Filing Papers THE CITY OF BOYNTON BEACH
2022 CANDIDATE NOTICE OF INTENT TO RUN
/Candidate's Name: lr1 L e_12rf�-tI 0 District 2 /District 4
J
Appointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9)
Ensure Candidate signs Block 26
_ Ensure Campaign Treasurer or Deputy Treasurer signs acceptance
_ Ensure form is completely filled out
Note: Only one primary and one secondary depository can be designated
[Appointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9)
_ Ensure Candidate signs Block 26
Ensure Campaign Treasurer or Deputy Treasurer signs acceptance
—
Ensure form is completely filled out
Note: Only one primary and one secondary depository can be designated
Eatement of Candidate (DS-DE 84)
;� f
I, /a✓Iny 1. ft/✓C// , acknowledge receipt of printed copies of
the followifig:
• Qualifying Information
• 2022/2023 Calendar of Reporting Dates.
• Florida Election Code
• Candidate & Campaign Treasurer Handbook
c._ Date: 6- 3. -7od-a
Signature
Comments:
Checked 4), ReviewedDA Date: (9 I ,,915
FILED
.IL:J 2_ 2'622
CITY CLERK'S OFFICE
OFFICE USE ONLY
STATEMENT OF
CANDIDATE FILED
(Section 106.023, F.S.) JU:'l 2 2622
(Please print or type) CITY CLERK'S OFFICE
2a, ny
candidate for the office of (' y �m�, �a�ry✓, �i5�2/cr ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X 6-23 -.P07 )
gnature 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)
APPOINTMENT OF CAMPAIGN TREASURER FILED
AND DESIGNATION OF CAMPAIGN JUL 1 2022
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITY CLERK'S 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: 0 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)
°' ' 1 e& %'vfe l l f4// /r'ov dT
4. Telephon 5. E-mail address
&cIi A_ 33tl34,
( 9 (1 ) 7413 is 25 Aysi‘ediargi4;i74-7,1
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
/�
1=1 My intent is to run as a Write-In candidate.
e/Ty tome,s5/o"P(/ D/37/2(67- y
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 Er No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deput Treasurer
c _47 o>7 P ve 12
11. IVIailing Addtess
Telephone
t y 0-1 eiMOCi i C CT (qcL( ) `7v3 eS7S
13. City 14. County 15. State 16. Zip Code 17. E-mail address
('�Pa PfrstAAA &/ (J. /7-41= 33 ,13 i-CQ r��,I�Yo'/7 ��t9,/, c d
18. I have designated the following bank as my [Primary Depository 12 Secondary Depository
19. Name of Bank 20. Address
1,/ r/) /d/ (280 N, (a1,2Zsce s s
21. City 22. County 23. State 24. Zip Code
2091770A-) 8eGie4 1 Lfr21 ,Ge4C1i It 33413 w
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
/V 2az2 XJ)�� � � Al,/
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
DOki/ir bee 1,tzieT4.4_ . do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
/4/ <,J4 2o22- x_
Date Signature o ampaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER FILED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES iL• 2 2622
(Section 106.021(1), F.S.) CITY CLERK'S 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):
Ir 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
annt/ Lee 7/'e1 code)
4N14 RootidW e et
4. Telephone 5. E-mail addressetzt-k FL 33 43c,
(9s`l ) 7q) ?S2S ()only (15y pots 1uv. e n1
6. Office sought (include district, circuit, group umber) 7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write-In candidate.
e i IL( ( myth ss,ow r' I STz cr
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 Fi No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer r----4/ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
]4 v i j 1 et lei re l l
11. Mailing Address 12. Telephone
(4L1 C e twd ' 6 te, e (fig ) 7f3 2(
13. City DD -- 14. County 15. State 16. Zip Code 17. E-mail address
T o4in-DN ? oiic�1 P4/PKkr/t 1=L 33ti Amih74/C//tiv,eS4h
18. I have designated the following bank as my 7 Primary Depository lirtecondary Depository
19. Name of Bank 20. Address
N/it 5 e S SSlrr l?SS A/
21. City 22. County 23. Slate 24. Zip Code
c A4)04/ / c1'- f�L— 3_:?q—?6
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
ep X , LiArla
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, -341th/U I I(//c / J , do hereby accept the appointment
/ (Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Er Deputy Treasurer.
3 - �o a X
Date Signature Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER FILED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2 LULL
(Section 106.021(1), F.S.)
CITY CLERK'S OFFICE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
b?HECK APPROPRIATE BOX(ES):
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
�
cod
y
code)
QOUNct Tv►bie. e-T a>7/� ��� �� lie I l
4. Telephone 5. E-mail address
F(, 33436
(954 Jy3 8575 � �A�n,^ons 13eaclti
ac(rn� eite1\cm (jahoi,cool
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
t ❑ My intent is to run as a Write-In candidate.
C l T d//1/r�/s5� � A 57- )/r T f
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 Ei No Party Affiliation [J Party candidate.
9. I have appointed the following person to act as my El Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
eh15/0pAer A J. s
11. Mailing Address 12. Telephone
LILilq RD %able e_r ((%s, ) 303 '7 501
13. City 14. County 15. State 16. Zip Code 17. E-mail address
8ouvp-TDAU i3eact3'«clt 1-(, 3.3i11,4)r for) 1.53 ao/, lQrn
18. I have designated the following bank as my 121" Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
()//4 555 Al. v2$/1s 5- 4v
21. City
22. County 23. State 24. Zip Code
ch PAl.iv 6e4 t h. F'L 33 y d 6
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
6 a.3- aoaa X r'/Donny .Y 'U
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
P-fe17 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: d Campaign Treasurer ❑ Deputy Treasurer.
Alhatilai
Date Signa ure of Campai..if reasur'or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
FILED
WAIVER OF REPORT
(Section 106.07(7), F.S.) CITY OFFICE
(PLEASE TYPE)
OFFICE USE ONLY
Y ,.
,7` r o T
Name Office Sought
�f�l Ro o�dati(� Cif" N 3. f%3�
Address City State Zip Code
Candidate ❑ Political Committee ❑ Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a
waiver)that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.).
❑ Check here if address has changed since last report. ❑ Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT(Check Appropriate Box and Complete Applicable Line beneath Box)
4MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION ❑ OTHER REPORT TYPE
Indicate report# Indicate report# Indicate report# Indicate report type and#
M 00 P G
as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
THROUGH b- 0P 6
r
l --- 0-)-a/
Signature Date
X I'J
nature Date
�I
, i.
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman(s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account(no funds expended or
received)the filing of the required report is waived. However,the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS-DE 87(Rev.06115)
CITY OF BOYNTON BEACH
CANDIDATE QUALIFYING CHECKLIST
Candidate's namen (.en
_
City Commissioner: _ District 2 istrict 4
Noi.8 .22 2:59PM
El/Qualifying Information
R idency Requirements Statement
Article I ciTY CLERK
BOYNTON BEACH
Appointment o Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). (Q j3 d P--
Candidate signature on Block 26
Campaign Treasurer signature on Block 27
Form is completely filled out
ote: Only one primary and one secondary depository can be designated
Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). \Q ia* a-
Candidate signature on Block 26
Campaign Treasurer signature on Block 27
Form is completely filled out
Note: Only one primary and one secondary depository can be designated
'atement of Candidate (DS-DE 84). V2 ta3100aA
O th of Candidate (DS-DE 302NP). (Accepted at time of qualifying)
ote: the Candidate prints name as they wish it to appear on the official ballot
Statement of Financial Interest Form 1 (CE Form 1). (Accepted at time of qualifying)
Form is completely filled out
Filing Fee for City Commissioner= $25.00 (Accepted at time of qualifying)
CHECK MUST BE FROM CAMPAIGN ACCOUNT(EXAMPLE: JOHN DOE CAMPAIGN
COUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
lection Assessment Fee for City Commissioner= $223.69 (1% of salary-Commissioner salary=
$22,369) (Check made out to City of Boynton Beach). (Accepted at time of qualifying)
HECK MUST BE FROM CAMPAIGN ACCOUNT(EXAMPLE: JOHN DOE CAMPAIGN
/ACCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
Petit'on Handbook
fFwenty-five (25) signed petitions that have been certified by the Palm Beach County
Supervisor of Elections a, a cost of 10¢ per name. (As of 2021, Candidates are
required to submit petitions to the City Clerk who will in turn will have them certified
by the PBC Supervisor of Elections. Please submit petitions no later than November
15`1'to help ensure they are certified prior to the end of qualifying.)
Resign to Run
Resign
(Candidate must resign in writing from elective or appointive office no less than ten (10) days prior to
the first day of qualifying) (F.S. 99.012)
I, 2 / i - r - , acknowledge receipt of printed copies of the following:
a lorida Election Code
FA 123 Election Calendar
I a,didate & Campaign Treasurer Handbook
Ij 5 esignation of Poll Watchers
Ij Copy of Treasurer's Report Documents
a 'lection Code for the City of Boynton Beach
1 ode of Ethics for Palm Beach County
5/ Sunshine Amendment and Code of Ethics for Florida
N ity Map
I 'recinct List for Boynton Beach as of 11-07-2022
I Candidate Workshop by SOE-TBD
I Notice of Logic & Accuracy Test for Election and Run-Off Election- TBD
Comments
Candidate's Signature: .,pp,/,p141 Date: //t13 zo ZZ
Checked: Reviewe Date: // Y Baa
RESIDENCY REQUIREMENTS
C I TY CLERK
BOYNTCON BEACH
I, / , , , % / candidate for
(Print ame)
Chinni sc,t,i 1)1<Trz < <r j of the City
(Mayor/Commissioner— District #)
of Boynton Beach, have received, read and
understand the residency requirements of Article I of
the Charter of the City of Boynton Beach.
/Gvr c
(Signature a Candidate)
,OZ-20zz
(Date)
CANDIDATE OATH
NONPARTISAN OFFICE Nous '22 2:5.7:
(Do not use this form if a Judicial or School Board Candidate) CITY CLERK
Check box only if you are seeking to qualify as a
write-in candidate: BOYNTON BEFiCH
Li Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a),Florida Statutes)
Dann (' te,RC IJ
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box n (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 6/y1 M/SS'/ OA/ee
(Office) (District#)
; I am a qualified elector of ALVA REneat 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): )1 77 tt_5 a 7.5
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.]
p 1� tC_C IA' (L E LL
x ( l ) • iY; 575 LearJSSize9 fIcrtmAtI. rti
Signature of Can date Telephone Number Email Address
404 int) d - &6k CTr� ,•���; ae/ 33513
Address City State ZIP Code
STATE OF FLORIDA I1 PI •
Signature • .tary Pu c
Print,Type,aro . •commissioned N e of Notary Public below:
COUNTY OF YYl \ \� ESS/1/i/���
Sworn to(or affirmed)and subscribed before me by means o `.\ y�.Ss..o'° pi•• %�
\1 -'441`�RY2, �RF. •,
online notarization II OR physical presence
z_•• :• wQ� i,.
this day of \iNeil()ber- ,20 �� • „>:
'` #NH°
PersonallyKnownProduced
OR ProducedIdentification (`�1 �• 'hod eo„ded`•ae •
Type of Identification Produced:�L t\Jr��/Q,rS (1t��e i��ggy•y•.....°� O``\\\�
DS-DE 302NP (Rev.08/2021) Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT OF 2021
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:
feizfe/RJa✓irk ti LeLING ADDESS
,�
)•�!=!tJ;= 'iii 2:59i:'11
661‘.4 ����✓� inl�i:�
C:1 TY CLERK
CITY: ZIP: COUNTY:
/3c N7ALA it 6eAt'h 33q Agt,6, ' 4 BOYNTi:IN BEACH
NAME 0 AGENCY
c,._/T t/ el lie A)reA) 464th
NAME OFFJOFFICE OR POSITION HELD OR SOUGHT:
L DMM/S.S/v.J Sc/i—i `/
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, 2021.
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 ch. k one):
COMPARATIVE (PERCENTAGE)THRESHOLDS OR ILF 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
)?14sS,A( r Gti it Gey' Jo 4-D L/tii U/r�Mt rL _ 4: 4 c,S
7
PART B-- SECONDARY SOURCES OF INCOME
(Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
A)/A
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 We") lines on this form.Attach additional
sheets, if necessary.
/`u/ �
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.
CE FORM I-Effective:January 1,2022 (Continued on reverse sides PAGE 1
Incorporated by reference in Rule 34-8.202(1),FAG.
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
17CA \ANGv1-2b
5;oC K .)r• yJ 'tcc'O ; I • r?
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
13!A
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,write"none"or"n/a")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY tJ/,4 /\j/4
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY (
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G—TRAINING For elected municipal officers,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.
(y/ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473,or attorney
Signature: in good standing with the Florida Bar prepared this form for you,he or
she must complete the following statement:
prepared the CE
L / Form 1 in accordance with Section 112.3145, Florida Statutes,and the
instructions to the form. Upon my reasonable knowledge and belief,the
disclosure herein is true and correct.
Date Signed:
CPA/Attorney Signature:
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment.
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing aadress or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter,file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does not relieve the filer of filing a CE Form 1
other format), send it to CEForm1@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31,2021.
for your records.Do not file by both mail and email.Choose only one
filing method. Form 6s will not be accepted via email.
CE FORM 1.Effective:.:anuary 1,2022. PAGE 2
Incorporated by reference'n Rule 34-8.202(1i.FA.C.
I
4
V
CITY OF BOYNTON BEACH
*** CUSTOMER RECEIPT **D�awer: 1
TYPe: DC 57131
Oper; BYB2VLJ 01 Receipt no:
Date: 11/09/22
Amount
tion
Descrip Quantity MISCELLANEOUS $25.00
99 1.00 9882045
Trans number:G/L account number:
00100003691000
DAN FERRELL
CITY FILINGCO MISIONER
10EE
RUN FOR
DISTRICT IV
detail 451 $25.00
Tender $25,00
CK CHECK
Total tendered
Total payment $25,00
Time: 16:51:30
Trans date: 11/08/22
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH
:TY OF BOYNTON BEACH
REPRINT
*** CUSTOMER RECEIPT ***
Oper: BYB2VLJ
Type: t Drawer: 1
Date: 11/09/22 01
Receipt no: 57132
Description Quantity
99 MISCELLANEOUS Amount
Trans number: 1.00 $223.69
G/L account number: 9882046
00100003691000
DAN FERRELL
1% ELECTION ASSESSMENT FEE
FOR COMMISIONER
DISTRICT IV
Tender detail
CK CHECK
Total tendered 452 $223.69
Total payment $223.69
Trans $223.69
date: 11/08/22 Time: 16:52:40
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH
V
CITY OF BOYNROCEBAC***
*** CUSTOMERLJ RECEIPT OC Drawer:51
Oat : 11/16/22 01 Receipt no:
Date: YY Amount
Description MISQuantit
CELLANEOUS
1.00 $2.80
8894096
Trans number:
GIL account number:
DANNOERRE
YYFLL
FEE FOR ELECTION
PETITIONS CERTIFICATION
Tender detail $3.00
$3. 0
CA CASH $2.80
Total tendered 2.80
Total payment
Change Time: 16:58:37
Trans date: 11/15/22
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH