SOE Petition Submittance Form 7-26-2021Al OF ��q 1
p'�
Wendy sartory link SUPERVISOR O ELECTIONS
��, 2421 JUL 26 PM 4: 38
OF
Palm Beach county supervisor of Elections
F. A.Li1 E3'GAC,H 0U`a`Yr €j,..
PETITION SUBMITTANCE FORM
Name on Petition, Candidate, or Committee: 3L
'IA W nL
Office Candidate is seeking:
Number of Petitions Submitted: (Approx. 1
Name of person submitting petitions:
Address: 100 f-.
City, State, Zip Code:
3
Phone: r' - r— O6 Email: ` 1p 4 b o U
Signature: Date: 026 0�
i
f
IL
Deputy's Initials:
Revised 04/2020
240 South Military Trail, West Palm Beach. FL 334151 Post Office Box 22309, West Palm Beach. FL 33416
Telephone: 561.656.62001 Fax Number: 561.656.6287
-71
=r:. _N Y