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Filing Papersgo7►� c -G` APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1). F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on fife with the qualifying Officer before oveM the r-arnpaign. account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): ® InI1181 Fling of Form Re•fIHng to Change: 0 TreasurerMepuly ❑ Depository ❑ Office ❑ Party 2. Nama of Candidate (m this order. First, Middle. Last) 3. Address (include post office box or street, city. state, zip Bernard Eric Wright code 2nd stns Boynton Beach Fl. 33435 [4. Telephone 5. E-maH address754 ) 246 0767 BemalTtwright52�yahoo. tiOT bal ce sought (include district, circuit, group rumnber) 7.Ifacandidatafora�?ZEUM ottice,checktf yoral applicable: [] My Intent is to run as a Write-in candidate. S. Na candidate fors partisan ofrico, check block and fill in name of party as apptkmm: My intern! is to run as a� ❑ write -In ® No Party Affiliation 0 Party candidate 9.1 have appointed the Wowing person to act as my ® Campaign Treaasuter ❑ Oepputy Treasueer 10. Name of Treasurer or Deputy Treasurer Kendra L. Rahming 11, Mailing Address ---- 713 N W 2nd Street _ (581 ) 503 9910 13. City 14 County 5 State 76. Tip Code 17 E mar adgrasa - Boynton Beach Palm Beach �]Fll 33435 Bemaidwrtghf_S2QyahW.CoM rCky gnated the following barrio as rf Primary -y ❑ Sasxurpary L -*P s,Wry nk 20 Armee 116W South Feftual Myer CR 2a: County 23 Stein - zi Zip Code h Palm Beach(Iowa 33436 UNDER PENALTIES Of f'ERJURy,SIGN I DECLARE THAT t NAYS CMStr THF Folmaotw rogtr 10R M"no ?"Naw or Cwlr►AtfZM Tllori}Urll R ►sen DasxsNATrDa t)F GwPAF[iN pEPB9trDRV AND T"r THE FACTS srAtan lM IT AN rrrtta 25.0ste ?6. Stgnalury of Cwrdidet. x �7� 5/16/2020 27. Treasurses Acceptsnce of APPotnti.tent Ifl1 tn ttie blank11 acid rs+'4 +4 app►opyq berrell I. Kendra L- Rahmina -------__. _ do hereby" accept ft spDw*r. nr (►'Ieast� Pant ar i`ype iwaniry _` designated above as Campaign Tressum t 5/16/2020 C1oNn � r ar C40Wnopow tn"aairra E 9 (Rev. JWj0) 4eti t DML FA C Of S,'0001 en. .cam' STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) OFFICE USE ONLY Raa 41;1 /,,4}-yi I, Bemard Wright candidate for the office of Mayor have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candid 5L1Bmf .]a Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depowtory rs tii4d WJKA failure to file this form is a first degree misdemeanor and a carni rnoiatbn of the Cain NmW Financing Act which may result in a fine of up to S1,00n. (ss 106.1 9(1)tc). 106 265(1)_ Fla Statutes). 68 FMto I) «> cn m a J J O a cn N z -j>- 2Q @a7 N >w>.LL ILO 0waar MU - 0 °-mLUv °N�-10 -iMoaa 19w<nF LU adjvww N w : F Lu = W , U 0 Y,,,3 1710 0 %1" Z -O 0 U.QN O Ll I Y UI- U.)YfU i Uhl tt ti CITY OF FNTON TfiCH Uf REEIFT cVar. MNIG Type: OC Dra!, r: 1 Date-. 8/?3/21 01 Rewipt no-. 42 Custorer Location Nxe Amount 12693 131E5 WHg t, BDmff-d p� A1�-•PAYI�"ENf �4.1U Trans n4 ani tai 1 IC -066=1.10 Total tendered $4.10 Total payment V.10 Trans date; 8'?U/21 Time: T N& Yal FOR YUJF P -T PAMT RESIDENCY REQUIREMENTS RECEIVED NOV 2 2d0 OWOFBOYNTON BEA 'per CRY CLERK'S OFFICE I, C-(-"G�- ► , candidate for (Print Name) `M 0�'.4 0 F- 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) J�aa�ar (Date) S:\CC\WP\ELECTION\Year 2022\CANDIDATE INFORMATION CD\4. Residency Requirements\A. RESIDENCY REQUIREMENTS STATEMENT.doc FORM 1 STATEMENT OF 2020 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 Ll d Cr i MAILING ADDRESS 13 �r Lv , acEN� �©y qTDq ` �--� f 5 - NOV 2 2 Mi CITY: ZIP: COUNTY OF BOYNTON NRAGH CRy cffy CLEAKS OFFIct NAME OF AGENCY : NAME OF OFFICE OR POSITION HELD OR SOUGHT ►N-�, a -t Q r - CHECK ONLY IF CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2020. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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 L7d' 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 3 .. .SMf'<tU tJuSi�c-C�`'9eS 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 BUSI SV INCOME OF SOURCE ACTIVITY OF SOURCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] You are not limited to the space on the (If you have nothing to report, write "none" or "nia") lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are at the bottom of page 2. Z INSTRUCTIONS on who must file this form and how to fill it out Jlocated begin on page 3. GE FORM 1 - Effective: January 1, 2021 (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 "nla") TYPE OF INTANGIBLE PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "nla") NAME OF CREDITOR ESS ENTITY TO WHICH THE PROPERTY RELATES ADDRESS OF CREDITOR 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 "nla") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITYJ t�..i'f`tL..lr-i ` A-E,J�S i `Z.S ADDRESS OF BUSINESS ENTITY °Z 1'3 !-C 51 PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY (� I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST V'I E) ILs— 'P[`p€. 'r�atL'I,S G A PART G — TRAINING For elected municipal officers, appointed school superintendents, and commissioners of a community redevelopment agency created under Part III, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S. e -'I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. I IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: 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), send it to CEForm1@leg.state.fl.us and retain a copy for your records. Do not file by both mail and email. Choose only in filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney 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. CPA/Attorney Signature: Date Signed: -- 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 IF) within 60 days of leaving office or employment. Filing a CE Form IF (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, 2020. GE FORM 1 Elective: January 1, 2021. PAGE 2 Incorporated by reference in Rule 34-8.202(1), F.A.C. CANDIDATE OATH — RECEIVED NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) NOV 2 2 2021 Check box only if you are seeking to qualify as a CITY OF BOYNTON BEACH write-in candidate: CITY CLERK'S OFFICE ❑ write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) (Print name above as you wish it to appear rn 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 O r (Office) (District #) I am a qualified elector of 10A ky1 -` 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. Candidate's Florida Voter Registration Number (located on your voter information card):/ -2L 4ecJ f e4l 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.] 7 Co ( F� C�3 ro ��a S` a 14±► Signature of Candid a Number Email Address ---Telephone -� �— 7i< 1� lac - L.t� . r . `� O fe�cc O A� S �.� - t—1 '�� C4�-3 S Address City State ZIP Code c STATE OF FLORIDA ign . ure of Notary Public COUNTY OF Print, type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me by means of ?-*i,""'• CRYSTAL D. GIBBON . . online notarization ❑ OR physical presence ❑ MY COMMISSION # GG 326964 A.-A! IRES: April 22,2023 this da of 20�ndedThNotary Pume Urwomliers Personally Known ❑ OR Produced Identification L� Type of Identification Produced:, 1`l— p n vP,r"cp r1� DS -DE 302NP (Rev. 0512021) Rule 1S-2.0001, F.A.C. Miscellaneous Cash Receipt CITY OF BOYNTON BEACH Account No. 001-0000-369-10-00 Received of Bernard Wright \ Y OP _= r ~TON P $ 25.00 November- .20 21 Address 713 NW 2nd Street Boynton Beach ii 334.35. \:mss m, , HUM For City Filing Fee to rain for Mayor. � 1 1 aDo $25e( -X-, Match 2022 I 006 CT6322 Dept city Clerk's Office BY f -- Miscellaneous Cash /Peceipt No._ 0-1 CITY OF BOYNTON BEACH Account No. 001-0000-369-10-00 -00 November e , 20 21 Received of Bernard Wright - Address 713 XW_ 2nd Street, Bo nt®n Beach FL 33435 -Lf �`P2: 'ti For flirt:; dee to run ®r Mayor { . 3a _. _ ;yn: 71 � March 8, 2021 1 -,,,is '- BMW! Dept. C`3 t �ler�i �iC� BY' 10th3 , -; ---r--ice-� LL2 �a n Z t:wn Pa f� � Um rug S Wendy Sartory link Palm Beach county Supervisor of Elections www.votepaimbeacn.gov RE�C�lyEp AUG'O 4 2021 CITY OF BOy WON BEACH CERTIFICATION CITY CLERK'S OFFICE I, WENDY SARTORY LINK, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 26 signatures on the Nominating Petitions of BERNARD WRIGHT for MAYOR, 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 BERNARD WRIGHT is a registered voter in Precinct 7182, in the City of Boynton Beach, Florida. Signed, this the 31d day of August, 2021. VVE*JDY SARTO Y LINK 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 kxowingly 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 mi ti print name as it appears on y r voter information card) in said state and cou ,y, petition to have the nam Wit— tit C r—C� placed on the Primary/General Election Ballot as a: [checkicomplete box, as applicable] Nonpartisan Fj No party affiliation Date of Birth (MM/DD/YY) Signature the undersigned, a registered voter Wt'<<. �- - Party candidate for the office of (insert title of office and include district, circuit, group, seat.number, if app)icable) or Voter Registration Number Address 159 q K. ?).Aalr k County State 1 Zip Code L334 Date Signed (MMIDD/YY) [to be completedy Voter) � -- q AS-DE104fEff,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 rerested information on this form is not completed, the form will not be valid as a Candidate Petition form. I, the undersigned, a registered voter (print name as it appears on'your vote Wormation card) r in said state and county,C.t' A � r v1 t petition to have the name of � C'JT� tt � Y" placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [—] No party affiliation Fj _ _ _ _ _ Party candidate for the office of (3�'� or (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth r Vote Registration Number Address ,I (MM/DD/YY) � Ci Coun S Z!p Code of Voter Date -241 e [to be Maj j Rule 13.2.045, F.A.C. 7Ds-DE T04 (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 form. I, 13e ' Ovi d reyral the undersigned, a registered voter (print name as it appears on your voter information card) II � in said state and county, petition to have the name of��"/�[ CV -d � SCJ 1-2, placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] [ENonpartisan E] No parry affiliation Party candidate for the office of (\--N (-'VibV- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address ,,) (MM/DD/YY) 79_ 12719 S�oZ-� r{0�� KIW �* City PCounty State Zip Code li At, Pa ln, 3e.c� FL 4 33435 Signature of Voter Date Signed (MMIDD/YY) r [to be completed by /Voter] Rule 1S-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. (print name as it appears on your in said state and county, petition to have the name of inlottnation card) i3�r ►.t C� r -J placed on the Primary/General Election Ballot as a, [check/complete box, as applicable] Nonpartisan E] No party affiliation El "_ v a the undersigned, a registered voter kT . 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 q / /Cl 3 �r City County State Zip Code L Rb,,,j - &4 C, a c 53c4 Signature of Voter c Date Signed (MM/DDIYY) (to be completed b Voter DS -DE 104 iEff. 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 fibrin. 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 fc:�>'t—&j , r—C L J r l c-1 k t placed on the Primary/General Election Ballot as a: [check/complete box, as applicable) Nonpartisan [D No party affiliation F� _ Party candidate for the office of 'f —,-\ -�\— -vf 'D r— (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number ( j Address Qn (, (Mi�V9 QD/YY U 6 i" L� I City County State Zip Code i bf _ �3u3 ' fILI j Signature of Voter c --1 - Rule 9S-2.045. F.A.C. Date Signed (MMIDD/YY) (to be completed byoter) 2 ns.Mr end fcrf n011 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It i a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If ll reque. ted information aft thi form is not completed, the form will not be valid as a Candidate Petition form. I, the undersigned, a registered voter (pf int name as it appears on your voter information card) in said state and county, petition to have the name of _ .�r-� L' 1—L �. t placed on the Primary/General Election Ballot as a, [check/complete box, as applicable] 2 Nonpartisan [—] No party affiliation M ICY� 1� Parry candidate for the office of (insert title of office and include district, circuit, group, seat number, if applica e) Date of Birth or V terR istr(ati(oumber Address (MMIDD/YY) d J City Cou � State Zip Code Signature of Voter Date Sign (MMIDD/YY) (to �betby ofer] � !� Rule 1S-2.045, F.A.C. DS -DE 104 IEff. 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 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. I' Cc- Cl > 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 _ rz!> et- "i r -C L) placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [] No party affiliation ` _ _ .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 ; I Address(MM/DDIYY) / 1 n� City: County State Zip Code J R Signature of ter I Date Signed (MM/DDNY) [to be completed by Voter] Rule 1S-2.045, FAC. 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 104.185, Florida Stat test - If all requested information on this form is not completed, the form will not be valid as a Candidate P titi 11 form. I, Cx'f Y c 1 � _e // s the undersigned, a registered voter y (print name as it appears on your voter information card) in said state and county, petition to have the name of_ M_ iE q�C _ _ �1� x C placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] onpartisan ❑ No party affiliation ❑ 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 �N -L RiA Date Signed (MM/DD/YY) [to be completed by Voter] DS -DE 104 fEf£ D911 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 form. I, l a v S �r� ez)d ems+ t TL the undersi d, a registered voter I (pMnt name as it appears on your voter information card) ) in said state and county, petition to have the name of C'/L%1141t d placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan F] No party affiliation El Parry -4-1. " 0 E-- - - (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number (MM/DD/YY) /I 7(p 7-a'' City a � Signatu o1 Rule 15-2.045, F.A.C. r Address 6'6 ftA t9 &/c� candidate for the office of County State Zip Code [j CC 91,,,t S -(- ,33c3 Date Signed (MM/DDNY) [to be completed by Voter] 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 Petition I, (print name as it appears on your voterAormation card) in said state and county, petition to have the name of rna r 01 V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] the undersigned,/a registered voter � JJ Nonpartisan [:]No party affiliation - - r -C' " Party candidate for the office of — - &4 YV-\, A � 16 [_ (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD Y) I kc) l3A re- city e City County State Zip Code Sig Date Signed (MM/DDNY) [to be mpleted by Voter] 00c �l d r 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 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 r iMered voter (print name as it appeon your voter information card) in said state and county, petition to have the name of :J e'r— at placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisa o party affiliation ❑ Parry 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) y� � �� 0 Q%. 22- I�i�Z / 7 County State Zip Code w� ?y '444 a Signature of Voter Rule 15-2.045, F.A.C. Date Signed (MM/DD/YY) [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 104.185, Florida Statut iel - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I (print name as it appears on your voter information card) a in said state and county, petition to have the name of r , placed on the Primary/General Election Ballot as a, [check/complete box, as applicable] Nonpartisan party affiliation M . _ 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 (MMIDDNY) , C4 - City County State Zip Code Signature of Voter Date Signed (MM/DDNY) _ [t//o be completed by Voted e 13-2.045, F.A.C. DS -DE 104 (Eff. 0411 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a, rime to knowingly sign more than one petition for a candidate. [Section 104.185, Florin a Statute. - If all ryquested information on this form is not completed, the form will not be valid as a CandiYate. P� tion form. 1, /_ IYl the undefsigned, a registered voter ,/ (prrnf name as it appears on y ur voter information card) AL in said state and county, petition to have the name of Y 1^! placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No party affiliation ❑ .__ _ _ -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) "� ©C� iL � B� \,[ Q Aw City County- state Zip Code foeckc Signatu of Voter Date Signed (MM/DD/YY) [to be completed by Voter] 7._ /d DS -DE 104 [Eff. 0911 Rule 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 I, -0—�-d C[ f --a �� VVI i`� G the unders ned (print name as it appears on your voter information card) in said state and county, petition to have the name of •R hfi'u a r- 6 placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] unpartisan Lj No party affiliation ❑ 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) C-00 l`c @ Is T_ registered voter Cit ru County State Zip Code �,j�L b `1A -A C0 Pit < ' j . '-f '3 S - Signature of 1/oter Date Signed (MM/DD/YY) [to be completed by Voter] r7-[L+--re-D,I Rule 1S-2.045, F.A.C. 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 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidat Petitia, orm. the unde ' d, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Won'partisan ❑ No party affiliation Party candidate for the office of ((1r� ASC b r (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration (MMlDD/YY),� City County State Zip CodeZA 1 4-1 ld'5� _- Number Address c4 Signature of Voter Rule 15-2.045, F.A.C. Date Signed (MMIDDNY) [to be completed by Voter] DS -DE 1041Eff. 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 Petiti form. I,! I P�•� the undersigned, a registered voter l l (print nam as it appears on your voter information a card) l) in said state and county, petition to have the name of e- pq' �r �- placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] onpartisan [:]No party affiliation F ` Party candidate for the office of iA, 0 T -- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number FAddress (MM/DD1YY) 15 4 City County State Zip Code / Signature of Voter Date Signed (MM/DDNY) [to be completed by Voter] wzu� Q_ -a-A - �:'� Rule 13-2.045, 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 Statut J - If all requested information on this form is not completed, the form will not be valid as a Candi P ition form. I, C LIW(pwo L 'T 6�- ) the undagned, a registered voter (print name as it appears on your voter information card) ,( r in said state and county, petition to have the name of 3er A4 at. & 1 C9_ - r placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] eNonpartisan ❑ No party affiliation ❑ . __ _ __ 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 1 (MM/DD/YY) 1 City County State Zip Code t4 CA -33 43_�- Signature of Voter Date Signed (MMIDD/YY) [to be completed by Voter] �. `7- � a °- � \ .A. Rule 18-2.045, FC. _ DS -DE 104 tEff. 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 Petition ' rm. the undersigned, a registered voter I l (print name as it appears on your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] onpartisan ❑ No party affiliation 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) Address 1 D16�� City County state Zip Code Signature Voter Date Signed (MM1DD/YY) [to be completed by Voter[ F.A.C. 104 lEff. 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 form. `,' t, 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 r 2 placed on the Primary/General Election Ballot as a, [check/complete box, as applicable] candidate for the office of Nonpartisan [:]No party affiliation _ Party (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 tip Code Signature of Voter Date Signed (MM/DDNY) [to be completed by Voter] Rule 7S-2. , F.A.C. DS -DE 704 EK. 0917 CANDIDATE PETITION r' Notes: - wi information on this form ben mee a public record upon rece2pT by The Supervisor of Elections. - It is R crime to knowingly sign more than one petition for a candidate. [Section 104.I85, Florida State - If all requested information on this form is not completed, the form will not be valid as a Candidate P-fition form. I, 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 .ice■ice �► _ . placed on the Primary/General Election Ballot as a: (check/complete box, as applicable] Nonpartisan M No party affiliation [D ._ . _ .. 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) C City County State Zip Code -Roo- L__ -f- ve. 7 _W Slgn re of voter Date Signed (MM/DD/YY) [t°b�,completed by Voted Rule 1S-2.045, F.A.C. 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 104.185, 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 tion card) in said state and county, petition to have the name of ftl CLF' placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No parry affiliation _ Rule the undersigned, a registered voter r-A.�� _� Party candidate for the office of M A.Y o (--` (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number (MM/D/l(Y qs 17n City State ZmCode lvl6nwh 15c 1� Signature cnVoter — ft Date Signed (MMIDDrM [to bempleted by Voter] VT OrD 10 I I DS -DE 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 forte" print name as it appears on your voter information card) in said state and county, petition to have the name of t placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] nonpartisan [D No party affiliation ❑ the undersigrfe6a 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 C0u7ty State Zip Code Rul Date Signed (MM/DDNY) [to be completed by Voter] �� ' 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. _'c 6 D U S Jai 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 placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] unpartisan ❑ No party affiiiation Party candidate for the office of (insert tide of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DDIYY)J � �2.. I15 City ounty State Zip Code Signature of Voter p Rule 15-2.045, F.A.C. Date Signed (MM/DDIYY) [to be completed by Voter] DS -DE 104 IEff. 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 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Pgtitio I, r -LLv.`- �,� P4 C ���� 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 i c -e, I" IQ r'L4, placed on the Primary/General Election Ballot as ate: [check/complete box, as applicable] Nonpartisan F] No party affiliation Party candidate for the office of -&i 0 /- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMlDD/YY) /�- Z.-► - s"y.v C..� City County State Zip Code by'I bN Signature of Voter Rule 13-2.045, F.A.C. Date Signed (MMlDDlYY) [to be completed by Voter] DS -DE 104 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. e—, cy-'5 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 w placed on the .Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan M No party affiliation Parry 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) _ 1 Address � I 1 /'� !(_:� rq-r- O'Nt e - City County State Zip Code Signature of Voter Rule 1 Date Signed (MMIDDNY) [to be completed by Voter] DS -DE 104 iEff. 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 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 F (print name as it appears on your vloformation card) in said state and county, petition to have the name of ri v ta,r.� i placed on the Primary/General Election Ballot as a: [check/complete box, as applicable Nonpartisan F] No party affiliation Party candidate for the office of Qn a �— (insert title of office and Date of Birth or Voter (MM/DDNY) _ , , , __4 City Signature of Number circuit, group, seat number, if Address County State Zip Code Ln-J, r Date Signed (MM/DDNY) [to be completed by Voter] Rule 1S-2.045, F.A.C. V T' . �_ ') ! / 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 104.185, Florida Sta sJ - 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 informationcard) j in said state and county, petition to have the name of _ G - placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] donpartisan ❑ No party affiliation ❑ De_ f -, OC­5�_ * t IT", 1�— Party candidate for the office of `'(("\ QN o r— (insert tide of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number (MMIDD/YY) t Address i30� mff< l�lve� City County Stva, Zip Code Signature of Rule 1S-2.045, F.A.C. Date Signed (MMIDD/YY) [to be completed by Voter] �-- �-- l -- "2--t DS -DE 104 tEff. 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 Sta Utes - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I, (print namd as it appears on your voter informatiop cared) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applica6e] the undersigned, a registered voter Nonpartisan ❑ No party affiliation ❑ _ 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 (MM1DD ) a61, 961,24 Address City County State Zip Code Signature of Voter F.A.C. Date Signed (MM/DDNY) [to be completed by Voter] a " Iaj,� ave i 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 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, X&yn,KC, L&:::�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 N placed on the Primary/General Election Ballot as a, [check/complete box, as applicable] (Nonpartisan ❑ No party affiliation ❑ ljaa��M 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) C1 V92."wfrf �zx L=, -2 bi xrl City County State Zip Code uam %2�n a-)� Signature Vo r Date Signed (MM/DD/YY) [to be completed by Voter] Rule 1S-2. , F.A.C. DS -DE 104 (Eff. 0911 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 Sta'Nutes - If all requested information on this form is not completed, the form will not be valid as a Candidate P iti 1. I,� ' !E� � � �1 f 71 ds the undersigned, a registered voter t (print name itappearson your voterinformationcard) in said state and county, petition to have the name of 4 sem' ,, 4 r' u'' r - 'j placed on the Primary/General Election Ballot as a, [check(complete box, as applicable] nonpartisan ❑ No party affiliation jo �� 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/DDIYY) ` � 4511 �i . - 1060W."o City County State Zip Code I -- la, 3?q3-5 11g Lure of Vo er Date Signed (MMIDDNY) [to be competed b Voter] N9&{ -1 j 1 IS-2. 5, F.AC. DS -DE 104 {Eff. 0911 CANDIDATE PETITION lv� A Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Election - It is a crime to kno�k wingly sign more than one petition for a candidate. [Section 104.185, Florida tutesJ - If all requested information on this farm is not completed, the form will not be valid as a Candidate Petition form. I, the undersigned, a registered voter ` (print name as 'it appears on your voter information card) rr in said state and county, petition to have the name of _ �-�� U-- �< 1� k: -r - placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] i ® Nonpartisan [:]No party afraiation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) F(MDaMte of Birth or terRe istratio Address umber/DD/YY) __�n 1 11q "0 City f County Stater, Zip Code APO)1 i 73 Signature of Voter Rule Date Signed (MM/DDNY) [to be completed by Voter] 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 Petition form. I, the undersigned, a registered voter (print name as it appe ya voter' formation card) in said state and county, petition to have th !4ffn ame of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable]. [RIlonpartisan el party affiliation Party candidate for the office of -1n-\ �I F - (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address _ of t/ 76 -t9 � City County State Zip Code Signature of Voter Date Signed (MMIDDNY) [to be com feted by oter] as Rule 1S -T.045, F DS -DE 104 Eff. 0911 11 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. (print name as it appears on our voter information card) �1 in said state and county, petition to have the name of is e-4- " 0.q— L! placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan 1*0 party affiliation YN--\"o Y - 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 (M MIDDNY) i-—��te Address City County State Zip Code Signature of Voter Date Signed (MM/DD" I' [to be completed by Voter] Rule 15-2.045, F.A.C. DS -DE 104 iEff. 0911 r CANDIDATE PETITION] Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Electi :s. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, 1' 6rida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I Y� the undersigned, a registered voter (print name as R appears on your voter ation c`ar�d in said state and county, petition to have the name of �m ► o placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] onpartisan []No parry affiliation ❑ l _ _ Parry candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) 1 Date of Birth or Voter Registration Number Address (MMIDDIYY) I q i L'3�— �a_cwa_, Dr City County State Zip Code Signature of Voter Date Signed (MM/DDNY) [to be completed by Voter] Rule 15-2.045, F.A.C. D -DE 104 Eff. 09111 CANDIDATE PETITION itw 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. (print name as it appears on your voter information card) in said state and county, petition to have the name of L�j�rn "erel placed on the Primary/General Election Ballot as a: [check/complete box, as ap Nonpartisan F] No party affiliation F1 v1/�4 A! — the undersigned, a registered voter Party candidate for the office of `ffy-\, A- �'c o �- (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) p2 /LI rSU/ l Q V--- 3 City Coul State Zip Code Signature of Vo r Date Signed (MM/DDNY) [to be completed by Voter] Rule 1S-2.045, F.A.0 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 Petition form. the undersigned, a registered voter ' (print Hfia a as it appeardon your voter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Non artisan No artyafiliation �Party candidate for the office of (insert title of office and include Date of Birth or Voter Registration Number (MM/DD/YY) n F— circuit, group, seat number, if applicable) Address City County State Zip Code J -fid e -m r Signature of Voter r. -U. Date Signed (MMIDDNY) [to be completed by Voter] 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 Statutesx- 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 (Pont neA_6 as it appears on your voter information card) in said state and county, petition to have the name of _e 'r placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No party affiliation 1 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/DDIYY) ZL/O(i 151 1'�-A /��_ City Counix State Zip Code Signature of Voter Date Signed (MMIDDNY) [to be completed by Voter[ -------------------- Rule 1S-2.045, F. C. DS -DE 104 fEff. 09/1 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. Y - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statut s - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition act CD— 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 &_ d YV# Y6� placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [—] No party affiliation F-1 Party candidate for the office of 0'1 A -'-(D F - (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) ?1p/g7 lVof ( 4SKVW i —PLQ.'L Cjty W P� Signature of Voter Rule 1S-2dAiA. 'A.C. CountyFF P�3 - ; Staff r Zip Code 33+(,S - Date Signed (MM/DDNY) [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 104.185, Florida Statutes] - Ifall requested information on this form is not completed, the form will not be valid as a Candidate Petition,form. 1, , - ;f the undersigned, a registered voter (pr t name as it appears on your voter information card) in said state and coun ,petition to have the name of_ r -C4 Lj i— t Cl iA 1. placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan [] No party affiliation 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 i (MM/Di,� Signature Rule 1 Address - State Zip Code T 31_333 Date Signed (MMlDD1YY) [to be completed by Voter) 2 DS -DE 104 IEff, 09111 Notes: -.tll E+�f :atia -1 crime to If all requestea CANDIDATE PETITION this form becomes a public recot� upon receipt by the Supervisor of Elections. vingly sign more than one petition )r a candidate. [Section 104.185, Florida Statutes] rma/tion on this for . ' , not co ple ed, the form will not be valid as a Candidate Petition form. i> I fV f l ��! (a the undersigned, a registered voter print name as it appears on you voter information card) in said state and county, petition to have the name of 'I4 Qr—a placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] el'Nonpartisan F] No party affiliation Party candidate for the office of Date of Birth or (MM/DD/YY) a L Of (insert title of office and include district, circuit, group, seat number, if applicable) )R9 stration Number Address W State Zip Code elej J 65i Date fined MMIDDNY) [to be ompl ed by Voter] DS -DE 1041M. 09/11 irn C 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 Petition form. r- �- �L �S f� �%�� — the undersigned, a registered voter (pnnt name as it appears on your voter information card) in said state and county, petition to have the name of 2� -e-'r"K4 (2cr -gi placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] �onpartisan F] No party affiliation Q Party candidate for the office of L) (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) -If % x.5-1 hl 01 - City County State Zip Code ko a,,,., - ; mat /� 5 Signature of Voter Rule 15-2.045. F.A.C. Date Signed (MM/DD/YY) [to be completed by Voter] DS -DE 104 (Eff. 09/11