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Filing Papers ��Y ° Miscellaneous Cash Receipt ` � No. 02148 CITY OF BOYNTON BEACH ,l i Br1 BEACH \ ,'I f' CLERK'S OFFICE �" g�P To,,, Account No. 001-0090.J06i9i•1 Pill 1 9 $ 262.19 i , Received of CHRISTINA L. ROMELUS Address P•O• BOX 872 BOYNTON BEACH, FL 33425 For 1% FILING FEE TO RUN FOR COMMISSIONER - DISTRICT III ON MARCH 12, 2019 Dept. CITY CLERK'S OFFICE By Miscellaneous Cash Receipt i CITY OF BOYNTON BEACH No. O..r`'' .5 2 . 7,1Li 1EAC CII Y CLERK'S OFFICE4,7'0N g�P Account No. 001-0000-369-10-00. i JAI i Fri 3. $ 25.00 20 Received of CHRISTINA L. ROMELUS Address P.O. BOX 872 BOYNTON BEACH, FL 33425 For CITY FILING FEE TO RUN FOR COMMISSIONER - DISTRICT III ON MARCH 12, 2019 Dept. CITY CLERK'S OFFICE By FORM 1 STATEMENT OF 2018 Please print or type your name,mailing FINANCIAL INTERESTS I FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME.,--FIRj- NAME-- IDDLE NAM • UIS 1�U)v) Lv S / k i-f.4lAa_. MAILING ADDRESS: PDBxKi ,k ii i1,i�DYL AA',- ,33q-2.5 Lbi/n &ac t CIT\': ZIP: COUNTY: ,-.,. -' a r NAME OF AGENI ? `'T, r2 isec & �f` ikr f S% 0.NAME O ICR POSITION HELD OR SOUGH : _ rf . -,r C. You are not limited to t space on the lines on this form.Attach additional sheets,if necessary. moi... CHECK ONLY IF CANDIDATE OR ij NEW EMPLOYEE OR APPOINTEE Cr .� rr A rn **** 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(r�ftist check one): ®/ DECEMBER 31, 2018 OR ❑ 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 QB ❑ 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 Ptk. L L- r al/ i# /I ilitibli aj 1� ib1 Pg1�i1 C � �, J,i Pr9k,gor - ktat�t,,� (,cwt wO ciS�rts�.r CaIr*rn ',4 - 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 f 41-- 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 N I rf located at the bottom of page 2. 1 INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2019 Incorporated by reference in Rule 34-8.202(1),F.A.C. (Continued on reverse side) 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 PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR )1/4)/4/v/4 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"Na") BUrSS ENTITY#1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY p ADDRESS OF BUSINESS ENTITY l PRINCIPAL BUSINESS ACTIVITY 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 icers 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 certified a If public accountant licensed under Chapter 473,or attorney Signature: /f in good standing with the Florida Bar prepared this form for you,he or she must complete the following statement: ///// /v , prepared the CE i /� 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: / ( t-{11/ CPA/Attorney Signature: / / Date Signed: FILING 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 form to thator cTo determineouruat category your pg un falls MULTIPLE FILING UNNECESSARY:A candidate who files a Form under,see page 3 of instructions. 1 with a qualifying officer is not required to file with the Commission Local officers/employees file with the Supervisor of Elections or Supervisor of Elections. f the in which they permanently reside. (Ifryou do not WHEN TO FILE:Initially, each local officer/employee, state officer, permanently reside in Florida, file with the Supervisor of the county anddate of his oor herate employee must file beginning 30 days of the where your agency has its headquarters.) Form 1 filers who file with Appointees his who appointment be confirmed or of the a Senate of musthis prior the Supervisor of Elections may file by mail or email. Contact your must be eshby the days from datee ofith it Supervisor of Elections for the mailing address or email address to confirmation, even if that is less than 30 from the 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. 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan Finally, file a final disclosure form (Form 1 F) within 60 days of your completed form and any attachments as a pdf(do not use any leaving office or employment. Filing a CE Form 1F(Final Statement other format)and send it to CEForm1@leg.state.fl.us. Do not file by ifoFinancial was Interests)inhis does 2 on relieve the mer r filing a . Form 1 both mail and email, Choose only one filing method. Form 6s will not if the filer in or her position on December 31,2018. be accepted via email. CE FORM 1-Effective:January 1,2019. PAGE 2 Incorporated by reference in Rule 34-8.202(1),F.A.C. OFF Esti .� ya Palm Beach County OF PAS'' 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 28 signatures on the Nominating Petitions of CHRISTINA LOUIS ROMELUS for CITY COMMISSIONER, DISTRICT 3, 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 CHRISTINA LOUIS ROMELUS is a registered voter in Precinct 7190, in the City of Boynton Beach, Florida. Signed, this the 11th day of January, 2019. _3 SUSAN BUCHER SUPERVISOR OF ELECTIONS -11 ' PALM BEACH COUNTY z� rn z (SEAL) , CANDIDATE OATH — NONPARTISAN OFFICE 31' 'r uI- BL, i t. 1 ,, 4E.4CH (Do not use this form if a Judicial or School Board Candidate) 4,1 .teck box only if you are seeking to qualify as a lz, JAN I I PH 3: .1F; write-in candidate: ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a),Florida Statutes) I, 6114 IS`T WJ (? L+iE1wc (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 [J. (See page 2 - Compound Last Names). No change can be made after the end ofuali in . printed above for oath Although a write-in candidate's name is not printed on the ballot, the name must be9 g purposes.) am a candidate for the nonpartisan office of goviv-zi\l, g69-af ( iy ' LoMM lSi� Sir) �' , (Office) (Dishict#) I am a qualified elector of P&L.-I Belit 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. Candidate's Florida Voter Registration Number(located on your voter Information card): ) I LH lo73 3-5 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' structions on page 2 of this form):JINot applicable to write-in candidates.) KRI ,STEeNUI4 i At-FM `t'bO L i ,3 X a � •� .�_-.` ate. (11) (43�. - 8a f � Signature of C date Telephone Number ` , re" m� - -fie" LI P ntii a Email Address Address City -1:1: P Code STATE OF FLORIDA A gnature of Notary Public COUNTY OF 20-- Print,Type,or Stamp Commissioned Name of Notary Public below Sworn to(or affirmed)and subscribed before me this I I +Or , Notary Public State of Florida day of 1 ►.c20 . Queenester Nieves A ha.� My Commission GG 210021 •<)rsonaly Known: or Produced Identification: eew Expves 07/16/2022 Type of Identification Produced: Queenester Nieves' DS-DE 302NP(Rev.11/17) - - •- Rule 1S-2.0001,F.A.C. Compound Last Names If your last name consists of two or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to check the box,your name will be listed with the name appearing last on the line. Example:John Jones Smith—If the last name has no hyphen and you do not check the box,the last name on the ballot would be`Smith". If you check the box,your last name woul be listed on the ballot as"Jones Smith."If you have a hyphen within your last name,the last name would be listed as`Jones-Smith'. Guide for Designating Phonetic Spelling of Candidate's Name for Audio Ballot 1. Use tables below. 2. Use upper case for"stressed"syllables.Use lower case for"unstressed"syllables. 3. Use dashes(-)to separate syllables. 4. Add any notes such as rhyming examples,silent letters, etc. Vowels Stressed Vowel Sounds Unstressed Vowel Sounds EE (FEET)feet uh (SO-fuh)sofa(FING-guhr)finger I (FIT)fit E (BED)bed A (KAT)cat(KAD)cad AH (FAH-thur)father(PAHR)par AH (HAHT)hot(TAH-dee)toddy UH (FUHJ)fudge(FLUHD)flood UH (CHUHRCH)church AW (FAWN)fawn Certain Vowel Sounds with R U (FUL)full , AHR (PAHR)par 00 (FOOD)food ER (PER)pair OU (FOUND)found IR (PIR)peer - O (FO)foe OR (POR)pour El (FEIT)fight _OOR (POOR)poor Al (FAIT)fate UHR (PUHR) purr 01 (FOIL)foil . YO0 (FYOOR-ee-uhs)furious Consonants B (BED)bed R _ (RED)ted D (DET)debt S (SET)set F (FED)fed T (TEN)ten G (GET)get V (VET)vet H (HED)head Y (YET)yet HW (HWICH)which W (WICH) witch J (JUHG)jug CH (CHUCRCH)church K (KAD)cad SH (SHEEP)sheep L (LAIM)lame . TS (ITS)its(PITS-feeld)Pittsfield M (MAT)mat TH (THEI) Thigh N (NET)net TH (THEI) Thy NG (SING-uhr) singer ZH (A-zhuhr)azure(VI-zhuhn)vision P (PET)pet Z (GOODZ)goods(HUH-buhz-tuhn)Hubbardston Examples of Phonetically Spelled Names NAME ON BALLOT PRONOUNCED AS Mishaud mee-SHO('d'is silent) Jahn HAHN(rhyme:fawn) Beauprez boo-PRAI(rhyme:hooray) Maniscalco man-uh-SKAL-ko Tangipahoe TAN-ji-pah-HO-uh Monte. Mahn-TAI Tanya . t . TAVVN-yuh(not TAN) DO*not submit-this page to the filing officer. DS-DE 302NP(Rev.11/17) Rule 15-2.0001,F.A.C.