Cruz, Angela 11-25-2024- Qualifying Documents H(L,2 '24 4& TM1
CITY CLERK
CITY OF BOYNTON BEACH
CANDIDATE QUALIFYING CHECKLIST'''H!TON BEACH
Candidate's Name: Cru.Z Mayor District 1 _ District 3
Qualifying Information
27Re '' ency Requirements Statement
["Article I
Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9).1 CLu.rt '(O. , cit t, Char -
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
XAppointment of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). )}P(
_ 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
iStatement of Candidate (DS-DE 84). 730Al . IQ 01,
P
Oath of Candidate (DS-DE 302NP). (Accepted at time of qualifying)
Note: 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 1\14)-
Filing Fee for City Commissioner= $25.00 (Accepted at time of qualifying)
CHECK MUST BE FROM CAMPAIGN ACCOUNT (EXAMPLE: JOHN DOE CAMPAIGN
CCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
amt,.g,
Election Assessment Fee for City Commissioner=-$2-23:W(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
ACCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
Lti ' n Handbook
wenty-five (25) signed petitions that have been certified by the Palm Beach County
Supervisor of Elections (ai 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
RESIDENCY REQUIREMENTS
') w2 7F'M
CITY CLERK
B OYtNTON BEACH
I, fin \ Wiz- , candidate for
(Print Name)
C��- Mt n`t Jk 1 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.
i
(Signature of Candidate)
M\2„.5 ( Zy-
(Date)
PM
APPOINTMENT OF CAMPAIGN TREASURER
�t`f'`c ' w,.""'
AND DESIGNATION OF CAMPAIGN CITY CLERK
DEPOSITORY FOR CANDIDATES 9;0Yt..ITCki BEACH
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing officer before
opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE��BOOX�X(ES):
El Initial Filing of Form L�'Re-filing to Change: ❑ Treasurer/Deputy 131Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last): 3.Address (include PO Box or Street, City, State, Zip Code):
(Please Print or Type Name) �,^t`n'`
\ �--� �-� vim. L 7 �
332C.
4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
S 1 (not required for qualifying purposes)
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a ponnartisart office, check the box
if applicable:
55`1...,,-N.--1-- ��.5 � CA ❑ I intend to run as a Write-In Candidate.
9. If a candidate for partisan office,ficheck the box and fill in the name of the party as applicable: I intend to run as a
ElWrite-InCandidate. Leo ~arty Affiliation Candidate. ❑ Party candidate.
10. I have appointed the following person to act as my: 0<a-mpaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
CNs ( St1` ) Gl =3y145 �.cvL. �
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
k .r\ Com, ' *'Ir\
18. I have designated the following bank as my (check appropriate box): Etrrimary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
` jJ A( S (�c�-�9� IJ• rec (NN -.Q.
21. City: 22. County: 23. State: 24. Zip Code:
-
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
ff 26. Signature f Candidate:
25. Date: \� ( 7� S 1 `RA,-Z X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
do hereby accept the appointment designated above as:
(Please Print or Type Name)
Lpaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaig Treasurer of Deputy Treasurer
28. Date: \d ---)- 51 Zr;, X
DS-DE 9(Eff. 10/23) Rule 1S-2.001, F.A.C.
CANDIDATE OATH
NONPARTISAN OFFICE t1C31.. .. 4 '` '
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a write-in C 1T%., CLERK
candidate:
BCYt4TOtN BEACH
Write-in candidate
OFFICE USE ONLY
Candidate Oath
Name to appear on ballot: ‘c>VC- CCS
Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.)
Check box if name includes nickname. ❑ (For use of a nickname,you must complete the Nickname Affidavit on reverse side.)
I swear or affirm that I am a candidate for the nonpartisan office of C �y Wrn `S6
n (Office) (District#)
I am a qualified elector of ',-� 4(?) o` County, Florida
(Circuit#) (Group or Seat#)
I am a qualified elector 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.
Statement of Outstanding Fines, Fees, or Penalties
I owe outstanding fines, fees, or penalties, that cumulatively exceed$250, for ethics or campaign finance violations(s. 99.021(1)(d), F.S.).
YES, I Do NO, l Do Not
If you do, you must also specify the amount owed and each entity that levied the same on the reverse side.
X (56( ) o./‘• ,c.(1/43Z. _5kcb. y,Q.s
Signature of Candidate Telephone Number Email Address (215;•.1/4
\c--kz ezir,
Address of Legal Residence City .tate6 ZIP Code
STATE OF FLORIDA
COUNTY OF
Qa'1 it
Signatur: otary Public
Print. Type, • - p Commissi ed Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me by means of
�pE JESV
online notarization ❑ OR physical presence �..• S
this *^^T day of ,rater , 20 J . ,\P"•
PUB(�C
r Z
Personally Known OR Produced Identification ❑ = ol'',
MVG ES 2.22.202.202
5 w=
Type of Identification Produced: EXp1R Q
4hAO2IT'EI,IIO$I Ft F"' •••DS-DE 302NP(Eff. 10/2023) ,,„j� ,
Rule 1S-2.0001, F.A.C.
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