Filing OATH OF OFFICE
I, TY PENSERGA, DO SOLEMNLY SWEAR OR AFFIRM THAT I WILL
SUPPORT, PROTECT AND DEFEND THE CONSTITUTION AND
GOVERNMENT OF THE UNITED STATES, THE STATE OF FLORIDA
AND THE CITY OF BOYNTON BEACH; THAT I AM DULY QUALIFIED
TO HOLD OFFICE UNDER THE CONSTITUTION AND LAWS OF THE
STATE AND THE CITY OF BOYNTON BEACH; AND THAT I WILL
WELL AND FAITHFULLY PERFORM THE DUTIES OF
COMMISSIONER - DISTRICT IV OF THE CITY OF BOYNTON
BEACH, FLORIDA.
<
DATED this 19th day of March, 2019
STATE OF FLORIDA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 19th day of
March, 2019 by Commissioner Ty Penserga. He is personally known to me.
4444/4 15,L
N ARY PUBLIC
Judith A. Pyle, CMC
City Clerk/Notary Public
Commission No. GG 078859
My Commission Expires: 04-21-2021 MrPv
JUDITH A.PYLE
r MY COMMISSION#GG 078659
'4.,":0:1179!.7_ EXPIRES:April 21,2021
oded Thai Budget Notary Services
FORM 1 STATEMENT OF 2017
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
4ST NAME--FIRST NAME--MIDDLE NAME :
,.,,AILING ADDRESS:
L{?&ic k- Y L1-"c--r &LAS SAMPLE
Bo)rrof.) S3E/1-u+ 334J36 3EA(4i
CITY : ZIP: COUNTY: SAM P L
O
NAME OF AGENCY:
COMMiSS.ConleIR -DLSTKFc1"#'L13oYn)7oiJ QaAc4 (/—
NAME OF OFFICE OR POSITION HELD OR SOUGHT : o
-• -rim
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. mC)
CHECK ONLY IF [CANDIDATE OR U 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):
Cs� DECEMBER 31, 2017 Q$ ❑ 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
`or further details). CHECK THE ONE YOU ARE USING(must check one):
❑ COMPARATIVE (PERCENTAGE)THRESHOLDS OR i 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
Flog-0A RTLAArrrc tuavog5 T`/ a[-A-D S Roy f3o nJ,F-L 3343[ RESF-Aau/
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
NONE
PART C—REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
6/NI. INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
D.
'LiA
rtiq
CE FORM 1-Effective:January 1,2018 (Continued en reverse aide) f PAGE 1
incorporated by reference in Rule 34-8202(1),FAC. fir.>-
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
l'oTF ,reA vA"34g.t/42.D
,RT RT E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
WELLS F644-&o (40o4...•f- 10..41> ??90 S. M//r a, ('l 6orio,1 8e.. .) Ft- 33yv.t-
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 tuo Nt5-.
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 U
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
____Ir/it4,.__ 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:
/R//o/tor 8
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.
'2317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
"ihassee, FL 32303. To file with the Commission by email, scan leavino office or employment. Filing a CE Form 1F (Final Statement
r completed form and any attachments as a pdf (do not use any of Financial Interests)does not relievethe filer of filing a CE Form 1
I ...:r 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 31,2017.
NN
both mail and email. Choose only one filing method. Form 6s will not
be accepted via CE Forsc A ,
CE FORM 1-Effective:January 1,2018. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.
RESIDENCY REQUIREMENTS
I, IYRoNE candidate for
(Print Name)
C� Mt1.1.r.Z2(7NP -- 'Dss-rrzrcr * Li 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.
nat - . �. - •idate)
/2 /o Zv/p
Dat )
W
Q
SC/ANN:6.a,, .
(—) w
y, 2/fR18
S:(Ot\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc
rj
OFFICE USE ONLY
STATEMENT OF —'
CANDIDATE
�c
(Section 106.023, F.S.)
(Please print or type) o c,
`..o -nco
n
I, rYRo,�C
?.7-yst---k6A
candidate for the office of CoM,4-7-552zNa2 — I , -r;zx c ir 9 ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X .,�.! > �L po f 2 i
•na Tri= pff andidate 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).
,
SCAN •___.
DS-DE 84 (05/11)
Lf-- q,li (u
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 NAME--MIDDLE NAME:
TEALS Er-Calr
MAILING ADDRESS: —.A n-
It31 r Kg/ 4'214 r 84✓D •
Tr
T
r—C7
CITY: ZIP: COUNTY: O 2D
To/Nronl BFAq/ jF 33I/3b
NAME OF AGENCY: 4
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
COMA4-7,SS T-b/V�'i2 - D -S 1 t r' L
G E v rn c�)
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF [CANDIDATE 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):
hd DECEMBER 31,2018 OR L3 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 etails). CHECK THE ONE YOU ARE USING(must check one):
COMPARATIVE (PERCENTAGE)THRESHOLDS OR LI 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 SOURCES DESCRIPTION OF THE SOURCES
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
Pt rp4 Aruf-A rre- LWJLT 1 41AOE3 BE64 arts) el- 13 ie I A- 4eA
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
Nl.4
PART C—REAL PROPERTY [Land.buildings owned by the reporting person-See instructions)
(If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
and where to file this form are
N/^� located at the bottom of page 2.
T INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM 1-Esective.Jaruary 1.201E (Continued on reverse side) PAGE 1
In.:otporafed by reference in Rule 344.202(1),F.A.C. SCANNED
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions[
(If you have nothing to report,write"none"or"nra")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
74-M-7—A 6 /Vh14.44) �
PART E—LIABILITIES [Major debts-See instructions[
(If you have nothing to report,write"none"or"nla")
NAME OF CREDITOR ADDRESS OF CREDITOR
Wa-]s Fi ' 0(sfG4.t,) ??90 s,444, '1>a Bir , �r L,Fc.. 33yN6
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-Soo instructions]
(If you have nothing to report,write"none"or"nla")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY �1
ADDRESS OF BUSINESS ENTITY A)/A M7,
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 U
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If s 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:
, prepared the CE
Furm 1 in accordance with Section 112.3145,Florida Statutes,and the
instructions to the form.Upon my reasonable knowMedge and belief,the
disclosure herein is true and correct.
Date Signed:
CPAIAttomey Signature:
ti/0//741?
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
retujned. 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 1 F) 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 Il9S 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
he accepted via email.
CO FORM -Fnertive:January 1,2019. PAGE 2
In_aporated by reference in Rule 34-8 202(1),r.A.C.
CANDIDATE OATH —
NONPARTISAN OFFICE ;1 > > 411- Hv.r tr I Oh BEACH
Ci r Y CLERK'S OFFICE
(Do not use this form if a Judicial or School Board Candidate)
,eck box only if you are seeking to qualify as a 13 DE.0 I 0 Mi 9: 511
write-in candidate:
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
I, I YR.ONr �Nstr
(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 D. (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 CoM,f ss,Zo,JcsJ2
(Office) (District#)
; I am a qualified elector of Ff}-L.M 'CA-G1/ 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): /2-30$/9 0 7
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.]
fte-rows - Penr- S.ra2 —6A-Fl
X Zr.� (dol ) 8gs yol S' PENS?�2( &ietaar„*n..cl�
Signet Telephone Number Email Address
QC.VD, 130 Tan) 3e- L. 3343L
Address City to . ZIP Code
4
STATE OF FLORIDA ' -
Signa,W otary Public
COUNTY OF PALM "CA-CH Print,T .e,or Stamp Commissioned Name of Notary Public below:
401 Ree J. Baldonado
Sworn to(or affi ed) and subscribed before me this [( l
X
_COMMISSION GG230321
day of a'cr' bti 20 i �-.•• EXPIRES:July 21,2022
in, Bonded Thry Aaron Notary
'zonally Known: or Produced Identification.►,
.,pe of Identification Produced: FI�� (,/t{ka II C-e tiSp,.
SC,Ar1j DS-DE302NP(Rev. 11/17)- - ule 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-Smith
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) M
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
YOO (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-PRAT(rhyme:hooray)
Maniscalco man-uh-SKAL-ko
Tangipahoa 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.
RESIDENCY REQUIREMENTS
►-00
a
m�
to—
o
-;i co
v m31>
c>
I, ft ENSFit4A , candidate for
(Print Name)
L O MM='SSSan1FK — re=4-1-- 'f of the City
(Mayor/Commissioner— District #)
Beach, have received, read and understand the
residency requirements of Article II of the Charter of
the City of Boynton Beach.
. • :idate)
/.Z ;0/20/8
(D te)
CANNED
11/12/2013 12:31 PM
S:\CC\WP\ELECTION\Year 2017\CANDIDATE INFORMATION CD\4. Residency Requirements\RESIDENCY
REQUIREMENTS STATEMENT.doc
,1 uF i3H BEACH
t ' O046El)S 'DNC
STATEMENT OF 19
JAN I O ATI 9: 2?
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
7ENSER4A
candidate for the office of CoMMissmcole'1E; — y
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x G1 /z/3o / to18
•• ••: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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05/11)
NED
311Y OF Be'T h Joh BEACH
CI? Y CLERK'S OFFICE
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 19 JAN I 0 AM 9: 32
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy [r Depository ❑ Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
1 NYLr24A code)
4. Telephone 5. E-mail address /f3tg- Key LA4e- 131-40 .
(561 )531-Y9*/
V of®lit-barv-kr" TaZNTnnl Qe c-I(, Ft- 33y3L, cew6. Office sought(include district, cit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
CoM..kA . — bT✓zrc.1- if ❑ My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office,check block and fill in name of party as applicable: My intent is to run as a
Ei Write-In ❑ No Party Affiliation ❑ - Party candidate.
9. I have appointed the following person to act as my 2' Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
4121C ieP Y 1.T►'14 a f,Lvd. ( S6 s ) X531 -‘117-1
13. City 14. County 15. State 16. Zip Code 17. E-mail address
oY, i- yJ g01-41 PA-t-M. B PA-u-1 FL 33 q 3 L v o bn`$e-*t I . caves
18. I have designated the following bank as my [J Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
w-4s F01-4-0 /400 S. /fry
21. City 22. County 23. State 24. Zip Code
3OY#Sro rJ Ge-A-4)J PAt-M QE`s F4 3 3 t'3.5—
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Signature of Candi to
/2-L12-15i X F• _
27. Treasurer's Acceptance of Appointment(fill in the bla s a ch the appropriate block)
y ?(9/4 Sc44 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer El Deputy Treasurer.
/2 3 o Zet$ X
Z/3
ate Signat_ • ..I%•n reasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
CANDIDATE OATH — CI OF B.;i r N I UN BEACH
CLERK'S OFFICE
NONPARTISAN OFFICE '' �`
(Do not use this form if a Judicial or School Board Candidate) 13 JAN I 0 AM 9: 32
teck box only if you are seeking to qualify as a
write-in candidate:
E Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a),Florida Statutes)
I, T ?dNSai G 4
(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 CeM M y'SST'oN ►� 1
(Office) (District#)
— ,I am a qualified elector of 7ii.,ti BF*d 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;
mnd 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): /23 0 81?CI--
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.]
-7 — E-1•1 — S z t2 - G i
X --- (SW ) 531 -K17-1 voi-c o"60y44-0105 1 cMt-
g
Si na r 'at= Telephone Number Email Ad cess
4315 Ke) LwE SLS♦. 3o NTw. BfA-C F 33143(.
Address City tat= ZIP Code
1I
STATE OF FLORIDA Signat `t� •• - P
COUNTY OF ?ALAI tr Print,Type, Stamp ROM s f 4/[yr9e of Notary Public below:
/N.',.o1ARY.....1.
Sworn t (or affirmed) and subscribed before me this S.
• ,'• '2
(J • W:
(or
, 20 t"1 Comm.,202 i
day oft _ G 01 2329
No.GG 130
,rsonally Known: or Produced identification: • ••
I
Type of Identification Produced: *& iiiiiidatW-
V V'k '\<«1. ---
DS-DE 302NP(Rev.11117) Rule 1S-2.0001,F.A.C.
SCANNED
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 woul
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-Smith.
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)M
E (BED) bed
A (KAT)cat(KAD)cad
AH (FAH-thur)father(PARR)par
AH (HART) hot(TAH-dee)toddy
UH (FUHJ)fudge(FLUHD)flood
UH (CHUHRCH) church
AW (FAWN)fawn Certain Vowel Sounds with R
U (FUL)full AHR (PARR) par
00 (FOOD)food ER (PER)pair
OU (FOUND)found IR (PIR) peer
O (FO)foe OR (POR) pour
El (FEIT)fight _OOR (POOR1 poor
Al (FAIT)fate UHR (PURR) purr
01 (FOIL)foil
Y00 (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)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
Tangipahoz TAN-ji-pah-HO-uh
Monte. Mahn-TAI
I Tanya • TAWN-yuh(not TAN)
Do not submit this page to the filing officer.
DS-DE 302NP(Rev.11117) Rule 1S-2.0001,F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER ;I i 1 OF BU Yti I UN bLACH
AND DESIGNATION OF CAMPAIGN CI Y CLERK'S OFF ICE
DEPOSITORY FOR CANDIDATES 13 DEC I 0 big 9: 5n
(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):
E 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
in
code)
� j" 93/5-- � E f3LyD.
�y2ontr KF`/ �t
4. Telephone 5. E-mail address aoyArron/ 3E-4cH , FL 3243k
i PPNS&-}2GA C�
( 401 ) 845-'to I .5— 7 oTo,vMATL. C-ki
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
aoyrvro'v gEA-cH applicable:
‘oAtMrSSZonJ - D'IS1-?ZLer- #-L. ❑ 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
0 Write-In ❑ No Party Affiliation ❑ Party candidate.
Q. I have appointed the following person to act as my [Campaign Treasurer ❑ Deputy Treasurer
Name of Treasurer oDeputy Treasurer
yRo#J I rivsrR4A
11. Mailing Address 12. Telephone
los KEY 1..1-ni r &VD ( Tot ) 84 5-L{o i s'_
13. City 14. County 15. State 16. Zip Code 17. E-mail add ess
$oyn)ro,J aE# l4 ?ittM 13r/tc4-f
FL 33 4 36 T PF,isF24,4(91000 ro r-1 Apt rL. al
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
7"I C g4,JK Soo /q. c0ArAr-.2-5.S ,4vts
21. City 22. County 23. State 24. Zip Code
i3OyNrorJ aers,c 1 ?A-c.AA s3 EA-c14 FL. 33424
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Signature of Candid- -
27/ 0 /Wgx ��
27. Treasurer's Acceptance of Appointment (fill in the br,'7 s -r'• - appropriate block)
I, YrzoNe ?rnJs 0724A , do hereby accept the appointment
(Please Print or Type Name)
SLAHNNEI
signated above as: -Campaign Treasurer ❑ Deputy Treasurer.
i7. i0 / Zoi$ X i
EDate Si. . - •• •,•- :/• +'�' .r Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
ott
APPOINTMENT OF CAMPAIGN TREASURER ��'� ut-i3rtBEACH
CLERK'S OFFICE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 13 NC 20 NA 4: l l
(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 d 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)
j& - PeNsevetiv 4310 ke.4 trAiF 61-ti0
4. Telephone 5. E-mail a dress 'Rom Top 6 � ft- 33'f31-
( �1 ) �a -11971- r Agar o .
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Dpvne_L�� applicable:
COA` �s�� ❑ 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 ❑ No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my Er.Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
apNE• riEwseitc..A-
11. Mailing Address 12. Telephone
Hair key s' guiD ( S(.t ) S21-41'1-1
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Vosep 'roN fg c4 1:14uut q -e4 9— 33436 'R'Ci,sE7 .®61e18^1n h2-•
18. I have designated the following bank as my Primary Depository J Secondary Depository
19. Name of Bank 20. Address
W EIL s FA-L4,O 7'0 0 5, M. y
21. City 22. County 23. State 24. Zip Code
RoYoraw 4i A-ca- ('A144 IOW( 'FLo Kam 4 33k3 G
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
I2-1 17-0 !4 X M
27. Treasurer's Acceptance of Appointment (fill in the b-Ilinks and eek the appropriate block)
I, 'i—`/rZO z_F P€ 4 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: a' Campaign Treasurer El Deputy Treasurer.
lzi
2a X
ik
Date Sig dg .: '' reasurer or Deputy Treasurer
DS-DF q rkPv. 10r1m Rule 1S-2.0001, F.A.C.