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Filing Papers MATERIAL FOR CANDIDATES YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, WE HAND YOU THE FOLLOWING: 1. t Qualifying Information & Municipal Election Schedule 2. Dates to Remember 3. -(.✓ 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 4. Residency Requirements (To be filled out and returned to City Clerk) 5. Form DS -DE 84 Statement of Candidate & copy of Chapter 106, Florida Statutes (Must be filed with City Clerk within 10 days after filing Appointment of Campaign Treasurer) 6. (/ S S tate of Florida Election Laws - Chapters 99, 105 & 106 (2012) 7. Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees _� 8. Directions for Posting Temporary Political Sign o �7 9. t City Commission District Map 10. Part I Charter, Article VII. Elections — City of Boynton Beach S 11. " P art II Code of Ordinances — Chapter 2 Administration, Article III. Elections / rn�� 12. 1. Poll Watcher Form & FS 101.131 — "Watchers at Polls" - 13. ' Candidate Handbook for Candidates 14. _ Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets 15. 1/ P etition Form - Candidate for Commissioner — TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF ELECTIONS AND RETURNED TO CITY CLERK DURING QUALIFYING 16. 1 Form 1 Statement of Financial Interests 2009 — TO BE FILLED OUT, SIGNED & RETURNED TO THE CITY CLERK DURING QUALIFYING 17. L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.) 18. 4/_ Loyalty Oath - Oath of Candidate (DS -DE 24B)— TO BE RETURNED TO CITY CLERK DURING QUALIFYING RECEIVED BY: 6;11 conk Cando ate Signature Date Signed O f et M. Prainito, MMC ty Clerk October 18, 2012 S: \CC \WP \ELECTION \Year 2013 \MATERIAL FOR CANDATES.doc 'ITY OF DOYNTON BEACH CITY CLERK'S OFFICE APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN 12 DEC 17 PM 12: 13 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. CHECK APPROPRIATE BOX(ES): ❑ Initial Filing of Form Re- filing to Change. Treasurer /Deputy fJ Depository ❑ Office ❑ Party 22 Name of Candidate (in this oorder First, Middle, Last) 3 Address (include post office box or street, city, state, zip ,,, �,✓ A t ,e' La ( &_ code) . j 4/ - /9/.71) _ttE // 4 Telephone 5 E -mail addres i Soyo1ZJ 6ea. ch , ' 10 ��` 6 Office sought (include district, circuit, group number) 7 If a candidate for a nonpartisan office, check if applica ,' V be My Intent is to run as a Write -In candidate 8 If a c ndidatte 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 of Treasurer or Deputy Treasurer . (...A)rimyie ) (6yr 4-Q---- 11 Mailing Address 12 Telephone 9/ j m Au& 6 ,) s ? .s ►� 13 City County , 15, State 16 Zip Code 17 mail address u fit g) ! , k (i • /, CLC /J RL 3'5 , 0 n Nil i rnc�. ( Cc ,� c� 18 I have designated the following bank as my / Primary Depository ❑ Secondary Depository 19 Name of Bank 20 Address )2_, , 1, ,50 t,3 e Vyl - hi bect_a 6( v_D 21 City 22. County 23. State 24. Zip Code . 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 r0) - 1/7— x, yi �zc 27, Treasurer's Acceptance of Appointment (fill in t t anks and check the appropriate block) 5 --- _1 011- 10me Z, do hereby accept the appointment (Please Print or Type Name) designated above as 0 Campaign Treasurer u-- Deputy Treasur r i / / X - ‘ , n C _ (i ra 71 - C. Date Si. nature 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 (Section 106.023, F.S.) (Please print or type) ' candidate for the office of / ' /a Y0( • have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. n G *f 211 rn CO X < _ �O �t Z -r4W fTi OD r X /aid. / Signature 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 (05111) RESIDENCY REQUIREMENTS N ?� tz, - <tz rd V �o Z cno N -T12 crt - 7 1 09 CZI I, 620204i e oZ a Co iY1c° , candidate for (Print Name) t /lia V r 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. / (Signature of Candidate) / /? (Date) 9/27/2012 11:03 AM S: \CC \WP \ELECTION \Year 2013 \RESIDENCY REQUIREMENTS STATEMENT.doc VOTER CARD • PALM BEACH COUNTY, FLORIDA �_ /•` TARJETA ELECTORAL, CONDADO DE PALM BEACH, FLORIDA REGISTRATION NUMBER REGISTRATION DATE PRECINCT Numero de Macrlpclon Fecha de lnscrlpclon Distrito Electoral 116662911 09 -09 -2008 7180 LACOMBE, SOPHONIE 321 NE 14TH AVE BOYNTON BEACH FL 33435 Signature ot oter- Firma de Votante 01/10/1984 REP . - OLD hER= DOS_S.ACL, !YOUR PRECINCT NUMBER Su Numero de Distrito Electoral I f 7180 YOUR POLLING LOCATION Su Centro Electoral ST JOHN MISSIONARY BAPTIST CHR 900 N SEACREST BLVD BOYNTON BEACH YOU ARE ELIGIBLE TO VOTE FOR A REPRESENTATIVE IN EACH DISTRICT LISTED USTED PUEDE VOTAR POR UN REPRESENTANTE DE CADA DISTRICO NOMBRADO US CONGRESS STATE SENATE STATE HOUSE Congreso de los EE UU Senado del Estado Camara de Drputados del Estado 20 27 88 COUNTY COMMISSION SCHOOL BOARD MUNICIPALITY Com,srbn del Condado Junta Escolar Munic/pa/idad 7 7 BB REGISTRATION NO ■ 116662911 • NUMERO DE INSCRIPCION ' SUSAN BUCHER • SUPERVISOR OF ELECTIONS ; SUPER" 'SOR DE ELE; ONES ‘1 Y 0 A. Miscellaneous Cash Receipt Nk, No. • CITY OF BOYNTON BEACH 11. N 00i-00'30-369-10-30 Account No. Jan :;1_ t3 20 Sophonie uaCumbe Received of Address For 1% state assessment tee for une mayor at larc; se3t tor th March 12, 2013 il.f.tction Dept. City C By rk Stanzione Miscellaneous Cash Receipt CITY OF BOYNTON BEACH No. • 001-0000-369-10-00 N Account No. :5.00 13 20 Received of Sophonie LaCornbe Address For city tiling lee for the mayor seat for Marci. t 313 election City Clerk Stanzione Dept. By FORM 1 STATEMENT OF 2012 Please print or type your name, mailmg FINANCIAL INTERESTS -- address, agency name, and position below 1 FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME -- MIDDL yIE ka- Y J Krzoi, MAILING ADDRESS _a. , : s /,'IvE C..r.) " Act, / - ,:a / 7/)1 040'W? P.,:?3 .//)/) 41)--11-2 CA rri C„) CITY ZIP COUNTY '5= 3C �C NAME OF AGENCY W .. C3 n > NAME OF OFFICE OR POSITION HELD OR SOUGHT N rf't You are not limited to the space on the lines on this form Attach additional sheets, if necessary CHECK ONLY IF a. 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'S DESCRIPTION OF THE SOURCE'S • • COM ^ ADDR S I �� � PRINC L BU ACTIVITY ( 0l i I !' eteirey10 / Dd v't_S f z()'►1 6 7r\ tAQ J 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 /tL// PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] FILING INSTRUCTIONS for (If you have nothing to report, you must write "none" or "nia ") when and where to file this ( form are located at the bottom ,6" 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) FA C (Continued on reverse side) PAGE 1 ---- - - — - 1 i PART E — LIABILITIES [Majoi ti Ei,ee instructibi,, (If you have nothing g report, you must write ' none" oi NAME OF CREDHJk ADDRESS OF CRED110i — .. I PART F — INTERESTS IN SPECIFIED BUSINESSES {Ownershw ol positio) — — f - 1 , , v oes of (If you have nothing to report, you must write "none" nr "Ylia" BUSINESS EN { T‘' , T BUSINEta:) i fsIHTY fff , „f DAE&a EN1, 7 - 1-- NAME OF BUSINESS ENTIT\ -4- , • ADDRESS OF BUSINESS ENTIT- ; 2=-H-- PRINCIPAL BUSINESS ACTIVi ; POSITION HELD WITH ENT if , t I OWN MORE THAN A :',' INTEREST IN THE BUSINESS , NATURE OF MY OWNERSHIP INTERES IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE J i SIGNATAJR (required):, D__ATEresil, 0 ---- 6 i i 1/4, ,,,,,,/ , ' J \,......, -,----• -,, t j i i , FILING INSTRUCTIONS . • WHAT TO FILE WHERE TO FILE WHEN TO F L E After completing ai, pait, , trihf- o, n , '' f 'v'efa, dailei 1 t a.f torch icy tf,e _ al Hi ,, issic initially including signing and dating it. sena back si, Ethics (,- ,, , 7.durity '=upervisot o1 Flectioi, ,3alr offica- - . ,),acified , oirpicvi-„ only the first sheet (nageo 1 anci 7 for filing '''' /-', ' - iisclosure fila , t J, f ' - -' vithir ?:1 days form to to that locatioh , s Or hu appointment of ,1 toe beginnib,, i If you have nothing to report 11 a particular Local officers/employees Ile wit, flat ■f employment Appointees vvric must h: 1 'le dri ,ed d, 'he S fb section, you must write "none" nr "rita" in that Superviscy of Elections of the county 1 onfirm enate ihicst uil f.f i section(s \ which they permanently res onfirmatio ver that ide 01 you do not lay:: 5 ilf ,- )e fart f ftf. arpointhann v permanently reside ,r, Florida, file with the NOTE: Supervisor of the county where your agency Candidates - uf publicly-elected ocal attic, MULTIPLE FILING UNNECESSARY. has its headquarters : nus: file 01 The r,a flnlE bin 5 Generally a person who has filed Form 1 qualifying raper State officers or specified state employees for a calendar or fiscal year is not required file with tne Commission on Ethics, PC Thereafter local officersiemployees slat,: to file a second Form 1 for the same year Drawer l Tallahassee EL 323 rfficers ani 7,pecified state employee', However a candidate who previously filed ere , equirec tt file by 0017 1st following Candidates Ole this form together with the.i Form 1 because of another public position each ,alenchr ;ea( vhicf—I-ev hole in ualifyg papers ffio- must at least file a copy of his or her original q;')ositiors • Form 1 when qualifying To determine what category your position falls Finally, t nally, at the enu or office or employmei, rider see the Who Must File" Instructions or each local officer/employee, state officer, aiih page ‘'t ,pecified state employee is required to file final disclosure form +r orm 1 F) within 60 day, Facsimiles will not be acceoted. lf leaving dffice rl employment Howeve tiling a DE Font ' tFinal Statemert -Inanciai l'iterest, does not relieve the toe - .)f filing a 1 :E.. l'orr I f he or she was 'fi 'he, , position or December o1, 2012 The City of Boynton Beach z. City Clerk's Office b 100 E BOYNTON BEACH BLVD BOYNTON BEACH FL 33435 to r (561) 742-6060 (561) 742 -6090 "a Z li -» E -mail: prainitoj @bbfl.us w o www.boynton - beach.org � �� PUBLIC NOTICE 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 RECEIPT of this notice is hereby documented: )`& - / , /3 Signature Date Receiifed DETACH IF YOU AND /OR YOUR REPRESENTATIVE(S) plan(s) to attend the Logic & Accuracy (L&A) testing on Friday, February 22, 2013, please detach and return the lower portion of this notice to the City Clerk. ) h 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 Y 8: 6 ri ., r Y" CRKY1 U 'S QE�'!CE BEACH CANDIDATE OATH - JAN 3 � P M 3� � NONPARTISAN OFFICE 13 J 2 (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section,99 021, Florida Sta utes) I , » , 7 4-1 , (� M,,' , (PLEASE RINT AME AS YOU WISH IT TO APPEAR ON THE BALLOT* - NA E MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of /�� ' , /2. i .e. ! J2 , �j (office) / (district #) , I am a qualified elector of 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 1 seek, and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes, and l will support the Constitution of the United States and the Constitution of the State of Florida t A. avzi_6-.4ynk( A --c b6,,,,ti... , ,,,,,,..(0 r.4.,v, ignature of Candidate TelephorWNumber Email Ad. ss �. / Alt/ I' /", - d7,4 �� -7 ► t- A. dress ' ity State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): &I [ 'c 9// * 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). 5o4jrye_ Lo- eorY1 STATE OF FLORIDA COUNTY OF PALM kAC#4 Sworn to (or affirmed) and subscribed before me this 3 1 day • � .t.i �•_ . . , 20 / Personally Known t / or �- Alw•A L ! 1 nature of Notary Public Produced Identification ' int, Type, or Stamp Commissioned Name of Notary Public NOTARY PUBLI C •STATE OF FLORIDA Type of Identification Produced / M. Prainito I = Cornmission # EE028433 $ Expires: SEP. 22, 2014 DS -DE 25 (Rev 5/11) Rule 1S- 2.0001, F.A.C. •c*- Of F r Palm Beach County OF 0 240 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. [561 ] 656 -6287 WEBSITE• www pbcelections org CERTIFICATION I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that Sophonie Lacombe submitted 62 petition signatures for the office of Mayor of the City of Boynton Beach. I further certify that 26 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 Sophonie Lacombe is a registered voter in Precinct 7180, in the City of Boynton Beach, Florida. Signed, this the 31st day of January, 2013. A tstaXin BUCHER, SUPERVISOR OF ELECTIONS PALM BEACH COUNTY w r ,ca 3 viC (SEAL) �? rr1 . . 'iTY OF BOYNI ON BEAD NOMINATING PETITIONT \'' r1_ERK'S OFFICE 13 JAN 3 1 PM 3: I 2 We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2-42, City Codc of Ordinances), dc hereby nominate: 50PhOM6 do- a co rnlc. 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. - ,:*-• - 7 C SIGNATURE ADDRESS ) 7 co c , CAe(0( 7 ,, C; re le ke Al 3 I - 1,4,6 4 „co- y vh „Ocktiz:e 1051d e. ' ,./ ii, d / 33Y3 0 1 K4k - yl . .ta.liwi: -- )z ,, ,o 6_163utotettfr. Arim etch 33‘,/3,6 \/ e 7 p /t asee„L e Lai, a &-4 4 3 / Fi -- 3 c ‘, Wkikt ( 1 - - --. c /31)q 4ii IV 1 I GZ ?Ci. 4iefAed R' 1:?2,1;;ILA,,44,L, C t i l l f eG.-&C - / e 5g der-I'62 ke a'116 ii —Atit-Y 3,y4d,6 - VI-4 6 Vo ivE )1ith.02 _ iro3Atoyi F/ e--4 -,20A, -7- /es //,/ /.=13 33V86 I ditti.r,t 1-e 3,2 iv 4 .-- /4 /A .dr2-e. 8.8 3`,-3 lqin 6W 1 ; 6 • 35 Ler wr ,,,- • , , \ \ \ C4S+ K/O m-1,ct, T-L3 ,,,k't' Alt U Ar 1--vk.2 q Lot etY -c 4 Do c:) .k) I qf--) i'--Li$z - 13 oivkl po ' v FL3.) ti3 /NI A %. \-■ .-' 13 -, '-*'%`(_4_t,,Ic_pA,:c___4.,_j,,x__k.2k__4 7 5 (,,) Lft ' , goytriot &lac/ H (tICu Le. 2513_ 'Defox (0 q65 ioN) )4('Ive 66kAtityi - /-53 - '. ldsta9,0 Goyyleb e,kr_ -)(b ty1 KVA L3 41 IG'\q\ee 109 Ali r dzikbn Dr, bce 0 s ' *AO . -. ` - ..ti ' tli : Q. .0i11,1V ifQ,CL6 . ,,- 1 ,„7 2 1 — ,..,9g/Arirr , LERK'S I '41f, ' 13 JAN 3 1 • ,Ier )_ei 1442 di\ci,c, ikita. Ctti ct fa), 0) 2 1 1, ,) , 0,4 fr) (Deue, / At cA\cW MoscAu? CnostelEi 0 \OE VIr:OrOe•%siL - 11 ( -1-1 '-/ -' nd 1/2"i . -'()(1 -- oi-IPq ii-3,&-T(33( v‘C'L.-\sck Rose - VA(cik - to -_ - ito i ' . ° Pro b4its_q3 /2 /1 ..._ -,, rib r ' . e t • (0 11 _. I A il _ _ t • , _ . • 0 FC 5343 /9; le• 61 0 qn ni) /Da ii ., ' : . et. :' J ' t61\i/l•RQf N1 se- \ 4 44120-4) kci :2c7). V 1 1 ik.zoiy)6e , 26/,r,) si,i) 11_{ ilk is. G FLa-3413,3" IA__- ito ____ (ti i 4 _ Viltir ' i • :36k a sd<: ith A \‘) 6 erytigi &roil fi /\\e rii 1 , , ' , , I , ,}.... / L 't r) SL L I it ) INI■ 4 ■ ,f / i to * "---a) /6 It/ 4' b 3:46A /(-, 6 SLJ i e, , ,. ,s,-„./ j-eet, be c rt pet:d: 4— i e , y s(. .. ie 19 - __f/ cif 2 A: 74 A-vt (-lip f;',; -''' )( 417441. 1Z- NJ ili , 1 1 we k3--zsypdpi. g-1- - 33"./3c - 17,o'kosa41 4/5 •:, A 1/) ;; A. ( 1 ro L t c2e AV ' 00-yn/suf At' 113 ( -13_ !: g • _ _•/ 6rgeJ ,:;7c. / 2 :7 e' do; 3 3 7 \/Ktpq i e L ,/r01-0( , i''' • A / 3 /6 SL y ../ .__,.." ■ AP' , 4 / A .■ A , ' . . _ t P : 2_ .41Yi_._ 411i Milrelallg. gi• tLt() c 2-)11, ck -xty_l_t(,3Qczcilk( 1+1 /' I ,., .., ., . _ ILAA. -...••-• 3(ki P..73Li a , • „.. ler • :: IA I C '-- -' ' I - • I alf)r\;33Lij 3schz ' 1 E Y 8F SOYN ION EACH iTY CLERK'S OFFICE ° t" NOMINATING PETITION I3JAN31 PM 3: 12 `` r . ;`J ' .,.. 33 f,i . We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2 -42, City Code of Ordinances), do hereby nominate: 6,pktip , at errr a fre ,_ 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. SIGNATURE ADDRESS i Z. _ - / q� Vii .! • 4 ;• ��i� ■ 0 i . f� .u : / pts3 � % I P,..0„.1 aDe ,, 1/14.-e*k : ii-. r -eat V Ail _,-.-..91.11 4111111 //7/7 1/- 9 49' 2 ( L , Afril , ' W7 C / 4 --'.- -1(:(4- /a lk 6 a 0 33 4 - (Crl o � /-0 3344, 7 : ' � ' ' i ' " , � f/ , , ..-2-ii yy .. 1 ,2/9-/XV/ '3/ __5((. _/ . 3 S (7'0 &,..*- .4/('--Y _ , 1 / 6/) ,3' ---/ 4 bA 1 71 i' ..r ' t.. , -- - ,:� : ;. In . b' /? 3 f CO - - C . f ' 1 ' ' ' ' " 4 7/ ' t : ; --- CI :-; -- ---- 4- -i t .4- / 1 (:,? L it/.' -, '[., C it A- --' :.:92; r r- v "1► Y OF 8DYNION BEAC ".f TY CLERK'S OFFICE 13 JAN 3I P1 3: !3 I, the undersigned, So f hon; . L F c...0 An be, , 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. LatP re Sworn to and subscribed before me at Boynton Beach, Florida, this 3 ( day of A.D. 20 / 3 . J P . Received at the City Hall in Boynton Beach this 31 day of l 20 (3 at .9 P.M. Y Phet City Clerk j \ shrdata \cc \wp \election\nominating petition doc