Filing Papers 120E0 13 PM 1:30
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(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
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: Fir t, iddle, Last) 3. Address (include post office K ox or,.street pity, state, zip
p j( ( ��r code) c(� j' (Itt�_'
( ? I mo ' 4,
4. Telephone 5. E-mail address
(S ( ) ` 1 - ` t - r q4:, Dke,WA pr6 l - -le
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
/4i ,4LT i'f ❑ My intent is to run as a Write - In candidate.
8. If a candidate for a partisan 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 Campaign Treasurer ❑ Deputy Treasurer
10. Name T�f T I�ty T
surer or D ta /r�e�r
11. Mailing Address 12. Telephone
'' l'5 Of , ( )
1 1 C unty 15. t to 1 Zip Coe ,...17. E-mail address
A Ci 6v P ia ( iv fr4a ( ' -5 -)4 /) -/
18 I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. yam? of/ ,ft 20. Address
k . e /?J l G(i C7 f b co .S. F ero ` #W
21. City . County 23. Sjat 24 .�
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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 F TS STATED IN IT ARE TR .
25. Date 26. Signs Candi
/ / / x - -� _‘,.
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the - • propriate block)
1, kV ,/J 7 , do hereby accept the appointment
(Please Print or Type Name)
desigpated above as: ( Campaign Treasurer 2 - "Deput y Treas er t / 7 x ,,� - Z
Date Signature of Campaign asurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.AC.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
1, � Ulil ti , ,
candidate for the office of k 4,-(7/.91 '3C -C ( ,
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes. -.
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Signature o Can.idate 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)
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Miscellaneous Cash Receipt °' °°
CITY OF BOYNTON BEACH NO' 77093
a - _
°
4 P
~TON 0
Account No. 661- 0000 - 369 -10 -00
$ 25.00
20
Received of Steven Holzman
Address 955 Brookdale,Pk., Boynton Beach, FL 33436
For City Filing Fee for the Mayor At -Large seat for the
March 12, 2013 election
,pt no: i 546
ie�a.C1O
Dept. City Clerks Office B
Total payisent $25.98
Miscellaneous Cash Receipt G Y ° °
CITY OF BOYNTON BEACH No. 77094
_
0
P
TON �
Account No. 0 01 - 0000- 369 -10 -00
$ 259.2!6
20
Received of Steven Holzman
Address 955 Brookdale P1.4 Boynton Beach, FL 30436
For 1% State Assessment Fee for tpi . A
yort -
,.��,. Large seat for
2013 e lec o1 !. O ate : M 8//
the March 12, I. Date: �'�`B��I13 e1 Receipt no: 14541
Total tendered Te 4
Dept. City Clerk's Office By Total pav,ent $259.2
1
FORM 1. STATEMENT OF 2012
Please print or y p
pe your name, mailing 1 FINANCIAL INTERESTS FTOR OFFICE USE ONLY:
address, agency name, and position below:
LA T NAME -- FIRST NAME -- MIDDLE NAME : - -
M�ILI ADDRESS : .4-11 -<
C(5- 0 L( Al C SE ONLY c—itio
( \ NA4 ik, N ii3 PA4 ,t:(24 7:A"'
: ZIP : COUNTY : cD y
NAME OF AGENCY : T i
. S
•
NAME - OF OFFICE OR POSITION LD OR SOUGHT :
`'W �1 MI
&e( la /r /JJ i �jK6o4 •
You are not limited to the space o the lines on this form. Attach ad sheets, if necessary.
CHECK ONLY IF CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
* * ** 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 ( st check one):
DECEMBER 31, 2012 OR ❑ 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). CHECK THE ONE YOU ARE USING:
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF SOURCE SOURCE Q�� DESCRIPTION OF THE SOURCE'S
w i.,1 ( OF INCOME , L L / /fj //, - / , R7 / �� W J 4 cr J J L BUSINESS ACTIVITY
,j 7 &
qc
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n /a ")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
1 ,cA \ rk\C'e 1 12 % , Q,![( . /"' r g>c lot) Pc . 61/0
4 - - 21 (i 'w\ g je Aver ,,/ Y ,U > - ��►t 4 mil fro
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] FILING �N -)-r
S ONS for
If you have nothing to report, you must write "none" or "n /a ")
/V
when and where to file this
form are located at the bottom
of page 2.
INSTRUCTIONS on who must
file this form and how to fill it
out begin on page 3.
CE FORM 1 - Effective: January 1, 2013. Refer to Rule 34- 8.202(1), F.A.C. (Continued on reverse side) PAGE 1
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions]
(If you have n thing to report, you must write "none" or "n /a ")
gib ik %, � TYPE 0 G B E St TITTY TO WHICH THE PROPERTY RELATES
5! VAlio40)
3� Y L) q (' • .
,m thr -
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF CREDITOR ADDRESS OF CREDITOR
Cl/4L ( OY bir 11 ,1"➢' - 96/0 n c ° t^ GV Uc t) (hr; -- 7 ( �1,) for(li
rG /A P/D
`� � 1 ' - ( CAA* C(/ - 1 to b( . 5. � r� �'t�'� f(Y', L' , C4 fi0
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions]
(If you have nothing to report, you must write "none" or "n /a ")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS —
NATURE OF MY
OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATU - ire •wire • _ � DATE SIGNED (required):
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, If you were mailed the form by the Commission Initially, each local officer /employee,
including signing and dating it send back on Ethics or a County Supervisor of Elections state officer, and specified state employee
only the first sheet (pages 1 and 2) for filing. for your annual disclosure filing, return the must file within 30 days of the date of
form to that location. his or her appointment or of the beginning
If you have nothing to report in a particular Local officers /employees file with the of employment. Appointees who must be
section, you must write "none" or "n /a" in that Supervisor of Elections of the county in confirmed by the Senate must file prior to
section(s). which they permanently reside. (If you do not confirmation, even if that is less than 30
permanently reside in Florida, file with the days from the date of their appointment.
NOTE: Supervisor of the county where your agency Candidates for publicly - elected local office
MULTIPLE FILING UNNECESSARY: has its headquarters.) must file at the same time they file their
Generally, a person who has filed Form 1 State officers or specified state employees qualifying papers.
for a calendar or fiscal year is not required file with the Commission on Ethics, P.O. Thereafter, local officers /employees, state
to file a second Form 1 for the same year. Drawer 15709, Tallahassee, FL 32317 -5709. officers, and specified state employees
However, a candidate who previously filed Candidat file this form together with their are required to file by July 1st following
Form 1 because of another public position qualifying papers. each calendar year in which they hold their
must at least file a copy of his or her original positions.
Form 1 when qualifying. To determine what category your position falls Finally, at the end of office or employment,
under, see the Who Must File" Instructions on each local officer /employee, state officer, and
page 3. specified state employee is required to file a
final disclosure form (Form 1 F) within 60 days
Facsimiles will not be accepted. of leaving office or employment. However,
filing a CE Form 1F (Final Statement of
Financial Interests) does not relieve the filer
of filing a CE Form 1 if he or she was in their
position on December 31, 2012.
onr_�
The City of Boynton Beach
City Clerk's Office
100 E BOYNTON BEACH BLVD
!` BOYNTON BEACH FL 33435
(561)742 -6060
=' FAX: (561) 742 -6090 w
E -mail: prainitoj @bbfl.us -1
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www.boynton- beach.org a _-") „
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PUBLIC NOTICE
-la to-
TO: CANDIDATES, POLITICAL PARTIES AND OTHERS
NOTICE IS HEREBY GIVEN that the Logic & Accuracy (L&A) testing of the
voting equipment to be used in the March 12, 2013 General & Special
Elections will be held:
Friday, February 22, 2013 @ 3:00 p.m.
Supervisor of Elections Warehouse
7835 Central Industrial Drive
Riviera Beach, Florida
RECEIP of t • s notice is hereby documented:
ii r ZZ - / 1
Signat . re I Date Received
DETACH
IF YOU AND /OR YOUR REPRESENTATIVE(S) plan(s) to attend the Logic &
Accuracy (L&A) testing on Friday, February 18, 2013, please detach and
return the lower portion of this notice to the City Clerk.
Signature #Attending
S: \CC \WP \ELECTION \Year 2013 \INFORMATION PACKETS \L&A Testing Public Notice - For Candidate's Signature.doc
Catch a Wave, Catch a Fish, Catch Your Breath - Breeze Into Boynton Beach
America's Gateway to the Gulfstream
i
N BE
CANDIDATE OATH — 13 FEB
NONPARTISAN OFFICE PM 12.2
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
1, _ C . \ 7016zi 1
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT * -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of t' a�iL' /Z � - l �-r/�Y ,
(office) (district #)
; I am a qualified elector of R N-4 (t - County, Florida;
(circuit #) (group or seat #)
I am qualified 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 Florid -.
('d /) ✓ .?" — /014
4/ �7o /Z.✓ !n ��v9`7t� �f�_ - //
T elephone Number E mail Address
Signature of Candi ate C� �
eck ).-(<4/1- . 3 3 z-7/".. 5
Address City State ZIP Code
Candidate's Florida Voter Registration Number (located on your voter information card): o 1 (4010C1
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
V Jl) 1-- Z A-A i
STATE OF FLORIDA n
COUNTY OF R ( eCC
Sworn to (or affirmed) and subscribed before me this 7 day of VC.- Df'LLOUry , 20 /'j .
Personally Known: or � . • / r
• ature of Notary Public
Produced Identification: nt, Type, or Stamp Commissioned Name of Notary Public
NOTARY PUBLIC OF FLORIDA
Type of Identification Produced: ''" , Janet M. Prainito
` ' Commission # EE028433
Expires: SEP. 22, 2014
1DIUDT1W • ivy lankiliNr. CO TNr.
DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C.
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MC P �ps9
<!e' �I I Palm Beach County
240 SOUTH MILITARY TRAIL
WEST PALM BEACH, FL 33415
POST OFFICE BOX 22309
WEST PALM BEACH, FL 33416
SUSAN BUCHER
Supervisor of Elections TELEPHONE: (561 ) 656 -6200
FAX NUMBER: C561) 656 -6287
WEBSITE: www.pbcelections.org
CERTIFICATION
I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do
hereby certify that Steven C. Holzman submitted 35 petition signatures for the office of
Mayor of the City of Boynton Beach.
I further certify that 27 of those signatures are registered electors in the City of Boynton
Beach, according to the registration records on file in this office.
This is to further certify that Steven C. Holzman is a registered voter in Precinct 4026, in
the City of Boynton Beach, Florida.
Signed, this the 6th day of February, 2013.
SUSAN BUCHER +ti "z
SUPERVISOR OF ELECTIONS -nor
PALM BEACH COUNTY
rn erD
(SEAL)
7,1TY OF IOYNFON BEAM
CITY LE c` Fir NOMINATING PETITION
13 FEB -7 PM 12: 24
We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2 -42,
City Code of Ordinances), do hereby nominate:
V {' U`C_VV C
to be a candidate for MAYOR AT -LARGE City of Boynton Beach, Palm Beach County,
Florida, for the term:
MARCH 2013 to MARCH 2016
pursuant to the Charter and Ordinances of said City.
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SIGNATURE ADDRESS
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I, the undersigned, S4-even C • H o I X , 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 candidate for the office of
Mayor At -Large for the City of Boynton Beach, Florida.
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Sworn to and subscribed before me at Boynton Beach, Florida, this 7 day of
Fe br u,o�.r A.D. 20 l3 .
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Received at the City Hall in Boynton Beach this 7 day of Fe- j ry
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20 l3 at /a: /5 P.M.
0 1111111 /I • ��_�.± _ •
City Clerk
S \CC \WP \ELECTION \Year 2013 \INFORMATION PACKETS \Nominating Petition doc