Wright, Bernard CITY OF BOYNTON BEACH
CANDIDATE QUALIFYING CHECKLIST
Candidate's name: •'Mara 1AJri Qh--
City Commissioner: rj 1 istrict 2 ❑Distl'ict 4
CITY CLERK
Qualifying Information BOYNTON BEACH
❑Ridency Requirements Statement NOIJ8 '22 2:15f✓M
Article I
Appointmen of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). 'i- 1 �.a.0--a.a
_ Candidate signature on Block 26
— Campaign Treasurer signature on Block 27
_Form is completely filled out
Note: Only one primary and one secondary depository can be designated
Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). -3-11 Candidate signature1,),Da,)-
on Block 26
Campaign Treasurer signature on Block 27
Form is completely filled out
Note: Only one primary and one secondary depository can be designated
WLTJ tement of Candidate (DS-DE 84).---1..) )9-oa-01Oath of Candidate (DS-DE 302NP). (Accepted at time of qualifying)
te: the Candidate prints name as they wish it to appear on the official ballot
Statement of Financial Interest Form 1 (CE Form 1). (Accepted at time of qualifying)
❑Form is completely filled out
iling Fee for City Commissioner= $25.00 (Accepted at time of qualifying)
CHECK MUST BE FROM CAMPAIGN ACCOUNT (EXAMPLE: JOHN DOE CAMPAIGN
COUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
Election Assessment Fee for City Commissioner= $223.69 (1% of salary-Commissioner salary=
$22,369) (Check made out to City of Boynton Beach). (Accepted at time of qualifying)
CHECK MUST BE FROM CAMPAIGN ACCOUNT (EXAMPLE: JOHN DOE CAMPAIGN
CCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
Petit'on Handbook
wenty-five (25) signed petitions that have been certified by the Palm Beach County
Supervisor of Elections (a a cost of 10¢ per name. (As of 2021, Candidates are
required to submit petitions to the City Clerk who will in turn will have them certified
by the PBC Supervisor of Elections. Please submit petitions no later than November
15`1'to help ensure they are certified prior to the end of qualifying.)
Resign to Run
(Candidate must resign in writing from elective or appointive office no less than ten (10) days prior to
the first day of qualifying) (F.S. 99.012)
I' iSo2.-0Ai-ci t.o9 r g ,kr acknowledge receipt of printed copies of the following:
I . orida Election Code
Ij i 23 Election Calendar
andidate & Campaign Treasurer Handbook
a i •signation of Poll Watchers
Copy of Treasurer's Report Documents
ction Code for the City of Boynton Beach
t►/ ode of Ethics for Palm Beach County
G nshine Amendment and Code of Ethics for Florida
f rity Map
Precinct List for Boynton Beach as of 11-07-2022
I Candidate Workshop by SOE-TBD
I Notice of Logic & Accuracy Test for Election and Run-Off Election- TBD
Comments
Candidate's Signature OL
4 Date: 11— ,- Z.,
Checke0 Reviewed
Date: a f df)�.
FORM 1 STATEMENT OF 2021
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 :
4I. T -+'usc�4 g r- G
MAILING ADDR S : NOUS '22 2:00PM
"2 13 1? . L---) • a"'a 6 r. cITY CITYCLERK
N� ht 13 C-41 33�3 g [.:(i`,'tJTl1t! BEACH
CITY ZIP: COUNTY:
n o �-F e�tt . VI .33(35.-
NAME OF AGENCY :
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
e..._-9.06%4-°N, t S 54'Q Iv e,r-
CHECK ONLY IF arrADIDATE OR D NEW EMPLOYEE OR APPOINTEE
**** THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2021.
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):
nCOMPARATIVE (PERCENTAGE)THRESHOLDS OR [ 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
At
9
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"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
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") lines on this form.Attach additional
sheets,if necessary.
FILING INSTRUCTIONS for when
and where to file this form are
AI l�/fV/r�) 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 1.2022 (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 BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
x 4
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
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"n/a")
BUSINESS ENTITY# 1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY S,rN4JtI L.01.44x1►'li*4.Sis
ADDRESS OF BUSINESS ENTITY Ap.1 ST 'Rs 19
PRINCIPAL BUSINESS ACTIVITY QIrirr RQ_.cA.
POSITION HELD WITH ENTITY • ' 1)
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST F Ou
PART G—TRAINING For elected municipal officers,appointed school superintendents,and commissioners of a community redevelopment
agency created under Part I, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S.
CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473,or attorney
Signature: in good standing with the Florida Bar prepared this form for you, he or
she must complete the following statement:
Awk.:24.7_ 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.
Date Signed:
CPA/Attorney Signature:
1 ( 1 oZ A.
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment.
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing address or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter,file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does aol relieve the filer of filing a CE Form 1
other format), send it to CEForm1@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31,2021.
for your records. Do not file by both mail and email. Choose only one
filing method. Form 6s will not be accepted via email.
CE FORM 1-Effective:January 1,2022. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.
CANDIDATE OATH
NONPARTISAN OFFICE
HODS '22 2t 1c1F,t,;
(Do not use this form if a Judicial or School Board Candidate) BC ;'hNTON BEACH
Check box only if you are seeking to qualify as a
write-in candidate: CITY CLEF„
P Write-in candidate OFFICE USE ONLY
Candidate Oath
6 t S k(, p (Section 99.021(1)(a),Florida Statutes)
I, r xi ar-d (... __)r .c r ,
(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 n (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 ofe__,, Drm i^r-l2(5 S ,L D nj
(Office) (District#)
I am a qualified elector of M_ O--i+Y\, j c_AN l l 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 a .`? ? giZ 9-3
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.]
X1412 -1,/- 1-- (7.�0. .cf Co - D -7 6 (�eru4rt41Jr li kTS` eis ktAct)
Signature of CTelephone Number Email Address •CizOn
71 jr Li to Kd sem—. ' c chi,. -- 3 3%-f--2 ----
Address City StateZIP Code
STATE OF FLORIDA ii 10
Signatu : ot' t , r
Print,Typ:,or.t.1.:
RESIDENCY REQUIREMENTS
I, ID cr'io,r-d t. T , candidate for
(Print Name)
Im s 'v �, 1.2a toes of the City
(Mayor/Commissioner— District #)
of Boynton Beach, have received, read and
understand the residency requirements of Article I of
the Charter of the City of Boynton Beach.
(Signature of Candidate)
/1 -
(Date)
r i
V
'4
CITY
OF BOYNTON BEACH
*** CUSTOMER RECEIPT ***
Oper: BYB2VLJ
Date: 11/09/22 01 Type: OC Drawer: 1
Receipt no: 57125
Description Quantity
99 MISCELLANEOUS Amount
Trans number: 1.00
G/L account $25.00
00100003691000er 9882039
mb
BERNARD WRIGHT
CITY FILING FEE TO RUN
FOR COMMISSIONER IN
DISRTICT II
Tender detail
CK CHECK
Total tendered 9504 $25.00
Total payment $25.00
$25.00
Trans date: 11/08/22
Time: 16:46:39
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH
r _
V
CITY OF BOYNTON BEACH
*** CUSTOMER RECEIPT *Drawer: 1
Type: OC 57126
Dper: BYB2VLJ Receipt no:
Date: 11/09/22 O1
Amount
tion Quantity
Descr1p MISCELLANEOUS $223,69
99 1 ,00 9882040
Trans number:
G/L account number:
00100003691000
BERNARD WRIGHT
1% ELECTCpMMISIONERENT
FEE FOR
DISTRICT 11
Tender detail 8503 $223.69
CK CHECK $223.69
Total
tendered $223.69
Total payment 47:54
Trans date: 11/08/22
Time: 16:
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH