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Filing Papers --.. - - co , 41 ry APPOINTMENT OF CAMPAIGN TREASURER . � 1-- AND DESIGNATION OF CAMPAIGN '� =rte DEPOSITORY FOR CANDIDATES a (Section 106 021(1), F S) 9 -k- ?Iv cm _ (PLEASE PRINT OR TYPE) N ,: 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 ❑ Depository ❑ Office ❑ Party 2 Name of Candidate (in this order First, , Middle, Last) 3 Addr (include post office box or street, city, state, zip VC lJS I" V1O (� ' ir�'C code) / LU - C I (/ r \c y-1 r { r 4 Telephone 5 E -mail address N J� C�c k ~ L� (562 I ) 3,0 ; c , --7 0 Kt 4 rr- I t e.JC,7 f 3 I) 3 6 Office sought (include district, circuit, group number) 7 If a candidate for a nonpartisan office, check if _ applicable: t l y -f-,, C -t- A I C2,) C t ►rn 11- 7 5,j ) J}1 , E My intent is to run as a Write -In candidate 8 If a candidate for a •artisan 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 ® Party candidate 9 I have appointed the following person to act as my Zr-- ampaign Treasurer J Deputy Treasurer .0 Name of Treasurer or Deputy Treasurer POt,t.{ck 1 '1.e_ 1 I e"`1 11 Mailing Address 12 Telephone ---- /=3-) 1\-/ v i ►C \ kJ LL) (� j 1 )I J 3 ci�0 13 City 14 County 5 State 16 Zip Code 17 E -mail address bf')., -. k� --Ii-N Pcii Y''1 t ittc" C.)K.L. f ••-- ` 'j3 Pck'v..1c,- i'YL<(l 44,w .G 18 I have designated the following bank as my KPnmary Depository ❑ Secondary Depository 19 Name of Bank 20 Address 1 6 rv") 5 \-- e c...r4 C trca ; )- 1, CMVm (o CV t1 L f - ? / 4 /U(. 2k,�..�City 2 County 7 23 State 24 Zip Code (d t- k V O v.- c- L_,_ (CU I%" h 1 . L__ r-L 3 39 yc� 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 Signature of Candid to \ -, X 1 (.4). i z UL 27 Treasurer's Acceptance of Appointment (fill in the blanks and check the approprl lock) tC. :'tip R_ 11 I, � �� , do hereby accept the appointment (Please Prin or Type Name) 'esignated above as e ` Campaign Treasurer ❑ Deputy Treasurer 11 7 X cPC:4A\ t Date Signature of Campaign Treas r Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. Y PEAtifi f - 1 � r "- APPOINTMENT OF CAMPAIGN TREASURER 14 FEB 21 PM 1 23 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. CHECK APPROPRIATE BOX(ES): ❑ Initial Filing of Form Re- filing to Change ❑ 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 Paula Melley code) 4 Telephone 5 E - mail address 720 Mariners Way ( 561 )310 -3970 Paulamelley @yahoo.com Boynton Beach FL. 33435 6 Office sought (include district, circuit, group number) 7 If a candidate for a nonpartisan office, check if City Commissioner District II applicable: ❑ My Intent is to run as a Wnte -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 of Treasurer or Deputy Treasurer Paula Melley 11 Mailing Address 12 Telephone 720 Mariners Way ( 561 ) 310 - 3970 13. City 14 County 15 State 16 Zip Code 17 E - mail address Boynton Beach Palm Beach FL 33435 Paulamelley @yahoo.com 18 1 have designated the following bank as my ] Primary Depository ❑ Secondary Depository 19 Name of Bank 20 Address PNC 1520 S Federal Hwy 21 City 22 County 23 State 24 Zip Code Boynton Beach Palm Beach FL 33435 UNDER PENALTIES OF PERJURY, 1 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 Sign re of and' ate 7� (2 . 2 LA k-) X ( tAS)../ 27 Treasurer's Acceptance of Appointment (fill in the blanks and check the approp - block) I , Po h (c, , do hereby accept the appointment (Please not or Type Name) designated above as Campaign Treasurer 0 Deputy Treasurer Date Signature of Campaign Tre.l or Deputy Treasurer DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C. Miscellaneous Cash Receipt No S2678 CITY OF BOYNTON BEACH )j r o I Account No. 001-0000-3W1-1A-00 222.57 February 10, ,20 14 L Received of PAULA MARIE MELLEY Address 720 MARINERS WAY, BOYNTON "'me 11 For 1% State Assessment to run for ComMtps140pistki6tut D.t.E“ prt in the general Election on March 11, 2014 Dept. City Clerk's Office By Miscellaneous Cash Receipt CITY OF BOYNTON BEACH No. 92677 ° J. Account No. 001 $ 25.00 February 10, 2014 Received of Address PAULA MARIE KELLEY 720 MARINERS WAY, BOYNTON BEACH FL 43435 Ir--1.7TW-PXC For CITY FILING FEE FOR THE MARCH 11, 04.4-4**EiAL5AtteilAR TOIdi 1 X FOR COMMISSION SEAT FOR DISTRICT II Dept. City Clerk's Office B 41 00 1.' ° . . CANDIDATE OATH - Ali 9; 35 NONPARTISAN OFFICE 14 FEB 1 0 (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99 021, Florida Statutes) I, ;Jr1 1j�. .r , ,�.) (PLEASE PRINT NAME AS YOU WISH IT TO AP -PZAR ON THE BALLOT * - NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of � ; = ': J --O'rr rr ' `' ; 1- ', , _ .,1 cut- (office) (district #) , I am a qualified elector of p (1 '&( m County, Florida, (circuit #) (group or seat #) -----6- I am qualified under the Constitution and the Laws of Florida to hold the office to which 1 desire to be nominated or e� ted, I have qualified for no other public office in the state, the term of which office or any part thereof runs co current with the office I seek, and I have resigned from any office from which I am required to resign pursuant to ction 99 012, Florida Statutes, and I will support the Constitution of the United States and the Constitution of the State of orida X C / / ( I )j ' 10 `` - 7c met " Signature of Candidate Telephone Number Email Address - 1 -=- N `c - i 1)e, li ---�J goy 1 r}, i c- I�, PL '3.4- LI 31--- Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card). In '1 f n L, z` * 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) t M E L' — GE v VIA-) rne4 c..ith. " !!e( L Li STATE OF FL IDA O ` 1 COUNTY OF 'm becCVC Sworn to (or affirmed) and subscribed before me this t e day of t1✓ 0 , 20 1• . / i Ito Personally Known ` � or ___ ___ Signa� of No ry • ublic Produced Identification Print, Type, or Stamp . - - - .. coned Name of Notary Public Type of Identification Produced LAUREN FLEWELLYN ' ?�` e= Notary Public - State of Florida ( •� eau Comm. Rakes Oct 31 2016 Y ; 9 '� DS - DE 25 (Rev. 5/11) , ± �,:! `„ •4 Commission Al EE 216842 Bonded owe* wog N ellobfJP 0001, F.A.C. _ fir FORM 1 STATEMENT OF 2012 Please print or type your name, mailing I FINANCIAL INTERESTS • address, agency name, and position below. FOR OFFICE USE ONLY: LAST NAME — FIRST NAME — MIDDLE NAME Melley Paula Marie MAILING ADDRESS` 07 C,t 720 Mariners Way CITY ZIP COUNTY Boynton Beach 33435 Palm Beach 7,1C NAME OF AGENCY ►9 City of Boynton Beach NAME OF OFFICE OR POSITION HELD OR SOUGHT ' � District II City Commissioner You are not limited to the space on the Ines 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: TI-HS 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) ❑ DECEMBER 31, 2012 QE XI SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR 2013 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 Qg ® 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 SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY First Choice Home Health, Inc. 4745 NW 7th Court Boynton Beach FL 33426 Home Health Coordination & Care Nurse on Call, Inc. 1926 10th Ave. N Ste 400 Lake Worth FL 33461 Home Health Coordination & Care 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 BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE None PART C — REAL PROPERTY [ Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, you must write "none" or "Ns") FILING INSTRUCTIONS for , when and where to file this None 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) FA C (Continued on reverse side) PAGE 1 PART 0 — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc - See instructions] ,-1 t F tl x ' ('4 1 (H you have nothing to report, you must write "none" or "n/a ") r t f' w a TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE P,�2QPft1h1' 'MATES n. C None N/A [ r��j (ijj ��jj 3 J 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 Wells Fargo DBA America's Svcng Co. One Home Campus Des Moines. IA 50328 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 None None None ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY 1 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 ❑ S ATURE (required): DATE SIGNED (required): yy ING 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, jncludina sinning and dating #. 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, retum 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 confim ed by the Senate must file prior to section(s) which they permanently reside. (If you do not confirma 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, PO 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 Candidates fife this form ether with their are required to file by July 1st following Form 1 because of another public position each calendar year in which they hold their must at least file a copy of his or her onginal qualitying papers 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 Padre 3 specified state employee is required to file a final disclosure form (Form 1F) 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 MX rekeve the filer of filing a CE Form 1 if he or she was in their position on December 31, 2012 CE FORM 1 - Efledrve January 1 2013 Refer to Rule 34-8 202 (1), F A C PAGE 2 1 RESIDENCY REQUIREMENTS I, Pccu -tc Or\ ei le.4 j , candidate for (Print Name) CO m MA'S s ) GYZe_C' -- b) s t' c,� 1 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 Boynt ach. a ill4 (Signature of Candidat t i • (p'( q (bate) -71 c, -- rn w kD 1t;s 11/12/2013 12:31 PM ri S: \CC \WP \ELECTION \Year 2014 \Information Packets \RESIDENCY REQUIREMENTS STATEMENT.doc .,0 ; STATEMENT OF P. '` CANDIDATE 14 FEB I p AM 9:35 (Section 106.023, F.S.) (Please print or type) v„( re !le_ candidate for the office of Gfivj O.-1 rYl ( SS j f i'c have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. 1 X Li it - lo• WSi 9 nature 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) MATERIAL FOR CANDIDATES YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, I 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 INDICATING YOUR INTENT TO / R UN 4. ✓ Residency Requirements (Tc 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 - Intent ) 6. ✓ State of Florida Election Laws - Chapters 99, 105 & 106 (2012) 7. ✓ Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees , .1 8. Directions for Posting Temporary Political Sign I«• -T; 9. ✓ City Commission District Map - 10. ✓ Part I Charter, Article VII. Elections — City of Boynton Beach tV 11. ✓ Part II Code of Ordinances — Chapter 2 Administration, Article III. Elections 12. ✓ Poll Watcher Form & FS 101.131— "Watchers at Polls" 13. 2014 Public Campaign Financing Handbook 14. ✓ Candidate Petition Handbook 15. _ ✓ Blank Campaign Report Summary Sheets, Contributions Sheets & Expenditures Sheets 16. ✓ Petition Form - Candidate for Commissioner — TO BE FILLED OUT, CERTIFIED BY SUPERVISOR OF ELEL 1 IONS AND RE I URNED TO CITY CLERK DURING QUALIFYING 17. c Form 1 Statement of Financial Interests 2009 — TO BE FILLED OUT, SIGNED & RETURNED TO THE Cl CLERK DURING QUALIFYING 18. ✓ L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.) 19. ✓ Loyalty Oath - Oath of Candidate (DS - DE 24B) TO BE RE I URNED TO CITY CLERK DURING QUALIFYING RECEIVED BY ' 1 v / // 2 3.t4 Candidate Signature Date Signed `1Y1 et M. Prainito, MMC ity Clerk 11/14/2013 3 47 PM S• \CC \WP \ELECTION \Year 2014 \Information Packets \MATERIAL FOR CANDATES.doc - OF, �P � cg a lSF� 4. s �I.. _ Palm Beach County OF PA 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 -8200 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 33 signatures on the Candidate Petitions for PAULA MELLEY, City of Boynton Beach, Commissioner District II, 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 PAULA MARIE MELLEY is a registered voter in Precinct 4024, in the City of Boynton Beach, Florida. Signed, this the 7th, day of February, 2014. SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY - (SEAL) •• eft . i CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form t iiaA `: QM 5 the undersigned, a registered voter (print name as l appears on your voter information card) in said state and county, petition to have the name of r pa U 1 Gi. All, G 11 placed on the Primary /General Election Ballot as a [check/complete box, as applicable) ❑ Nonpartisan ( No party affiliation ❑ Party candidate for the office of '.--- 54r CI �6 n �n 13. - C A � t ' 7' 60.1 "less ior� (insert btie of office anti- +*lude district, circuit, group, seat numberpplicable) Date of Birth or Voter Registration Number ( Addrre e ss � ���,, � ( ( g. - /pedi 1(. �"r4a` Dt J C:�'��"`^� VIA City County State Zip Code j 0 . 1 n — id n r 3-ea aA Pa iw,'Beae11 Fes- 3i./3 Si nature of V r Date Signed (MM /DD/YY) Am ) w /�I�� Ito be co / by oter) 4 Rule 1S- .045, F.A.C. DS -DE 104 (Eff. 09/11) f CANDIDATE PETITION �� Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. %, Or P 1 0 T R R L ASS C the undersigned, a registered voter (print name as it appears on your vo inform tion card) _ / in said state and county, petition to have the name of < t G / /l/ ' j e-'V / placed on the Primary/General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan tti No party affiliation ❑ / Pa candidate for the office of (insert title o office and inclu -e district, circuit, group, seat number, i - pplicable) Date of Birth or Voter Registration Number Address ( (MM /DD/YY) " i 11 3/ 111 1 IkJ • T ei v cL, J City County State Code '�o Y vifovt P I� Ft 3� 4 36 Signature of Voter Date Signed (MM /DD/YY) 0 r Pialc Rtict to be completed by Voter] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) \.) , CANDIDATE PETITION Notes: - All rnfor matron on this form becomes a public record upon r ece:pt by the Supervisor of Elections - It ,s a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on thisfarm is not completed, the Jorm 1YJlr not be valid as a Candidate Petition form I, , 'r. i ` the undersigned, a registered voter ■ (print :me as it appears on your voter i rmation ca d) in said state and county, petition to have the name of a v`,l C , t4 placed on the Primary/ eneral Election Ballot as a [check/complete box, as applicable) ❑ Nonpartisan o party affiliation ❑ Party candidate for the office of U l mot- ...1_ exttcf, cA (,dynni ISS, ce (insert title of office and mclu district, circuit, group, seat number, if ap Iicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) ■ City County Zip Code Signature • Vo er Date Signed (MM /DD/YY) [to be completed by Voter] 1 \ \ Rule 1S- 2.045, F A.C. DS -DE 104 (Eff. 09/11) i,V CANDIDATE PETITION C Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] -1 all requested information on this form is not completed the form will not be valid as a Candidate Petition form ICI / � n ) I J C0 A.14Q a the undersigned, a registered voter (print name as it appears on your voter Information card) In said state and county, petition to have the name of - Pat-) LA AA ` -e 1 e placed on the Primary /General Election Ballot as a [check/complete box, as applicable} 0 Nonpartisan [�� No party affiliation ❑ / Party candidate for the office of an (J 15 ► L 1 LG� 31 1 3 IUD B2a.Cln Ci Caen rv,t,S,3io (insert title of office and Jude district, circuit, group, seat num ppllcable) Date of Birth or Voter Registration Number Address f� �f (MM/DD 0) Ca _ / 7- .1r2 L 5Lf ' O l � - .C.) a i , � r'w Qc e City County State Zip Code Bo n+on 3 - ` fa , //71 F6- . V -.- Signet of Vote Date Signed (MM!DDIYY) `ir [to be comple d by Voter) — z /ma Rul 1S•2.045, F.A C DS -DE 104 (Eff. 09/11) CANDIDATE PETITION e Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1, , the undersigned, a registered voter (print name as it appears on o voter info W -tion card) , q in said state and county, petition to have the name of �C�. 0 t A /v . Q. t tL n placed on the Primary /General Election Ballot as a (check/complete box, as applicable) ❑ Nonpartisan [2 party affiliation ❑ } 4 Party candidate for the office of � \ 5 t G� 3t7 n 4- es r 3- e42.c.. 1 C, T C6 „,,,, vr,, 5 S i C” (insert title of office and i district, circuit, group, seat numberpphcable) Date of Birth o V ter Registration Number Address G� I .) J (MM/DD/ Y) 3 9 J '7 3 p� / 5 A ! 3 A-v-e, , City I County '� ! State Zip Code ( Bo n Ton �eaG� _ Pa. I w\ IJ -eA G -(n FL-- 33 3 c Signature of Voter Date Signed MM /DD Y) 1 i • / 21111Gili ■ / ,/ A [to be comp! ed by ter] Rule 1S -2.0 3 .A.C. DS -D 104 (Eff. 09/11) CANDIDATE PETITION 's Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form i ' O J �orCS 1 -055�1 ivuovn the undersigned, a registered voter (print name as it appears on your voter formation card) in said state and county, petition to have the name of A 0 (a. A e., II-e- placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan 1 party affiliation 0 l Party candidate for the office of 71) is C G+ 3. (Bd Yl -1'1 C1 � C A Cc r" ry, t SS / Or, e t _ (insert title of office and incNade district, circuit, group, seat numb licable) Date of Birth or Voter Registration Number Address 1 (MM /DDIYY) I !l- 30' tq"n 7/ 0 5w .,2 7 r City County State Zip Code - A 40 ?.,ea ch ?a / ,i cii , Fes-- "3 3 LF 3 S Signature of Voter Date Signed (MM /DD/YY) [to be completed by Voter] Rule 1S- 2.045, F.A C. DS -DE 104 (Eft. 09/11) 1 , i CANDIDATE PETITION C,' Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons -1t is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form I �1)� 1 �Q� the undersigned, a registered voter (print name as it appe s on your vote Information card) in said state and county, petition to have the name of GtV la_ , ._ Ll! -e placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan [ No party affiliation - ❑ - J Party candidate for the office of ii 4rtc+ _L1- . Vl +O n ? €l ail l_ i + CO r3 ryrte'� /c3 n .• C (insert title of office a clude distnct, circuit, group, seat number, If pplicable) Date of Birth or Voter Registration Number Address (Ape I (M /DD� Y) "(:)0 1 1v4Roc (-...1.4* - G City County State Zip Code . B0 94)/i ?-eA ?AIM a14 33 Sign ure of Voter Date Signed (MM /DD/YY) Ito be om ifeted by Voter] ( / P (/ '7 Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09111) CANDIDATE PETITION L Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is n t completed, the form will not be valid as a Candidate Petition form t, ' C 4 /1 C'e. the undersigned, a registered voter (print name as it appears on your voter information card) 1 in said state and county, petition to have the name of f a (A) a e t t �:-c 4 placed on the Primary /General Election Ballot as a [check/complete box, as applicable] '): ❑ Nonpartisan No party affiliation ❑ Party candidate for the office of Di s el`c. E P. n ge c_ c.l CA Urn nn "s) � (insert title of office and district, circuit, group, seat number, if applicable), Date of Birth or Voter Registration Number Address 1 (MM /DD/Y) _ T du ca 7 City County State Zip Code ?ololei le ___ P +M g c k - FL, Signature o ote Date Signed (MM /DD/YY) [to be com leted y Voter] Rule 1S- 2.046, F A C DS -DE 104 (Eff. 09/11) ,..0 CANDIDATE PETITION L Notes: - All information on this form becomes a public record upon receipt by the Supervisoi of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (' 1 r , C A G A - M c_r \u rro n the undersigned, a registered voter (print name as it appears on your voter information card) rn said state and county, petition to have the name of ' Pa U 1 - M ... 11 .e, 3 placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan Ez No party affiliation ❑ 11 Party candidate for the office of \ �'C l C_ Bo -'#ov- "Be.Gi°I -% C T Co w.rr. t $3 o tc (insert title of office and in de district, circuit, group, seat nu _ r, if applicable) Date of Birth or Voter Registration Number Address (MM /D /YY t a /o► 9 70 s(i) Z - 11 -h Trr. City County State Zip Code �ci"-ern -eA c 11 t. -- 6. ti FL- 3 3 y (3 S Signatu o • Date Signed (MM /DDIYY) �� � � [t [mord by Voter] Rule 1S- 2.045, F.A.C. DS -DE 104 (Eff. 09/11) ✓/ y CANDIDATE PETITION � Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be vand as a Candidate Petition form I, KI I L F-o.�e S the undersigned, a registered voter (print name as It appears on your voter Information d)► card)�� A n ,, in said state and county, petition to have the name of -Fa V` 1 CA � L J Y X—� /., placed on the Primary /General Election Ballot as a [check/complete box, as applicable] G ❑ Nonpartisan N o party affiliation ❑ Party candidate for the office of D 1 31 C IL '.0ii n ni Qeac k Cr-t- ( m cc S ) GY ,' (insert title of office and clude district, circuit, group, seat number, I f ppllcable) Date of Birth or Vot r Registr ion Number Address (MM /DD/YY) 0 , 10 p - 7 D 1 1 5 - 5 V Y7 re rr <r r' e I City County State Zip Code i rHal &L P ex. FL_ 33 `l3 -5 ::::::: Voter Date Signed (MMIDDIYY) [to be completed by Voter} Rule DS -DE 104 (Eff. 09/11) ) CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons -11 is a crime to knowingly sign more than one petition foi a candidate (Section 104 185, Florida Statutes) - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form 1, 4 ,l V ' i /� "' - ° � Z the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of �Ct.0 V,� k e \\ ` LY placed on the Primary /General Election Ballot as a [check/complete box, as applicable) p Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of --- V - N,k" -- 1 - i C../1 3 C: c)r weuro") 73c( c,,,,,,; s,te)A (insert title of office and in 7 ude district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM! D/YY) / / o) /to /7.q q5 S / ) kOtqle Dr City County State Zip Code 'a Y DAj Sac 4 ?C.4 It) 6C c61 I:7-C_ -C_ 3 ? t i 3 Signature of Voter Date Signed (MMIDDIYY) ate& 1 [to be completed by Voter) � Z , Rule 1S- 2.045, F.A C. DS -DE 104 (Eff 09/11) CANDIDATE PETITION 1, -7 Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons -1t is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form I �'24-n1OS V tM 0 , p i.1 the undersigned, a registered voter (print name as it appears on your voter information ation card) fo in said state and county, petition to have the name of ( P`' `0 L M-'.-1( __L( placed on the Primary /General Election Ballot as a [check/complete box, as applicable] Nonpartisan D No party affiliation ❑ Party candidate for the office of 15/`LiC I 2— 80, 0 4- pp b C it ( Cab44/ ok (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Addre q (MM /D /YY) � 4 t5 C if City County State Zip Code Ma ] a F. a . F, 33 4 ( 3 . Signature of Voter Date Signed (MM /DD/YY) i (to be coingg��ted by oter} . 6,/, 2 / S Rule 1S•2.045 F A C / DS -DE 104 (Eff. 09/11) 1 V CANDIDATE PETITION :" Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - 11 is a crime to knowingly sign more than one petition for a candidate [Section 104185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form I (' i W A •� 1.,.3.-i- . F. the undersigned, a registered voter (print name as it appears on your voter inform card) �° in said state and county, petition to have the name of a A t f'ry r ( L - (� placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan (No party affiliation ❑ Party candidate for the office of J�iS 4- r , C ( 0)„, ( vA f `„,4`'y) llCS( A (insert title of office and include ditrict, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address MM /DD/YY City ., P, C u nty I ,-. State Zip ode 3/, \i't DC, 1 6 - eA( 1 ‘ , -/-- 3 . z1 'AL Signatur o r 1 Date Signed (MM /DDIYY) / [to ;2 _ cop ted / b Voter} Rule 1S- 2.046, F.A C. DS -DE 104 (Eff. 09111) J did v / CANDIDATE PETITION L Notes: - All information on this farm becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form I / /y the undersigned, a registered voter , ti �,.� A / : Cli °, � � rz - __ (print name as it appears on your voter fo card) / , in said state and county, petition to have the name of c", ,.�. /e ( (e y placed on the Pnmary /General Election Ballot as a [check/complete box, as applicable) / ❑ Nonpartisan,No party affiliation ❑ _ Party candidate for the office of C j 4 ► 7 ' . C r i COv �,0 V, e-41 — (insert title o office and include distnctitircuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/ D/YY � / �' l l City r unty S t o Zip Code C ,,,,A--t,v--‘ g,.2, � 6'_e,"-_,, 337 5 Signature f Voter Date Signed (MM /DD/YY) / [to be co plet d by Voter) /, Rule 1S -2.g , F.A.C. DS -DE 104 (EH, 09/11) i CANDIDATE PETITION \:y Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate /Section 104 185, Florida Statutes] - If all requested Information on this form is not completed, the form will not be valid as a Candidate Petition form. 1, - � Os, i 1 the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of ?at-) I eA- , " ^ ` n placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan R3 No party affiliation ❑ Party candidate for the office of ( D t:S c+ .1!-_ Ba n r\ - 3ej1Lh C' Com ts5lort�C (insert title of office and l de district, circuit, group, seat numb pplicable) Date of Birth or Voter Registration Number Address 1 ©71; 7 City County State Zip Code 303 n , r C_I^, Rt. ► in B AG, �.- 33 -‘-; Signa re of Voter Date Signed (MM /DD/YY) 1 i [to be�/ Voter] Rule 1S- 2.045, F A C. DS -DE 104 (Eff. 09/11) J CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crone to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form 1, J, • rl b n M Vet the undersigned, a registered voter ( (print name as it appears on your voter information card) in said state and county, petition to have the name of Pa. J (a frt Q 11.e. placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan, No party affiliation E Party candidate for the office of . � t c.:± 1 o (.1 r1 + n f ?:)..2c CI- CI 4 Li Co w, w► 155 , on -e (- (insert title of office an nclude district, circuit, group, seat numbai, if applicable) Date of Birth or Voter Registration Number Address //�� r, 4ftrubi f� (MM` - IY SS 3 001 U,' D € -• iea('c f 1 33 93,5 City County State Zip Code 30 n4dn �Jea� f alp Be i" Fie 33Y3S Signatu of V ter Date Signed (MM /DD/YY) ,./......_1___". Ito be completed by Voter) Rule 1S - 2.04 .A. DS -DE 104 (Eff. 09/11) CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -1t is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1 the undersigned, a registered voter A as_ •_ • s G (pnnt name as it app ars on your voter i • rmation card) in said state and county, petition to have the name of placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of 01 s /in L r ,�� 1 I k C2 L C% Ss, o he r (insert title of office and 1 clude district, circuit, group, seat numt r, if applicable) Date of Birth or Voter IY Registration Number Address f� (MM /DDY) 1170 / wa � 6, / 1 S N v E ( �- t � - "�t'✓ (c� C_�' City y j County State ` Zip Code it t 3 61 kl - 1 �/ P`ctc- " , l tN■ b ca r V �iC.v`. cl �. 33 T 3S Signature of Voter Date Signed (MM /DD/YY) [to be completed by Voter] (76— a/4 by Rule 1S- 2.045, F.A C. DS -DE 104 (Eff. 09/11) CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign mote than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form I al t < -' ,/u At) J the undersigned, a registered voter (print name as it appears on your voter o formation card) Ile- in said state and county, petition to have the name of a e> l� / "� /� -e. ``e- placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan 'No party affiliation ❑ Party candidate for the office of ` (insert title of office an• • de district, circuit, group, seat numb- if a• •/liable) Date of Birth or Voter Registration Number Address 1 (MM /DD/YY) as 0 5s SuNsc - y , i ` Ci jj _f / County / • State Zip Code T �°7o n ! d1'1 -Q,<C/ ?Alm ege R-- 3 . (7 Signat e Voter Date Signed (MM /DD/YY) [to be completed by Voter) _ 5_, / i i ...... 1....,-, , Rule 1S -2 045, F.A.C. DS -DE 104 (Eff. 09/11) V' d ' CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form i 6v bet It (`e q_vi f14.g L C f l/ the undersigned, a registered voter (print name as it appears on your vot information card) , in said state and county, petition to have the name of 2-f-t. /Q .C( C� / placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan [, No party affiliation ❑ Party candidate for the office of /DI 5±11 7/-d 651 [ 1 � 1 S�Jcy c�' - - I Jvy h c (insert title of office and include d�nct, circuit, group, seat number, if applicable) / Date of Birth or oter Re istration Number Address (MM /DD/YY) `, 40 2 ' 72 0 w+a I l/t V S 0. C Co ty State Zip Code 14 > a C-c r gepqc / �— 33 y3\ Signature Voter Date Signed (MM!DD/YY) /, /�� jto be comp ted by otr] ,,,..._ajH 02 Rule 1S -2 045, F A.C. DS -DE 104 (Eff. 09111) Vf CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate /Section 104 185, Florida Statutes) - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form the undersigned, a registered voter j 14/J A M t L iS Pr L 0 (print name as it appears on your votet card) in said state and county, petition to have the name of y i) L" L , ti E, f • I placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan in No party affiliation ❑ Party candidate for the office of 41' 1 s , ` i' ik, l t ) 1) R < [ % � � ) 5 S z' 6I-L-1? (insert title of office and inclu district, circuit, gr up, seat number, if applicable) Date of Birth or Voter Registration Number Address I (MMIDDIYY) 1 E Li l z /6 -- 7 l L / z 7&i - 6 7 j City County State Zip Code Lai / . ✓ 6' Ac- 4 /& t SL c t'1 '3 3-4 7f , Signature of Voter Date Signed (MMIDD/YY) __ [to be completed by Voter] 627667/It Rule 1S -2 046, F A C. DS-DE 104 (Eff 09/11) J CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons - It is a crime to knowingly sign more than one petition foi a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form `kc, A e V \ a \ Z � the undersigned, a registered voter (print name as It appears on your vor information card ` in said state and county, petition to have the name of \ 1 A '\ placed on the Primary /General Election Ballot as a [checWcomplete box, as applicable] Nonpartisan El No party affiliation ❑ ` � = \ —"` t t Party candidate for the office of (insert title O f office and Include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/ 9/YY) ) c arD3LUAr-c Dc' . 1 City County State Zip Code t.-Dy gec., PAri, R C-, kir 3 3�• Sign oter / Date Signed (MM /DD/YY) [to be completed by Voter] ule 1S -2 045, F A.C. DS -DE 104 (Eff 09/11) ` CANDIDATE PETITION L J Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form t, CO r / 7 0 n G ml' `l iv r- the undersigned, a registered voter (print name as it appears on your voter / information card � ) in said state and county, petition to have the name of T [� LA- ta. / / / 4A 4j j placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan No party affiliation ❑ Party candidate for the office of (insert title of office and include • " riot, circuit, group, se5117 tuber, if applicable) Date of Birth or Voter Registration Number Address � j�(,/ (MM /DD/YY) ('a 3 1 o _s F 67(1 , o tr /Lets �i�r" / J 1 City State Zip Code i&lhollfar \Rd\ PC 33 L/ 3S . Signature of Voter ---- Date Signed (MM /DD/YY) •I - [to be completed by Voter] Dc /OS /ice Rule 1S -2 045, F.A.C. DS -DE 104 (Eff. 09/11) CANDIDATE PETITION (, Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections -11 is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form ( 1.---- A (p j } i ' ' 0 14) . - - the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of P G -G 0. fr\--t('C..i placed on the Primary /General Election Ballot as a [check/complete box, as applicable] ❑ Nonpartisan party affiliation ❑ Party candidate for the office of D i S 1 I cr -t--, C�e rn, i S si� � e.(' (insert title of office and include di nct, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address 7 3 _ 7 4) is- 1 a m 514, G� '! `MR pc ,-) 1 ` 36 A) o N rI- /3A c_, R 3` 4/93 r City County State Zip Code _ I A N G ift fie. G1- PA tq it-f1 1 ,---,.._:, e , 3 " `f '9 S Signat of ter Date Signed MMlD /YY) , / if.)S1--/Z)V—C).,/// (to be com oter] Rule 1S- 2.045, F.A.C. [ DS- E 104 (Eff. 09/11) t 1 V , ,_ __________ CANDIDATE PETITION r,,, Notes. - All info! »nation on this forni becomes a public record upon receipt by the Supervisor of Elections - It Is a crime to knowingly sign mote than one petition /or a candidate (Section 104 185, Florida Statutes) - If all requested Information on tins form is not completed, the form will not be valid as a Candidate Petition form Y 1 1` t \,%/ f I k \ I \ 1U- \U. Y � I m the undersigned, a registered voter (print name as it appears on your voter i card) _ in said state and county, petition to have the name of 1 `,\ t C( € C 14 \ placed on the Primary /General Election Ballot as a (check/complete box, as applicable) --- Nonpartlsan0No party affiliation ❑ Party candidate for the office of . S '''J LT : ± e _ (insert title of office and include district,kircuit, group, seat number, if applicable) '' - Date of Birth or Voter Registration Number E I Address I 1 (MMIDD/YY) I 2 \ ? _ il L L_1 4 5 I (- U* ty \cor v ‘A c 5 \, \I (L..,i �Ci C ounty 1 � State Zip Code >� �� � t���1 �� k a y 35 L Sig -ture o , •ter Date Signed (MMIDDIYY) 1 Ito be completed by Voter) I ' AIL 1 ,_ 2_ \ L--k \ \ L- Rule 1S -2 046, F A.C. 1111111 DS -DE 104 Eff. 09/11 CANDIDATE PETITION l Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Electrons -1t is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form the undersigned, a registered voter eS� ca Pt role (lv c F, pIcc, (print name as it appear on your voter information card) in said state and county, petition to have the name of r, lCt / (' u1 (CL placed on the Primary/General Election Ballot as a [check/complete box, as applicable] r ❑ Nonpartisan © No party affiliation ❑ Party candidate for the office of s hi o ((.vvlWll34, ,c.f/ (insert title of office and ir(clude distract, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) C! /G5 ( 0 5 `t St, .I4 "A„e, City County State Zip Code ac� i�C 1)�`ctCL � (cL �- J3`t .2(. Signature of Voter Date Signed (MM /DD/YY) [to be completed by Voter] ; 0= I `t/..2 C I4 Rule 1S- 2.045, F.A.C. ,' 1 DS -DE 104 (Eff. 09/11) 1.1 CANDIDATE PETITION U Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections - It is a crime to knowingly sign more than one petition for a candidate [Section 104 185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form 1, itfil.',-. ,et L.&. (c) the undersigned, a registered voter (print n. e as it appears on your voter information � card) I in said state and county, petition to have the name of Pa U e placed on the Primary /General Election Ballot as a [check/complete box, as applicable] - ❑ Nonpartisan ; No party affiliation 0 Party candidate for the office of �►,.5 n c i a B -each C� �✓nrn153,0,1 (insert title of office and ind district, circuit, group, seat numbe if plicable) Date of Birth or Voter Registration Number � n NNuum Address ` ! - (MM /DD/YY) O l 2.,c> J J a 6 .r.' 5' � / � ■ ✓' i City County State Zip Code .: -- 60U\k " ii "-- 0 fl ?-e a CA ■—) P A /hi ,....eacGi F-6.--- 33 Signature of Vot Date Signed (MM /DD/YY) [to be completed by Voter] 42 2 — o 1 7/ — /Lye Rule 1S- 2.045, .A.0 DS -DE 104 (Eff. 09/11) / CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections itJ - It is a crime to knowingly sign more than one pennon for a candidate [Section 104 185, Florida Statutes] b - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form 1, . _.eon arc the undersigned, a registered voter u� -✓� (print name as it appears on your voter information card) in said state and county, petition to have the name of P _u, la, A ` placed on the Primary /General Election Ballot as a [check/complete box, as app!/ able] ❑ Nonpartisan ❑ No party affiliation 0 Party candidate for the office of C - II mbef, I n sert title of office and Include district, circuit, group, seat nu if applicable) Date of Birth or Voter Registration Number Address I (MMIDDlYY) , I� a 7 � r, City County State Zip Code Le,,,,,,,,--., i ,,:,,:\,_. r ( I(11\ ri F ( , - s :s.--4- Signature of Vo ---- > _ Date Signed (MM!DD/YY) �� _� -- [to be completed !�+ Voter] —y ' . , 2,- / Rule 1S -2 '45, F A C DS -DE 104 (Eff. 09/11)