Filing PapersAPPOINTMENT OF CAMPAIGN TREASURER
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.
1. CHECK APPROPRIATE BOX(ES)-
0 Initial Filing of Form Refiling to Change; 0
2. Name of Candidate (in this order. First, Middle, last)
Golene L Gordon
OFFICE USE ONLY
TreasuredDeputy ❑ Depository [] Office ❑ Party
j 3. Address (include post office box or street, city, state, zip
II fie)
�P.O.BOX 4303
4. Telephone 5. E-mail address Boynton Beach, FL 33424
(561 ) 853-5959 lelectggordon@gmail.com
6. Office sought (include district, circuit, group number)
Mayor, City Of Boynton Beach
7. If a candidate for a nonpartisan office, check If
applicable:
❑ My intent is to run as a Write -In candidate.
8. if a candidate for aaQ rtisan office, check block and fill In name of party as applicable: My intent is to run as a
❑ Write -In ❑ No Party Affiliation --
9. 1 have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
Golene L Gordon
11. Mailing Address
P.O.BOX 4303
13. City
i 14. County
Boynton Beach
jPalm Beach
18.1 have designated the following bank as my
19. Name of Bank -
- -
Wells Fargo
21. City
22. County
Boynton Beach
Palm Beach
R Campaign Treasurer ❑
I 15, State
FI L -
Party candidate.
Deputy Treasurer
12. Telephone
( 561 ) 853-5959
16. Zip Code 17. E-mail address
33424 Electggordon@gmaii.com
Primary Depository ❑ Secondary Depository
20. Address - - -
200 North Congress Ave
123. State 24. Zip Code
FL 133426
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ THE FOREGOING FORM FOR APPOINTMENT Of: CAMPAIGN TREASURER AND
DESFGNATFON OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25, Date - - - 26. 'Signature of Candidate T
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I Golene L Gordon do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer ❑ Deputy Treasurer;,
-� Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 lRev.10€1101 Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER CI' i �Jr 13C' ` i + bEACH
AND DESIGNATION OF CAMPAIGN
f'Il 'r' CLER 'S OFFICE
DEPOSITORY FOR CANDIDATES 13 APR -2 P1112: 19
(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):
XD Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office El Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Golene L Gordon code)
P.O.BOX 4303
4. Telephone 5. E-mail address Boynton Beach, FL 33424
(561 ) 853-5959 electggordon@gmail.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Mayor, City Of Boynton Beach applicable:
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
❑ Write-In El 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
Golene L Gordon
11. Mailing Address 12. Telephone
P.O.BOX 4303 ( 561 ) 853-5959
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Boynton Beach Palm Beach FL 33424 Electggordon@gmail.com
18. I have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
Wells Fargo 200 North Congress Ave
21. City 22. County 23. State 24. Zip Code
Boynton Beach Palm Beach FL 33426
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 26. Signature of Candidate
�D/9 X �2
27. Trea urer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Golene L Gordon , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer ❑ Deputy Treasurer. -
/c72/ 0/C/".
X ae Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
RESIDENCY REQUIREMENTS
I, ( D/ei'l'e 1-- 6kr,4&/ , candidate for
(Print Name)
a6r of the City
Commissioner— District #)
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)
V W cr
aa
`t) 0_ 0I7PW
ate
ti.CJ C�
r H- rn
09/08/16
S:\CC\WP\ELECTION\Year 2017\RESIDENCY REQUIREMENTS STATEMENT-2017.doc
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
�1
(Please print or type)
0't
rT
l Golene L Gordon
candidate for the office of Mayor for the City of Boynton Beach ;''Y
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
26/
Signature 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)
FORM 1 STATEMENT OF
Please print or type your name, mailing FINANCIAL INTERESY13
address, agency name, and position below:
LAST NAME -- FIRST NAME -- MIDDLE NAME
L 66a / (/ C 0lea �
MAILING ADDRESS
930 1-q)k4?
CITY: / ZIP: COUNTY:
2020
FOR OFFICE USE ONLY:
RELIED
NOV 12 202;
NAME OF AGEINCY : I CITY OF BOYNTON BEACH
NAME OF OFFICE OR POSITION HELD OR SOUGHT.
H a ZGG-
CHECK ONLY IF CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
aa� �
**** THIS SECTION MUST BE COMPLETED
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR EI'-eDING I:)ECEMBER 31, 2020.
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLI...AR VALUES, WHICH REQUIRES
FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUA.-LY BASED ON PERCENTAGE VALUES
(see instructions for further details). CHECK THE ONE YOU ARE USING (must check one]:
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR C9 DOLLAR WE LUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See it::,truction ]
(If you have nothing to report, write "none" or' nla")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by the reporting I:)erson -:Hee instructions]
(If you have nothing to report, write "none" or'Wa")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C -- REAL PROPERTY [Land, bulidings owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "nla")
C�3 lakP #/
CE FORM 1 - Effective: January 1, 2021
Incorporated by reference in Rule 34-8.202(1), F.A.C.
r
(Continued on reverse side)
YOL are not limited to the space on the
lineal on this form. Attach additional
shoats, if necessary.
FILING INSTRUCTIONS for when
antl where to file this form are
loclIted at the bottom of page 2.
INSTRUCTIONS on who must file
thio form and how to fill It out
beg: in on page 3.
PAGE 1
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See i:lstructiors]
(If you have nothing to report, write "none" or "n/a")
TYPE OF INTANGIBLE I BUSINESS ENTITY TO'NHICH THE PROPERTY RELATES
a1 A iadl,s ifavr
fita
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF CREDITOR
ADDRIE.SS OF ;REDITOR
II-GIGI�o mliYlCCi'(I Arx 0/.P 71 Lullsv/A,P, ,err 4/00, m _ 1771 11
urn
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of bl•isinesses - See instructions]
(If you have nothing to report, write "none" or "n/a")
BUSINESS ENTITY # 1 I BUSINESS ENTITY # 2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
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 officers, appointed school superintendents, and comrrissione its of a community redevelopment
agency created under Part III, Chapter 163 required to complete annual ethics training pursuant to sec.lion 112.;6142, F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REC;[.UIRE:D TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER:
Signature:
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County
Supervisor of Elections for your annual disclosure filing, return the
form to that location. To determine what category your position falls
under, see page 3 of instructions.
Local officers/employees file with the Supervisor of Elections
of the county in which they permanently reside. (If you do not
permanently reside in Florida, file with the Supervisor of the county
where your agency has its headquarters.) Form 1 filers who file with
the Supervisor of Elections may file by mail or email. Contact your
Supervisor of Elections for the mailing address or email address to
use. Do not email Your form to the Commission on Ethics, it will be
returned.
State officers or specified state employees who file with the
Commission on Ethics may file by mail or email. To file by mail,
send the completed form to P.O. Drawer 15709, Tallahassee, FL
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200,
Tallahassee, FL 32303. To file with the Commission by email, scan
your completed form and any attachments as a pdf (do not use any
other format), send it to CEForm1@leg.state.fi.us and retain a copy
for your records. Do not file by both mail and email. Choose only one
filing method. Form 6s will not be accepted via email.
CE FORIA 1 - E,'*kctive: January 1, 2021.
Inc"rnarated by reference in Rule 34.8.202(1). FAC
CPA or ATT'ORN -:Y SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or attorney
in good standing with the Flori:la Bar prepared this form for you, he or
she must complete thl;! following statement:
I, prepared the CE
Form 1 in accordance:. with Se(: -.tion 112.3145, Florida Statutes, and the
instructions to the form. Upon 7•ny reasonable knowledge and belief, the
disclosure herein is tr.,e and c::)rrect.
CPA/Attorney Signature:
Date Signed:
Candidates file this forrn togett:er with their filing papers.
MULTIPLE FILING UNI'JECESI!9ARY: A candidate who files a Form
1 with a qualifying officr;;.,r is not required to file with the Commission
or Supervisor of Elections.
WHEN TO FILE: Initle!lly, each local officer/employee, state officer,
and specified state employee: must file within 30 days of the
date of his or her appointment or of the beginning of employment.
Appointees who must t::a confirmed by the Senate must file prior to
confirmation, even if th;:t is less;- than 30 days from the date of their
appointment.
Candidates must file at the ;lame time they file their qualifying
papers.
Thereafter, file by July I folio%ing each calendar year in which they
hold their positions.
Finally, file a final disclosure form (Form 1F) within 60 days of
leaving office or employment. Filing a CE Form 1 F (Final Statement
of Financial Interests) does not relieve the filer of filing a CE Form 1
if the filer was in his or her poli: on on December 31, 2020.
PAGE 2
miscellaneous cash Receipt
CITY OF BOYNTON BEACH
Account No.
Received of
Address
For
Dept. By
MVSCe11t7n00US Cash Receipt
CITY OF BOYNTON BEACH
Account No. 001- ,) 0 0 0- 36 V - L 0
Galen Gordon
Received of
Address PO Box 4303
ton Baach FL 33
m
-20
ox,;
i Cx 91
No. 91722
$ 238.23
20
U
1% Filing Fee to run
for
For
-March 8, 2022
77
M -L
Fij
Dept. Clerk's Off icE-I
By
r ej
f
77
M -L
Fij
r ej
f
R4
R --0
i�
U
PPP
-k
Miscellaneous Cash koceipt
CITY OF BOYNTON BEACH
Account No.
Received of
Address
For
No. .0.1-733
U- V! okvtl
t cj'A
20
pi
Dept. By Trms Tyre. ii !!,/Li ff2:
CITY CF M-Ttjjct� oDi
,1-','Y OF M-TLN EN -11
cTu.ff,, FEMPT ***
oper'. &BM I Pe!
Date: '100ti"i 01 1.2 elpt 11g,.
1�2;scri pt ion PilatItity mount
mismi-PbE
1.00
Trans -,jufter:
GIL account r0fiber:
0=591wi
GJ,W1,j - PEr-,T10N URT
GTJAION
ITI ON Cff(RFICAT
2T, LXF- OTffe' CiR
Tender detal", $4.10
CK - 1006 $4.10
Otal tendered $4.10
Total pant
Trak date- Tim.* '1505:34
-qq,K YW FOR YM STT 1AMW
CANDIDATE OATH -
NONPARTISAN OFFICE
RECEIVED
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a
NOV 2 2 2021
write-in candidate:
CITY OF BOYNTON BEACH
Elwrite-incandidate
CITY CLERK'S OFFICE OFFICE USE ONLY
Candidate Oath
(Section 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 Q r. Y o-On l
(Offi ) (District #)
I ?1
am a qualified elector of 044 ( 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): L) C/ 1 ?6 /2r?
? _
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): [Notapplicable to write-in candidates.]
Signature of Candidate Telephone Number ail Address
.931) 1 a 14 e cyi CIA k3c)�L.rf en 'OeuL.) i�4 --f I 3 BIZ 6
Address City State ZIP Code
4
STATE OF FLORIDA Z414v� c f
�(Q� � Sign ure of Notary Public
.
COUNTY OF 1 Q_I 1'''t 13�dL- �� Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by means off•, !'�� "•. CRYSTAL D. GIBBON
online ri ation ❑ OR physical presence 1:1+� .: MYCOMMISSION AGG326964
nota
Af EXPIRES: April 22,2023
this o day of Nn m 20 • Qs"N -0 Wded rnNNotary Public u„am,t m
Personally Known ❑ OR Produced Identification u
Type of Identification Produced: Nn1ft'"(' 4t Cf!5,e_
DS -DE 302NP (Rev. 05/2021) Rule 1S-2.0001, F.A.C.
Wendy sartory Link
Palm Beach County Supervisor of Elections
NOV 1612021
CERTIFICATION
CRY OF BOYNTON BEACH
CITY CLERK'S OFFICE
I, WENDY SARTORY LINK, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do
hereby certify that 33 signatures on the Nominating Petitions of GOLENE GORDON for MAYOR,
FOR THE CITY OF BOYNTON 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 GOLENE GORDON is a registered voter in Precinct 4053, in the City
of Boynton Beach, Florida.
I am only certifying that the signatures match the signatures we have on file and that the electors
reside within the municipal limits. I am not certifying the validity or legal sufficiency of the petitions
Signed, this the 15th day of November, 2021.
- f
NDY SA RY LINK L
SUPERVISOV OF ELECTIONS
PALM BEACH COUNTY
(SEAL)
240 South Military Trail. West Palm Beach, FL 33415 I Post Office Box 22309. West Palm Beach. FL 33416
Telephone: 561.656.62001 Fax Number: 561.656.6287
CANDIDATE PETITION
Notes. -All information on this, form becomes a public record upon receipt by the super•v . ror oft: fictions.
- It is a crime to knowingly sign more than one petition for a candidate. [Section 111.1.185, 1,7orida Statutes]
- If all requested information on this for•►n is not completed, the form will not be vai'd as a o 'andidate Petition form.
1, , j r� � c n 6� p:he undersigned, a registered voter
c_
(print name as it appears on your voter inform tion card)
in said state and county, petition to have the name of . i � ��
placed on the Primary/General Election Ballot as a: [checwcomplete box, as applicable]
nonpartisan ,� „_ Party candidate for the office of
1 CA : r
(i ert title of
C'f
and include
it, group, seat nurr bar, if ai,:plicable)
Date of Birth or Voter Registration Number Address
112y)
IV C 41,51 gy
City County St.'A , Zip Code
ecec
Signature of Voter
Rule
A r M
[Ml 9:e Signed (MM/DD/YY)
a be completed by Voter]
D3 -DE 104 (Eff. 09111)
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.
I, PyvLrr' � W the undersigned, a registered voter
(print name as it appears on your voter i
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 M No party af€rAet:i'ai
1111AV
(insert tie of
Party candidate for the office of
Ct Y& �z
and include Atrict, 4ircuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DDNY)
City County State Zip Code
Signature of Voter Date Signed (MM/DD/YY)
[to be completed by Voter]
Rule 75-2.045, F.A.C. DS -DE 104 (Eff. 09191
It A!53koq Q
POSTULACION DE CANDIDATO
Notas: - Todo la informacidn contenida en este formulario se convertirb en registro publico una vez recibido por el Supervisor de
elecciones.
- Firmar mds de una postulacidn para un candidato a sabiendas constituye un delito. [Seccidn 104.185, Estatutos de Florida]
- Si no se completa toda la informacidn solicitada, este formulario carece de validez para la Postulacidn de candidates.
EI/La que suscribe,
votante registrado/a
(nombre en letra de imprenta tal como figura en su tarjeta de informacidn de votante)
en el mencionado estado y condado, solicito que se incluya el nombre de G—O " `-O /ZD Q Al
en la papeleta de eleccidn prima ri a/general como: [marcar/completar casilla segon corresponda]
VfNo partidista ® Sin filiacidn partida andiclato con filiacidn partidaria para el cargo de
oK D 7^4E ��T O O yN7Os�!
(insertartitulo de cargo a incluir distrito, circuito, grupo, n' ero de escano, si corre onde)
Fecha de nadmiento O N° registro de votante Diretdon y
(MM/DD/AA)
/) 12-19
Ciudad] / Condado /- Estado Cddigo postal
C .t/� c��✓ � � EA �! 760 fZZI -
Firma de a Fecha firma (MM/DD/AA)
[a completar por vo ' nte]
i 1S-2.04 F.A.C. De artamento de Estado, Divisidn de Elecdones DS -DE 104 Wk. 091111
l':�aiL-c1�)o1-7
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.
L 1 �7the 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 r-, 01 r 1J C_d �� 0 J\,1
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan ❑ No party affiliation ❑
Y-Yi G r : }Ti✓
(insert title of office and include
Party candidate for the office of
l'- Wa c'y / ' L eGC L
circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MMlDDlYY)
City County State Zip Code
Signature
,00f� Voter I
M a
Date Signed (MM/DDlYY)
[to be completed by Voter]
rL/
Rule iS-2.046, F.A.C. DS -DE 104 (Eff. 09111
I���7
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.
I, ` � `G l �` Al the undersigned, a registered voter
(print name as it appears on your voter Inform7;_
ncard)
in said state and county, petition to have the name of V/ e I oydyj �i/
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan F-1 No party affiliation F-1 _
r #�X_ Ck
;ert titlelof office and include di;
Date of Birth or Voter Registration Number
(MM/DNY)
�-(/�3 - 1S `
Party candidate for the office of
group, seit number, if applicable)
Address
__L :9S2�1
City
jae>,va/
County
State
FL_ i
Zip Code
Date Signed (MM/DWY)
[to be completed by Voter]
/ (FZ
Rule 15-2.045, F.A.C. DS -DE 104 (Eff. 0911
14 Wb51
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 farm is not completed, the form will not be valid as a Candidate Petition form.
I, a i ` e. S e (' d i t the undersigned, a registered voter
(print name as it appears on your voter info ation card) e--.0 /
in said state and county, petition to have the name of �� b G e j 'L �,/� /
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
i/
❑ Nonpartisan _No party affiliation
❑
Party candidate for the office of
(A -
r4
IVO �ccG�j
mber, if applicable)
Date of Birth or Voter Registration Number Ydress
/
(MM/DDNY)
'1 17-7j�,
City County State Zip Code
Signature of Voter
Rule 15-2.045, F.A.C.
Date Signed (MMIDD/YY)
[to be completed by Voter]
- .2 0 Z.
DS -DE 104IEff. 09/1
I Oq o 143 30Q�3
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.
I, 21 '5 the undersigned, a registered voter
I (print name as it appears onl your voter information card)
in said state and county, petition to have the name of le—ive- G'c (-C/O)
placed n the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan ❑ No parry affiliation ❑ _ _ Party candidate for the office of
m �� � ]ir C�- �y K'IV)� eC i
(insert title 6f office and include(district, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DDIYY)
City County State Zip Code
P 4-71 � AJ � acct 4T C, �L 33 J
Signature of Voter Date Signed (MM/DDlYY)
[to be completed by Voter]
�v ZD Z!
D 1S-2.045, .A.C. DS -DE 104 (Eff. 09/11
(t gGL-P25S'�S-7
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
(p.Jrli ream as it appears on your voter info ation card)
in said state and county, petition to have the name of ( [�`� 0 Y -dol
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
[—]Nonpartisan [—]No party affiliation ❑ _
yI 0L W r a
(insert titlO of office and inclu
Date of Birth or Voter Registration Number
(MM/DD/YY)
Party candidate for the office of
>t ' t, circuit, group, seat number, if applicable)
Address 9-4 CA -c5 -05 t
- -;� c
City County State Zip Code
0
X3�v Ll
�3
Signatur of Voter Date Signed (MM/DD/YY)
- — [to be completed by Voter]
2
Rule 1S-2.046, F.A.C. DS -DE 104 (Eff. 09111
_ C-1 -7 "_%
(-) oc t ow.
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.
I, 42—'K C-1, � R P� � �1 0' (Z L_ the undersigned, a registered voter
(print name as it appears on your voter information rd) /i
in said state and county, petition to have the name of J� G /e! �l c
placed on the Primary/General Election Ballot as a: [check/complete box, as applica /e]
O Nonpartisan ❑ No party affiliation Party candidate for the office of
)Y v o tl r)4tNy� ►� Pc�
insert title of office and include istrict, c1rcuit, group, se number, if applicable)
Date of Birth or Voter Registration Number Address`
(MMIDDIYY) ` 3l
City County State Zip Code
(3
Signature of
Voter
1 V lK
Rule 1S-2.045, F.A.C.
r1l
ate Signed (MM/DD/YY)
o be completed by Voter]
/ I �/ _
DS -DE 104 (Eff. 09/1
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.
(print name as it appears on your voter information card)
in said state and county, petition to have the name of d i) le 1 V—C—
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
❑Nonpartisan ❑ No party affiliation ❑
C( n GA
(insert titlO of office and include district, ircuit group, seat
Date of Birth or Voter Registration Number
(MMIDD/YY) City County
fi
Signature of Voter
Rule iS-2.046, F.A.C.
Address 3 Z o l
the undersigned, a registered voter
Party candidate for the office of
if applicable)
State Zip Code _ _
(L_j_ L 33 �3
Date Signed (MMIDD/YY)
[to be completed by Voter]
17ZVI Zj
DS -DE 104 t Eff. 09/11
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.
1,
a -C_ -� � the undersigned, a registered voter
_(print name as it appears on your voter i ormati n card) ,, /
in said state and county, petition to have the name of (� / e [ l�1 ��'0 co
placed on the Primary/General Election Ballot as a: icheck/comp/ete box, as applicable]
ONonpartisan E]No parry affiliation .F-1
(inse title of ce and include
Party candidate for the office of
rcuit, group,lseat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/
da
L
County State Zip Code
Signature oi`� { Date Signed (MM/DD/YY)
10
be completed by Voter]
IS -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 Salperv', ror of f sections.
- It is a crime to knowingly sign more than one petition for a candidate. [Section 111.1.185, Florida Statutes]
- If all requested information on this form is not completed, the form will not be vai'd as a Q 'andidate Petition form.
I. l 2 ,e_ bCA, lie undersigned, a registered voter
tpnnt name as It appears on your voter Inform tion carat
in said state and county, petition to have the name of
placed on the Primary/General Election Ballot as a: [checwcomplete box, as applicable]
nonpartisan [D No party affiliation F-1 _. Party candidate for the office of
}'Y) C1 '/C))-
(irtsert title of
C.t
and include distAct, circuit, group,
Date of Birth or Voter Registration Number Address
(MM/DD/YY) r ^ 1
1-bil I r X16 /V C-1
nurr, I: ar, if applicable)
City County St.r: Zip Code
Signature of Voter DI! t.e Signed (MM/DD/YY)
[k, Nbe completed Dy Voter
Rule 1S-2.045, F.A.C. DS -DE 104 IEff. 09111
I 14 �3:6 (-C) cDc C
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 ane 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.
'(print name_ as it appears on your voter �Mp rmati n card)
in said state and county, petition to have the name of 6 / e [
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan E] No party affiliation M
Ys Cc DY2nak Dr
(inselt title of cifice and include district. i
the undersigned, a registered voter
Party candidate for the office of
rcuit, group, seat number, if applicable)
[Date A Birth or Voter Registration Number Address
lDD/YY)
lal% five
City County State Zip Code
Signature of Voter ' Date Signed Me_?
r r [to be comp
15-2.045, F.A.C.
DS -DE 1041Eff. 0911
CANDIDATE PETITION
Notes: -All information on this form becomes a puhlic 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 he valid as a Candidate Petition form.
I,
the undersigned, a registered voter
(grin name as it appears on your voter i ormati n card)
in said state and county, petition to have the name of ? (j / e f"� C rwov/
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
allonpartisanE]No party affiliation r_j _ - Party candidate for the office of
CA U
(inse title of ice and include istrict, ircuit, group, seat number, if applicable)
fDate of Birth or Voter Registration Number Address
(MM/DD/YY) �'
City Cou �Ww
State Zip Code
Signature of Voter Date Signed (MM/DD/YY)
[to be c pletb(pyy Voter]
Rule 15-2.045, F.A.C. /
DS -DE 104(Eff.09/11)
-7OfaC,;:�)C)-::�
CANDIDATE PETITION
Notes: -All information on this form becomes a public record upon receipt by the Supervisor• of Elections.
- It is a crime to knowipgly sign more than one petition for a candidate. [Section 10='.185, Porida Statutes]
-- - If all requested information on this form is not completed, the form will not be valid" as a Candidate Petition form.
I, �- , ®S J th€: 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 C, U `�
placed on the Primary/General Election Ballot a�check/complete box, as applicable]
nonpartisan_j❑No party affiliation L_ f tarty candidate for the office of
�'V l a ;_r Gt. 0 L, K) +M 3 (?(AGr-)
(insert title or office and includ dist(ict, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY
10(l 'ki,
C� 2
City County Statin Zip Code
Dr. elm eaG ?� c�G� 33 q1 (, _
Signature of Voter _ Date Signed (MM/DDNY)
[to Ise c mplled by Voter]
Rule 1S-2.045, F. C. a DS -DE 104 (Eff. 09!11
1"'3 1991-7 Lt�;k
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.
I' the undersigned, a registered voter
(print na _ e as it app ars on your voter i orrnati n card) ,/
in said state and county, petition to have the name of -� b le /� � o-rWt) , y
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
nonpartisan [:]No party affiliation [:] — _ Partycandidate for the office of
L cc L py Cc, YI CGIG .
Onse title of office and include istrict, ircuit, group, seat number, if applicable)
Eof Birt, or Voter Registration Number f AddressDD/YY
r
Cl'
/ C�orty State Zip Code
x�
Signature of Vot Date Signed (MMIDD/YY)
[to be completed by Voter]
Rule iS-2.045, F.A.C.
DS -DE 104 (Eff. 09/11
1) QQ(.O �R o(f)4
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.
I, P LAN
(print name as it appears on your voter i orma�ca
in said state and county, petition to have the name of '� (�
placed on the Primary/General Election Ballot as a: [checw Complete box, as applicable]
nonpartisan No party affiliation r Party candidate for the office of
Dat number, if applicable)
the undersigned, a registered voter
r q L.1
(inse. title of aiea�ncluy
ricuit, group,
Date of Birth or Voter Registration Number Address
(MM/DD/YY)
City County State � ZipCode
CjM I�-eoC X34 3
Signature of Voter Date Signed (MM/DD/YY)
- [to be pcompleted by Voter]
Rule 15-2.045, F.A.C.
r�fl D 2vz1
DS -DE 104 [Eff. 09/111
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
(print nam as it appears on your voter informs on card)
in said state and county, petition to have the name of 42r d l r7 ,•-
placed on the Primary/General Election Ballot as a: [check/comp/ete box, as applicable]
unpartisan [—]No party affiliation ❑ Party candidate for the office of
' X9-1 �j4 rZ- CZ
(i6s-M title of office and include district, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number
(MM/DD/YY) %
City e)
Address
his Pe�4�
Countv State Zip Code
_f _F 3S X35
Signature of Votepj Date Signed (MM/DDIYY)
[to be completed by Voter]
1) o
Rule 7S-2.045, F.A.C. DS -1)1244 (Eff. 09/77
Iatm-70
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.
I, 7 IE 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 yr) (a14Q_ dd.cln
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Olonpartisan ❑ No party affiliation ❑
���f _
(insert title o ce and include district, ciro�it, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY)
oXiqlq _j���_ � 2L
City County State Zip Code at
&A �_IUDq _Vj"Vi P-0 I VY)
Party candidate for the office of
Signature of Voter
Rule 1S-2.045. F.A.C.
Date Signed (MM/DD/YY)
[to be co pleted y Voter]
DS -DE 104IEff. 09/1
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
I, 0&11 Fq N "0 J� 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 0 z e- Id 6o l— Imo, co
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
I � Nonpartisan [:]No party affiliation ❑ Parry candidate for the office of
&�i 0C
> 1 u' -o 'V--- M
(insert title of office and include district, circuit, group, seat number, if al plicable)
Date of Birth or Voter Registration Number Address
(MM/D /Y
/® �30719(,o ci r
C1-0m
County State Zip Code
4n lk-6 pp- m r EA-ccf r_l 3, y 3 7
Signature iff Voter
Rule
Date Signed (MM/DD/YY)
[to be comp/et d by Voter]
o �ko
DS -DE 1041Eff. 09/1
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
I,
SSC� W1 c�L�
_J C ,e r, L/.
v 1 1 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 �-1 �) 1 f �7 C) h �(() �!
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan [—] No party affiliation ❑ Party candidate for the office of
4 OY- KbbJ J�S ea 610
(insert title off office and include district, ciftuit, gr p, seat number, applicable)
Date of Birth or Voter Registration Number r Address
(MM/DDNY)
City County State Zip Code
1�3i ?cLUmrz e• 3 3 4 3 0
Signature of Voter Date Signed (MMIDD/YY)
[to be
completed by Voter]
Rule 1S-2.045, F.A.C. __ DS -DE 104 (Eff. 091171
llq
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.
(print name as it appears on your vot r inform tion card)
in said state and county, petition to have the name ( 7--1 ( I aAJ
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan [—]No party affiliation ❑ _
the undersigned, a registered voter
Party candidate for the office of
Date of Birth or Voter Registration Number
(MM/DDNY) I I- 01-- t q q
Address 3 2 0 1 & iA L 9-t D n
City County State Zip Code
2gnaure of Voter
Rule 1S-2.045, F.A.C.
Date Signed (MM/DD/YY)
[to be completed by Voter]
/ 2
DS -DE 104 (Eff. 09/11
114301 -7410 -?a
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.
I,/ ,l /v the undersigned, a registered voter
(print name as it appears on your voter inform a ion card)
in said state and county, petition to have the name of �-.r t �. f� �' cDt- Q�V r"j
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
F-1 Nonpartisan ❑ No party affiliation ❑ _
Rul
Y V1 Ck- \,
(insert title of office and include
Date of Birth or Voter Registration Number
(MIDD Y)
, 7
City
n /I
Sig ure of Voter
4Q -'J nae c e e
Party candidate for the office of
0V/�
circuit, group, seat number, if applicable)
Address
County Zip Code
P[S!t!at!eH
Date Signed (MM/DD/YY)
[to be comp/ ed by Vter]
�D zb 202[
DS -DE 104 (Eff. 09/11
Iaonci Sc�I113i
CANDIDATE PETITION
Notes: -All information on this form becomes a public record upon receipt by the Superviscr• of Elections.
-It is a crime to knowingly sign more than one petition for a candidate. [Section I N .185, F'orida Statutes]
- If all requested information on this form is not completed, the form will not be valla as a Candidate Petition form.
thea undersigned, a registered voter
I- kn rvY L: -• t� —
(print name as it appears on your voter information card)oLI
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 {nMo,p&dy_affiliation ❑
(' sert title o office and include di trict, c' cult, group, se
Date of Birth or Voter Registration Number
I(MMIDDIYY)
Address
Qs-;mr'i� -- -
party candidate for the office of
�2+Eq a- CCA C_
nl umbi!r, if applicable)
City Cunt —� Statc. Zip Code
Signature of VoterDate Signed (MMIDD/YY)
— [to a completed by Voter]
L
DS -DE 104 (Eff. 09111
Rule 15-2.045, F.A.C.
�W 0 a � 9
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.
I,
(print name as it appears on your voter i ormation card)
in said state and county, petition to have the name of L) Q `"
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan E] No party affiliation F
a L9 oY `C:t,�
(ince title of ice and include
the undersigned, a registered voter
crrolD Y
Party candidate for the office of
it, group, eat number, if applicable)
Date of Birth or Voter Registration Number Address 3f ` h
(MM/DD/YY)°
C t City State Zip Code
Signature of Voter Date Signed (MM/DDNY)
[to be completed by Voter]
Rule 1S-2.045, F.A.C.
DS -DE 104 (Eff. 09/11
IIc,c5-1gg3S
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.
A(w` 014,- —be -!25 the undersigned, a registered voter
(print name as it appears on your voter iq#onnation card) l /
in said state and county, petition to have the name of K � G (' r_ `--7
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of
s
1 C� Ir LY 11 C
(inseh title of ojMce and include cf1strict, eircuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DDNY) 11ti 5I g
`�j2 �%1C e `l t o h 4C K,��it 3 3
City County State Zip Code
Signature of Voter Date Signed (MM/DD/YY)
[to be co plet d by Voter]
I(18 Z_r
Rule 1S-2. ; 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.
- 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.
/ v L
(print name as it appears on your voterriinformati n card)
in said state and county, petition to have the name of ( '7 L; T'' i VC
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Ruh
the undersigned, a registered voter
C%1'e-t'll
Nonpartisan L_j No party affiliation L_J Party candidate for the office of
(inseFt title of ofte and include strict, 6rcuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY)
City County State Zip Code
V2_
Signature of Voter
1SR_9 AAA F e I'
Date Signed (MM/DD/YY)
[to be compieted bP Voterl
DS -DE 104
1I1'�s-7H70(o
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.
I,
l�f I �-7 ' ! /�� the undersigned, a registered voter
y(pirint iname as it appears onlyyoo^ your r i/maltion card)
in said state and county, petition to have the name of ( & / l _c C, t `6)'1V _
Wpla d on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan ❑ No party affiliation Party candidate for the office of
(inseh title of office and include 11strict, eircuit, group, eat number, if applicable)
Date of Birth or Voter Registratio Number Address
(MM/DDYY)zo("
t
C. % F
City County State Zip Code e 0-4
SigPatu ' of Voterd/d a117 1�
Rule 1-
Date Signed (MDD/YY)
[to be conpletec y Voter]
Xxy ��01/
DS -DE 104 (Eff. 09111
i HBc
CANDIDATE PETITION
Notes: -All information on this form becomes a public record upon receipt by the Superri, ror of "?ctions.
- It is a crime to knowingly sign more than one petition for a candidate. (Section 104.185, Pgorida Statutes]
- If all requested information on this form is not completed, the form will not be val 'd as a ("'andidate Petition form.
Iy 6 C J lie undersigned, a registered voter
(print name as it appears on your voter inform tion card)
in said state and county, petition to have the name of �� ( Ie All_ 67--) t9t OA/
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan PNo party affiliation Q -..Party candidate for the office of
tMCA�L'�- Jnr UL 63L 0gzLl- )
(itsert title of office and include distAct, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY) J l '
City County,
�-Dtjkj4m -j3-eq_('y7n'I
Signature of Voter
1
Zip Code
Date Signed (MM/DD/YY)
[to be completed by Voter]
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.
- 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, M R P i� 4 -ell
22 K 1 1 1 �,y o A :1 the undersigned, a registered voter
�"��j (print nameasit appears lonfyour voter information card) `�
in said state and county, petition to have the name of Q Yl e. C, �% v✓
placed on the Primary/General Election Ballot as a: [checwcomp/ete box, as applicable]
nonpartisan [—]No party affiliation ❑ Party candidate for the office of
I'l rP-�aC�-
insert tit/ of office and inclu a distrIct, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY)
124f3 S ZV 7
City County State Zip Code
Q �9 ✓1'l i 3
Signature of Voter Date Signed (MM/DDIYY)
[to be completed by Voter]
2 --
Rule 1S-2.045, F.A.C. DS -DE 104 (Eff. 09/11
�j416673�;?
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.
_C. AJ4C6,�,c MA) ��S�.L/ 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
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
[2/Nonpartisario party affiliation 0— Party candidate for the office of
(insert title of office'and include district, circuit, group, seat numb f, if applicable)
Date of Birth or Voter Registration Number Address
City/✓J1 !/�, A County State Zip Code
Signatu oter Date Signed (MM/DWY)
[to be completed by Voter]
/�) _ n
1 -2.045, F.A.C. DS -DE 104 IEff. 09/1
CANDIDATE PETITION
Notes: -All information on this form becomes a public record upon receipt by the Supervisc r• of Ele:•tions.
It is a crime to knowingly sign more than one petition for a candidate. [Section IN'. 185, F''orida Statutes]
- If all requested information on this fora: is not completed, the form will not be valia 1. asoma Condidate Petition form.
(print name as it appears on your voter informat
ion 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
inse0itle office and include strict, rcuit, group, seat numbrer, if applicable)
Date of Birth or Voter Registration Number Address t� 164"t
�/�(MMIDDNY)„OYI
j County Stat ! Zip Code
City AM 33 vzk2
the undersigned, a registered voter
Signature of Voter
F.A.C.
rtData�Signed (MM/DDIYY)
o :,e co p/eted by Voter]
DS -DE 104 {Eff. 09111)
xA -,;�-7CX�Dl-!5S
CANDIDATE PETITION
Notes: -All. information on this form becomes a public record upon receipt by the Superj,isc r� of Elections.
_It
is a crime to knoll ingly sign more than one petition for a candidate. [Section M .185, F'orida Statutes]
- If all requested in
on this form is not completed, the form will not be valla as a Cc+lndidate Petition form.
S�thc!I undersigned, a registered voter
4fi
(print name as it appears 61n your voter information card)
in said state and county, petition to have the name of l 1 ® le- 1\-( C— G ---o
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan No party affilia+i^., r�A
party candidate for the office of
r
(insert title of office and incl a distri t, circuit, gr up, seat numb(::;r, if applicable) —
Date of Birth or Voter Registration Number Address
(MM/DDlYY)0 e ice— -�
County• State . Zip Code
City _
V, tw Gc-
Data: Signed (MM/DD/YY)
7IS-2.045,
re f r
it
.e c mpleted by Voter]
IDS -DE 104 tEff. 09/11
Rule
I I a I'-4 035 3
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.
I, Ot U'v\_ the undersigned, a registered voter
(print name as it appears on your vot& information 'card) �j
in said state and county, petition to have the name of 6 e6N- 6 y)
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
nonpartisan 040
party affiliation El Party candidate for the office of
title of office and include district, circuit, group,
number, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD1YY)
City County State Zip Code
Signature of Voter Date Signed (MM/DD/YY)
[to be completed by Voter]
ili&l /0 -2�O -2_o&j -
Rule 15-2.046, F.A.C. DS -DE 104 (Eff. 0911
jl 014 1 lagS
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.
I, _ { _ (_ C' - '60 r d a— the undersigned, a registered voter
rint name as it appears on your voter information card)
in said state and county, petition to have the name of �C( f N91 �� DON
placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable]
Nonpartisan []No party affiliation Party candidate for the office of
_ M o rf2A L C AIV Di J)A-2,
(inserl title of office and include district, circuit, group, seat number, if applicable)
Date of Birth or Voter Registration Number I Address
(MM/DD/YYJ
Cit
Signature
----.I
Rule 1S-2.045, F.A.C:
q-1 MreA-D0k)5
A(2le
LfhV£�
County State Zip Code
ons
Date Signed (MM/DD/YY)
[to be c7&)
pleted by Voter]
Is 10z
DS -DE 104 (Eff. 09111
CANDIDATE PETITION
Notes: -All information on this form becomes a public record upon receipt by the Supervis6-, of Ele ,l i ns Statutes]
- It is a crime to knowingly sign more than one petition for a candidate. [Section IN.,
185, - I all requested information on this form is not coi.tipleted, the form will not be valid, as�ondidate Petition form.
thi,: undersigned, a registered voter
(print name as it. pears on your voter information card) C�
in said state and county, petition to have the name of
placed on the Primary/General Election Ballot as>140pleck/complete box, as applicable]
� affiliation 'arty candidate for the office of
C.
LJ'lonpartisan ❑ No party ❑ —'
(inse title of o ce and include district, ci uit, group, s at numb�:,r, if applicable)
Date of Birth or 'Voter Registration Number Address, / d' "`� �}
(MMIDDIYY) �,� v 1!
City
County Statc;, Zip Code
Signature of Voter
F.A.C.
Dain Signed (MM/DD/YY)
[to ::ie poTpryted by Voter]
DS -DE 1041Eff. 09111
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.
I, c) VE (__. �f Aj ` 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 7 I It
placed on the Primary/General Election Ballot as a: [check/complete box, as applicab ]
❑ Nonpartisan ❑ No party affiliation ❑ _ Party candidate for the office of
f' C qoy q -n_ Ave- CA
C�r
(insert title f office and include district, qrcuit, g oup, seat num r, if applicable)
Date of Birth or Voter Registration Number Address
(MM/DD/YY) 1� T'_r - //
11
City County State Zip Code
0Out 4�n ba be' -WA
Signature of Voter
C
Rule 15-2.045, F.A.C.
Date Signed (MM/DD/YY)
[to be completed by Voter]
Z- C, I
DS -DE 104 (Eff. 09/1
(1C� Us
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.
I,
(print narrk As it appears on your voter information card)
in said state and county, petition to have the name of 1
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
i
nonpartisan ❑ No party affiliation F
(insert title of office anti include district, circuit, grobp, seat r
ice)
the undersigned, a registered voter
Party candidate for the office of
if applicable)
Date of Birth or 1 Voter Registration Number Address
(MM/DD/YYI l / C ! �L)ZI Al
� ()_ rC
City County State Zip Code
Date Signed (MM/DD/YY)
[to be completed by Voter]
Rule 75-2.045, F.A.C. DS -DE 704 (Eff. 09/17
I 2c'-�H1 593
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.
] r2: /3 taed _!C{ J the undersigned, a registered voter
c } LJI
(print naamme as it appears on your voter information card) /
in said state and county, petition to have the name of _ C5 & 61 C' Y -d o i
placed on the Primary/General Election Ballot as a-. [checwcomplete box, as applicable]
nonpartisan No party affiliation Party
(insert Htle of office and include district, circuit, group, seat number, if applicable)
Rule
candidate for the office of
Date of Birth or Voter Registration Number Address n
/ _C� — S� C ! ! l 'eaU I _ &? 4- ��l�l
City , Cour}ty State Zip Code
Signature of Voter
Date Signed (MM/DDNY)
[to be completed by Voter]
f DS -DE 1041 Eff. 09/11
flg3SaF�Ro
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.
I, C?
(print name as it appears on your voter ip�ormatipn card)
Jr
in said state and county, petition to have the name of L, / ( / `..�_
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
Nonpartisan ❑ No party affiliation Fj
j (inseh title of office and include
Date of Birth or Voter Registration Number
(MM/DD Y/) 7/�
�
Y [ l
the undersign/ed, a registered voter
Party candidate for the office of
it, group,'seat number, if applicable)
Address
jam- LA kpi r
City County State Zip Code
,,,,
I '� 9&—&, �(/_ _3�
Signature of Voter
Rule 1
Date Signed (MM/DD/YY)
[to be m�pl/eted by Voter]
DS -DE 104
CANDIDATE PETITION
Notes: - All information on this, form becomes a public record upon receipt by the Superri,ror of As'f ctions.
- It is a crime to knowingly sign more than one petition for a candidate. [Section '04.18 'i'. ,", Iorida Statutes]
- If all requested information on this form is not completed, the form will not be ral d as a Candidate Petition form.
-.he 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 < � i e A lE
placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]
nonpartisan [:]No party affiliation
—.-..— t) ,,,-,.Party candidate
/for the office of
(i ert title of o`.ice and include distAct, circWt, group, seat nur-ber, if applicable)
Date of Birth or Voter
/Registration Number Address
(MM/DWYY) 1/ / 6
City CountySt��.
�n� Zip Co ®
Pq� eats.
Signature of
Late Signed (MMIDDIYY)
[i c; be.completed by Voter]
ld•'ysl�
C�`