Filing OFF#CE,p'J H
O
STATEMENT OF I ") "' J lit
CANDIDATE 18 DEC -3 12: 03
(Section 106.023, F.S.)
(Please print or type)
(12_c50.1: MAI-taut/
candidate for the office of Com(v1 ' V,Sr(-fcr
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X 4W/t.'7 „ -
Signature of Can...ate 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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05/11)
,�
RESIDENCY REQUIREMENTS
1
r-ncam.
W
N tea:
rT
'..J rn n
I �Sa'z
(1/141,0051
, candidate for
(Print Name)
i‘vtA (5ft.t‘rcr i5r(-icer `fi of the City
(Mayor/Commissioner' istrict *)
of Boynton Beach, have received, read and
understand the residency requirements of Article II
of the Charter of the City of Boynton Beach.
• 1 •
(Signature of Candidate)
) 2— 3- j &
(Date)
2/15/18
S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc
SCANNED
N
APPOINTMENT OF CAMPAIGN TREASURER I ' �) OFB ' NN OFFICE
BEACH
CITY CLERK'S FICE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 18 DEC -3 PM 12: 03
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy El Depository ❑ Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
gEsi-ir. N,111q./15V code) /01g f+g-FZ2o c 1(L
4. Telephone 5. E-mail address Day►'fro/✓ 6f 4c-'1 1�C 3 P-.-3b
(5ii( ) so `lLIoS" RiCkM _t) CCLa0,;0u- A/fr
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
ASTapplicable:
i v applicable:
❑ My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
El Write-In D No Party Affiliation ❑ Party candidate.
° I have appointed the following person to act as my Ercampaign Treasurer ❑ Deputy Treasurer
I. Name of Treasurer or Deputy Treasurer
2�.skli ("�auj D j
11. Mailing Address 12. Telephone
/3 IS e- u✓J1I2U'v _ (50 )$Z3 'PI of-
13. City 14. County 15. State 16.Zip Code 17. E-mail address
(1-)9/tKori t)3CncM t- 3 3'v-6 fldrML ku.S,,,mrbt, Ncr
18. I have designated the following bank as my Er Primary Depository 0 Secondary Depository
19. Name of Bank20.Address
Bank , 20.
Vit ik s7 yvi s1- itv
21. City vsate7
n 22. County 23. State �C 24. Zip Code
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
12 s - 1 x( 2
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 514/' 1 /,yailid5u , do hereby accept the appointment
(Please Print or Type Name)
signated above as: Campaign Treasurer ❑ Deputy Treas er.
IZ— 3— ' X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) S A D Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT OF 2018
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME--FIRST NAM MIDDLE NAME
M4114941H KOH'
MAILING ADDRESS: c.0
1018 /411rao 1it-
z
goyeinhil VLMM 3 POO, t4cei Erni f ft
CITY ZIP• COUNTY
C,T y of /CY1/Kot✓ a£Au+ c.v
NAME OF AGENCY Gsi
v/ N —r1 aMMISSItsNC/l. Sl'�cc y
n
NAME OF OF OFFICE OR POSITION HELD OR SOUGHT: rn D
c)
You are not limited to the s ce on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF dCANDIDATE OR ❑ 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)
IV'
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).
COMPARATIVE (PERCENTAGE) THRESHOLDS OR J DOLLAR VALUE THRESHOLDS
PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
?-14 4o5,Tcc-&i ,, ( 1375"GI,�F.IJ/ QUA Olt' 64.1 Dr Vi5rIGOvrwnes--
iG 114?.G
PART B- SECONDARY SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
/Veer cf//• '0
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
v this form and how to fill it out
begin on page 3.
CE FORM 1-Effective.January 1,2019 (Continued on reverse side) sc
® PAGE 1
Incorporated by reference n 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"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
J/f /%1//k
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,writs"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
`/ht
ANN/h.
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"n/a")
BUSINESS ENTITY#1 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 required to complete annual ethics training pursuant to section 112.3142, F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: R CPA or ATTORNEY SIGNATURE ONLY
VIf 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 Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment.
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing address or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter, file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee; FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does not relieve the filer of filing a CE Form 1
other format) and send it to CEForm1@leg.state.fl.us. Do not file by if the filer was in his or her position on December 31,2018.
both mail and email. Choose only one filing method. Form 6s will not
be accepted via email.
CE FORM 1-Effective.January 1,2019. PAGE 2
ircorporatee by reference,n Rule 34-8.202(1),F.A.0
CANDIDATE OATH —
NONPARTISAN OFFICE
i 't OF Btu r N I ON BEACH
(nn not use this form if a Judicial or School Board Candidate) CI1 Y CLERK'S OFFICE
eck box only if you are seeking to qualify as a
write-in candidate: JAN.--8 P`:A` (2' i'
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
I, �sck Apiltp)71-1
(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 COI4MII$%10V1/ - (Joym-oN aC tcl1 , ,
(Office) (District#)
; I am a qualified elector of (,e *11644 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;
- id 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): 1 1 17!9 /4 6°
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.]
1g i c (wa Po f tt .-N
)(474 (0 ) 5Z3 9it o t" gickM€gcusoorK. Nr.r 0
Signature of Candidate Telephone Number Email Address
/018 twiu GR- 1‘412n1 FIN" L P91(
Address City i State s ZIP Code z
STATE OF FLORIDA t� .— az
Signat a of Notary Pu '
COUNTY OF ?alta ll Print,T or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed) and subscribed before me this �' ,...4,'�., JESSICA CANTER 14)
r/' .'.s MY COMMISSION/FF 986086
day of J 0,1up,,►r(,� 20 19 *._. EXPIRES:August 28,2020
J '` $ Bonded nen,Nam Public undenwitero
rsonally Known: or Produced Identification:
fiype of Identification Produced: \\011 .
DS-DE 302NP(Rev. 11/17) Rule 1S-2.0001, F.A.C.
Compound Last Names
If your last name consists of two or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to
check the box, your name will be listed with the name appearing last on the line. Example: John Jones Smith—If the last name has
no hyphen and you do not check the box, the last name on the ballot would be "Smith". If you check the box, your last name wot
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
I (FIT)fit
E (BED) bed
A . (KAT) cat (KAD) cad,
AH (FAH-thur) father(PAHR) par
AH (HAHT) hot (TAH-dee)toddy
UH (FUHJ) fudge (FLUHD) flood
UH (CHUHRCH) church
AW (FAWN) fawn Certain Vowel Sounds with R
U (FUL) full AHR (PAHR) par
00 (FOOD) food ER (PER) pair
OU (FOUND) found IR (PIR) peer
O (FO) foe OR (POR) pour
El (FEIT)fight OOR (POOR) poor
Al (FAIT)fate UHR (PURR) 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 (JUNG)jug CH (CHUCRCH) church
K (KAD) cad SH (SHEEP) sheep
L (LAIM) /ame 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
Tangipahoa .�. TAN-ji-pah-HO-uh
MonteMahn-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.