Filing Papers E
CH
APPOINTMENT OF CAMPAIGN TREASURER %l i ,r OF BG Y!; UN d
CITY CLERK'S OFFICE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 19 MAY —7 AM 9: fl7
(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 p Office ❑ Party
2. Name of Candidat (in this rder: First, Middle, Last) 3.Address(include post office box or street city, s ante,, zip
.if— [) ( 0 r Rig, SS code) I Tara-
3 Le `� J
4. Telephone 5. E- ail address D V ( v_e_ ) B c 9 v kt t v 14
( gl ) S 1701 s 3466. Office sought(include district, circuit, group nur1a //.
r) 7. If a candi• .to for a nonpartisan office, check if
La
ap•lic• •le:
A4 a yov A / V j n 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 ❑ No Party Affiliation p Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer rDeputy Treasurer �� g /
11. Mailing Address 12.Telephone
1 ) 1etve L tk Dr (S61 ) c23 1701
13. City14. C 15 to 16. Zi Code 17. E- au address
—
b
bg X343 pZ/ass 0167 /1'(v
pct
18. I have designated the following bank as my ❑ Primary Depository ❑ Secondary pository
19. Name of Balk, r---c 20.AU1 / i± rii-
ss n
8
21. City n 22. Count 23. State, / 24. Zip Code
DoY14f00 b� — I 3342)K
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
D7 iESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 1 ,� 26. Signature of Candidate
X 1) ir* ,E../...4„,„(H,1
27. Treas rer's A ceptance of A pointment(fill in the blanks and check the appropriate block)
I, _ 5 I I ) r 13 6 S ( , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer ❑ Deputy Treasurer.
5 7 1 I q x 0v g / syate Signature of Campaign Treasurer Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
',ILI 1 ur Bu;N[u,- bc_ACI
RESIDENCY RE UIRE IO TS
U ' candidate
� l � � � , for
(Print Name)
i(-44V 0 (�
'/\ of the City
(Mayor/Commissioner — District #)
of Boynton Beach, have received, read and
understand the residency requirements of Article I of
the Charter of the City of Boynton Beach.
)
/4,4
(Signature of Candidate)
I �1
(Date)
2/15/18
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc
l i Ur OFFICE USQ( Y
STATEMENT OF CI1Y CLE , ,'S OFFICE
CANDIDATE 19 MAY -7 AM 9: 07
(Section 106.023, F.S.)
(Please print or type)
1, D r- Piui
candidate for the office of Ma y0 ,
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
10 c iq
Signature of Candidate ate
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)