Filing papers Noy.,? '22 2:32P11
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN CITY CLERK
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
BEACH
(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: ❑ 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
code)
Per/u11 I D ✓ y
4. Telephone!_ . c 5. E-mail address 3Z Nw 0'1� c �u.In1v� etch r"c. 33'-i2•,.
(S(e( ) &W- 77 (tack%PdaviseSMe,A -("),
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write-In candidate.
((>rnneti S5.'.P42r Di s << i 2
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
❑ Write-In El No Party Affiliation ® Party candidate.
9. I have appointed the following person to act as my n Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
?(//1,( /I
11. Mailing Address 12. Telephone
2 Ave I ( ` I ) L(,1-21 3 5
13. City 14. County 15. State 16. Zip Code 17. E-mail address
3O V.1 geaCi *PAN uh I 33(I24 CO6, ( PCIQvi3K- }c t .( c'
18. I have designated the following bank as my [3 Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
Th 25'C% 1 i „), r j; c'
21. City 22. County 23. State 24. Zip Code
bg0,1itvI &•41,. 171 P41,14 17<14Cr, ! _ 2 (t
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. Signat n' of Candidate
II- 7- 2o X /- - (/f.
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I e'v'tG // /') ; , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer El Deputy Treasurer.
/1- - 2027 X 4f4,019,(iz
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
NOV7 '22 2132PM
CANDIDATE
(Section 106.023, F.S.) CITY CLERK
(Please print or type)
B;O',NTON BEACH
candidate for the office of Cm .N,-- \F-) %Q L � ��--
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X /l- 7 - 2071
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)
THE CITY OF BOYNTON BEACH
2022 CANDIDATE NOTICE OF INTENT TO RUN
0 Candidate's Name: hex e M Tj. .5 V liistrict 2 ODistrict 4
E/Appointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9)
Ensure Candidate signs Block 26
Ensure Campaign Treasurer or Deputy Treasurer signs acceptance
Ensure form is completely filled out
Note: Only one primary and one secondary depository can be designated
0 Appointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9)
_ Ensure Candidate signs Block 26
_ Ensure Campaign Treasurer or Deputy Treasurer signs acceptance
_ Ensure form is completely filled out
Note: Only one primary and one secondary depository can be designated
'Statement of Candidate (DS-DE 84)
I, \7Q-'c \\ 7`S , acknowledge receipt of printed copies of
the following:
• Qualifying Information
• 2022/2023 Calendar of Reporting Dates
• Florida Election Code NOV7 '22 2:32PtM
• Candidate & Campaign Treasurer Handbook CITY CLERK
B.,ta coa tE� Hcry(f !,
Date: %( 2 o 2 a
Signature
Comments:
Checked a Reviewe Date: ' -7
di