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APPOINTMENT OF CAMPAIGN TREASURER 11 I ut 66 x ,r i Utr bEACH AND DESIGNATION OF CAMPAIGN Ci Y CLERK'S OFFIC DEPOSITORY FOR CANDIDATES 19 ,JAN -3 Pit 3: 3R (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 1.2h(ECK APPROPRIATE BOX(ES): DI 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) S Lye_ 004, LcAnG +chit\ S -C- , sCt.kg,t hn5h 1-3oyn-+oh 5GGGhi F1or:clu, 33''134 4. Telephone 5. E-mail address (994 )6GZ-`6.2_30 A,Sgbranosl^IaXoiZvi-mra,I,can 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: ❑ My intent is to run as a Write-In candidate. Cl+y ak Royn+on C3ecrh Conlin SS'one.r- b, got i-1 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 0 No Party Affiliation ❑ Party candidate. Q. I have appointed the following person to act as my 'Campaign Treasurer E Deputy Treasurer Name of Treasurer or Deputy Treasurer /1/1; +- 6141\ S-b9 hem Sakkosi,, 11. Mailing Address 12. Telephone 3 z s L.;ve. Gc,t< Larc, ( 95' ) (0(o2- S23o 13. City 14. County 15. State 16. Zip Code 17. E-mail address 3 'r - r SeaGl, Pc4t)- I eG,I1-, R ; 33 3(t / & K'@ -o-m6;1,Cohh 18. I have designated the following bank as my []r Primary Depository 0 Secondary Depository 19. Name of Bank 20. Address kV&ISS -ay'yg 3c,.n k 4/4- 1 G so W Iiay nian flu.c,b wva, 21. City 22. County 23. State / 24. Zip Code Dor) for 1 Ac,l rn 1)PL,L' -1OrOx.i. 33L-1 (,2 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. Signatur- of Candi,- - 1 3 2, 14 X 27. Treasurer's Acceptance/cof Appointment (fill in the blanks and check the appropriate block) I, '' ± Ch&11 Sr( CLa V)oS 17 , do hereby accept the appointment (Please Print or Type Name) -signated above as: 'Campaign Treasurer ❑ De•uty Treas - _- 1/ 3/ zvl )2' x �/ Date to o m ai n Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) 5 CIg Rule 1S-2.0001, F.A.C. CAMPAIGN TREASURER'S REPORT SUMMARY '1) / 1 I-Gb1\ Sabano.Sh :1,;,' OFFICE USE( 8H , . _ A .,'S 071 ICE '^ Name 325 Lk - cxx. L Anc. 19 FEB —8 Ki 12: I n Address (number and street) Bo/n46111 Bec J ,FL 33L] City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ��``��"" 11�� [Candidate Office Sought: G.;A-7 Gk- 'oyn-kyn Q,eOd t (..0 him;SS16hr/r DiS-1rzaL'/ ❑ Political Committee (PC) ` ❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded ❑ Party Executive Committee(PTY) ❑ Check here if PTY has disbanded ❑ Independent Expenditure(IE)(also covers an ❑ Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From U\ / o / 19- To pl I 3 I / )¢ Report Type: 20\9/i 1 [Original 0 Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary ;h & Checks $ , , 550 • 00 Expenditures $ , , 2S(7 . 1 ' Loans $ , • Transfers to Office Account $ , , . Total Monetary $ , • Total Monetary $ . In-Kind $ (8) Other Distributions $ , , • (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , , _ • Uo $ , , 2rf'7 . I , (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, correct, and complete: (Type name) (Type name) A ;4-Gi61I S& t v oSh ❑Individual(only for IE ❑Treasurer D Deputy Treasurer 0-Candidate ❑ Chairperson(only for PC and PTY) or electioneering comm.) . X � Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS t.AIVIrMIuIV I KtAJUKtK"J K J UK I — I I tIVIILtU CMV I KIbU I IUIVJ (1) Name ) - Ghe I l SLibctradS (2) LD. Number (, Cover Period CSA / CA / through a 1 / 3 1 / 19' (4) Page 1 of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number City, State,Zip Code Type Occupation Type Description Amendment Amount /14I+Cht11 Sr; nosh jrG4 4 tiertry / 15 / 19- 32 L?vt O4I6. LonL M �,fnn}- GUr, C TGG+i(i►1 001 OC C nice P44),)J FL 3.3` S , ' /1-64?)/6r cprtriAypr I / / / / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ( ��11,,,,C MPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1)Name /'1:"fr . Chc&fOSh (2) I.D. Number ( (3)Cover Period t / ( / I Q through / 31 / 19 (4) Page 1 of 1 (5) (7) (8) (9) (10) (11) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought If Sequence Street Address& contribution to a Expenditure Number City,State,Zip Code candidate) Type Amendment Amount / l S/ q :+t,hoR slosh 047 "F:I:nyFee.. 2s.00 32S oma. 1I SC420(6h G1 �:11N AcG I /Is/1q 32s�;i�, C IC 2G2,19 1yhin 13u1,111, 1 / / / / / / / / 14 S-DE (Rev. - 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES l;11 l Ut: bU Y N i UN titALh CITY CLERK'S OFFICE WAIVER OF REPORT 19 FEB 15 AH 1I: LS (Section 106.07(7),F.S.) (PLEASE TYPE) OFFICE USE ONLY /l4;1-G116l1 Sae&n06/1 6;47 at- 130/01-a, l3eGh catrolu,kar Dul Name Office Sought 32.5 L-► - o(414 L.C416 i;a7rPM Re e) . 33413G Address City State Zip Code [Candidate Political Committee ❑ Party Executive Committee NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a waiver)that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.). ❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file reports. TYPE OF REPORT(Check Appropriate Box and Complete Applicable Line beneath Box) MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and# as applicable: ERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF THROUGH X 21151201¢ Signature Date X Signature Date REQUIRED SIGNATURES FOR: Candidates: Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5ii FiS.) n S Political Committees: JUIN L . Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5). F.S.) Party Executive Committees: Treasurer and Chairman(s. 106.29(2), F.S.) Except as noted above for an ECO,in any reporting period when there has been no activity in the account(no funds expended or received)the filing of the required report is waived. However,the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS-DE 87(Rev.06/15) To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter"ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Amount of expenditure. CAMPAIGN TREASURER'S REPORT SUMMARY (1) A, .�L�j Sauna-01 OFFICE USE ONLYrrl Name co (--) r— (2) _ 31.5 c-:UG (c14 L-tanc - rn Address (number and street) City, State, Zip Code -1-4Cr _,T ❑ Check here if address has changed (3) ID Number: rn� (4) Check appropriate box(es): ErCandidate Office Sought: c;4y p4. (3cyn 61 0 3,11.0 sJ,lCh4" ❑Political Committee (PC) ❑Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded ❑Party Executive Committee(PTY) ❑Check here If PTY has disbanded ❑Independent Expenditure(IE) (also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From / 10 To 2. I r , /9 Report Type: _6. [Original 0 Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ Expenditures $ , 212. Loans $ Transfers to Office Account $ Total Monetary $ , Total Monetary $ , '1L12 - Q' In-Kind $ , (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , 904 . od $ , SCk) . 00 (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss.839.13, F.S.) I certify that I have examined this report and it is true, correct, and complete: (Type name) ((�Type name) ,4l;+ .,} ,1) S61606:611 [ ❑Individual(only for IE 0 Treasurer 0 Deputy Treasurer -candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) JUN x i!G� Signature Signature DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS Instructions for Campaign Treasurer's Report Summary (1) Name: full name of the candidate, political committee, party executive committee, electioneering communications organization, or individual making an independent expenditure or electioneering communication. (2) Address: the full address or post office box. city. state. and zip code. Check the box if the address has changed since the last report filed. (3) ID Number: identification number assigned by the filing officer. (4) Check the appropriate box(es). (5) Report Identifiers Cover Period: the dates this report covers (i.e , From 1/1/15 To 1/31/55). Important: use the appropriate cover period dates as published by the filing officer. Report Type: refer to the filing officer's calendar of reporting dates for the correct codes to be used for each reporting period. If report is for a special election add"S"in front of the report code (i.e., SG3). Check one of the appropriate boxes: Original: first report filed for this reporting period. Amendment: must summarize only contributions/fund transfers and expenditures/distributions being reported as additions or deletions. Read instructions for sequence numbers and amendment types on the back of Forms DS-DE 13A and 14A. Special Election Report: Important: once a special election report is filed, the entity is required to file all remaining reports due for the special election. (6) Contributions This Report: Cash and Checks: total amount for this reporting period. Loans: total amount for this reporting period. Total Monetary sum of Cash and Checks and Loans. In-Kind: the fair market value of the in-kind contribution at the time it is given for this reporting period. (7) Expenditures This Report: Monetary Expenditures: total amount of monetary expenditures for this reporting period. Transfers to Office Account: total amount transferred to an office account by elected candidates only. Total Monetary: sum of Monetary Expenditures and Transfers to Office Account. (8) Other Distributions: the total amount of goods and services contributed to a candidate or other committee by a PC, ECO, or PTY. (9) TOTAL Monetary Contributions To Date: the amount of total monetary contributions to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (10) TOTAL Monetary Expenditures To Date: the amount of total monetary expenditures to date. Candidates keep cumulative totals from the time the campaign depository is opened through the termination report. (11) Type or print the required officer's name and have them sign the report: Candidate report: treasurer and candidate must sign. PC report: treasurer and chairperson must sign. PTY report: treasurer and chairperson must sign. ECO report: organization's treasurer must sign. IE or EC report: individual must sign (this applies when an individual acts alone to make these expenditures) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, &fund transfers being reported as additions or deletions. Read the instructions for the sequence number&amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name 41. k h&l! &a teiria(��Ii J 2 (2)I.D. Number (3)Cover Period 2/ 1 / T through - / ( / /T (4)Page of I (5) (7) (8) (9) (10) (11) Date Full Name Purpose (6) (Last,Suffix, First,Middle) (add office sought if Expenditure Sequence Street Address& contribution to a p Number City,State,Zip Code candidate) Type Amendment Amount 2. /15/r9 MI�(,heil SGbunl GoS(ry De:Cikurt F. �= 2)2 32S'L; -e 0•414 ane Acc v,-1- V&lit e'er,F6 334134 / / / / / / / d DS-DE 14(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (10) Type the description of any in-kind contribution received. Candidate's Only—If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable,type an "N". (11) Amendment Type (required on amended reports)—To add a new(previously unreported)contribution for the reporting period being amended, enter"ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type"ADD' will start at one plus the number of contributions in the original report. For example, amending an original M1 report that had 75 contributions means the sequence number of the first contribution having amendment type''ADD"will be 76;the second "ADD"contribution would be 77, etc. When amending an original M2 report that had 40 contributions, the sixth"ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter"DEL'in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter"ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Political Committees ONLY: Multiple uniform contributions from the same person, aggregating NMT 5250 per calendar year, collected by an organization that is the affiliated sponsor of a PC, may be reported by the PC in an aggregate amount listing the number of contributors together with the amount contributed by each and the total amount contributed during the reporting period. The identity of each person making such uniform contribution must be reported to the filing officer by July 1 of each calendar year, or, in a general election year NLT the 60th day immediately preceding the primary election. CANDIDATE OATH — NONPARTISAN OFFICE ;�� , �F E3t n,iSO=1 FFICE EEACN LI;Y C!_E°u, (Do not use this form if a Judicial or School Board Candidate) �a 6 eck box only if you are seeking to qualify as a 19 JAN 114 Pt t J write-in candidate: ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) , All'"-F.Ghe 11 S Ckb GLv OSYl (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 C rn n;SS;OPWlr — (',I`-1-y 0-c n Veiabh l (Office) (District#) ; I am a qualified elector of pc,l Yfl 1'e c4t,h 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; -^d 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): 12192,65S 3 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates] ML - G1 -u ►-ALL SACS- U4-NoS4 ffir X `I (a 2 Signature of Candidate Telephone Number Email Address S 2 s L,vc Gc,k Lcne. 13941- Cie CAth Florida - 11'1-S(2 Address City �`.�� State ZIP Code STATE OF FLORIDA P, (4,41---(-- Signature of Not 11 lic Print.Type,or`tap'bM 1 gifc411 flame of Notary Public below: COUNTY OF �r^�t� 1�7('CxC� y . .•NOTAi y.. 01; Sworn t rkl (or affirmed) and subscribed before me this i• ::Q': 20 l ;My Comm.Expires: O day of Ct n�AuNovember 20,2022: Z ovally Known. or Produced Identification: 7 . No. GG 278053 •,,�e of Identification Produced: FIU� . • %9�`.•'ovB1-`S', \Q�, i d# " ©1- I-.-o��` Rule 1S-2.0001, F.A.C. DS DE 302NP(Rev. 11117) R -.�1111111111" CPNN Compound Last Names If your last name consists of two or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to check the box, your name will be listed with the name appearing last on the line. Example: John Jones Smith—If the last name has no hyphen and you do not check the box, the last name on the ballot would be "Smith". If you check the box, your last name wo be listed on the ballot as"Jones Smith." If you have a hyphen within your last name, the last name would be listed as"Jones-Smit Guide for Designating Phonetic Spelling of Candidate's Name for Audio Ballot 1. Use tables below. 2. Use upper case for"stressed" syllables. Use lower case for"unstressed" syllables. 3. Use dashes (-) to separate syllables. 4. Add any notes such as rhyming examples, silent letters, etc. Vowels Stressed Vowel Sounds Unstressed Vowel Sounds EE (FEET)feet uh (SO-fuh) sofa (FING-guhr)finger (FIT)fit E (BED) bed A (KAT) cat (KAD) cad AH (FAH-thur) father(PAHR) par AH (HAHT) hot (TAH-dee)toddy UH (FUHJ)fudge (FLUHD) flood UH (CHUHRCH) church AW (FAWN) fawn Certain Vowel Sounds with R U (FUL)full AHR (PAHR) par 00 (FOOD) food ER (PER) pair OU (FOUND)found IR (PIR) peer O (FO)foe OR (POR) pour El (FEIT)fight OOR (POOR) poor Al (FAIT)fate UHR (PUHR) purr 01 (FOIL)foil YO0 (FYOOR-ee-uhs) furious Consonants B (BED) bed R (RED) red D (DET) debt S (SET) set F (FED) fed T (TEN) ten G (GET)get V (VET) vet H (HED) head Y (YET) yet HW (HWICH) which W (WICH) witch J (JUHG)jug CH (CHUCRCH) church K (KAD) cad SH (SHEEP) sheep L (LAIM) lame TS (ITS) its (PITS-feeld) Pittsfield M (MAT) mat TH (THEI) Thigh N (NET) net TH (THEI) Thy NG (SING-uhr) singer ZH (A-zhuhr) azure (VI-zhuhn) vision P (PET)pet Z (GOODZ) goods(HUH-buhz-tuhn) Hubbardston Examples of Phonetically Spelled Names NAME ON BALLOT PRONOUNCED AS Mishaud mee-SHO('d'is silent) Jahn HAHN(rhyme:fawn) Beauprez boo-PRAI(rhyme:hooray) Maniscalco man-uh-SKAL-ko Tangipahos TAN-ji-pah-HO-uh Monte Mahn-TAI Tanya TAWN-yuh(not TAN) Do not submit this page to the filing officer. DS-DE 302NP(Rev. 11/17) Rule 1S-2.0001, F.A.C. tFFICE USE.ONLYEACH STATEMENT OF CLEr.1‘'S OFFICE CANDIDATE 19 JAN —3 Pel 3: 39 (Section 106.023, F.S.) (Please print or type) 1, Al; +Chc11 S-1-eNedn cliaAnoSh candidate for the office of c..}y of C3oyn-fon terALk C o►Y,rn;s5:oncr -Ds-k:,+y; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X 1 /3/2d ) ¢ 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) SCANNEE:: RESIDENCY REQUIREMENTS C) Z c7 icu �Z N C Q W --v1r1 00 Zi mrn� I ; 4-cl1ne) 1 S rt.c.rm OSl � n , candidate for (Print Name) Cos -\?J - b;S+r► � 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. (Signature of Candidate) 1/ )/201 9- (Date) 2/15/18 S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc SCANNED: