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Filing PapersOF CAMPAIGN TREASURER 'Al T ;-- B'JTAI!�N BEACHAPPOINTMENT ['i I ! ,,#S OFFICE AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES `' N 0V 13 [;l (: 4 (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): 0 Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy Q Depository Office Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Ty Penserga code) 4. Telephone 5. E-mail address X4315 Key Lime Blvd (561 ) 531-4971 tpenserga@protonmail.ch I Boynton Beach, FL 33436 I 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Commissioner, District 4, City of Boynton Beach applicable: E] 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 Q Write-In E] No Party Affiliation E] Party candidate. 9. 1 have appointed the following person to act as my 0 Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Ty Penserga 11. Mailing Address 12. Telephone 4315 Key Lime Blvd ( 561 ) 531-4971 13. City 14. County 15. State 16. Zip Code 17. E-mail address Boynton Beach Palm Beach FL 33436 tpenserga@protonmail.ch 18. 1 have designated the following bank as myX❑ Primary Depository E] Secondary Depository 19. Name of Bank 20. Address BB&T 100 N. 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. Signa_ture'of Candid 11/12/2019 x Z7 27. Treasurer's Acceptance of Appointment (fill in the on-and check the appropriate block) I, :Ti _ _ , do hereby accept the appointment (Please Print or Type Name) designated above as: 0 Campaign Treasurer U Deputy Treasurer. 11/12/2019 X .1 Date Si mpaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/101 Rule 1S-2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER Oti BEACH (;1�l_f �? S OFFICE AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES 19 SEP —9 Pi=c 1: 31 (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 code) �31S` AV' trmF Si -WO . &r,4e t="L 3343b 4. Telephone 5. E-mail address P1-oro,v)4 A-rL. 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if r�oM M�SSa—"r�rL — �5�"(—i2�r� 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 ❑ No Party Affiliation ❑ Party candidate. F9. I have appointed the following person to act as my Rr Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer l y P00ScIe4A 11. Mailing Address 12. Telephone g3lS KFY LrkUrr 9WO. (56( 13. City 14. County 15. State 16. Zip Code 17. E-mail ad Less 30y^gb j por&a Potm g0" 1`Ir 331;3L '' � 18. 1 have designated the following bank as my ET Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address W 0" S F-A,Ra-0 rip s . Alzzz r7-/f_y �erFXL— 21. City 22. County 23. State 24. Zip Code 'FvY0-J'r0 9 g ?A, -At WAC.4/ 1 L4,tx 1 A- 3 3 f3 6 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 zoo I x 27. Treasurer's Acceptance of Appointment (fill in the bl s ap5 check propriate block) I, / eti S , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ❑ Deputy Treasurer. f ____ Date Signa surer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 73 sem_ w; candidate for the office of C--orVnrs5�iUNc� -- is-M�' � ; have been provided access to read and understand the requirements of Chapter 106. Florida Statutes. ndidate 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 (05111) RESIDENCY REQUIREMENTS CIO E] I, i y ?VW S€K A candidate for (Print Name) 6'0MM- SSXQNr W —='S -M J : of the City (Mayor/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. 30 -z.> t (date) S:\CC\WP\ELECTION\Year2020\CANDIDATE INFORMATION CD\4. Residency Requirements\RESIDENCY REQUIREMENTS STATEMENT.doc FORM 1 STATEMENT OF 2018 Please print ortype your name, mailingFINANCIAL INTERES5 $011 � bito >�I&€h�seoNLY• address, agency name, and position below: i ; Y ; -Ef��� K `13- OFFICE LAST NAME -- FIRST NAME -- MIDDLE NAME: n f fEWSE-94A --1Y MAILING ADDRES . lF315- V01 I.rnmE Bl.Vn. doYPJTbnl f %A -Cg 33LW. . PAWA& Gar -If CITY: ZIP COUNTY: NAME OF AGENCY: C0I64Mr5FL—V^&; DSS C r 9-sYpirbat NAME OF OFFICE OR POS ION HELD OR SOU HT : You are not limited tothe pace on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF ANDIDATE OR LJ NEW EMPLOYEE OR APPOINTEE **** 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 (must 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 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 (must check one): / El COMPARATIVE (PERCENTAGE) THRESHOLDS OR LM/ 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'Wa") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL ACTIVITY �BUSINESS 33y3( 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 PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nla") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. N INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 - Effective: January 1, 2019 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.202(1), F.A.C. PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "ri TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "ri NAME OF CREDITOR ,,� ADDRESS OF CREDITOR Will 0 1 st..,I.61L,) 1 It to S. A66 'ZZA 601." At- 13AUC, 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'Wa") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY 1J A 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 required to complete annual ethics training pursuant to section 112.3142, F.S. Ld 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 If a certified public accountant licensed under Chapter 473, or attorney Signature: in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: 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/Attorney 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) and send it to CEForm1@leg.state.fl.us. p4 not fi(g by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates file this form together with their filing papers MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, 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 be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following 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 position on December 31, 2018. (;E FORM 1 - Effective: January 1, 2019. HAVt 2 Incorporated by reference in Rule 348.202(1), F.A.C. CANDIDATE OATH — NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT `— NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of Co MAf2 Ssa-44 -p, I _ _ I (office) (district #) I am a qualified elector of J9,4L Al 9451+614 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. X 2 (. O f3 I �- 'f9 i-( ?�crtsC R[,�4�3aRo�iw,,t�n..c.ft u of C didate Telephone Number Email Address `fin 9 kt y LMUE- VO 5— 3 3Y 36 Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 123 Z4 j g p .-7- �* *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): I y Few - gTp, -- 4.4 H STATE OF FLORIDA COUNTY OF Sworn to (or subscribed before me this day of L 0 affirmed) and , r Personally Known:. or Queenester Nievftnature of Notary Public Produced Identification: v� Print, Type, or Stamp Commissioned Name of Notary Public Type of Identification Produced: f t v roc, Vii '_ �' ' rida Notary Public7Nieves QueenesterQJaMy Commissi211U UExpires 07/16 DS-DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C. The city of Boynton Beach PUBLIC NOTICE TO: CANDIDATES, POLITICAL PARTIES AND OTHERS NOTICE IS HEREBY GIVEN that the Logic & Accuracy (L&A) testing of the voting equipment to be used in the March 17, 2020 General Election will be held: Wednesday, February 26, 2020 @ 10:00 A.M. Palm Beach County Supervisor of Elections Service Center 7835 Central Industrial Drive Riviera Beach, Florida 33404 Attendance at the L&A testing is strictly optional for candidates and you are welcome to observe. PLEASE SELECT YOUR AVAILABILITY BELOW: I will be attending the Logic & Accuracy (L&A) testing of the voting equipment on February 26, 2020 @ 10:00 a.m. Estimated number of attendees: I will not be available to attend the Logic & Accuracy (L&A) testing of the voting equipment on February 26, 2020 @ 10:00 a.m. I ACKNOWLEDGE RECEIPT OF THIS NOTICE OF LOGIC & ACCURACY (L&A) TESTING. /z/ Date F(eiAved 5:\CC\WP\ELECTION\Year 2020%&A Testing Public Notice - For Candidate's Signature.doc Updated 12/5/2019 CITY CLERK'S OFFICE 3301 QUANTUM BLVD.'= SUITE 101. c, BOYNTON BEACH, FL 33426 PHONE: (561) 742-6060 X FAX: (561) 742-6090 "' c E-MAIL: dtyderk@bbfl.us cD n www.boynton-beach.org -n F,M v C7� PUBLIC NOTICE TO: CANDIDATES, POLITICAL PARTIES AND OTHERS NOTICE IS HEREBY GIVEN that the Logic & Accuracy (L&A) testing of the voting equipment to be used in the March 17, 2020 General Election will be held: Wednesday, February 26, 2020 @ 10:00 A.M. Palm Beach County Supervisor of Elections Service Center 7835 Central Industrial Drive Riviera Beach, Florida 33404 Attendance at the L&A testing is strictly optional for candidates and you are welcome to observe. PLEASE SELECT YOUR AVAILABILITY BELOW: I will be attending the Logic & Accuracy (L&A) testing of the voting equipment on February 26, 2020 @ 10:00 a.m. Estimated number of attendees: I will not be available to attend the Logic & Accuracy (L&A) testing of the voting equipment on February 26, 2020 @ 10:00 a.m. I ACKNOWLEDGE RECEIPT OF THIS NOTICE OF LOGIC & ACCURACY (L&A) TESTING. /z/ Date F(eiAved 5:\CC\WP\ELECTION\Year 2020%&A Testing Public Notice - For Candidate's Signature.doc Updated 12/5/2019 VV ISceiianeous Cash Receipt CITY OF BOYNTON BEACH Account No. 001-0000-369-1 0-00 Received of TY PENSERGA $ 25.00 C® ,, 20-�— Address 4315 KEY LIME BLVD, O.YNT N FL 3 436 _ MARCH 17, 2020--- -- Dept. CITY CLERK'S OFFICE By miscellaneous Cash Receipt CITY OF BOYNTON BEACH Account No. 001-0000-369-1 0-00 Received of TY PENSERGA - Address No. 92187 4315 KEY LIME BLVD. BOYNTON BEACH, FL 33436 For 1% FILING FEE TO RUN FOR COMMISSIONER — DISTRICT IV ON MARCH 17 2020. Dept. CITY CLERK'S OFFICE__ By OF P4 : �_ � f Wendy Sartary Link t 1 ' Y C' E °S OFFICE .�' Or, as - Palm Beach County Supervisor of ElectigosOLEC —9 Ail 10: 9.9 CERTIFICATION I, Wendy Sartory Link, Supervisor of Elections, for Palm Beach County, Florida, do hereby certify that 42 signatures on the Nominating Petitions of Ty Penserga for Commission District 4 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 Emir Tyrone Penserga is a registered voter in Precinct 3164, in the City of Boynton Beach, Florida. Signed, this 9th day of December, 2019. Supervisor of Elections:', Palm Beach County (SEAL) 240 South Military Trail, West Palm Beach, FL 334151 Post Office Box 22309, West Palm Beach, FL 33416 Telephone: 561.656.6200 1 Fax Number: 561.656.6287 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 101.185, Florida Statutes] If all requested information on this form is not completed, the form will not be valid as a Candidate Petition print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I Nonpartisan [—]No party affiliation N/A Rul the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address MM/DD/YY) a City County State Zip Code Boynton Beach Palm Beach County FL 3 yq Signat^ f Voter el 1 S-2.045. F.A.C. Date Signed (MM/DDNY) to be completed by Voter] 12 I DS -DE 104 (Eff. 09111 CANDIDATE PETITION 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. the undersigned, a registered voter (p(i&7ame as it appea n your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A _ Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY)rr.4k �J�( 011 i 1 City County State Zip Code Boynton Beach 1 Palm Beach County FL Signature of Voter '° �)Jj Date Signed (MM/DD/YY) A 4 [to be completed by Voter] t j Rule 15-2.045, F.A.C. DS -DE 104 (Eff. 09111 ta� °u CIO n M [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. (./ J /�D /I C.,q%3 R-OSo Af 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan F__j No party affiliation 7 N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) V IA -A /)JI -5 ZA-Sh S 5 U A t b Z City County State Zip Code Boynton Beach Palm Beach County FL v 3q2, Signature of II. Rule 1S-2.045, F Date Signed (MM/DDIYY) [to be completed by Voter] DS -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 101.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. C1641,16 - 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] I W- Nonpartisan ❑ No party affiliation F-1 NIA Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY Ay &CL,01q 03 2Y City County Boynton Beach Palm Beach County Signature of Voter Rule 1S-2.045, F.A.C. _e. State Zip Code FL 33 fit, Date Signed (MM/DDNY) [to be completed by Voter] • 6' 20/ DS -DE 104(Eff. 09111 q0 CANDIDATE PETITION Notes: -.411 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 farm will not be valid as a Candidate Petition form. (pr name as it appears on your voter information card) in said state and county, petition to have the' name of Ty Penserga placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] R Nonpartisan ❑ No party affiliation r-1 N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) D 00 d 6',e- *) City County State Zip Code Boynton Beach Palm Beach County FL 33y3 Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voter) Rule 1S-2.045, F.A.C. DS -DE 104(Eff. 0911 31 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 101.185, 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 mtormation card) in said state and county, petition to have the' name of Ty Penserga placed on the Primary/General Election Ballot as a: [check(complete box, as applicable) Q✓ Nonpartisan r-1 No party affiliation ❑ N/A the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) 0S j Liu 1 (to [A'd BU&UWA �n City County State Zip Code Boynton Beach Palm Beach County FL -: of Rule Date Signed (MM/DD/YY) [to be completed by Voter) DS -DE 104 (Efr. p911 3$ CANDIDATE PETITION Notes: -.411 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] -j1 all requested informatio;Yon this farm is nol�ompleied, the form will not be valid as a Candidate Petition (print name as it appears on your voter information card) in said state and county, petition to have the` name of Ty Penserga placed on the Primary/General Election Ballot as a; [check/complete box, as applicable] f ❑✓ Nonpartisan F-1 No party affiliation n N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration NumberAd ssred City County State Zip Code Boynton Beach Palm Beach County FIL Signature of Voter _ Date Signed (MMIDDNY) [to be completed by Voter] j t Rule &2 5, F.A.C. DS -DE 104 (Eff. 0911 3--- CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Superi,isor 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 "fes (print name as it appears on your voter information card) in said state and county, petition to have the' name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A _ Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) city County State Zip Code Boynton Beach Palm Beach County FL SignatU of Voter Date Signed (MM/DD/YY) ' [to b co pleted by Voter] (o l Rule 1S-2.04;, F.A.C. DS -DE 194 (Eff. 09111 4 i l {ylI= 70 ^4 cn J s C CC _n h �y 36 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 name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter R71c) gistratiogn Number Address �, / e ��y�j� j (MM/DD/YY) '� 1 1 �J v ��� ',lJWv Ll f5 fb City County State Zip Code Boynton Beach Palm Beach County FL Signature of Voter Date Signed (MM/DD/YY) [to be com 1 ted by Voter] Rule 1S-2.045, F.A.C. DS -DE 104 (Eff. 0911' 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 Petitio I, n r. tV 6 aoo (print namb as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] �✓ Nonpartisan E] No party affiliation r-1 NIA the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) 3 Z f 3�Jv� IA / City Boynton Beach Signature of Vot� Rule IS -2.045. F.A.C. County State Zip Code 'a m Beach County 7]FL _S3 _'f3 6 Date Signed (MM/DD/YY) [to be om eted by Voter] DS -DE 104 C—J %'D 70 Cid _ i, © o C::)rn -.TI rr, 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 F 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ NIA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address 6�D Llt) (MM/DD/YY) --ilk' 19y8 , 0 2_ t3,5,tc 14 FL 33 436 City LPaBeach y State Zip Code Boynton Beach County FL 33LI36 Signature of Voter �4" 4" r Ll Rule 15-2.045, F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] DS -DE 104 (Eff. 09111 �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 /04.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. T' �r 1f I r) 1"1 (print name as it 4ears on yourtkter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I Q✓ Nonpartisan F-1 No party affiliation ❑ N/A the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) (,66 `ff C�',/W 0oJ L1\1, 13 a LBcoy FPaolm unty State Zip Code ynton Beach I Beach County FL 33y+,S (3 Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voter] Rule 15-2.045, F.A.C. DS -DE 104 (Eff. 09H i 37, 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 farm i-vill 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] F7 Nonpartisan 0 No party affiliation ❑ N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DP/YY) ®a �- �° rnA)a0� � City County State Zip Code Boynton Beach Palm Beach County FL [7;q_36 Signature of Vot Date Signed (MM/DD/YY) [to be completed by Voter] Rule 1S-2.045, F.A.C. D5 -DE 104 fElf. 0911 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 101.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo m. the undersigned, a registered voter (print name as it appears on y ur voter information card) in said state and county, petition to have the' name of Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter RegistrationAdd _ Number ress (MM/DD/YY) O O ce City County State Zip Code Boynton Be ch FPalm Beach County FL 1-2 Signature f V r Date Signed (MM/DDNY) [to be complet9d by Voter] Rule 15-2.045j.A.C. DS -DE 104 tEff. 0911' C -j QQ C7D ' i fl e7; G i C- �a CD C 00 M L`7 30 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. Ie C (print name as it appears on your voter information card) in said state and county, petition to have the' name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I ONonpartisan F�No party affiliation FI N/A Commissioner, District 4, City of Boynton Beach the the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address } (MM/DD/YY) 02- / t& 166 to Hvn i/•ood Z -A City County State Zip Code Boynton Beach Palm Beach County FL 3 0 M Signature of Voter F.A.C. Date Signed (MMIDD/YY) [to be completed by Voter] DS -DE 104 (Eff. 0911 2-1 CANDIDATE PETITION Notes: —411 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 Pelition form. (print name as it appears on your voter rmation card) in said state and county, petition to have the°name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] QNonpartisan F-lNo party affiliation F --j N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) S-)— _ � ) � b City Boynton Beach County FFL Zip Code Palm Beach County Signature of Voter (wVU)'- Rule 1S-2.045, F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] 1 Z- In - � DS -DE A4 (Eff. 0911 62J CANDIDATE PETITION Notes: - All information on this form becomes a public record upon receipt by the Supers,isor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 10=1.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. J / (print name as it appears onyou ter information card) in said state and county, petition to have the` name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] M Nonpartisan F-1 No party affiliation M N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) � � ��� ❑ / City County State Zip Code Boynton Beach Palm Beach County FL 3 - 3� Voter Rule Date Signed (MM/DD/YY) [to be completed by Voter] DS -DE 104 tEff. 0911 '2:V 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 Pelition form. 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] QNonpartisan r__j No party affiliation F-1 N/A Rul Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD ) / City County State Zip Code Boynton Beach Palm Beach County FL ��� `3 - Signature of Voter 1S-2.045. F.A.C. Date Signed (MM/DDNY) [to be completed by Voter] 6/doI, DS -DE 104 (Eff. 09111 2b 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. re rr (print name as it appears on your voter Yformation card) in said state and county. petition to have the, name of Ty Penserga placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] the undersigned, a registered voter ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Rut te of Birth or Voter Registration Number Address [Da MM/DDIYY)O-z-, lcity County State Zip Code Boynton Beach Palm Beach County FL 33 V3 Signature of Voter 4e-7 nds o e r Date Signed (MM/DDNY) [to be completed by Voter] 1e52 i� DS -DE 104 (Eff. 0911 °1 5— 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. uJ� the undersigned, a registered voter (print name as it Wpears on your voter information card) in said state and county, petition to have the- name of Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation NIA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) �Nlv"' (�C� 7 03 12-tsel 1,7,1 &+jOn ane, City County State reap_; de Boynton Beach Palm Beach County FL 1��� Signature of Voter 1 Date Signed (MM/DDNY) [to be completed by Voter] Rule 1S-2.045, F.A.C. DS -DE 104 (Eff. 0911 2q 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 101.185, Florida Statutes] - If all requested information on this farm is not completed, the form will not be valid as a Candidate Petition form. t. Nwn i_ MN Rj,N Ua�IS� (print name as it appears on your voter information card) in said state and county, petition to have the�name of Ty Penserga placed on the Primary/General Election Ballot as a: (checklcomplete box, as applicable] the undersigned, a registered voter Q Nonpartisan ❑ No party affiliation ❑ NIA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) WJ BUTTWW, nD LN City County State Zip Code Boynton Beach Palm Beach County FL 33436 Sigwatoee of Voter ` Date Signed (MMIDD/YY) [to be completed by Voter] 1 a/0` � . Rule 6-204'6. F.A.C. DS -DE 1D4 (Eff. 0911' z3 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Superi,isor 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 S° -t Vy.Q �t� 0 Z CV- i S W d l (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable) F✓ Nonpartisan F1 No party affiliation ❑ N/A the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/D /YY) City County State Zip Code Boynton Beach Palm !!a ounty FL Signature Date Signed (MM/DDNY) [to be completed by Voter] ss GG Rule 1S- . 45, F.A.C. DS -DE 104 (Eff. 09N' 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. t, e kl� _D" �-- S -)i0 N+0 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] I W Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) Cn 1V2_I D® �Z� ij� , oft& `P(L City County State Zip Code Boynton Beach Palm Beach County FL 4 Z. (p Signature of VoterDate Signed (MM/DD/YY) to be complef9d by Voter] Rule 1S-2.045, F.A.C. DS -DE 104 (Eff. 09111 :j -Tt 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. SAL_V'4T01?0' Tj"*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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan E]No party affiliation ❑ N/A Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number (MM/DD/YY) o io $ Address bob 3w.l�otiwr�o LA.+�a_ City County State Zip Code Boynton Beach Palm Beach County FL 3383 I. Signature of Voter r Rule 1S-2.045, F.A.C. Date Signed (MM/DD/YY) to be completed by Voter] DS -DE 104 (Eff. 09/11 M 20 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 101.185, Florida Statutes] �4/ - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. L _ GiCClgyrc 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan [—]No party affiliation ❑ NSA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (M f YY) 703 Ckc$g,zcc. City County State Zip Code Boynton Beach Palm Beach County FL 33y 3 6 Signature of oter Date Signed (MM/DDNY) [to be completed by Voter] Rule 15-2.045, F.A.C. 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. — Y V l OL�6 f P1 ' 4ID � 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable) ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) F County State Zip Code Beach Palm Beach County FL S3 �3 Signature of Voter Date Signed (MM/DDNY) I ). [to be completed by Voter] fin! ' �� 1 o t I �1� �a q0t ? Rule 1S-2.045, F.A. DS -DE 104 (Eff. 09/1 fd 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 fora . 1, I 67I7', of �� � ��� 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] F✓ Nonpartisan F-1 No party affiliation F-] N/A _ Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DDNY) City County State Zip Code Boynton Beach Palm Beach County FL ?3 %�6 Signature of Voter Rule 15-2.045, F.A.C. Date Signed (MM/DDNY) [to be completed by Voter] %Zz �/ 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 forn �tCIQD M ,pel6q 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) h a p s Ccs ?arta Lit, . City County State Zip Code Boynton Beach Palm Beach County FL 93H3 6 i Signature of Voter Date Signed (MM/DDNY) [to be com eted by oter] Rule 1S-2.045. F.A.C. DS -DE 1 (Eff. 0911' /b 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] -1f all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. t' 4(ofr^j Ceescmy- r me -b jw, , 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] M Nonpartisan F] No party affiliation ❑ NIA Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM DD/YY) Gyus "r ' Ln,. City County State Zip Code Boynton Beach Palm Beach County J FL 33y.3b Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voter] Rule 15-2.0 , F.A.C. DS -DE 104IEff. 09/11 Ir 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 ivill not be valid as a Candidate Petition form. f' Cl�re� T W3WfjQ (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] the undersigned, a registered voter ❑✓ Nonpartisan [—]No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) Ct des PO.Y-L (X►.. City County State Zip Code Boynton Beach Palm Beach County FL 33yb to Signature of Voter Date Signed (MM/DDNY) to be completed by Voter] Gee 12- --I q Rule 1S-2.045, F.A.C. DS -DE 104 (Eff. 0911 if 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] -1f all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. T, t YDrA C, DElAy4-0 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan E] No party affiliation F—] N/A Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) 03oy rb C� -Irus City County State Zip Code Boynton Beach Palm Beach County FL 33436 Signature of V e Date Signed (MM/DDNY) [to be comp/ ed Voter] 1;�/� Rule 1S-2.045, F.A.C. T DS -DE 104 (Eff. 09/11 r3 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 mill not be valid as a Candidate Petition form. i' QOL-04 S 2% P 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] F,—/]Nonpartisan F] No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration NumberAddress+ (MM/DD/YY)3 C -t - Z Ss '61�5 City County Boynton Beach Palm Beach County Signature of Voter Rule 1S-2.045, F.A.C. State Zip Code FL 33Kbb Date Signed (MM/DDNY) [to be comple d by oter] DS -DE 1041Eff. 09111 C> tee.. i CD:r F5 rl •� -7 "n� F � V M)> C-) r 1'2 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. if / " (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] the undersigned, a registered voter ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) lZity— Ue County State Zip Code nton Beach Palm Beach County FL 33 `!3 Date Signed (MM/DDNY) [to be completed by Voter] DS -DE 104 (Eff. 09111 11 W 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. t' AA-2� z1 c POA) RSDS h (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan [—] No party affiliation r-1 N/A the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address n r (MM/DD/YY) 4315' /� n (bl�•l% City CountyState Zip Code Boynton Beach Palm Beach County FL 3314-34., Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voter] 1 S-2.045, F.A.C. DS -DE 104 (Eff. 09/11 I 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 for I, :r r ko . , AL�.A tE r ) C�� the undersigned, a registered voter f (print name as it appears on your voter information card) T in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] F✓ Nonpartisan [:] No party affiliation F� N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) U 46%S-- �4l9 / U City County State Zip Code Boynton Beach Palm Beach County FL e of Voter Date Signed (MM/DDNY) e co�mple d by Voter] lo�. Rule 1S-2.045, F.A.C. DS -DE 104 IEff. 01_ z� C"7 r-- CL) co r 30 � n :.r- 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 Pelition form. M (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] P/ Nonpartisan ❑ No party affiliation F-1 N/A Commissioner, District 4, City of Boynton Beach the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) a s r City EPalm y State Zip Code Boynton Beach BeachCounty FL Signature of Voter Rule 1- � r.w.-. Date Signed (MM/DDNY) [to be completed by Voter] DS -DE 104 (Eff. 0911 Z8 rpt C © y —j MY M� H CANDIDATE PETITION Notes: -A// 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. (' JDSFi'll A. GASE1,!_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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] F✓ Nonpartisan [-]No party affiliation F-] N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number (MM/DD/YY) 7;ds .4aM/W0/1>4 Y OR. State Zip Code City County Boynton Beach Palm Beach County FL 3 3834 Signa ure of V r Rule 15.2.045, F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] 1C�-- 9-zo 19 DS -DE 104 (Eff. 09/11 M 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 fbrm. 1, ,7 ; Fthe 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checlubomp/ete box, as applicable] Q✓ Nonpartisan L] No party affiliation F—] NIA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth MM/DD/YY) or VotelyRegri7.,N(0�� Address City County State Zip Code Boynton Beach Palm Beach County FL 3 31� fp Signa a Voter Date Signed (MM/DD/YY) [to be comp/e dKo r] „L l Rule 1S-2.0 .A.C. 0 DS -DE 104 (Eff. 09111 r 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 ivill not be valid as a Candidate Petition form. I, -D, t _ _ j , ._ __ j ,i the undersigned, a registered voter (print name as it appears on yow',Voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Q✓ Nonpartisan [:]No party affiliation ❑ N/A Commissioner, District 4, City of Boynton Beach Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) 1 7 Q 0 1 City Boynton Beach County-7State Beach CountyFL Zip Code � F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] 1�. 7 !9 DS -DE 104 (Eff. 09111 "Y c c�� 1 rvi TM -Ts'- ,s � xT no r" n -r I 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. t, W tLQANscr✓' AYdt 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number EAdds (MM/DD/YY) 0 q LOS lu, e�G4e. CityCounty State Zip Code Boynton Beach Palm Beach County FL L 3343,L Signature of Voter - 1'.), yr�� Rule 15-2.045, F.A.C. Date Signed (MM/DDNY) [to be comp/e ed by Voter] DS -DE 104 (Eff. 0911 =1 - Ca -< r L_o 7V :.R - 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] -1f all requested information on this form is not completed, the form will not be valid as a Candidate Petition J AY +LA _ (print name as it appears on your voter information card) in said state and county, petition to have the name of Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I ❑✓ Nonpartisan ❑ No party affiliation ❑ N/A the undersigned, a registered voter Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/PD/YY) City County State Zip Code Boynton Beach Palm Beach County FL 3 3'f5 Signature Rule 1 S-2.045, F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] 1.)-16/ L. DS -DE 104 (Eff. 09111 — _� CD r -yrs, M M > I CANDIDATE PETITION Notes: -A// 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, theform will not be valid as a Candidate Petition form. J-4aAV- A LA 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 Ty Penserga placed on the Primary/General Election Ballot as a: [checWcomplete box, as applicable] ❑✓ Nonpartisan 0 N party affiliation ❑ N/A Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) 7-3 c�a n n �L . J .:.�ctr� City County State Zip Code Boynton Beach Palm Beach County FL ?7`436 Signature of Voter Date Signed (MM/DDIYY) [to be complete by Voter] Rule IS -2.045, F.A.C. V 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 i-vill not be valid as a Candidate Petition form. I, r/YeoNw 1063e726of 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 Ty Penserga placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ❑✓ Nonpartisan ❑ No party affiliation ❑ NSA Party candidate for the office of Commissioner, District 4, City of Boynton Beach (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration NumberAddress (MM D/YY) 7315 [`- �w./1�� � `v�• 08 3� S S City County State Zip Code Boynton Beach Palm Beach County FL 33q 5 L Signature of Voter D igned (MM/DD/YY) o be completed by Voter] Rule 15-2. .A. 04 (Eff. 09111 10