PM
S:\CC\WP\ELECTION\Year 2017\CANDIDATE INFORMATION CD\4. Residency Requirements\RESIDENCY
REQUIREMENTS STATEMENT.doc