Filing Papers EACH
PPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 13 JAN 10 AM 9: 0
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):
p a Initial Filing of Form Re- filing to Change' 0 Treasurer /Deputy [] Depository 0 Office [] Party
2. Name of Candidate (in this order First, Middle, Last) 3 Address (include post office box or street, city, state, zip
} code) L` y 3 -e S -, k t'_
4 Telephone 5. E -mail address R t, i nJ --c, r , PyL<t c I-, C -1 _ v j tf
( (,, I )- ).5d, -; 3i koj14 -4 ra,l -1` argot cbr
6 Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
, , Ni- 1 o r M s s 1 a N w Gs t s , , t - 1 d 0 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 0 No Party Affiliation J Party candidate
I have appointed the following person to act as my jg Campaign Treasurer fl Deputy Treasurer
. .j Name of Treasurer or Deputy Treasurer
11. Mailing Address 12 Telephone
13 City s '1 ( 4, Count 15 State 16 Zip Code 17. E-mail address
COL/- -6--1 1 Cy -1, a - L County, S' - S 1 ( _6 0 Yid ►) c, rE NW, C (V) ,
18 I have designated the following bank as my Primary Depository 0 Secondary Depository
19 Name of Bank . 20 Address
21 City 22. County 23 State 24 Zip Code
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 Candidate
X a \—: ,
27 Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
RI,- c r c, N _ �-.Q — - �
I, TS (7___ 1t' ) c, , do hereby accept the appointment
(Please Print or Type Name)
signated above as Campaign Treasurer El Deputy Treasurer
- . —) 0 i2 X
Date Sig to of am reasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.
RESIDENCY REQUIREMENTS
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c c. , candidate for
(Print Name)
C__0( 5, ►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)
o-0/
(Date)
9/27/2012 11:03 AM
S: \CC \WP \ELECTION \Year 2013 \RESIDENCY REQUIREMENTS STATEMENT.doc
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Miscellaneous Cash Receipt
No.
CITY OF BOYNTON BEACH
0
4 9-
4. 0
ON
Account No. 001-0000-369-10-00
$ 222.5,
J anuary 0, ,20-L1
Received of Sharon Grcevic
Address 7043 Chesapeake Cir., Boynton Beach, FL 33436
For i% State Assessment or District 1 City Commission seat
for election on March 12, 2013
City Clerk Of 1Ce
Dept. By
Miscellaneous Cash Receipt
—
CITY OF BOYNTON BEACH No.
0 \
N
Account No. 001-0000-369-10-00
$ 25.00
January A, 13
, 20
Received of Sharon Grcevic
Address 7043 Chesapeake Cir, Boynton Beach, FL 33436
For City Filing Fee for District I City Commission seat for
election on March 12, 2013
Dept.ei tY Clerk's Officc By
FORM 1 STATEMENT OF 2012
Please print or type your name, mailing 1 FINANCIAL INTERESTS I FOR OFFICE USE ONLY:
LAST NAME -- FIRST NAME -- MIDDLE NAME
G C G 'C.11 i L J h a C■ 0 NS L. •
MAILING ADDRESS
•
- 2 O 3 C -e-S4? A . \ c • ate.
„i u�
R 4+ o ►J &Q.= cl, 3 3 y 3ic, I Repel,, _
CITY ZIP COUNTY 3 �i �,
C'
NAME OF AGENCY
•
C OMMISS fo1V-1/- eZJ)S r m �,
NAME OF OFFICE OR POSITION HELD OR SOUGHT
You are not limited to the space on the lines on this form Attach additional 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 (must 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 SOURCES DESCRIPTION OF THE SOURCES
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
at:› y 4- \-t, fr,A 5 3) °t 1.3 al As Re..AL Es-t-44-4._ Sa 1 es
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
�I
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 "n /a ")
when and where to file this
O 4 3 CNI'e_s -t. a \r-t_ 0-1 gb �,` L. / form are located at the bottom
Y r4 7 f of page 2.
INSTRUCTIONS on who must
file this form and how to fill it
out begin on page 3.
CE FORM 1 - Effectwe January 2013 Refe o R,le 34 -8 202(1) FA c (Continued on reverse side) PAGE 1
' 'o` „`tia lip. ^< ,. ,
1
PART E — LIABILITIES [Major debts See Instructions,
(If you have nothing to report, you must write "none' 0 "Hir t
NAME OF CREDITOP •vDDRESS OF CREDIT01
.. ,
(3Ina)._ c' ...„, !co 0,.o4.4- a . _ . - _ -
i i
PART F -- INTERESTS IN SPECIFIED BUSINESSES [Ownership ' ,,uslho”- , -do ;,, , ,, I,,rre.,s, , ' ,_• „ S r r ,„ '
(If you have nothing to report, you must write "none" or - we'
BUSINESS EN I it , r 3USINES. t=NTi1 , 0 •sJSINtbS EN -
NAME OF BUSINESS ENTITY ig b 6,J r Qaac1,, ( i� .
ADDRESS OF BUSINESS ENTI Pr 31 q , E w o06 n J56 b IA t3 , , �_ .
PRINCIPAL BUSINESS ACTIVI T R 1 s - - .-
POSITION HELD WITH ENTITs, a
I OWN MORE THAN A 5",
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST O L.,13 %. - 4j
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET PLEASE CHECK HERE J
SIGNATURE (reqqired): DATE SIGNED (required):
.__� -'y t `` ,
FILING INSTRUCTIONS :
WHAT TO FILE' WHERE TO FILE WHEN TO FILE.
After completing all parts .» 1ni, :3■ J=1,IIVt(3 ' ' , lr , ._n'∎ • _. ' I)• 1, ',I,, 1 mitfally , r.Ti�:r.p
including signing and dating it, send bacr In Ethu,= , - C.Nurtv ' 1 ,1 10e,' 'AS,' .;i,li , tau 'tfis- 'i1 -4,eciher' - <_ gyp;∎
only the first sheet (pages 1 and 2' for Hoc
`ru x'01'' onluai disc. =r flh ' ' r us' ' , within 30 days rr'J _ ± -11c
dorm to chat location Lt, ' iC) dpPummerlt Or f the begiiin 1» 1
If you have nothing to report , II a articuial employment Appointees who rnua3 'ilr
y 9 p P Local officers /employees lur �Ifr unfirmed f)y thr" Senate •dust file ono _ i
section you must write "none" , r "n/a" m that Supervisor cf Elections of Chi-- 'aunt n
y .confirmation =over if that less than
;
section(s) .vhich they permanent) r eside 11 ou do 'lot
;,ermanent Y ly reside Florida file with the � file 'Al, 3or >r'Inf '
NOTE: Supervisor of the .,ourr�> //here -o I' agenc. Candidates lur ,,ubhcly- electeo Iucai ,r i
MULTIPLE FILING UNNECESSARY has Its headquarters n h. =m
nest , le ' ', ae 'rm 'he'v :III 'r
Generally, a person who has filed Fo ' State o or specified state employees tuallfyrnq naoer
for a calendar or fiscal year Is not required file with the Commission on Ethics P1; Thereafter Iota, utticers,employees :,,:a.: e
to file a second Form 1 for the same year Drawee 1 5709 Tallahassee ' "32 17 - 570c 301(01 31I:: -, ecifiec' ,tate employe
However, a candidate who previously filed are iequirea i2 rile by July 1 51 followin,;
Form 1 because of another public position Candidates file this tom- royethe= ,vilo the r , calendar ,Fir,, ,v,,,ti.-, they hold rho- -
must at least file a copy of his or her original qualifying papers positions
Form 1 when uali in lo determine what category your position tall:, q fY 9 F at Inc erla of office' or employmen
andei , ee the "Who Must File" Instructions on each local officer /employee, state office) an
Page ` specified state employee is required to file o
final disclosure form (Form 1F) within 60 day:
Facsimiles will not be accepted. of leaving office o employment Howev4
filing a CE Fo1m ',F ,'Final Statement
cinancial Interests, does not relieve the ft!ei
,t fling 3 CE F', 1 1' of she was in tt
position or December 5' 2012
'1 FY OF Br;YNCOP( BEACH
..,; rLM'S CFFICE
CANDIDATE OATH -
NONPARTISAN OFFICE 13 JAN 3 I AM 9: 39
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99 021, Florida Statutes)
I, S \ ar o a 1.• G r ce V t c_
(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 C. 0 M M LS S 1 0 Nom`
(office) (district #)
, I am a qualified elector of PA t Al 2lov+ c. In County, Florida,
(circuit #) (group or seat #)
I am qualified under the Constitution and the Laws of Flonda 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 Florida.
X �`A �� �Gt> 3a - 2l o • • e.. 16.so%
Signature of a idate Telephone Number Email Address 46
- 7 Di-/3 C1vesci °e',r 04 «by/4-1-6 4 Bc..cl., V 1_ 33 (. /. 3. . Address City State ZIP Code
Candidate's Flonda Voter Registration Number (located on your voter Information card)
* 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)
Shat r- o,l G, c..k.,..-vi k, G rk se v(t<
STATE OF FLORIDA
COUNTY OF Pa I M Be,% t.I / ?
Sworn to (or affirmed) and subscribed before me this f t( 10 day of , , 20 ( J LINDA FAZIIO
Personally Known or = *: *: MY COMMISSION # DD997513 �-f '3 /..)
�-t EXPIRES June 04, 2014 $igna ure of Notary Public
Produced Identification (401)3A FlofldaNwarysernce.com Pnnt, Type, or Stamp Commissioned Name of Notary Public
Type of Identification Produced
DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.C.
OF F4
,�P FeGAI 9,
Palm Beach County
OF pp'
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 -8287
WEBSITE www pbcelections org
CERTIFICATION
I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do
hereby certify that Sharon L. Grcevic submitted 38 petition signatures for the office of
Boynton Beach City Commission, District IV.
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 Sharon L. Grcevic is a registered voter in Precinct 3136, in the
City of Boynton Beach, Florida.
Signed, this the 31st day of January, 2013.
S SAN BUCHER w :-_;..<
SUPERVISOR OF ELECTIONS i = ">
PALM BEACH COUNTY w�
M BCD
(SEAL) `•9 :c rrt
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tit= BG''i' JO CH
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13 JAN 3 ' AM 9: 4o NOMINATING PETITION
We the undersigned, duly qualified voters of the CITY OF BOYNTON BEACH (Sec. 2 -42,
City Code of Ordinances), do hereby nominate:
to be a candidate for COMMISSIONER— DISTRICT IV, City of Boynton Beach, Palm Beach
County, Florida, for the term:
MARCH 2013 to MARCH 2014
pursuant to the Charter and Ordinances of said City.
SI ATURE ADDRESS
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I. the undersigned, h ARoN L • reev + G , 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
CofYW1 ionc , - i • =1i
M n t r a r e for the City of Boynton Beach, Florida.
Sworn to and subscribed before me at Boynton Beach, Florida, this Si day of
A.D. 20 f 3 .
Lm
Received at the City Hall in Boynton Beach this 3 ( day of
A.M.
20 /3 at c /. 33
City Clerk
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S \CC \WP \ ELF CTION \Nominating Petition - Special Election doc.
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