Filing Papers
TO:
MATERIAL FOR CANDIDATES
RDna.ld We; Ia..nL
DATE:
5-~d.-07
YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, WE HAND YOU THE FOLLOWING:
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2007 Qualifying Information & Municipal Election Schedule
Form DS-DE 9 Appointment of Campaign Treasurer and Designation of Campaign Depository for
Candidates (8/03) - TO BE SIGNED AND RETURNED TO CITY CLERK
Form DS-DE 84 Statement of Candidate (Must be filed within 10 days after filing Campaign Treasurer
Appointment) (8/03)
State of Florida Election Laws - Chapters 99, 105 & 106 (09/05)
Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Directions for Posting Temporary Political Sign
City Commission District Map
Part I Charter, Article VII. Elections - City of Boynton Beach
Part II Code of Ordinances - Chapter 2 Administration, Article III. Elections
Poll Watcher Form & FS 101.131 - "Watchers at Polls"
2007 Election Dates to Remember
Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets
2006 Candidate Handbook for Candidates (07/04)
Petition Form - Candidate for Commissioner - TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF
ELECTIONS AND RETURNED TO CITY CLERK DURING QUALIFYING
Form 1 Statement of Financial Interests 2005 - TO BE FILLED OUT, SIGNED & RETURNED TO THE
CITY CLERK DURING QUALIFYING
L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.)
Loyalty Oath - Oath of Candidate (DS-DE 24B) (08/03) - TO BE RETURNED TO CITY CLERK DURING
QUALIFYING
Statement of Residency Requiremen
TO CITY CLERK
'tv Charter - TO BE SIGNED AND RETURNED
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Date Signed
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March 19, 2007
S:\CC\WP\ELECfION\year 2007\MATERIAL FOR CANDATES.doc
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
OFFICE USE ONLY
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CHECK APPROPRIATE BOX:
D Original Appointment
Name of Candidate
D Deputy Treasurer
D Reappointment of Treasurer D Secondary Depository
1. Address (include post office box or street, city, state, zip code)
2540 SW 14th Street
Boynton Beach, FL 33426
Ronald Ray Weiland
Telephone (optional)
( 561)
2. Party (Partisan candidates only)
3. Office (add district, circuit, group number)
City Commissioner-Dist. 1
Ii] Campaign Treasurer D Deputy Treasurer
I have appointed the following person to act as my
4. Name of Treasurer or Deputy Treasurer
Ronald Ray Weiland
5. Mailing Address (If post office box or drawer add street address)
2540 SW 14th Street
7. City 8. County 9. State
Boynton Beach Pa1m Beach Florida
6. Telephone
(561) 734-6885
10. Zip Code
33426
I have designated the following named bank as my
11. Name of Bank
Sun Trust
13. City
Bo nton Beach Pa1m
17.~~
Ii] Primary Depository D Secondary Depository
12. Street Address
S?Ju7)f
15. State
Florida
Date
06-07-07
Campaign Treasurer's Acceptance of Appointment
I,
Ronald Rav Weiland
(Please Print or Type)
I!J Campaign Treasurer D Deputy Treasurer for the campaign of Ronald Ray Weiland
, do hereby accept the appointment as
who is seeking nomination or election as a
Ci ty Commissioner District 1 candidate to the office of
(Party)
City Commission
. As a duly registered voter in
pa1lt. Beach County
County, Florida, 1 am qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIG
ACCEPTANCE OF APPOINTMENT AND ~~~E TR
06-07-07 ~ ~.-A
Date Signature of Campaign Treasurer
DS-DE 9 (Rev. 02106)
06/07/07
Ron Weiland came into the office on 05/31/07 to submit his Appointment of Campaign
Treasurer and Designation of Campaign Depository for Candidates. He designated Bank
Atlantic, on Congress Avenue, as his depository.
When he went to Bank Atlantic to open the account on 06/05/07, the bank would not
open the account without a tax 1.0. number. Ron called me from the bank, and I
explained that I had not had that question from anyone else, but each bank had its own
rules. Ron asked me to fax the Form OS-DE 9 to the bank which I did.
After I faxed the form, Ron called back advising that he was not opening his account
there since it was bank policy to provide a tax 1.0. number which he did not have.
Today, Ron called to advise he would be in at 2: 10 p.m. to fill out a new OS-DE 9 since
he was going to open his account at Sun Trust on Federal Highway. Ron arrived at 2: 10
p.m. and filled out the new form.
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STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
OFFICE USE ONLY
(PLEASE TYPE)
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CHECK APPROPRIATE BOX:
D Original Appointment
Name of Candidate
D Deputy Treasurer
o Reappointment of Treasurer
gA./4r t?
6. Telephone
-a; ~ ?.? f% 6' '7?;P-
10. Zip Code
g3Y'~t:
A/e
16. Zip Code
g~y..2C;
Date
~ 2/-0
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, do hereby accept the appointment as
~~paign Treasurer
for the campaign of
U '/V1#?,J.f; c.l/J
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(Party)
CYVf. As a duly registered voter in ,f/A(,p?? A(?/lc.~' COL/~~
candidate to the office of
who is seeking nomination or electi
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OFFICE USE ONLY
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STATEMENT OF
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(Section 106.023, F.S.)
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candidate for the office of
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have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candidate '.
"-S-:~/.~ cJ~
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-OE 84 (Rev. 08/03)
The City of Boynton Beach
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City Clerk's Office
100 E BOYNTON BEACH BLVD
BOYNTON BEACH FL 33435
(561) 742-6060
FAX: (561) 742-6090
www.boynton-beach.org
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PUBLIC NOTICE
TO: CANDIDATES, POLITICAL PARTIES AND OTHERS
NOTICE IS HEREBY GIVEN that the Logic &. Accuracy (LM) testing of the
voting equipment to be used in the November 6, 2007 General Election will
be held:
Friday, October 26, 2006, at 10:00 a.m.
Supervisor of Elections Office
240 South Military Trail
West Palm Beach, FL 33415
RECEIPT of this notice is hereby documented:
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Signature
P,2?-v7
Date Received
-----------------------------------------------------
-----------------------------------------------------
(Detach)
IF YOU AND/OR YOUR REPRESENTATIVE(S) plan(s) to attend the logic & Accuracy
(l&A) testing on October 26, 2007, please detach and return the lower portion of this
notice to the City Clerk.
Signature
Number Attending
8/6/20074:19 PM
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S:\CC\WP\ELECfION\year 2007\PUBNOTE - L&A TESTING NOTICE FOR CANDIDATE SIGNATURES-1.doc
I
RESIDENCY REQUIREMENTS
I, A~L/ ~~ ~,~ ,candidate for
(Print Name)
~ /.~ "-~H?~JY"J/~ of the City
[Mayor/Commissioner - District #)
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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(Date)
1/10/20063:02 PM
S:\CC\WP\ELECTION\year 2006 Elections\NOTICE OF ELECTION DISTRICf RESIDENCY REQUIREMENTS STATEMENT.doc
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CANDIDATE FOR
NON-PARTISAN OFFICE
(Sections 876.05-876.10, Florida Statutes)
OFFICE USE ONLY
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STATE OF FLORIDA
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First Name
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Last Name
a citizen of the State of Florida and of the United States of America, . .. and a candidate for public office. .. do
hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of
Florida.
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
I, fO/l/JI!Z-O b,/~J'L~
(PLEASE PRINT NAME AS YOU WISH IT TO BE WRITTEN IN ON THE BALLOT -- NAME MAY NOT BE CHANGEO AFTER THE ENO OF QUALIFYING)
am a candidate for the office of C / ~ ~~""}:rf/~' /
(office) (district) (group)
My legal residence is .:2."'; Yo -5 ~ /yPI' Jr ,~L!5 ;e:e:-ount~ Flori~. I am qualified
under the Constitution and the Laws of Florida to hold the office to which I des~~~minated 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 who h I am required to resign pursuant to Section
99.012, Florida Statutes.
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Signature of Candidate
Daytime Telephone Number
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Address
City
State
ZIP Code
Sworn to (or affirmed) and subscribed before me this ~ 7 day of AUG. ,2ooL.
Personally Known: X
or
Produced Identification:
ignatu of Notary Public - State of Florida
pe or Stamp Commissioned Name of Notary Public
Type of Identification Produced:
NOTARY PUBUC.STATE OF FLORJDA
ii"~ Janet M. Prainito
; . i CommJsslon # DD5921-' )
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BONlJlill THRU AI1A'Il1C BONlJING ( "
OS-DE 25 (08/07)
Palm Beach County
240 SOUTH MILITARY TRAIL
WEST PALM BEACH. FL 33415
POST OFFICE BOX 22308
WEST PALM BEACH. FL 33416
DR. ARTHUR ANDERSON
Supervisor of Elections
TELEPHONE: (561) 656-6200
FAX NUMBER: (561) 656-6287
WEBSITE: www.pbcelections.org
CERllFICA liON
I, DR. ARTHUR ANDERSON, SUPERVISOR OF ELECTIONS, for Palm Beach County,
Florida, do hereby certify that the 26 signatures on the Nominating Petition for CITY
COMMISSION, DISTRICT NO. 1 of RONALD RAY WEILAND are registered electors
within the municipal limits of the City of Boynton Beach, according to the registration
records on file in this office.
This is to further certify that RONALD RAY WEILAND is a registered voter in Precinct
3164, in the City of Boynton Beach, Florida.
Signed, this the 27th day of August, 2007.
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DR. ARTHUR ANDERSON
SUPERVISOR OF ELECTIONS
PAl:.M'BEACH COUNTY
(SEAL)
NOMINATING PETITION
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We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH, do
hereby nominate:
RoNIILO ~I4Y b../e/L~
to be a candidate for City Commission, DISTRICT NO.1 City of Boynton Beach,
Palm Beach County, Florida, for the term:
NOVEMBER 2007
to
NOVEMBER 2009
pursuant to the Charter and Ordinances of said City.
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I, the undersigned, --Rnr1a L D We,' (a..,lld
, do solemnly swear
(or affirm) that I am duly qualified to hold office under the Charter and Ordinances of the
City of Boynton Beach, Florida, and I do hereby accept the foregoing nomination as a
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candidate for the office of City Commissioner for the City of Boynton Beach, Florida.
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Sworn to and subscribed before me at Boynton Beach, Florida, this ~ 7
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SICCIWPIELECTIONIYear 20071PETITION - Nominating Petition - DISTRICT 1 - YEAR 2007.doc
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Miscellaneous Cash Receipt
CITY OF BOYNTON BEACH
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No. 46855
Account No. W4
$ 226.76
7 .2007
Received of RONALD WEILAND
Address '-Ki40 ~W 14t-h ~t-TPPt-, ROYTJt"on Rp"'''''h, FT. 33416
1% STATE ASSESSMENT FEE FOR QUALIFYING FOR ELECTION -
,
For
COMMISSION DISTRICT 1
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SEAT - NOVEMBER fh"t'2007 , ..
By ~'lJjj.E~-
Dept. Ci tv Clerk' s Office
ClI)' OF BOYNTON BLACH
R E P R 1 N T
III CUSTUMER REellyT 1**
,-'peT: f! 1\ OWN j.: . Type: OL DraweT: 1
Date: 5/27/0: ~l kecelpt DC: jJtll~tl
l.:.escnptloli lluanbty .. Amount
'~4 ~lISCCLLANtoU5 INLUM!::.r~01
1. B0 $22ii. 7b
Trails numbeT; 3250088
G/L account number:
001@0@036'j10~~0
fWNAL~ WEILAND
Il '1 uF BOTHl I?, ~;.~~\1
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Cv., CHECK
Total tendered
Total payment
1~02 $226.7b
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Trans (late:
Sj~7!07 l'ime: 14:12:52
T c?nder detaiJ.
CK CHECK ,
-Gtal tendeTeCi
lotal paymert
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~25.00
$25.31'
THANK YOU F'OR YOUR ~IROl'tPT PAYMENT
u/'~7!€7 Time: 14:~2:20
--. ao,; GatE: u_
THANK YOU :uR YOUR PRUMPT:Yl"lEJif
Miscellaneous Cash Receipt
CITY OF BOYNTON BEACH
No. 46856
Account No. W4
Received of
RONALD WEILAND
2540 SW 14th Street, Boyntqn Beach, Fl 33426
$ 25.00
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For
CITY FILING FEE FOR QUALIFYING FOR:iELBC'l'~-oN - COMMISSION
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FORM 1
STATEMENT OF
FINANCIAL INTERESTS
2006
Please print or type your name, mailing
address, agency name, and position below:
LAST NAME - FIRST NAME - MIDDLE NAME:
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FOR OFFICE
USE ONLY:
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NAME OF AGENCY:
Conf. Code
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P. Req. Code
You are not Imited to the space on the lines on this form. Attach additional sheets, If necessary.
CHECK ONLY IF J2rCANDIDATE OR 0 NEW EMPLOYEE OR APPOINTEE
""BOTH PARTS OF THIS SECTION MUST BE COMPLETED""
PDF 2006
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON
A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):
E. DECEMBER 31, 2006 QB 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MA~ER 0) CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):
o COMPARATIVE (PERCENTAGE) THRESHOLDS QB 0 DOLLAR VALUE THRESHOLDS
PART A - PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person]
NAME OF SOURCE SOURCE'S
OF INCOME ADDRESS
DESCRIPTION OF THE SOURCE'S
PRINCIPAL BUSINESS ACTIVITY
~
PART B .- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person]
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
8,jJ -
PART C - REAL PROPERTY [Land, buildings owned by the reporting person]
FILING INSTRUCTIONS for when
and where to file this form are locat-
ed at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out begin
on page 3.
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Eft. 1/2007 (Continued on reverse side)
PAGE 1
PART D _ INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
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PART E - LIABILITIES [Major debts]
NAME OF CREDITOR ADDRESS OF CREDITOR
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PART F - INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
NAME OF A-- A.... A. .AAA /' '"
BUSINESS ENTITY
ADDRESS OF r~~ dd -r ....-,\ - 7A...l
BUSINESS ENTITY
PRINCIPAL BUSINESS -//dO s:"~O L L A' .~,
ACTIVITY ---- ,
POSITION HELD ~R~/ ,
WITH ENTITY
I OWN MORE THAN A 5% LA./J
INTEREST IN THE BUSINESS
NATURE OF MY ~ ~.::J?
OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SE~TE SHEET, PLEASE CHECK HERE m
SIGNATURE (~q"'red~~/? 4- ---~. DATE SIGNED (required): 7
-, g,,2?-()
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, including If you were mailed the form by the Commission Initially, each local officer/employee, state
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified state employee must
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to file within 30 days of the date of his or her
that location. appointment or of the beginning of employ-
If you have nothing to report in a particular Local officers/employees file with the Supervisor ment. Appointees who must be confirmed by
section. you must write "none" or "n/a" in that of Elections of the county in which they perma- the Senate must file prior to confirmation. even
section(s). nently reside. (If you do not permanently reside if that is less than 30 days from the date of their
in Florida, file with the Supervisor of the county appointment.
Facsimiles will not be accepted. where your agency has its headquarters.) Candidates for publicly-elected local office
NOTE: State officers or specified state employees must file at the same time they file their
MULTIPLE FlUNG UNNECESSARY: file with the Commission on Ethics, P.O. Drawer qualifying papers.
Generally, a person who has filed Form 1 for a 15709, Tallahassee, FL 32317-5709; physical Thereafter. local officers/employees, state
calendar or fiscal year is not required to file a address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are
second Form 1 for the same year. However, a 201, Tallahassee. FL 32312. required to file by July 1 st following each
candidate who previously filed Form 1 because Candidates file this form together with their calendar year in which they hold their posi-
of another public position must at least file a copy qualifying papers. tions.
of his or her original Form 1 when qualifying. To determine what category your position Finally, at the end of office or employment.
falls under. see the "Who Must File" Instructions each local officer/employee, state officer, and
on page 3. specified state employee is required to file a
final disclosure form (Form 1 F) within 60 days
of leaving office or employment.
CE FORM 1 - Eft. 1/2007
PAGE 2
GENERAL ELECTION
NOVEMBER 6, 2007
FILE NO.
1
DISTRICT NO.
1
CANDIDATE CHECK LIST
for
COMMISSIONER - DISTRICT 1 - CITY OF BOYNTON BEACH
NAME
Ronald R. Weiland
Term of Office
3 vrs. to 11/10
ADDRESS 2540 SW 14th Street
Qualifying Fee
$25.00
BOYNTON BEACH FL 33426
Receipt No.
'-IfoB" 5 ~
Assessment Fee:
PHONE
(Residence) (561) 734-6885 , II . B -
(Cell) Receipt No. -reo b 5
(BusinessU~b - ~R7 - fnlU>i~5CelI
uJeib.nd..@ ai. bOinT~w ~JC.....ff.us Name to Appear on Ballot
PAPERS FILED
Appointment of Campaign TREASURER
Acceptance of Campaign Treasurer
Designation of DEPOSITORY (DS-DE 9A)
Copy of VOTER'S REGISTRATION (Candidate)
Copy of VOTER'S REGISTRATION (Treasurer)
_~,la..nd
~(.1.n .TRu.ST - 316" N FerlCfll.-1 Hw'f
Date: t::)C'IN TOt-i B c:.A~;.; I /::'L- .2:3L.2~r
"o.b-D7 - 0-7
o to - 0 -7 - 07
SAME AS ABOVE
Certified PETITION - 25 Registered Voters
CERTIFICATION of Candidate
Financial Disclosure
Qualifying Fee ($25.00) Check. No.
Assessment Fee ($ ~at.16) Check. No. IOOa.
8'-;),7-07
f?-::J.7-o7
8> -r!l7-DJ
Oath of Loyalty
FS1 06 Acknowledgment - Statement of Candidate
(DS-DE84)
05-31-07
L & A Testing Notice
Treasurer's Report - 1st quarterly - July 10, 2007
Treasurer's Report
Treasurer's Report
Treasurer's Report
Treasurer's Report
Sign Intent Request
Sign Intent Request
Sign Intent Request
Endorsements
Endorsements
Other
Other
5/31/20073:05 PM
S:ICCIWPIELECTIONIYear 20071District 11Ron WeilandlChecklist.doc
Ijmp
FORM 1 STATEMENT OF 2006
Please print or type your name, mailing I FINANCIAL INTERESTS I
address, agency name, and position below:
LAST NAME - FIRST NAME - MIDDLE NAME: ~/t-!I' FOR OFFICE
we (L"-W'o ~ ".A/~O USE ONLY:
MAILING ADDRESS:
~t'YfJ ~ t.../'-- / o/'~ J(
~l 10 Code
13 ();/'~ ~~If 33 'I.)' j2-ff1
CITY : ZIP :' COUNTY :
10 No.
NAME OF AGENCY:
G:T3; np ~nw~ a~ Conf. Code
NAME OF OFFICE OR POSITION HELD OR SOUGHT: P. Req. Code
C-/~ ~J'I - -"~.J:"sYU~^,
You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF 0 CANDIDATE OR ~ NEW EMPLOYEE OR APPOINTEE PDF 2006
..BOTH PARTS OF THIS SECTION MUST BE COMPLETED..
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON
A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):
:EJ- DECEMBER 31, 2006 QB 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
'- ~
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLE'f;ZrEITHER (check one):
o COMPARATIVE (PERCENTAGE) THRESHOLDS QR ,I DOLLAR VALUE THRESHOLDS
PART A - PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person!
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
A- ... tJ~.f/j 4!.. ~NV,yUFf ...# //t90 ~ ~ P~iJ~ ~/..
r,C) ~c. A...... .Ai\.o. /(Mc# ,A ~... 17'~~17~ .t7~ I(tMliIIO
-
... , '3.?V3f
PART B - SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person]
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C - REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for when
and where to file this form are locat.
ed at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out begin
on page 3.
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Eff. 1/2007 (Continued on reverse side)
PAGE 1
PART D - INTANGIBLE PERSONAL PROPERTY [Stock5 bonds certificates of deposit etcj
TYPE OF INTANGIBLE BUSINESS ENTITy .TO WHICH THE PROPERTY RELATES
PART E - LIABILITIES [Major debts]
NAME OF CREDITOR
-i
--------1
ADDRESS OF CREDITOR
PART F - INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of bUSineSses)
BUSINESS ENTITY # 1
NAME OF
BUSINESS ENTITY
ADDRESS OF
BUSINESS ENTITY
PRINCIPAL BUSINESS
ACTIVITY
POSITION HELD
Vv1TH ENTITY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST
SIGNATURE (required):
WHAT TO FILE:
After completing all parts of this form, including
signing and dating it, send back only the first
sheet (pages 1 and 2) for filing.
If you have nothing to report in a particular
section, you must write "none" or "n/a" in that
section(s).
Facsimiles will not be accepted.
NOTE:
MULTIPLE FILING UNNECESSARY:
Generally, a person who has filed Form 1 for a
calendar or fiscal year is not required to file a
second Form 1 for the same year. However, a
candidate who previously filed Form 1 because
of another public position must at least file a copy
of his or her original Form 1 when qualifying.
CE FORM 1 - Eft. 1/2007
BUSINESS ENTITY # 2
BUSINESS ENTITY # 3
SEPARATE SHEET, PLEASE CHECK HERE 1m
DATE SIGNED (required):
c2-027- 0
FILING INSTRUCTIONS:
WHERE TO FILE:
If you were mailed the form by the Commission
on Ethics or a County Supervisor of Elections for
your annual disclosure filing. return the form to
that location.
Local officers/employees file with the Supervisor
of Elections of the county in which they perma-
nently reside. (If you do not permanently reside
In Florida, file with the Supervisor of the county
where your agency has its headquarters.)
State officers or specified state employees
file with the Commission on Ethics, P.O. Drawer
15709, Tallahassee, FL 32317-5709; physical
address: 3600 Maclay Boulevard. South Suite
201. Tallahassee. FL 32312
Candidates file this form together with their
qualifying papers.
To determine what category your position
falls under see the "Who Must File" Instructions
on page 3
WHEN TO FILE:
Initially, each local officer/employee, state
officer. and specified state employee must
file within 30 days of the date of his or her
appointment or of the beginning of employ-
ment. Appointees who must be confirmed by
the Senate must file prior to confirmation, even
if that is less than 30 days from the date of their
appOintment
Candidates tor publicly-elected local office
must file at the same time they file their
qualifying papers.
Thereafter. local officers/employees. state
officers. and specified state employees are
required to file by July 1 st following each
calendar year in which they hold their posi-
t'on~.
Finally, at the end of office or employment,
each local officer/employee, state officer, and
specified state employee is required to file a
final disclosure form (Form 1 F) within 60 days
of leaving office or employment.
PAGE :::