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Filing PapersDS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. RECENED APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN AUG, 10 2021 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) CITY OF BOYNTON BEACH (PLEASE PRINT OR TYPE) CITY CLERK'S OFFICEypW 11 NOTE: This form must be on file with the qualifying officer before openln2 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 Th G/h� 5 �h/r, code) l 3 2 / Sw 2 S th t..� (/////1 /fin 4. Telephone E-mail address — ` , ( ) ��6—J2i/), -�5. 170-1�ef `-ITIpQ 6.. Office sought (include district, cir it, group number) 7. If a candidate for a nonpartisan office, check if J /_h �l 15Pef6't' Gidz^/�;55 i applicable: My intent is to run as a Write -In candidate. a 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 -Indo Party Affiliation ❑_________________________________________ Party candidate. 9.1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Dep TTreasurerof l hO/tlgi s W !''I A/It 11. Mailing Address 1371 S�/ Z " 12. Telephone ( -1 )Yi(-`3273 - 13. City rn VAA 1 County 15. State ��c� ���� ti �� 16. Zip Code 17. E-mail address 3 <« eC�.0 18.1 have designated the following bank as my ® Primary Depository ❑ Secondary Depository 19. Name of Bank W(tlS % a�iU 20. Address Co comy 5 21. Ci 22. County / doh t��, P��4 �1 l3e4--m 23. State F i- 24. Zip Code UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 Candidate 1 --/ x0.-; 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1,� , do hereby accept the appointment (Please Print or Type Name) designated above as: 10' Campaign Treasurer ❑ Deputy Treasurer. 1 GZ�2, 2r Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) OFFICE USE ONLY RMEM AUG 10 2021 C" OF BOYWON BEACH Cffy CLERKS OFFICE candidate for the office of _ �(%/Lhf�� %�Pf�rFl, G�V-1-" C6-,-'i`S,yj{9�j 0( have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Signature of Candidate r ��l 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 VIA DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. RECENED APPOINTMENT OF CAMPAIGN TREASURER SEP ® 3 2021 AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES C,DyOFBOYNTON BEACH CITY CLERKS OFFICE (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: Q Treasurer/Deputy ❑ Depository ❑ Office ❑ Parry 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Thomas Anthony Pomante code) 1321 sw 25th way boynton beach, FL. 33426 4. Telephone 5. E-mail address (561 ) 596-3272 thomas.pomante@gmail.com 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check If Boynton Beach City Commissoner District 1 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 ❑ Write -In JR No Party Affiliation [] _____________ _______ Parry candidate. 9.1 have appointed the following person to act as my Q Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Omono Ighodaro (campaign treasurer) 11. Mailing Address 12. Telephone 2104 S Cypress Bend Drive #302 ( 954 ) 656-7795 13. City 14. County 15. State 16. Zip Code 17. E-mail address Pompano Beach 113roward �FL 133069 �omonol988@gmail.com 18.1 have designated the following bank as my ® Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Wells Fargo 200 N Congress ave 21. City 22. County 23. State 24. Zip Code boynton beach palm beach �FL j33426 UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 Candidate 9/2/2021 X G 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Omono Ighodaro , do hereby accept the appointment (Please Print or Type Name) designated above as: 0 Campaign Treasurer C] Deputy Treasurer. 9/2/2021 X_ o� Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER FRES AND DESIGNATION OF CAMPAIGN SEP 0 3 2021 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) OFBOYNTON BEACH CITY CITY Ct_ER1CS OFFICE (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before oeening 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 Thomas Anthony Pomante code) 1321 sw 25th way boynton beach, FL. 33426 _ 4. Telephone y 5. E-mail address (561 ) 596-3272 thomas.pomante@gmail.com 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Boynton Beach City Commissoner District 1 applicable: E] 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 Q 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 Kimyatta Pomante (deputy treasurer) 11. Mailing Address 12. Telephone 1321 sw 25th way ( 561 ) 601-1860 13. City 14. County 15. State 16. Zip Code 17. E-mail address boynton beach palm beach FL 33426 1 kimyattag89@gmail.com 18. 1 have designated the following bank as my Primary Depository C] Secondary Depository 19. Name of Bank 20. Address Wells Fargo 200 N Congress ave 21. City 22. County . State 24. Zip Code boynton beach palm beach 33426 LLF 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 Candidate 9/2/2021 x 0:;�- 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Kimyatta Pomante , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer © Deputy Treasurer. 9/2/2021 x A"Oed�� ��. Date Signature o Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 101101 Rule 1S-2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER RECENED AND DESIGNATION OF CAMPAIGN SEP 0 3 2021 DEPOSITORY FOR CANDIDATES (Section 106.021 (1), F.S.) CITY OF BOYNTON BEACH (PLEASE PRINT OR TYPE) CITY CLERK'S OFFICE NOTE: This form must be on file with the qualifying officer before openl9a the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: © Treasurer/Deputy 0 Depository Office 0 Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Thomas Anthony Pomante code) 1321 sw 25th way Boynton beach, FL. 33426 4. Telephone 5. E-mail address (561 ) 596-3272 thomas.pomante@gmail.com 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Boynton Beach City Commissioner District 1 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 Write-in ® No Party Affiliation C] Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer © Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Thomas Pomante 11. Mailing Address 12. Telephone 1321 sw 25th way ( 561 ) 596=3272 13. City 14. County 15. State 16. Zip Code 17. E-mail address boynton beach palm beach �FL 33426 thomas.pomante@gmaii.com 18.1 have designated the following bank as my © Primary Depository Secondary Depository 19. Name of Bank 20. Address wells fargo 1200 N congress ave 21. City 22. County 23. State 24. Zip Code Boynton beach palm beach FL 33426 UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 Candidate 9/2/2021 x D:;�- /71`X„ 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Thomas Pomante , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer © Deputy Treasurer. 9/2/2021 x o Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/101 Rule 1S-2.0001, F.A.C. RESIDENCY REQUIREMENTS NOV 17 217 g'36g,n 017y' OF BO YNTON BL -,v, i, I, candidate for (Print Name) ff- kMi>, ,/'O (7,,— fi i 5fi�`C+ 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 Candidate) t� /76�02 (Date) S:\CC\WP\ELECTION\Year 2022\CANDIDATE INFORMATION CD\4. Residency Requirements\A. RESIDENCY REQUIREMENTS STATEMENT.doc FORM 1 STATEMENT OF 2020 Please print or type your name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agency name, and position below: LAST NAME -- FIRST NAME -- MIDDLE NAME: MAILING ADDRESS CITY: ZIP: COUNTY: 60P-0?t Oat, 3 3 'U1 A PVM' , OYNTON SEAch NAME OFAG NCY : +V 0 NAME OF OFFICE OR POSITION HELD OR SOUGHT: n—t, �' �. & Li-d�'" C��r�[Ssi ���� uktrd-4:r- 't CHECK ONLY IF If CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2020. 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 9 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 A w 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 "nla") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOMEOF SOURCE ACTIVITY OF SOURCE YZZ PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] You are not limited to the space on the (If you have nothing to report, write "none" or "n/a") _ 5,t,/ 2� tiK KAV 0I �J t pit6o 6 e(ect, rG `�`� y.� J ! lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are 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, 2021 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.202(1), F.A.C. 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 I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or'Wa") NAME OF CREDITOR ADDRESS OF CREDITOR 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 "nla") 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, appointed school superintendents, and commissioners of a community redevelopment agency created under Part III, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S. ❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. I IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@leg.state.fl.us and retain a copy for your records. Do not file br both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, , prepared the CE 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. CPA/Attorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2020. C_ :::ELM 1 - Etrecuve: January 1, 2021. PAGE 2 Incorporated by reference in Rule 34-8.202(1), F.A.C. CANDIDATE OATH - PSI MI NONPARTISAN OFFICE i11011 1 7 2.02 (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a CITY OF BOYNTON± BEACH t5�i 3b/+iA write-in candidate: (& ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) (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 7a:? A,*I CA ( ;#— Si 6a+. Pv (Office) (District #) ; I am a qualified elector of �' 6/ (A % /9 e6 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): 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.] X t (�61 S �b --3 ?.7Z Signature of Candidate Telephone Number Email Address i;2,1 S G- ? 1,,e��h rot �S eg /L. 33-1/)-6 Address City State ZIP Code STATE OF FLORIDA COUNTY OF %? Sworn to (or affirmed) and subscribed before me by meanss of online notarization ❑ OR physical presence Ltd this i± day of �,ge&6, 20 -24 -- Personally Known ❑ OR Produced Identification Type of Identification Produced: r(-6r�y 'y- l.�t&t_ SicjAature of Notary Public Print, Type, or Stamp Commissioned Name of Notary Public below: CRYSTAL D.GIBSON MY COMMISSION # GG 326964 EXPIRES:Apol22,2023 ��'':;dsr°"'=' Bonded 11uu Notary Publlo UndeiwrNere DS -DE 302NP (Rev. 05/2021) Rule 1S-2.0001, F.A.C. Miscellaneous Cash /Receipt 725 CITY OF BOYNTON BEACH No. * Account No.n1-/ 7 — 031: 9 y E r F` !/f20 Received of--N-Ln l f>P L, Address CITY OF 1J[h%,'iiN TEXH ### C-b—REEiPT *** Opera � Type: OC Dr : 1 Date: 11/17/21 41 Receipt no: 65542 Description Qjantity Amunt 33 MISIDACOLE 1.00 $3.OD Trans nuker: M035 O/L account nuitber: OOIODD03651OW PMITE-fETITIM 1BU TfflIAS 1dTE PMI -IM CERT Teri�tdffry{-rd2t8i 1 (�@tt� Lt l LI LJ..A S I. VolJ4 (� SIV Total tendwed $3.00 Total paiwt $3.00 Tres date: 11/17/21 Time: 3:11:52 TW YOM FOR YU PROMPT PAYfW miscellaneous cash Receipt No. CITY OF BOYNTON BEACH Account No. 001-0000-369-10-00 Received of Thomi-As Pomante Address 1321 SW 25th Way For 1%.Filing Fee to rl Xarch,8, 2022 r, -f- y OINI U I ^-C 4:4 for $ 198.53 November 21- 20 Beach F4,.3.3426_ I V�M W17PI • 01, fb�Bipt no: 5500 Dept.U;Z. By W T-- Miscellaneous cash Receipt &`70A CITY OF BOYNTON BEACH No. Account No. 0 0 1 $ 25.00 20 Received of Thomas Pomarits-m Add.... 1321 STq 25th WaV Boynton Beach FL 33426 PEr,!- t Q-` I - 117— 1 Typ2: oC a For Ci V r, 11im, 'Fee to n f or Colra-11 March 8, 2022 10k) Trzdhs nLzte-,,F CrP71C 4 .194 Dept. City Clerk e -a Off ice By $ I PaIIS Ci!12: il "17/21 Time:, I 8:t5:4 I LO 3� 0 - en L :J L G� 71 U1 EAR Wendy Sartm link Palm Beach County Supervisor of OWNS CERTIFICATION EA I, WENDY SARTORY LINK, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 27 signatures on the Nominating Petitions of THOMAS POMANTE for COMMISSION, SEAT 1, FOR THE CITY OF BOYNTON 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 THOMAS POMANTE is a registered voter in Precinct 3200, in the City of Boynton Beach, Florida. I am only certifying that the signatures match the signatures we have on file and that the electors reside within the municipal limits. I am not certifying the validity or legal sufficiency of the petitions Signed, this the 2nd day of November, 2021. -.,. DY SAR, f'`INK SUPERVISOR OFqLyECTIONS PALM BEACH C60 - (SEAL) t 240 South Military Trail. West Palm Beach. FL 334151 Post Office Box 22309. West Palm Beach. FL 33416 Telephone: 561.656.62001 Fax Number: 561.656.6287 rr� j1acc a: 6657 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate_ [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1, MhJ?6-A0"C pzjlthe undersigned, a registered voter (print name as it appears on your voter information card)) in said state and county, petition to have the name of 0/1 qS /-��1f'I tC/� placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan F] No party affiliation Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY) City Coul State Zip Code Signat f Voter Date Signed (MMIDDIYY) [to be ompl ed by Voter] 49 Rule 1S•2.045, F. DS -DE 104 MR 0411 RECEIVED OCT 18 2021 CI CH CITY CEFIKSOF OOFFICE CANDIDATE PETITION J Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1, the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of U"115 �� 7`e placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan n No party affiliation Party candidate for the office of jai/!- f7 IF 04r1 (insert title of office and include district, circuit, group, seat number, if applicable) R Da� to of Birth or Voter Registration Number Address (MMIDDIYY) �� 25 /% i 6, L_ z5Y_s S � City County State Zip Code Signature of Voter n Date Signed (MMIDD/YY) [to be completed by Voter] DS -DE 104 (Eff. 08!11 lr 19. 1 15 �5a31 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 11, (print name as it appears on your voter information card) in said state and county, petition to have the name of M q.5 L''I'lin placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] the undersigned, a registered voter Nonpartisaan�n ❑ No party affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) cC2ty County State Zip Code Signatu of V ir Date Signed (MM/DD/YY) [to be co pleted by Voter] lbl(a 1'�2j DS -DE 104 Eff. 09/1 Iviq:3Q-7Tsc® CANDIDATE PETITION / Notes: -All Information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition farm. 1, the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of pl o placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] RNonpartisan MLN/o party affiliation Party candidate for the office of y (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDD/YY) S + W y 2--S_k246 Q wv City ( 1 County State Zip Code Signat a of Voter Date Signed (MM/DD/YY) [to be completed by Voter Rule 1S-2. .A.C. _ _ a -DE 104lEff. 091111 IIsi�9cQgSI CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this farm is not completed, the form will not be valid as a Candidate Petition form. I, ',LL the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of Th- P 11 ja rt C .1) placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [3 No party affiliation Party candidate for the office of �PfC-ln GIS Dlrm`Sfr'1G7- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) city County State Zip Code 33 Yz a Signature of Rule 1S-2.045, F Date Signed (MM/DDN ) [to be completed by Voter] ' 10 itf: u 1)S -DE 104 I Eff. 09/1 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition farm. the undersigned, a registered voter (print name as it appears on your voter information car in said state and county, petition to have the name of �q'M H placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Parry candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (Mcq("-02-43 4::1;, �� YS 3 S7t-_ City County State Zip Code ea- 00 1 8,, Sign/at_ f Voter 1 Date Signed (MM/DDNY) [to be completed by Voter] (0 DS -DE 104 Eff. 0911 11�,Qco�!)(-oQc CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1, "Q ' r'� l y S O' Q the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of n` l _5 iPRA-747Y� placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan F1 No party affiliation M Party candidate for the office of �iCj/7%f1 C,pj & ► H-"'Std-57nGe/- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DDS D I b , Ixyg City County State Zip Code -ro,./ - Pfvl 3 yaL Signature of Voter � Rule 1S-2.045, F.A.C. Date Signed (MM/DD1YY) [to be completed by Voter] / / Zi/ 05 -DE 104IEff. 0911 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (print name as It appears on your voter �� informatio%c-ryard) t in said state and county, petition to have the name of i � !klo placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Rub Nonpartisan FlNo party affiliation the undersigned, a registered voter Party candidate for the office of 6f��b!G1�77 e>1" (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY 5 L a City County State Zip Code Signature of Voter daw-, 18.2.046. F.A.C. Date Signed (MM/DDNY) [to bempl ted by Voter] I co 7/1 DS -DE 1041Eff. 0911 CANDIDATE PETITION ✓ Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. i, LM CA li ? the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of (A4 -S _19Qli`rrr7q, placed on the Primary/General Election Ballot as a: [checkicomplete box, as applicable] - > I RNonpartisan [:]No parry affiliation ❑ 06 Pelt -'6 cifl--�. (insert title of office and include Party candidate for the office of trict, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address City County state Zip Code Signature of Voter Date Signed (MM/DDNY) [to be co plated by Voter] ro Rule 15-2.045, F.A. DS -DE 104 {Eff. 09111 II`aulIy'9"ce) -_;� CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition far a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. Ic the undersigned, a registered voter (print name] as it appears on your voter information card) I in said state and county, petition to have the name of TIV'I'i,S Y -r _ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [—]No party affiliation M Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address � c� (MM/DD/YY) p i rGj 0 of • City Co State Zip Code 74 r4Aat�_,AC 3W24) Signature.of Voter/ -- F.A.C. Date Signed (MMIDDIYY) [to be com ileted by Voter) ►i DS -DE 104 tEff. 0911 i1 ('Qggqq(09' CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. H 13LblliiiI_ (print name as it appears on your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Rub the undersigned, a registered voter Nonpartisan "No party affiliation U Party candidate for the office of 6621P -17A rI� � Ge e-v���ss�o� �r c iS ic`f (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address h �" (MMI � IYY) 5 i/ � d "z'cvl'� CityCo/ Sta kte Zip Code Signature of Votph 1S-2.045. F.A.C. Date Signed (MM/DDIYY) [to be comp! ted by Voter] /Jj��rZ,-? r CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (print name ar§ it appears on your voter information cajd) in said state and county, petition to have the name of 7,*GIS O" -,1'i7 placed on the Primary/General Election Ballot as a: (checkicomplete box, as applicable] Nonpartisan [:] No party affiliation E] the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address / G J City Co" State Zip Code Signature of Voter Date Signed (MM/DD/YY) (to be gompleled by Voter] Rule 1S-2.045, F.A.C. /,. ` y/`t' I 1 DS -DE 104 lEff. 09111 0�g14(149 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. `.P._ (print name as it appears on your meter information card) in said state and county, petition to have the name of t�� '/'44n placed on the Primary/General Election Ballot as a: (check/complete box, as applicable, Nonpartisan [:]No party affiliation F1 the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address /2-3/5,A), 54` - C' CountyState Zip Code &� n4on c G 3 Signature of Voter Rule 15-2.045. F.A.C. Date Signed (MMIDD/YY) [to be c/Mete by Voter] DS -DE 104 (Eff. 0911 I') 'P�1 (i7 I(�D I CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (print name as it appears on your voter information ca in said state and county, petition to have the name of 1�7 0e44 placed on the Primary/General Election Ballot as a: (checWcomplete box, as applicable] RNonpartisan F] No party affiliation M the undersigned, a registered voter Party candidate for the office of jb01111-&,,h (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (M lY'r) 1'23; sw ZS -h W C4 tJ Ci Co�lnty Stat j tip Code �b h lQ h� C1�( Z Signatu Voter Rule 18-2.045, F.A.C. Date Signed (MM/DD/YY) [to be co //let by Voter] G� Z'! DS -DE 104 {Eff. 0911 I a`6? 9 ._7 53( CANDIDATE PETITION ,/ Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the farm will not be valid as a Candidate Pelition form. I, G04 71 -veil / the undersigned, a registered voter (print name As it appears on your voter information card) in said state and county, petition to have the name of OA49_� yf placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] y attiliation L] Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) ! Date of Birth or Voter Registration Number Address 145'4115' ZE Al SS',lAIC� GOA 144T e540 X2/2 City County State Zip Code 26o rv71v 40;�-AP4 t1 itil VZG Signature o ter �- ? 13.2_Ad5. F.A_C_ Date Signed (MM/DDlYY) [to be completed by Voter] to ,6 2,r DS -DE 104 (Eff. 0911 CANDIDATE PETITION V Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1,1 t� � the undersigned, a registered voter (4nt name as it appears on your voter information card) in said state and county, petition to have the name of i fir""�S &/' -i placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan M No party affiliation Party candidate for the office of baAA Rul (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) Zlk tQ'-2 Lf .ei City County State Zip Code Signature of Voter 1A_2.Mg F.A C_ Date Signed (MM/DD/YY) (to be completed by Voter] �6 ,6 2,/ DS -DE 104 (Eff. 09111 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. h ) �! ( t �� r_ the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of -rh o l' w -� placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan E]No party affiliation Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address 1 (MMIDd> hL 6> I 0 3C� '51 1,.), -)-,> City Co minty State Zip Code Signature of Voter F.A.C. Date Signed (MM/DDIYY) j to be completed by Voter) 11 104 (Eff. 04111 I 1 �": 5CAa73� 0 CANDIDATE PETITION Notes. -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I, the undersigned, a registered voter (brint name as it appears on your voter information card) in said state and county, petition to have the name of -TWA -s- f Q�4A-7-P ` placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] &Nonpartisan F] No party affiliation ❑ A!'I _ Party candidate for the office of title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD1YY) City County State Zip Code VQa �a\nn'M@ Cin I FL S's L-iZ Signature of Voter %Ww WO� F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] DS -DE 104 (Eff. 0911 I a4 S�o 1 SSI CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (print name as it appears on your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Nonpartisan F1No party affiliation M the undersigned, a registered voter Party candidate for the office of �'✓'(St�'�hr/t d7C��'h L i�7�C�!s"t�r,S��h�� �LY������ (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD ®) "4'1 q � 1 � � � I w 2 - City City C�j'ty State Zip Code Signature of Rule 15-2.046, F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] ?� D6 Z- MOE 104 {Eff. 0911 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] i - If all requested information on this form is not completed the form will not be valid as a Candidate Petition farm. I, ') r; E' the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of _ i lxs� �U.hri,r 7-4! _ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan F-1 No party affiliation Party candidate for the office of T (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY) L z ig 13�a W CP_ �� �t A City County State Zip Code Signature of Voter t4 Date Signed (MMIDDIYY) [to be completed by Voter] a®07 / DS -DE 104 (Eff. 09/1 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of )_A,0,/h0 &��7 placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] Nonpartisan M No party affiliation M 0 L`�E � LI 7f " (insert title of office and include Party candidate for the office of S3iO.hi� s�f��Y% circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY) CRY POAM Cunty State Zip Code VG�� Sig ure of Voter Date Signed YY) [to be completedted by by Voter] i I el •— Rule 15.2, , F.A.C. DS -DE 104 jEff. 0WV 1t�a9i CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1,the undersigned, a registered voter t f S (print name as it appears on your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] > I Nonpartisan M No party affiliation Rule Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) ' S _ r City County State Zip Code Signature of Voter �:4 r.w.c. Date Signed (MM/DD/YY) [to be comple# by ter] 1 b �%64/ CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. the undersigned, a registered voter (print name as it appears on your voter information card in said state and county, petition to have the name of/r placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan U No party affiliation LJ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) City County State Zip Code ryf zt'1� Signature of ter I Rule Date Signed (MM/DD/YY) [to bepla/te�d by Voter] I i d3 -1 (o -7 (-6-7 1 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the farm will not be valid as a Candidate Petition form. 1, the undersigned, a registered voter (print name as it appears on your voter information c9o) in said state and county, petition to have the name of 7�^'�lf placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] (insert title of office and Party candidate for the office of circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM D/YY o 1i 10\ g I S I SUjZS City C ty State Zip Code NO Signature of V r Rule 15.2.045, F.A.C. Date Signed (MM/DDIYY) [to be completed by Voter] 1L 1 vU� . DS -DE 104 (Eff. 0911 fl (O�)L4► V/1 - CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. M name as it appears on your voter information in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] the undersigned, a registered voter ERNonpartisan []No party affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address cwt City C my State Zip Code Signature of Voter Date Signed (MWDDlYY) [to be mp ed by Voter] 1 6 Rule 1S- 46, F.A.C. DS -DE 104 Eff. 09111 ll aqq-3-7910 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a cr{me to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all 11114ues# infor�4i tion on this form is not completed, the form will not be valid as a Candidate Petition form. the undersigned, a registered voter (print name as it appears'on your vo I . i� I forpldo in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] &Nonpartisan F] No party affiliation Party candidate for the office of f�b )'l►7vh b (luL h �it/v�r SSi Gr, i�'' c2 i S7`y?C 1 (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address n (MMlDDIY ) a C � 3 S 1 J City � F�, t Coun n State Zip Co� Signature of Date Signed (MM/D lltlf) t I A �fl �� [to be cggWoted by �Ioter], 18-2.045. F.A.C. I os -DE 104 rEff. 09111 AIiLDIIIT%OL74 ttro : Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. Pie ! c qll the undersigned, a registered voter (print name as it appears on your voter information card) Cenqf)_�e in said state and county, petition to have the name of o f r 4aS placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] )arty affiliation �J Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY �_ ¢ v� �J G cfS,?" Ci County . State Zip Code n ,,�v4o k 'B;; Signature of Votef Date Signed (MM/DD1YY) % [to be completed by Voter] e 13-2.045, F.A.C. DS -DE 104 �Eff. 09111 11 0 i f x i' �lq I lr4-) c CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form . 's not completed, the form will not be valid as a Candidate Petition form. 1, �-t [� lthe undersigned, a registered voter '� A.r 1 (print name as it appears on your votr information ca ) in said state and county, petition to have the name of 7_19 aA,;J . placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if al Date of Birth or Voter Registration Number Address .3 �-/./ (J City Coul,>fy- Sta ZI Code E Signature of Voter Rule 1S-2.045, F.A.C. Date Signed (MM/DD/YY) [to be complete t d by ro_ter] f / DS -DE 104;EM 0911 0 qi6Lo�31A CANDIDATE PETITION Notes. -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. the undersigned, a registered voter (print name as it appears on yout voter information card) in said state and county, petition to have the name of 77/10A 15 fo!k fhT placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan Fj No party affiliation rj Party candidate for the office of 6dL4th, (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM !t#1 _' ) 5 cso_ i�,� City County State Zip Code Signature of Voter Date Signed (MM/DDIYY) [to be completed by Voter] Rule 13.2.046. S.A.C. _-_ —� 133•DE 104 (Eff. 0911 D1c---)+ CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information an this form is not completed, the form will not be valid as a Candidate Petition form. (print name as it appears on your toter information card) in said state and county, petition to have the name of 190/t' qP, placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I 2Nonpartisan r_1 No party affiliation M the undersigned, a registered voter Party candidate for the office of 0th -00 /SP (insert title of office and include district, circuit, group, seat number, if applicable) F(MW.W of Birth or Voter Registration Number Address IDD/YY) 7 , o G L� " f City County State Zip Code O -Al il Rule Signature of Voter ! - r � e n n.e c a n It Data Signed (MMIDDIYY) [to be completed by Voter] DS -DE 104IEff. 0911