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Filing Papers OFFICE USE ONLY STATEMENT OF ' o CANDIDATE (Section 106.023, F.S.) roGT 21 1�-S (Please print or type) CITY OF BOYNTON BEACH 1, ei (\n, A- ic_o candidate for the office of VV,l.}kA ®.( have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X ' '� lak-a(..O• e,m0-6 /09 a 2/t ..nature of Candidate Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS-DE 84(05/11) Firefox about:blank RECEIVEID 9 APPOINTMENT OF CAMPAIGN TREASURER OCT 2 5 2021 �'`� AND DESIGNATION OF CAMPAIGN 7-t^ DEPOSITORY FOR CANDIDATES CITY OF BOYNTON BEACH (Section 106.021(1), F.S.) CITY CLERKS OFFICE (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: V Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2ame of Candidate(in this order: First, Middle, Last) 03.Address(include post office box or street,city,state, zip code) S � jcOn �\� \e-Oct 0 31 to w 4.Telephone 5. E-mail address 2 ,n,n F1 l° ( 501- CJD -Q410i-4 ,cow E.3 4 .i3 6.Office sought(include district,circuit,group number) 7. If a candidate for a nonpartisan office,check if applicable: r n 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 ❑ Write-In n No Party Affiliation [1 Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer n Deputy Treasurer 10. Name of Treasureor Deputy Treasurer Tex- \ v..\_ 11. Mailing Address 44.) 12.Telephone 1 1 act. a \6 CT (561) q620- 39/ ( 13. City 14.County 15. State 16.Zip Code 17. E-mail address vP ( \e Qa\m P)e.4cil fl 3�YT .\---e__<-iec9 . U5 18. I have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository 19. Name f Bank 20.Address l 5 VGA 50 PDk �0 0 O c�e�a ,� .\---W ' . City County 23. State ` 24.Zip Codd - ' n -oc� & lam Q Q P1&1oA- 43(-1 2 ' UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 25. Date ! 26. Signat of Candiled2-c., c(ce4A,A, fl(---- oa. 1 X -1 �-� 21. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) I ' 'CI ,do hereby accept the appointment I (PleasJrinfor Type Name) designated above as: `v, Campaign Treasurer El Deputy Treasurer. ii‘o C /.. 3J. _ 4 / X /OP F Date Sign e o Cam gn rrasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001. F.A.C. I of 1 10/23/2021,8:53 AM 13F---crivi-J I /'\ 1-/) APPOINTMENT OF CAMPAIGN TREASURER UL 12 1 2021 Ti-S %or AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) CITY OF BOYNTON BEACH., (PLEASE PRINT OR TYPE) l NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1.9HECK APPROPRIATE BOX(ES): El Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code) wc,� Fa,l to -b.! C ff ri a d o 3' N.`,fl�y �� r•t".43 1/41 -s--) 4. Telephone 5. E-mail address --604 1" dogautt ( qOV ) SOI- a 13ft r(xG1�L- h 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: V\a'Q (.. 0 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 ❑ Write-In ❑ No Party Affiliation ❑ Party candidate. stow9. I have appointed the following person to act as my IpiCampaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Tera t4.uOhes 11. Mailing Address 12. Telephone 1I:)-`1- - 169 Cl- rNi ( 5101 ) 400 3411 13. City 14. County 15. State 16. Zip Code 17. E-mail address T iP 14ex Pal m �-eu cg- FE 3 39-79 - --e r i' e e C 9 , vs 18. I have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address 21. City 22. County 23. State 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 /OP 0 0 2/ X i I,CAA,--e6e f41--.0 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) I, 'CrI {-- tAtb kes , do hereby accept the appointment (Plea a Print or Type Name) designated above as: Campaign Treasurer ❑ Deputy Treasurer. 41111 /0/HAI-0.3-1 X �,,e l,t_ Sal-GT lL.Z4 Date Signature of Campaig�(i Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C. i ,f.wt :�sssE t) C, ?i ucTr BGvt�;'To f +SPA QFME UU 'F "•. i� ti a d Fc9iwr uy3 FY9A itS� I ati°.? + �x+titstA Pa61 all C� be- L4 It"L car wsw. a � ,;...� ,x s. �.� _ tae rtr +ni�c+• e4wd` t *ovum { 6R+s �t Cert *tg pbi tts�+ ni a \�c�d6 re Cs�rw'�ti6r rkbla�t 1 is S�SY Ck x# a �%V a i7s. C1pi hasty taaftla$ * r -I 13 M" y NVltta atfR asi �. �lO V" 9 v t Ri C#W * M40 fam SliitiilYt iNTSNIp pc}sst 26. 6"6el�ly40 Ri �( * In the tita od dh" t 27 i L:�t" �tetwtRa �! T o,bowa I Of= kir hixetN sr'e uw aiK*'��'S u' tit � 1 sl,gy�r,M xzri+�Kw v. L,gx�tr ll1w;`w1,1.$)kit, RESIDENCY REQUIREMENTS "�� C' - '0 i C' " r+d (PrhA Name) REceivEr, NOV 19 20.2.- q"39, CITY CSF 130YNTON BEACH � candidate for of the City (Mayor/C6mmissioner — District #) of Boynton Beach, have received, read and understand the residency requirements of Article II of the Charter of the City of Boynton Beach. i zl (Date) S:\CC\WP\ELECTION\Year 2022\CANDIDATE INFORMATION CD\4. Residency Requirements\A. RESIDENCY REQUIREMENTS STATEMENT.doc FORM 1 STATEMENT OF 2020 Please pfiM or type your name, mailing FINANCIAL INTERS STS FOR OFFICE USE ONLY: address, agency name, and position below: LAST NAME — FIRST NAME — MIDDLE NAME: MAILING ADDRESS 31 - � s- AwcouQ-, CITY: ZIP: COUNTY : y AO- 33 ki 3 s bA rm AM OF AGENCY: t 1 NAME FFICE OR POSITIO H R SOUGHT `CY\2- p� � �Azfj bea� 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 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 ❑ 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 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 BUSINE S' INCOME OF SOURCE ACTIVITY OF SOURCE PART C — REAL PROPERTY [Land. buildings owned by the reporling person - See instructions] You are not limited to the space on the (If you have nothing to report, write "none" or "nla") lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3_ II^cu rwra d�y rTn k.ufex���� f'tr 4I1+9YIIAlI,vlhY} 11 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 I I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or NAME OF CREDITOR 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 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 BUSINESS ENTITY # 2 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. ❑ 1 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: Signat e: 7 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 specked 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 Re by both mail and email. Choose onk one filing method. Form 6s will not be accepted via email CE FORM 1 - Effective_ January 1, 2021. Incorporated by reference in Rule 34-8.202(1), FAC. 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: 1, , 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/Attomey 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 1 F) within 60 days of leaving office or employment. Filing a CE Form 1 F (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. CANDIDATE OATH - RECENED NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) NOV 19 2021 Check box only if you are seeking to qualify as a write-in candidate: �°�CLERICSOFFFICE"bluer ❑ write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) CO -- � 1 aC� 0 , (Print name above s 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 c0V ) Q �\' (District #) 't(Office) I am a qualified elector ofCounty, 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. () `7 It) ? 7 v Candidate's Florida Voter Registration Number (located on your voter information card): _ Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as maybe used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to writj-in candidates.] �J pQel,)o-v- res a;)d o fe . heck-'tS � 1/t�fiM�� Z..car►-� �C.dZ- (�n � X S©-303'-), Signa of Ca date Telephone Number Email Address, � V30 33y3,,:5 l� � Address City State ZIP Code STATE OF FLORIDA Signature of Notary Public (� f I COUNTY OF r01. PC[ Gf Print, Type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me by means of µr;•. CRYSTAL D.GIBSON ^/ ?, zation ❑ OR physical presence MY COMMISSION # GG 326964 online gL� _ n^``b�= EXPIRES: April 22,2023 this day of ooytrt"t),� 201a. ' Bonded lhruWWyPublicundmmisrs Personally Known ❑ OR Produced Identification Type of Identification Produced: 1_ rVb— G SA DS -DE 302NP (Rev. 0512021) Rule 1S-2.0001, F.A.C. MISCOlIM70OUS Cash Receipt ,� -M No. 091720 CITY OF BOYNTON BEACH - Account No. 25.00 November 21. Receivedof Cindy Falco DiCorrado Address 316 011 Ist Avenue,, Boylitom'-ftach FL 33435 L11L�m--- 1-- lype*. 'I', ' D-878: 1=6Z �211.0_1— at m. F. City Piling! Fee to run for rr, .. For AT971 1'� N -F.11 F, $L -93. March 2�0-2 2 55 Dept. City C,lekk's Office By I TV 127:3-'ep- Miscellaneous cash Receipt 7# CITY OF BOYNTON BEACH No. Account No. 001-0000-369-10-00 $ 238.23 Movember � I-,', Received of Cindy. Falco DiCorrado Address 316 MW 1st A-vanue, Boynton Beach FL 33435' Uu-1r: F, It Filing fee to run for Ma�,or D6- tP-.- - ov -Z3 March 8 2072 26 21 CC Drawer: t 69m 1b' 7 A Dept. City Cs Lerk I Of f i0e By -q J 9 -m- b� &i rpmT ;A MR NP; 6 --n rin G 73 cnS FR- S; ?,L:i io E� rn fa 7CI i6a P-� f4 1W Miscellaneous cash Receipt CITY OF BOYNTON BEACH Account No. {,Ql 3f -,- Received Address For Dept_f By A op X 0 'j, A. -F 7,0 N T ol- -1715 ��5- Z CITY T BN MM IFALH *** n U RECEIPT*** --m- op2r: MMC - Type* CC Dra,0i'o- 1 2 .01 Receipt no.' Dat2: t2/()3/i 83157 Degror i pt i LifioilnL 99 m 1 -3 1.00 Trans nuib2p: 93908 G/L account nmbpr: C010M1910M FA DI-CH-A'D -00 SFEE fST SUNICE Trans number'. 5383301 C/1- account number: 5EfMCE- FFFE FULCHICAffiAM 316 W 1S' A& S N a PETITI,fERT TencL-r detai I �V'T I �j _CC GO 5 C $4.00 51 OT --CI; GN'T $.11 Total tenctred $11.11 Total payrolt $4.11 Trans date,* 12/03/21 Tim: 9:07:24 TWW, n FIS yUy PFUIPT WMT , OF F4CO �f Wendy Sartory link OF P Palm Beach County Supervisor of Elections CERTIFICATION i'0v 16 ?021 CITY OF eQY,NtTorl SEA"' I, WENDY SARTORY LINK, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 35 signatures on the Nominating Petitions of CINDY FALCO-DICORRADO 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 CINDY FALCO-DICORRADO is a registered voter in Precinct 7186, in the City of Boynton Beach, Florida. I am only certifying that the signatures match the signatures we have on file and that the electors reside within the municipal limits. I am not certifying the validity or legal sufficiency of the petitions Signed, this the 12th day of November, 2021. 41,A4&4�1 DY S TORY LINK SUPERVIS 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; 561.656.62001 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 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. ( ( U\r1M & the undersigned, a registered voter (print name as it appears on your voter i formation card) \ in said state and county, petition to have the name of � �}(� 1 C:d placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] WNonpartisan [:]No party affiliation El Party candidate for the office of (insert title of office and inckabe district, circuit, group, s at number, if applicable) Date of Birth or Voter Registration Number Address (MM/D� 3 Q I 2o� '/\J O o ( G2'Gw, (hn.1 e- City County State Zip Code IaA r ra 5Y Signature of Voter F.A.C. Date Signed (MM/DD/YY) [to be complete by Voter] )( z ( DS -DE 104 IEf - 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 Imowingly 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 name as it appears on your voter information card) in said state and county, petition to have the name of (, ,_ 1CAA c� placed on the Primary/General Election Ballot as a: [check/complete, as applicable] jNonpartisan n No party affiliation Party candidate for the office of (insert title of office-gnd include district, ci t, group, seat number, if applicable) Date of irth or Voter Registration Number Address ^ S ig City County State Zip Code Signature of Voter Date Signed (MMIDD/YY) [to be co plete by Voter] kb 7,o 1-4, Z( Rule 1S -2.W- F_A_C_ CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. V/ / - 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 �t: (� i tr fo.) 0 the undersigned, a registered voter (print name as it appears on your yrpter information card) _ in said state and county, petition to have the name of it '� d plad on the Primary/General Election Ballot as a: [checklcomplft4ox, as applicable] 7Nonpartisan [:] No party affiliation Party candidate for the office of "y (insed title of of4h and include district, circui , group, seat number, if applicable} Date of Birth or Voter Registration Number Address 2 (MM/DD/YY 0 7 �'V City County State Zip Code Signature of Voter Date Signed (MM/DD/YY) [to be completed by Voter] Rule 1S-2.045, F A C. DS -DE 104 Eff. U9l11) 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. in said state and county, petition to have the name of f pla d on the Primary/General Election Ballot as a [chedotomplete box, Nonpartisan 0 No party affiliation (insert tide of office and incldlie district, circuit, the undersigned, a registered voter Parry candidate for the office of number, if applicable) Date of Birth or Voter Registration Number Addres& (MEREMMt Z q /!Y l � � Gam . Q' C� T /_9 /V City County State It Zip Code Signature of Ver �_1107 c W Date Signed (AlMM IEYY) [to be completed by Voter] E0 3Co- P( DS -0E 104 iEM 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 forin is not completed, the form will not be valid as a Candidate Petition form. ,E q 47 the undersigned, a registered voter (print name as it appe=.rs on your vg4r information card) o in said state and county, petition to have the name of ` �� ;."C 7plac d on the Primary/General Election Ballot as a: [check(complete bal.), as applicable] Nonpartisan 1 No party affiliation El_ , Party candidate for the office of (insert title of office -dna include rYistrict, rcuit, group, seat number, if appli ble) Date of Birth or Voter Registration Number Address {MM1D131Y Y - 6'1 - 1'? - ©C2C A-� City County State Zip Code .1m - F }� �-3L"j 3,r Signature of ote Date Signed (MMIDDNY) [to be completed by Voter] Rule 15-2.045, F.A.C. DS -DE 104 (Eff. 09111 I ID 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 name as it appears on your v ter information card) i in said state and county, petition to have the name ofI placed on the Primary/General Election Ballot as a: [check/complete s applicable] nonpartisan F_j No party affiliation 1_1 Party candidate for the office of (insert title of office and inc de district, Grcuit, g oup, seat number, if applicable) Date of Birth or Voter RR istrraytion Number AddressIDDIYY) (0 r %j City County State Zip Code m ach-i �o� 2, 3 Signatu o Voter Date Signed (MMIDD/YY) [to be cof7pleted Py Voter] 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 knatvingly sign more than one petition for a candidate_ [Section 104.185, Florida Statutes] - If all requested information on this form is not completet4 the faun ivill not be valid as a Candidate Petition farm: L v (print name as it appears on your voter card) in said state and county, petition to have the name of — _ i ') am t- U pla don the Primary/General Election Ballot as a_ [check(complete box, as applicable] the undersigned, a registered voter Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of (insert title of office anh include district, circuit, grow , seat number, if applicable) Date of Birth or Voter Registration Number Address 30 -!> (MMIDDIYY) Cily Co niy State Zip Code 3zgl rK Signature of Voter Date Signed (MMIDDNY) [to be completed by, Voter] /Rip 6 u Rule 1S-2,045, F.A.C. D"E 104 (EA 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 lorowingly sign more than one petition for a candidate_ [Section 104 185, Florida Statutes] L/ - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. I, 4-J\P''1V�SA P D wLc� the undersigned, a registered voter (print name as it appears on your v er information in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete Nonpartisan ❑No party affiliation ❑ as applicable] Party candidate for the office of (insert title of office aW include district, circuit, groilp, seat number, if applicable) Date of Birth or (MWDD Y) Voter Registrafion Number Address Aj L5- city county state Zip Code SignatureVoter CdO Date Signed (MWDDIYY) [to be completed by Voter] I0 130 ,x, CANDIDATE PETITION Notes: -AH information on this form becomes a public record upon receipt by the Supervisor of Elections. / -11 is a crime to laaowingly sign more than one petition for a candidate_ [Section 10=1.185, Florida Statutes] - If all requested reformation 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 WpeaFs on your v r information card) in said stale and county, petition to have the name of - ((a pla don the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan No party affiliation T- Party candidate for the office of 1 (insert title of Ace- and i ude district, circuit, group, eat number, if applicable) Date of Birth or/Voter R stration Number Address (MllslDD/YY) � City County State Tip Code Si re of ter Date Signed (MM/DDNY) Ito be completed by V ter) I e 1S-2.04& F.AC_ CANDIDATE PETITION Notes: -AM information on thisform becomes a public record upon receipt by the Supervisor of Elections_ -1t is a crime to knowingly sign more damn 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. LolqD trel_ .) 'T, R 0 the undersigned, a registered voter �N (printnerne,askappeamorLyour valeC irdmmatiweafoJ in said state and county, petition to have the name of l A _ � � (� Ci 0 pla r on the Primary/General Election Ballot as a: Idwdobomplete box, as aAafkablej Nonpartisan [—]No party affiliation Party candidate for the office of ick (insert We of office and indbk a district, cinwit, grdup, seat number, ir9ppiicabie) Date of Birth or Voter RegistratiomMumber futt�lnDnnry r0 � Amoss I9 nature of Votar Rule Date Signed (MMOMY) [to be_corryxWe r by V er] CANDIDATE PETITION Notes: -All information on this farm becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than ane 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, {print name as it appears on your v informat card) in said state and county, petition to have the name of pia don the Primary/General Election Ballot as a: [check(complete box, aaAg Nonpartisan ❑ No party affiliation ❑ the undersigned, a registered voter nmt�_ 5 MIM Party candidate for the office of (insert title office and inclu2e distnca circuit group, seat number, if applicable) Date of Birth or Voter Registration Number Address A��_ - w . by Znty Stale Tp Code y�'p Signature of V ter Date Signed (MMIDDNY) [to bertsrrtpleted by VanIVB ) _ Rwe t 045. E.A.C. DS -DE 104 tEff. Q4t1 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 10.1.185, Florida Statutes] - ff all re uested informat' ,n on this form is not completed, the form will not be valid as a Candidate Petition form. I, 6'1�6dl the undersigned, a registered voter (print name as it appears on you r inform 'on card 4 b in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete box s applicable] dNonpartisan [:] No party affiliation Party candidate for the office of (insert title of office and in de district, circuit, g oup, seat number, if applicable) Date of Birth or V er Regi ation Number Address ttw/DDm} � 01 Ci County State Zip Code c� \ cry oil 6 Signatu Voter Date Si ed (IIA DDIYY} [ � �p�e by Voter Rule iS- , F. DS -0E 104 fEff. 09111 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Flections. �/ - It is a crime to knowingly sign more than one petition for a candidate. [Section 101.185, 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 [pri t na a as it ap ars on youryajer infomaton cagll_ n �1 in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [cher complete boA as applicable] nonpartisan i__t No party affiliation Q Party candidate for the office of MILAN (insert title of offi d include district, clrcult, group, seat number, if applicable) Date of Birth or Voter Registration Dumber Address � cMM/DDIYY, r� _ un rte - - � Zip Code Date Signed (MM/DD/YY) [to be completed by Voter] 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] VVV - If all requested information on this farm is not completed, the form will not be valid as a Candidate Petition form_ I, `I�ON45 tom_ O P_Vl ( 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, �Nonpartisan� No parry affiliation M (insert tibe'of office and Date of Birth or Voter Registration Number (MM/DD/YY) applicable] district, circbit, group, seat riii�ii Address 3 w cue LV1 Party candidate for the office of if cz_'-� i%,yr-oro C' County State d &'ac 'i) Date Signed (MMIDWY) 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. I, v the undersigned, a registered voter (print name as it appears on your rinformation card r in said state and county, petition to have the name of a 1 C_D t� placed on the Primary/General Election Ballot as a: [check/complete box, 4s applicable] Nonpartisan MNo parry affiliation M Parry candidate for the office of (insert title of office and include district, circuit, groin, seat number, if`aWic able) Date of Birth or Voter Registration Number Address MRA/DD/YY> O l I (' l I �[�� Cityunty State -- Zip Code �` Signature of Voter Date Signed (RAM/DD/YY) v [to be completed by Voter] le iS-2.045, F.A.C. __ DS -DE 104lEff. 09111 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -1t 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 (plint name as it appears on your vo;q information card) j in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [check/complete bo , as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of Elate of Birth (MMIDDiVY (ins He of office and inch or Vo er Registration Number b� 7/ 9 -s -Y Im ak 7, strict, circuit, group, seat number, if applicable) Address cl 3/( ,o IV,11d City County J State Zip Code 1)0� ow eoch__ clop) dam- Si Ire of Voter rr /l (^�/C/!A_ Pule 1S-244.5_ F_1�C_ 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 10=1.185, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. I, /111 A111t.l (print name as it appears your the undersigned, a registered voter in said state and county, petition to have the name of C j A&A '��� placed on the Primary/General Election Ballot as a: [check/complete A, as applicable] Nonpartisan [:] No party affiliation 1:1 Party candidate for the office of (insert title of offer and include district, circuit, group, sea. number, if applicable) Date of Birth or Voter Registration Number Address (MMID❑ Y} City County State Zip Code u gf_Voter Date Signed (MMIDDNY) v [to be complete by Voter] F.A.C. DS -DE 1041Eff. 09/1 CANDIDATE PETITION Notes: -All information on this farm becomes a public record upon receipt by the Supervisor of Elections_ -It is a crime to knowingly sign more than ane 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 for7n. ,�}fi ?1 _e !2: 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: [c6eck/complete A as applicable] (Nonpartisan ❑ No party affiliation 11 Party candidate for the office of (insert title of ofticii) and include iistricticircuit, group, seat number, if applicable) Date of Birth or Voter Registratio Nu' rN Address nn Dnnry r! J — C city Cony State Zip Code Signature of Voter Date Signed (NHWDDNY) [to be completed by Voter] CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections_ j,/ - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If fall requested information on this form is not completed the form will not be valid as a Candidate Petition form: -ci1 4_x_ 12 4* Y j tr ' the undersigned, a registered voter (print name as it appea on your v r inform apion card) in said state and county, petition to have the name of 1 c CirOL placed on the Primary/General Election Ballot as a: [checidcomplete bois applicable] unpartisan ❑ No party affiliation ❑ - Party candidate for the office of (insert title of offic nd include district, circuit, group, seat number, i applicable) Date of Birth or Voter Registration Number Address (MWDDNY) County State Zip Code Signature of Vo Date Signed (MMlDDNy) [to be completed by voter] Rule 18-2.045, F.AC. u CANDIDATE PETITION Notes: -All information on this farm becomes a public record upon receipt by the Supervisor ofFlections- - It is a crime to knowingly sign more than one petition far a candidate_ [Section 104-185, Florida Statutes] - If all requested information on this form is not completei4 the form will not be valid as a Candidate Petition form: I,the undersigned, a registered voter e (print name as itars on your vft information card) — in said state and county, petition to have the name of , C 0 placed on the Primary/General Election Ballot as a: [check/complete bax, id applicable] dNonpartisan [—I No party affiliation ❑ -Party candidate for the office of (insert title of office aftfhclude districircuit, broup, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIM /.Z165//5 City County state Zip Code b�kh_ cjy) Date Signed (M WOWM [to belete by Voter] d6comp CANDIDATE PETITION V/ Notes: -All information on this form becomes a public record upon receipt b}% the Supervisor of Elections_ 4/is a crime to knowingly, sign more than orae petition far 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, —&r tn A .r t'. 4 .— , _ AM _rn r X_ the undersigned, a registered voter (print name as ijappears on your in said state and county, petition to have the name of _ placed n the Primary/Genera! Election Ballot as a_ [chE Nonpartisan ❑NGparty affiliation ❑ title of Date of Birth or Voter Registration Number L(M110)) g ) Rule card) a c.o - D i as applicable] Party candidate for the office of iWct, chuit, group, seat nu`fnber, if applicable] Address [7�nty Sime Zip Code 1 I Date Signed (MMIDDIM [to comp ted by Marr` W43E 104 (Eff. 0911 CANDIDATE PETITION Notes: - A11 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 int name as it appears on your yyg�ter information card) in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [c Nonpartisan F] No party affiliation ❑ (insert title of office and the undersigned, a registered voter as applicable] Party candidate for the office of , seat number, if applicable) Date of Birth or Voter Registralon Number (M DIYY Address 1/ ///�J ?/7Q 1I �V / ✓J i Rule CountyState Zip Code PQI(n i�fioRld 31� Date Signed (MMIDDNY) [to be Ilpted by Vot xa 054DE 904 (Eff. 09/t CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to Anowingly 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, as it appeart qh your>" information in said state and county, petition to have the name of V 7pla d on the Primary/General Election Ballot as a_ [check/complete b , as applicable] Nonpartisan ❑ No party affiliation ❑ Rule (insert We of Date of Birth �No] r rrjVoter Registration Number the undersigned, a registered voter Party candidate for the office of di5fiict, itircuit, group, seatT ftber, if applicable) n State Zip Code m - oQ)d Signature of VoterII Date Signed (MM/DDNY) r n r 1 I I [to by gomp4ted by Voter} CANDIDATE PETITION Notes: -1411 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] - ff all requested information on this form is not completed' the form will not be valid as a Candidate Petition form. A I I,C'U' ajy6L the undersigned, a registered voter {print name as pears on your v❑ r information card in said state and county, petition to have the name of �1 Cc n placed on the Primary/General Election Ballot as a: [checklcomplete bo , s applicable] g'Nonpartisan E3No party affiliation Parry candidate for the office of (insert title of office anjI ' c de district, circuit, g up, seat num r, if ap (cable) Df Birth _or VRter Registration Number Address 25 eR O 0? �O 1 (0 W %ac 0 City Sig iS-2.045, F.A.C. J- _ - - State Zip Code V u ckq, q Date Signed (MM/DD/YY) [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, (print name as it appears on your in said state and county, petition to have the name of V ba k Co -- placed on the Primary/General Election Ballot as a: [check/complete 6 x, as applicable] 5ZNonpartisan E]No parry affiliation the undersigned, a registered voter Party candidate for the office of (insert title ol office and4clude district, cir uit, group, seat nu r, if applicable) Date of Birth or Voter Registration Number Address I 'A C? 930 city County State Zip Code T5 35 Signature of Voter F.A.C. Date Signed (MM/DD/YY) [to be ompleted by Voter] 24DS-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. I. (print name as 0 appears on yourL'r inform c in said state and county, petition to have the name of 7plac d on the Primary/General Election Ballot as a: [checWcomplete Nonpartisan F] No party affiliation Rule was applicable] the undersigned, a registered voter N Party candidate for the office of (insert title of office a c ude district, ci group, seat num r, if applicabl ) Date of Birth or Voter Registration Number Address (MM/DD1YY) b n 614 11 2135 QRS Z�ol S w S� City County State Zip Code ch I' 'lot" 55435 Signature of Voter Date Signed (MM/DDNY) [to be completed by Voter] If i 2a 2( 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. MOM the undersigned, a registered voter print name as it appears on your voter irdprination 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 a plicable] nonpartisan -]No party affiliation Party candidate for the office of M-aQ . (insert title of office and inc iu a district, circuit, Oroup, seat number, if applicable) Date of Birth or Voter Registration Number Address DDIYY) City County State Zip Code 'bWiN*� (?O\m r6ld�, 33 Y35- Signature 3s Signature of Voter F.A.C. Date Signed (MMiDDIYY) [to be completed by Voter] L—ALLLt Zo2A DS -DE 104 rEff. 091111 CANDIDATE PETITION Notes: -All ll information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to Irnowingly sign more than one petition for a candidate. [Section 104. I&S, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form_ I, "_/©S)ff Aypnu'6.v ,_z_ the undersigned, a registered voter (print name as it appears on your er information card in said state and county, petition to have the name of lc,�� placed on the Primary/General Election Ballot as a: [check/complete Irex, as applicable] dNonpartisan [:]No party affiliation M Partycandidate for the office of (insert title of office ar%Onclude district, circW group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDD/YY) City County State Zip Code Signature of Vote Date Signed (MMIDD/YY) [to be completed by Voter] // Z l�Z-J 1 -2. 45' DS -0E 104 (Eff 091111 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knenvingly 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 halne ds it appeals on your vo r information card in said state and county, petition to have the name ofASA 9no-0Co�-�-CLC� placed on the Primary/General Election Ballot as a: [check/complete b s applicable] ['Nonpartisan F] No party affiliation El Party candidate for the office of (insert title bf office group, seat Date of Birth or Voter Registration Number ddress IM713 IN 1 �� City ountyState Zi Code 1m. �� DA 3 Signatu of V er F.A.C. Date Signed (MM/DDIYy) (tbe1 pjeted by Vater] rf� DS -0E 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 completeg the form will not be valid as a Candidate Petition form L t•�,�(� _Sose L./e,rr the undersigned, a registered voter (print name as it appears on your vQIRL information card in said state and county, petition to have the name of F 1 ' i Cormc�o placed on the Primary/General Election Ballot as a: [checWcomplete box, applicable] nonpartisan F-1 No party affiliation El Party candidate for the office of (insert title of office and in de district, circuit, grobp, seat number, if applicable) Date of Birth or Voter Registration Nurnt�er rddress (MMIDD Y l t ) 1010g1 j -y q13 S w -1 9 { ISL . ty C my State Zip Code Signature of Voter Date Signed (MMIDDIYY) f [to be completed by Voted Rule 15-2.045, F.A.C. DS -0E 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 hnmvingly 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 appears on your v ter information car in said state and county, petition to have the name of r G ^, i �� -MAO placedon the Primary/General Election Ballot as a: [ehecWcomplete b , as applicable] Nonpartisan [:] No party affiliation F] Party candidate for the office of JI (insert title of office aMd include distnct, ciPit,ro seat number, if applicable) Date of Birth or Voter Registration Number Addr�efss ,, / (MM/DD/YY) I p� lL I! f S, W . 9 -7 ce, s iCounty State Zip Code 4a� ��C� I i - �3s-- Signature of Vater Date Signed (MM/DDNY) tto be mp eted by Voter] IS -2.045, F.A.C.- DS-DE 104 fEff. 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 101.185, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. 9 the undersigned, a registered voter �+ (prinf-namei as it appears o�your r information `� in said state and county, petition to have the name of aNco -� l .J k&'cfo- placed on the Primary/General Election Ballot as a: [check/complete b , as applicable] ��/onparfisan ❑ No party affiliation ❑ Party candidate for the office of (insert title of offrceland include district,+circuit, group, seat number, if applicable) Date of Birth or Voter R gistration Number Address 1 (MMfDDNY) city county statezip code lm ��33 z1 -L3 Signature of Voter Date Signed (MM1DD/YY) {toI ted b/ II'761�Ao1 CANDIDATE PETITION Notes: -All information on thisform becomes a public record upon receipt by the Supervisor of Elections. -1t is a crime to knowingly sign more than one petition far a candidate. [Section 104.185, Florida Statutes) - If all requested information on this form is not completes; the form will not be valid as a Candidate Petition form: I, 5, J ml Ca. 14 the undersigned, a registered voter (print name as it appears on yourvo information card) �� in said state and county, petition to have the name of eA1eo ) 1 ((ad t3 placed on the Primary/General Election Ballot as a: [checkleomplete box, 74s applicable] nonpartisan [—INoparty affiliation Party candidate for the office of (insert title of office and iw_kke district circuit, gfoup, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM2-2 - ► 60 J 730 5 W 2 7 City CountvState Tp code (biftl2am-__3 Lao— 331134- of 31134 of Voter Date Signed (MM/DD/YY) [to be completed by Voter] v ✓ CANDIDATE PETITION � Notes: -All information on thisform becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to Imrnvingly sign more than one petition far a candidate_ [Section 104185, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form: 1, the undersigned, a registered voter (print name as it appears on your vo 'nforrnation ca in said state and county, petition to have the name of C lei Nc% R, C'c to placed on the Primary/General Election Ballot as a: [checklcomplete as applicable] donparfisan ❑ No party affiliation ❑ Party candidate for the office of (insert title of office apdincludi Date of Birth or Voter Registration Ntunber (MNiIDDIYI() district, circuit, jroup, seat number, if applicable) unty Statezip ■d It! AM - - Mw 91 W�11 a Ir I - "-t-itum Signature Of V0 15-2.045. F C. Date Signed (MM/DDNY) [to be completed by Voter] CANDIDATE PETITION ��' 3 Notes: -All information on this form becomes a public record upon receipt by the Supenisor of Elections. t� - It is a crime to knowingly sign more than one petition for a candidate_ [Section 101.185, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. 1> � k'i M&&1K_ the undersigned, a registered voter (print name as it appears on you ter info ation card) in said state and county, petition to have the name of V AC'0% C Vora (lv placed on the Primary/General Election Ballot as a: [check(complete bc.:, as applicable] ' Nonpartisan M No party affiliation ❑ _ Party candidate for the office of <, (insert title of office an include disinct, cir group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDD1YY) _47 w, a- Lase City County State Zip Code nn1d�. Signature of Voter Data Signed (MM/DD/YY) [to be completed by Voter] >° it r - L�z 06� Rule U-2.045, PAC. DS -DE 104 (Eff. 0911 CANDIDATE PETITION 1 53 9 f( Notes: - All informatio+z this form becomes a public record upon receipt by the Supen�isor of Elections. - It is a crime to Ivzoti ` igly sign more than one petition for a candidate. [Section 104.185: i forida Statutes] - If all requested inform 'on on this form is not completed the form will not be vali�a a Candidate Petition foR 11, the undersigned, a registered voter (print name as it ars on your er information card &rr o'j C) in said stale and coon u, [, 1 county, petition to have the ame of pla on the Primary/General Election Ballot a a: [check(complete x, as applicable] Nonpartisan ❑ No party affiliation ❑ X. Party candidate for the office of (insert title of office and ' lode di".0 ct, arcuit, group, seat number, if applicable) Date of Birth or Voter Registration N bar Add (AABHMNYj City County State �p Zip Code _,;1 Signature of Voter Date Signed (NUMD1YY) C� -[to be completed by Vater] i CANDIDATE PETITION in ` Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -11 is a crime to knowingly sign more than one petition for a candidate. [Section 101.18.1, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. L ® 15;'e the undersigned, a registered voter (print name as it appears on your informs on card) in said state and county, petition to have the name of `% ` ;'N d on the Primary/General Election Ballot as a: [check/complete box, s applicable] onpartisan ❑No party affiliation Party candidate for the office of (insert title of office andim ude district, crrcuit, 4oup, seat number, applicable) Date of Birth or Voter Registration NumberAddress (MWDD ) _ City County Stale Zip Code ?OLI rn M& rr 4 Signature of Date Signed (MMIDDIYY) [to be completed by Voter] CANDIDATE PETITION 1 I LP �j 11+ O Notes: -All information on thisform becomes a public record upon receipt by the Supervisor of Elections. T11 CDL - It is a crime to kno►vingly sign more thmr one petition for a candidate. [Section 104.185, Florida Statutes] � - If all requested information on this form is not completer4 the form will not be valid as a Candidate Petition form. �- r i ct�j p U� Lz>�:c c H-c� 3 _ (print name as it appears on your voter i rm`` ation card) in said state and county, petition to have the name of 4 placed on the Primary/General Election Ballot as a: [checklcomplete box, a onpartisan ❑ No party affiliation ❑ (insert title of office the undersigned, a registered voter U1 ccl rf Ad'G _ Party candidate for the office of seat number, if applicable) Date of Birth or Voter egistrafton Dumber Address (MWDDIYY) r n q City County State I Zip Code 0 )�nr�l1alm1 F 33 V 3 Signature of Voter Rule 434", F.A.C. Date Signed (MM/DD/YY) [to be mpleted Y Voter] DS -DE 104 (Eff. 0911 CANDIDATE PETITION T j) C ago Notes: -All information on this farm 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, name as it appears the undersigned, a registered voter in said state and county, petition to have the name of �px, 1 � placed on the Primary/General Election Ballot as a: [checkas applicable] GLCJ 1c, �onpartisan F-1 No party affiliation Party candidate for the office of 1 ert title of off& and include distri , circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DDIYY) ity County State Zip Code bpn� = _E1bRVC 33( Signature of Voter Rule Date Signed (MM/DDIYY) [to be completodby 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 rint name as it appears on your Ater informatio d) in said state and county, N�tion to have the name of 1c.a =moi placed on the Primary/General Election Ballot as a: [check/complete b , s applicable] jNonpartisan ❑ No party affiliate ❑ Party candidate for the office of (insert title of office includ istrict, d1rcuit, group, seat number, if applicable) [Date of Birth or Voter Registration Num Address /DD/YY) City County f State �ip Code Signatu of Vater Date Signed (MM/DD/YY) [to be completed by Voter] Rule 15-2.045, FAL-C. DS DE 104 tEff. 091111