Blass, Piotr- Notice of Intent to Run THE CITY OF BOYNTON BEACH
2025 CANDIDATE NOTICE OF INTENT TO RUN
0/Candidate's Name: --P;cric-,r jkt ''Mayor _District 1
District 3
ipointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9) FILED
Ensure Candidate signs Block 26
Ensure Campaign Treasurer or Deputy Treasurer signs acceptance Mil' 3 0 2023
Ensure form is completely filled out CITY CLERK'S OFFICE
Note: Only one primary and one secondary depository can be designated
Appointment of Campaign Treasurer and Designation of Campaign
epository for Candidates (DS DE 9) V40
_ 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) ,
o -iir R (gill
I, r ,
R 'em L-__>;--acknowledge receipt of printed copies of
the following:
• Qualifying Information
• 2023-2025 Calendar of Reporting Dates
• Florida Election Code
• Candidate & Campaign Treasurer Handbook
1) f Will Date: 1( 3 (2/z2
Signature
Comments: NiC
,}
Checked:UtIk..0-- Reviewed: Date: 5 13D la'p23
APPOINTMENT OF CAMPAIGN TREASURER FILED
AND DESIGNATION OF CAMPAIGN 1.:,-%.1 't; 0 2023
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITY CLERK'S OFFICE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. ECK 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, S 3. Address (include post office box or street, city, state, zip
D r pi. 0 f r to Ss code)
138 F1
4. Telephone 5. E-mail address i
( 561 ) S" 23171 p / c t(- (Ow 9 --q3CCYo 1 of4
6. Office sought(include district, circuit, ow1Qup number) 7. If a candidate for a nonpartisan office, check if
applicable:
Ma
r�rnl My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and Write-In filliniin name of pa as applicable: My intent is to run as a
❑ No Party Affiliation /IV U ` Party
y candidate.
9. I have appointed the following person to act as my Campaign Treasurer Er Deputy Treasurer
10. Name of Treasurer Deputy Treasurer
Di P tr loss
11. Mailing Address 12. Telephone
1B WT/ vuLo, 04 fir, 13$ F133 ( 0 ) s- 2-s171
13. City A 14. County 15. ate 16. Zip Code 17. E-mail addres
�o Vt.f00 Big g iWI k,/ 1i , 1Y pilass ma 11, ( `„ ,,
18. I haVe designated the following bank as my j Primary Depository ❑ Secondaryepository
19. Name of Bank. 20.Address
� ((s q qqo c 4/ht.,/ i , ,,,,,flog,,,a,
21. City 22. C unty, 23. S e 24. Zip Code
r?0y1zi0VI PE (ativtt ,, I 3 936
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
M � 3 �) , 7 �2 � X --) v 1 , !/
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, C V I� 1 0 (ti M-eht4 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
.,/e,t/3 o )uz-) X
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
CANDIDATE FILED
(Section 106.023, F.S.) M,-,Y 3 0 2023
(Please print or type) CITY CLERK'S OFFICE
U 1Y fr R-6eA4
candidate for the office of /4 yo I
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
xV M 3 0 70 2.
ignature 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)