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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. /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. ✓State of Florida Election Laws - Chapters 99, 105 & 106 (2012) 7. .7 Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees 8. ✓ Directions for Posting Temporary Political Sign 7-1-t 9. ✓ City Commission District Map o �� ,C :7" _ r 10. ✓ Part I Charter, Article VII. Elections — City of Boynton Beach 11. c7 Part II Code of Ordinances — Chapter 2 Administration, Article III. Elections o ca 12. Poll Watcher Form & FS 101.131 — "Watchers at Polls" f p rn 13. ✓ Candidate Handbook for Candidates 14. r✓ Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets 15. Petition Form - Candidate for Commissioner — TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF ELEC I IONS AND RETURNED TO CITY CLERK DURING QUALIFYING 16. ✓ 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. ✓ Loyalty Oath - Oath of Candidate (DS -DE 24B)— TO BE RETURNED TO CITY CLERK DURING QUALIFYING RECEI ED BY: 1 f J 9 z ©iL ndidate Signature D e Signed ( th PA a 1a et M. Prainito, MMC Clerk October 18, 2012 S \CC \WP \ELECTION \Year 2013 \MATERIAL FOR CANDATES.doc T',, • • PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN 12 DEC 1 1 PM 1: 314 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* p Treasurer /Deputy J Depository [] Office ID Party 2. Name of Candidate (in this order. First, Middle, Last) 3 Address (include post office box or street, city, state, zip Gait -L n code) p A / ✓5 4 Telephone 5. E-mail E - - ad ress j f a J `� _ �d A ( 94 vq sJ 6 Office sought (include district, circuit, group number) 7 If a candidate for a nonpartisan office, check if atLri1,64 3 applicable: ❑ 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 El Write -In J No Party Affiliation Party candidate I have appointed the following person to act as my Campaign Treasurer J Deputy Treasurer J Name of T as rer or Deput reasurer ,� � Tel 11 Mailing Address 12 Telephone Li(QQA 5w 1Z 4: (.0( )5 13 City 14. County 15. State 16. Zip Code 17 E -mail address 18. I have designated the following bank as my Eig Primary Depository fl Secondary Depository 19. Na �ank 20 ddress 21 City 6tite 2 C unty 3 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 Signat e of Candi. ate IL/70// X _ 27 Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) ©V\ -Co , do hereby accept the appointment (Please P int or Type Name) 'signated above as .O Campaign Treasurer El Deputy Treasurer X Date Signatur of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. RESIDENCY REQUIREMENTS i Kw° , candidate for (Print Name) �►r�rnia.�t 7� i� 3 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) kze,042,)/6 2t)) (Date) ry ca -, rn _ C1 - D z _ CA) 9/27/2012 11:03 AM S: \CC \WP \ELECTION \Year 2013 \RESIDENCY REQUIREMENTS STATEMENT.doc OFFIC 1 ONLY' STATEMENT OF CANDIDATE 12 DEC I I PM 1: 34 (Section 106.023, F.S.) (Please print or type) V uo /71- 17. .].-ctc)L candidate for the office of �1� � _ 2 5 have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. A- 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 (05/11) ; • r -- I _L.. VOTER CARD • PALM BEACH COUNTY, FLORIDA � I gW TARJETA ELECTORAL, CONDADO DE PALM BEACH, FLORIDA 12 DEC I I PM i•36 °• y REGISTRATION NUMBER REGISTRATION DATE PRECINCT Numero de InscrIpclon Fecha de lnscdpcion Distrito Electoral 112353209 09 -11- 1990 3194 RADA, VINOLA I 718 SW 3RD AVE ; BOYNTON BEACH FL 33426 Sign ure of Voter firma de Votante 12/10/1953 DEM ' I FOLD HERE, DOBLE AQUI YOUR PRECINCT NUMBER Su Nlimero de Distrito Electoral 3194 ;YOUR POLLING LOCATION Su Centro Electoral BOYNTON BEACH FIRE STATION #2 2615 W WOOLBRIGHT RD BOYNTON BEACH YOU ARE ELIGIBLE TO VOTE FOR A REPRESENTATIVE IN EACH DISTRICT LISTED LISTED PUEDE VOTAR POR UN REPRESENTANTE DE CADA DISTRITO NOMBRADO US CONGRESS STATE SENATE STATE HOUSE Congreso de los EE. UU Senado de! Estado Camara de Diputados del Estado 20 34 88 COUNTY COMMISSION SCHOOL BOARD MUNICIPALITY Comisibn del Condado Junta Escolar Municlpalldad 3 4 BB REGISTRATION NO • 112353/09 • NUMERO DE INSCRIPCIONI SUSAN BUCHER • SUPERVISOR OF ELECTIONS / SUPERVISOR DE ELECCIONES