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Filing Papers PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES - "r '', CH (Section 106.021(1), F S.) (PLEASE PRINT OR TYPE) 13 JIM 15 AM 91 16 NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Ijir Initial Filing of Form Re- filing to Change: 0 Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip US �h Cis e✓ l ( � code) q 81 shAs Dletvc 4. Telephone 5. E -mail address y CAutV ( t ) (Do2.-Co(Ace &isexkooe PloL.cUrh Fult.‘aiN 33430; 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if C 0ON IvN %SS I O J DcaltZX t applicable: ❑ My intent is to run as a Write - in candidate. 8. If a candidate for a partisan office, check block and fits in name of party as applicable: My intent is to run as a D Write -In El No Party Affiliation ❑ _ C�oc 2r�i C. Party candidate 1 have appointed the following person to act as my Campaign Treasurer fl Deputy Treasurer J. Name of Treasurer or Deputy Treasurer CJSG\\,0 11. Mailing Addres 12 Telephone 7q C- (50 )(00.1 13. City 14 County ' 15. State 16. Zip Code 17. E-mail address yVry 13C-4.1\ lr,,, b�A� 3543Co C1SE1%Joe e P)oU co 18.1 have designated the following bank as my V2 - Primary Depository 0 Secondary Depository 19. Name of Bank 20 Address /5 So W. Go ziToN 13Ee8". 8" 21 City 22. County 23 State, 24 Zip Code 3o1.)>.'oki k:411.14. toEec. '( oa..dc . 3343 Co UNDER PENALTIES OF PERJURY, 1 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. Si. ature • f C - ndi to 1' /U 20(3 27 Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) T s I� L • c Ek 11J , do hereby accept the appointment (Please Print or Type Name) iignated above as. EVCampaign Treasurer C7 Deputy Treasurer /- /C - 20/3 X 1 (e - -7 ;Pt Date ignatu - of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 15- 2.0001, F.A.C. OFF1C USE ONt. STATEMENT OF 13 Ali 5 AM 9:16 CANDIDATE (Section 106.023, F.S.) (Please print or type) — ON --A-. a6seklo candidate for the office of C.om m t SS L b NW YL 0 kV ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X / -io -2a/3 ignature 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) RESIDENCY REQUIREMENTS I, - 3 - '05E-0\4 ' . CP1 SE\ \ b , candidate for (Print Name) CO YIN V\ 1 C\ we . r D Stkt 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. � n (Si • nature of Candidate) /-- /U 20 13 (Date) 9/27/2012 11:03 AM S: \CC \WP \ELECTION\Year 2013 \RESIDENCY REQUIREMENTS STATEMENT.doc 9 t:6wd S1 co N a) co ca 0 D CO m r r 0 O m D 0 m K w rn .A V CO CO 0) 1 D 0 0 0 0 0 X CO 0 z --I 0 z CO M > 0 1 m r w w A co O N N O O Ui N.) g v Oi N O O O) N O N N N W A co O W A co co co co A OF F LO �P �F \GAS S�c 9 ° l: Palm Beach County - / OF p 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 ) 658 -8200 FAX NUMBER• C561) 856 -6287 WEBSITE www pbcelections org CERTIFICATION I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that Joseph Casello submitted 49 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 Joseph A. Casello is a registered voter in Precinct 3164, in the City of Boynton Beach, Florida. Signed, this the 24nd day of January, 2013. /g b-Atki2/1 SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY �, c (SEAL) - 0 cr C i i ,4 c V . i / ,l v :� - '--YVV 4 V 111 i r 3 --- '7 5 P 3 ") , 6> ,://) /(7 r l ,,,,,, F ? -,/ 1 'r--?-v? F. rvoi-ci vg: `t . S -Id l/ 'rd, -)--, >H ?' 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MIDDLE NAME LQS ( j h r') L MAILING DDRESS r t �� d p/ ,) � D--i C-. -< Cf t — CV CO t"'1c C) -;s -<. ITY 33 C U �n � NAME OF AGENCY NA O ICE OR POSITION HELD ORS UGHT '� fn= E OF al (t ( IStri tf You are of 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 1S FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one) i( 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 "nla ") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME / ADDRESS P CIPAL BUSINESS ACTIVITY C'l 1 o-F UUt)rceq-t4 5 ryici t ✓1 ji'rec' -1- c I PeasiGr- 1/vor�c_ -c e� r' /ti(c� l '; , .G -/ tic( i fJ 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 "nla ") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUS ESS ENTITY OF jUSINESS' INCOME F SOURCE AC IVITY OF SOURCE 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 'C / ShaddOcK /t'i c -_ form are located at the bottom 15/X-1 Al (3eLz(il 33 1 + 3 of page 2 INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 - Effeavy January 1 2013 Refer to Role 34 -8 202(1) FA c (Continued on reverse side) PAGE 1 r oy -- IN - rf•ts t,,t , -, , YPE v' IN ■AN, . ;. INE�`` rig — — _ — __ - - - — --- ! , PART E — LIABILITIES [Mayor debts - See instructions) (If you have nothing to report, you must write "none" or "nia "; NAME OF CREDITOR w ADDRESS OF CREDITOR r P L7 I I PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positrons in certain types of businesses See instruction (If you have nothing to report, you must write "none" or "nfa ") BUSINESS ENTITY 0 ; BUSINESS ENTITY #. BUST ESS EN - I I1Y # s v_ NAME OF BUSINESS ENTITY n ! (A } ' ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVIH Y I 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 Q SI NATURE (r qui DAT SIG ND(reguired): (1) 1 1 FILING- INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE WHEN TO FILE. After completing ail parts ,r this form If you were mailed the form by the Commissior €nit ally, n., --1, . i +lcei,employeE including signing and dating it, send back on Ethics or a County Supervisor of Elections state officer ai - 10 5pecifieo sate employee only the first sheet (pages 1 and 2) for filing for your annual disclosure- filing r ' r` r- r not fdr. wrthrn 30 days r>> the date nf form to that location nis of het appointment or of the beginning If ou have nothing to report in a particular . ■f employment Appointees who must Of y S p P Local officers /employees file with the confirmed by the Senate must file prior to section, you must write "none" or "n /a" in that Supervisor of Elections of the county ir confirmation even that is less than it- section(s) which they permanently reside (If you do not clays `rorY 'he datF }f 'hel' appointment permanently reside in Florida, file with the [ NOTE: Supervisor of the county where your agency Candidates for publicly elected local office MULTIPLE FILING UNNECESSARY. has its headquarters must file at the game tire- 'hey file 'her Generally, a person who has filed Form 1 State officers or specified state employees qualifying paper= for a calendar or fiscal year is not required file with the Commission on Ethics, P G Thereafter local officers /employees, state rt to file a second Form 1 for the same year Drawer 15709, Tallahassee FL 323 5709 officers aric specified state employees However, a candidate who previously filed Candidates file this torn together to ether with their are required to file by July 1st following Form 1 because of another public position each calendar year , n which they hold their must at least file a copy of his or her original qualifying papers positions Form 1 when qualifying To determine what category your position falls F at the end of office or employment under, see the Who Must File" Instructions on each local officer /employee, state officer, ano , page 3 specified state employee is required to file r final disclosure form (Form 1F 1 within 60 days Facsimiles will not be accepted. :,f leaving office ox employment Howeve filing a CE Form "F (Final Statement (- -it-lance interests; does not relieve the fil€ it filing a OE Form 1 if he or she was n, the ' )osition on December 31 2011 i n(-+- 1 ITY ;1F' at „, ,,, ti Y HT O L f r5 LACH (frt. t i, ) ,JAS 30 PM 12: 17 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99 021, Florida Statutes) 1, .T o f C.J 1 o (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 Ll�� Q_OY \ fr 1SS1OAl €R . 1 V (office) (district #) , I am a qualified elector of V11M \36'jG\. 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 Florida x OpAr 1 (00)- 3O s SOG Q.ASC ,\o eCiOL ke Sign ture of Candidate Telephone Number Email Address • , Tit(-\U C3C k - Z3 ( 13 ro At dress City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card) t ( 3 2' 9 V t 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) SC3 K S I-0 STATE OF FLORIDA COUNTY OF PALM M L CH Sworn to (or affirmed) and subscribed before me this 3D day of Jai) U.Q (-8/ , 20 t3 . Personally Known 1. or Sign. ure of Notary Public Produced Identification Pri. , Type, or Stamp Commissioned Name of Notary Public Type of Identification Produced NOTARY PUBLIC - STATE OF FLORIDA Janet M. Prainito -,. Commission # EE028433 '�....i Fvp iron• cz D Y) 2 ^14 BONDED THAL ATLANTIC BON"DLYG CO INC. DS -DE 25 (Rev 5/11) Rule 1S- 2 .0001, F.A.C. The City of Boynton Beach ; . , ,'-',- t r7�e'' t�rl City Clerk's Office to jAri "u PM 12 : 1 7 r' ,. --� 100 E BOYNTON BEACH BLVD BOYNTON BEACH FL 33435 (561) 742-6060 FAX: (561) 742 -6090 E -mail: prainitoj @bbfl.us 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 RE EIPT of this notice is hereby documented: / ` 201.3 S i� nature Date Received 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. 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 Miscellaneous Cash Receipt No. CITY OF BOYNTON BEACH 0 4 '7 - 0N i54' Account No. 001-0000-369-10-00 $ 25.00 20 Received of JOSEPH. CASELLO Address 7981 SHADDOCK DRIVE, BOYNTON BEACH FL 33436 For CITY FILING FEE FOR THE COMMISSION DISTRICT 1V SEAT FOR PHE MARCH 12, ,.:013 ELECTION. Dept. Ci ty Clerk's Offi r -! By 01Y Op. Miscellaneous Cash Receipt .4 4 No. CITY OF BOYNTON BEACH zo \, ), if r N Account No. 001-0000-369-10-00 $ 222.57 t : • 20 Received a JOSEPH CASELLO Address 7981 SHADDOCK DRIVE, BOYNTON BEACH, FL 33436 For E % STAT ASSESSMENT FEE FOR THE DISTRICT IV COMMISSION SEAT FOR THE MARCH 12, 2013 ELECTION Dept, City C1erks OfL ice By