Precinct 1537 Temple Beth KodeshThe City of Boynton Beach
TO: TEMPLE BETH KODESH
501 NE 26TH AVENUE
BOYNTON BEACH, FL 33435
PRECINCT NUMBER(S): 1537
POLLING LOCATION AGREEMENT FORM
CITY OF BOYNTON BEACH CITY CLERK'S OFFICE
This agreement, dated this day of
Beach, FL, and the owner of the Polling Place located at:
FROM: CITY OF BOYNTON BEACH
CITY CLERK'S OFFICE
100 E. OCEAN AVENUE
BOYNTON BEACH, FL 33435
2023, by and between the City of Boynton
Temple Beth Kodesh
NAME OF POLLING LOCATION (Include name and/or room number)
501 NE 261' Avenue, Boynton Beach, FL 33435
(POLLING LOCATION STREET ADDRESS, CITY AND ZIP CODE)
THE OWNER AGREES TO
• Provide the Polling Place for holding the following elections:
GENERAL ELECTION ------------------------------------------------------TUESDAY, MARCH 14, 2023
RUN-OFF ELECTION (if necessary) -------------------------------------TUESDAY, MARCH 28, 2023
• To provide the following items from 6:00 a.m. until all closing procedures required by the Florida
Statutes to be performed by the Election Board are completed:
Yes No NECENED
CHAIRS FOR ELECTION WORKERS ❑ ❑ JAN 9 O 2023
TABLES FOR ELECTION WORKERS El 11
RESTROOM FACILITIES AVAILABLE ❑ ❑ CIN OF 80YNTON BEACH
CITY CLERK'S OFFICE
• To provide access to the Polling Place on election day by one of the following means:
❑ Owner will open Polling Place NO LATER THAN 5:30 a.m. on Election Day
❑ Owner will provide the Precinct Clerk with a key to the premises prior to Election Day.
THE CITY OF BOYNTON BEACH, THROUGH THE CITY CLERK, AGREES:
• To pay the owner $_ ; '� O < for the use of the above described location for each Election, if
it is used.
I AGREE TO THE ABOVE CONDITIONS AND WILL MAKE MY FACILITY AVAILABLE TO THE CITY OF BOYNTON
BEACH ON THE DATES INDICATED ABOVE.
�u (tet A>'l�Er L► S c F'�1S _ Q�F�e Mn�1 C►� X701-��''� - 9`7'�
,.- SIGNATURE PRINT NAME TITLE TELEPHONE NO.
0 / /YE a "' t/F v
MAILING ADDRESS (INCLUDE CITY, STATE AND ZIP CODE)
L 341-3t—
SIGNED
Q-3
ADDITIONAL INFORMATION.
• To provide access to the premises for delivery and pickup of voting equipment before and after each
Election, please provide the days/hours facility is open for equipment delivery/pickup: M &V -
Name of contact person and telephone number at Polling Place: i 7 r>c) v
Name of contact person and telephone number before and after regular business hours, in case of
emergency. t=R ?c, . I e. Lc S 19-4 - &717- S z/
Make checks payable to: —,c -- Pi- c 2, - 7-, , 6L5 4