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PETITION SUBMITTANCE FORM 2025 NOV 13 nm 8: 57
Name on Petition (Candidate/Initiative) r l 1«-C L a1C C.(t
Office Candidate is seeking (if applicable): 1J- c'n'l� JAS c -
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Number of Petitions Submitted: f b 7 Number SOE Counted: I (
Name of person submitting petitions: 6)0 • .Eze ,se cu
Address: /OD E . ()Leal-) Area4..
City, State, Zip Code: r.ircF: I'l P._ 53 LI 3c-
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Phone: ( i) --iL1?62N/ Email: (i-S/Yl I r
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Signature. I ai Date: ///3/c.A2.9S--
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OFFICE USE ONLY
Deputy's Initials: -JL‹3
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Paid By Check: ( O 13 Paid By Cash: Receipt#: (moi( I tv6
OR Undue Burden (verified)
BATCH #:
Revised March 2025
UMW
0 4301 Cherry Road,West Palm Beach, FL 33409 0 561.656.6200 .1'R VotePalmBeach.gov 0 info@VotePalmBeach.gov
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