Filing Papers APPOINTMENT OF CAMPAIGN TREASURER CITY OF BOYNTON BEACH
AND DESIGNATION OF CAMPAIGN CITY CLERIC'S OFFICE
DEPOSITORY FOR CANDIDATES 16 SEP 29 PH12: ?R
(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
akiECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: (] Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name /D andida a (int 's order. irst, Middle, Last) 3. Address (include post office ors eet;ci , state, zip
code)
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4. Telepho e P . E-mail addr ss
(5 / ) r c �► C-3 C 3`6Office sought (inP3/0-ig-3 e district, circu. ,"grou number) 7. If • candidate for a nonpartisan office, check if
applicable:
flS 1 c- 0)1541� ❑ My intent is to run as a Write-In candidate.
8. If a candidate for a p isan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write-In No Party Affiliation ❑ �, Party candidate.
9. I have appointed the following person to act as my Er Campaign Treasurer ❑ Deputy Treasurer
10. Name o Treasur or yly s rer
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11. Mailin dre s / 12. Telephone
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/ DI( )? -Q14. u ty 1 St to 16. Zip .ode 17. E-mail address
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1 . I ave designated the follow'n bank as myPrimary Depository Secon ary Depository
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19. :..- of Ba 20. Address
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21. ' it/ 74 pty 23.,g/t5 �' 24. I. •de/
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UNDER PEN: IES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTME► •' CAMPAIGN REASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T ' - S S • IN IT A- UE.
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25. D 2.. ignature of f <•• :ate
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27. Tr s eA Ac ept c o pointme t (fill I bl-nks an. - - the a-•ropriate %lock)
1 1 ( , do hereby accept the appointment
eas int or ype N me)
designated ab•ve - V Campaign Treasure ,epu reasur:r.
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Date( ..g - u • C- -•-'= Treasurer • Deputy Treasurer
DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
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candidate for the office of i)V
have been provided access to rea and understand the requirements of
Chapter 106, Florida Statutes.
c)c (
c Can4i. -te 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)
RESIDENCY REQUIREMENTS
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I, , candidate for
offrii, ',Print me)
1SS Na/ of the City
(Mayor/Commissioner— District#5
Beach, have received, read and understand the
residency requirements of Article II of the Charter of
the City of Boynton Beach.
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I, fir 176
(Date)
11/12/2013 12:31 PM
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc