Filing Papers Miscellaneous Cash ReceiptOLf
YOA, No. 40
CITY OF BOYNTON BEACH
o
TON
Account No. 001-0000-369-10-00
$ 306.81
, 20
Received of DAVID T. MERKER
Address 8—D SOUTHPORT LANE BOYNI'ON BEACH. FL 33436 - +-:
For 18 FILING FEE TO RUN FOR MAYOR ON MARCH 12, 2 019 r`*1 t�
o�
Dept. CITY CLERK'S OFFICE By CO r1
CA rn�
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\SY Odt
Miscellaneous Cash Receipt No. 921 4i
CITY OF BOYNTON BEACH )61
~TON
Account No. 001-nnnn-369-10-00
$ 25.00
20
cc,
Received of DAVID T_
MRRKRR
Address 8—D SOUTHPORT LANE BOYNTON BRACH, FL 33436 .s� ter.
;Cr.,
For CITY FILING FEE TO RUN FOR M YOR *ON MARCH. 12, 20}9 +%\-
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Dept. CITY CLERK'S OFFICE By
FORM 1 STATEMENT OF 2018
Please print or type your name,mailing FINANCIAL INTERESTS l FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME--FIRST NAME—MIDDLE NAME:
MAILING ADD ESS:
N Seti Qr,--7- 1.,1< 1 ._On,
O3 ''
Ni 3
CITY: ? c
ZIP: COUNTY: „� e;
I i_.a
NAME OF AGENCY:
X
NAME OF OFFICE OR POSITION HELD OR SOUGHT: `2` g
ni ..Ti
You are not limited to space on the lines on this form.Attach additional sheets,If necessary. DC7 m�'
CHECK ONLY IF CANDIDATE OR J NEW EMPLOYEE OR APPOINTEE _
ROTH 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):
0)( DECEMBER 31,2018 ,Q$ ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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(must check one):
❑ COMPARATIVE(PERCENTAGE)THRESHOLDS Qj3 ❑ 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,write"none"or"n/a") °
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
BA5U1FRC5 N-Wr_
� l 331. d -
1 '
�I
5icritcil_ sacusq.-\(
PART B— SECONDARY SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
MON-C----,^^.+,,,�� C
PART C—REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
_ and where to file this form are
located at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORMAn-Erfeclive:January 1,2019 (Continues on revere*side)
ncorpo by reference in Rule 34-8.202(1),FAC. PAGE 1
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE ' BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
f'LPL S or,- s tJ ct' cl (i. 6h)(AlVrvo
-
l_ I A ) 101 '.1 ' if ''—iii•1 III . itti,AIL LAI 1I `1
PART E—LIABILITIES [Major debts-See Instructions] ';" i)T ,] . A
(If you have nothing to report,write"none"or"n/a") .
NAME OF CREDITOR ADDRESS OF CREDITOR
I
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,write"none"or"n/a")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY jci\)
c
PRINCIPAL BUSINESS ACTMTY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G—TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142,F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
Si nature: If a certified public accountant licensed under Chapter 473,or attorney
in good standing with the Florida Bar prepared this form for you,he or
`' she must complete the following statement:
1 V) t I, , prepared the CE
Form 1 in accordance with Section 112.3145, Florida Statutes,and the
instructions to the form.Upon my reasonable knowledge and belief,the
disclosure herein is true and correct.
Date Signed:
CPA/Attomey Signature:
Date Signed:
TILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls
under,see page 3 of instructions. 1 with aa qualifying officer is not required to file with the Commission
Local officers/employees file with the Supervisor of Elections or Supervisor of Elections.
Lf aounin which they permanently reside. (Ifryou do not WHEN TO FILE: Initially,each local officer/employee,state officer,
permanentlyftheuye in Florida, file withathe Supervisor of you
county and specified state employee must file within 30 days of the
where your agency has its headquarters.) Form 1 filers who file with Appointeesdate of his whoor her mustapbetmeir or df bytthe beginning Seate of mustfile priormeno
the Supervisor of Elections may file by mail or email. Contact your confirmed Senate file to
Supervisor of Elections for the mailing address or email address to confirmation, even if that is less than 30 days from the date of their
use. Do not email your form to the Commission on Ethics. it will be appointment.
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file.by mail, Thereafter,file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
?317-5709;physical address: 325 John Knox Rd, Bldg E, Ste 200,
illahassee. R 32303. To file with the Commission by email, scan Finally, file a final disclosure form (Form 1F) within l Statement days of
completed form and any attachments as a pdf(do not use any leaving office or employment. Filing a CE Form 1 F(Final
Iour
ther format)and send it to CEForm1 le state.fi.us. Do not file by
of Financial Interests)does position relieve the filer of filing a CE Form 1
oth mail anemail. Choose only one filingilmethod. Form 6s will noif the filer was in his or her on December 31,2017.
• e accepted via email.
CE FORM 1-Effective:January 1,2018. PAGE 2
Incorporated by reference In Rule 34-8.202(1),F.A.C.
OFF'
r Palm Beach County
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 62 signatures on the Nominating Petitions of DAVID THEODORE
MERKER for MAYOR FOR THE CITY OF BOYTON BEACH are registered electors within
the municipal limits of the CITY of BOYNTON BEACH, according to the registration records
on file in this office.
This is to further certify that DAVID THEODORE MERKER is a registered voter in Precinct
4050, in the City of Boynton Beach, Florida.
Signed, this the 9th day of January, 2019.
/LOC(/),-N bAtiN
--SU AN BUCHER W V� :
SUPERVISOR OF ELECTIONS _ ,
PALM BEACH COUNTY r;�;
(SEAL)
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
S
_APPOINTMENT OF CAMPAIGN TREASURER
C►. Y OF BC) Y�1 � M 8E'A BN
C«�` C�-FRI�'S OFFICE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
i8 APR -1`3
(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):
a 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
code) F3 �,V l � IFL
4. Telephone
CO -
5. E-mail address
6. Office sought (include district, circuit, oup umber)
7. If a candidate fora nonpartisan office, check if
applicable:
E] My intent is to run as a Write -In candidate.
8.. If a candidat for a- artisan 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.
a. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
J. Name of Treasurer or Deputy Treasurer
DiNymL-
11. Mailing Address
12. Telephone
aaj 'A
13. City
14. County
15. State
16. Zip Code
17. E-mail address
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address
21. City
22. County
23. State
24. Zip Code
,� 1 -1
�Lvv�
33m
UN6A 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.L'ture of Candidate
0'Ji/31q_nO
XI-
27. J.Treas rer's Ac eptance of Appointment (fill in the blanks and check the appropriate block)
I, , do hereby accept the appointment
(Please Print or Type Name)
esignated above as: Campaign Treas r r Deputy Treasurer.
o
'Ditd Signature of Campaign Treasurer or. Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
I
e ONAYH
STATEMENT OF CITP�FI5 OFFICE
CANDIDATE 18 APR 13 AH 1i: 40
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of Q
have been provided access to read a understand the requirements of
Chapter 106, Florida Statutes.
X Il
Signature of Candidate
A,, L-11, qQ2)
4L—L 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).
Tn r
✓U-Lli UT `V J/ 11/
RESIDENCY REQUIREMENTS
03 C-�
r— cry
ca o=, ,D
�-<
MI
DPW z I , P)L--lg Arm , candidate for` ��
(Print Name)
LDE of the City
(May /Commissioner — District #)
of Boynton Beach, have received, read and
understand the residency requirements of Article II
of the Charter of the City of Boynton Beach.
(Signature of Candidate)
2�L `D
(Date)
2/15/18
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENTAOC
CANDIDATE OATH ® � y
NONPARTISAN OFFICE -`
(Do not use this form if a Judicial or School Board Candidate) c') T'
,eck box only if you are seeking to qualify as a
write-in candidate:CD
, }
❑ Write-in candidate ., n
�W
Y
Candidate Oath
_ ( ecction 99.021(1)(a), Florida Statutes)
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of
(Office) (District #)
I am a qualified elector of P".) 1ZCounty, 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;
-nd I will support the Constitution of the United States and the Constitution of the State of Florida.
ICandidate's Florida Voter Registration Number (located on your voter information card):
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
XU D� 736^61112—
Signature of Candidate Telephone Number Email Address
VL3�3 b
Address City a e ZIP Code
STATE OF FLORIDA
Signa re of o ary Public
COUNTY OF �f , V Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me this I `�
day of'�xr_�!--�— , 20.
l ,onally Known: or Produced Identification:
Type of Identification Produced:
DS -DE 30214P (Re'v. 11/11Y",
2o�SgY PU@�� SHAYLAS. ELLIS
* * MY COMMISSION # GG 031774
c` EXPIRES: September 19, 2020
p�F6f F60, agMw Thru dutipt Notary Sere n
Rule 1S-2.0001, F.A.C.