Filing Papers THE CITY OF BOYNTON BEACH
2022 CANDIDATE NOTICE OF INTENT TO RUN
7/Candidate's Name: r Aey [✓District 2 _District 4
Appointment of Campaign Treasurer and Designation of Campaign
Depository for Candidates (DS-DE 9) t E D
— Ensure Candidate signs Block 26
Ensure Campaign Treasurer or Deputy Treasurer signs acceptance .; A
Ensure form is completely filled out 2 8 [ULz
Note: Only one primary and one secondary depository can be designated CITY CLERI\S OFFICE
Appointment of Campaign Treasurer and Designation of Campaign
pository 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
Statement of Candidate (DS-DE 84)
I, idoo)7.0GJ 2c , acknowledge receipt of printed copies of
the following:
• Qualifying Information
• 2022/2023 Calendar of Reporting Dates.
• Florida Election Code
• Candidate & Campai.n Treasurer Handbook
ZA)....=� _ - % 6' — Z$---"2 Z
..- �' �' Date:
Signature
Comments:
Checke . Reviewed: Date: (4900:2
APPOINTMENT OF CAMPAIGN TREASURER FILED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES LA 28 2522
(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: ❑ 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
2d0OJPROLA-) i gbirs /74 y code) 27 /VW 7�
4. Telephone 5. E-mail address
( p) VA/r0/1/ R.-z 331 r,/;
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
C047/1'1-r531r0/c/ ' ]2Z3 Z L f 2 ❑ 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 a No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my 101 Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
2,<)00_01-60 LA) Lc-2 17111 V
11. Mailing Address 12. Telephone
92 /VA) _�- c/b' ( i ) ->io - 70 9s
13. City 14. County 15. State 16. Zip Code 17. E-mail address
,3o y/[o JI ' 174)2m i9 // L 33 93 S 42oo22.ift)J//-2)/ i ts/V.Con1
18. I have designated the following bank as my a Primary Depository E Secondary Depository
19. Name of Bank 20. Address
.1A7 C << 500 C. -.5:-c S,s A-vt-
21. City 22. County 23. State 24. Zip Code
.3
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 Candidate
X /
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the_appfo. • ock)
)) , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
Date Signature of C mpaign Treasu - • •eputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE FILED
(Section 106.023, F.S.) LA 2 8 2u22
(Please print or type) CITY CLERKS OFFICE
1, L)ooJ C7.) LE/4). - Ay
candidate for the office of ('oP)yv1.TSS._rOA .7\7 -D- ".STUC 7 7 •
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
Signature • 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)
CITY OF BOYNTON BEACH
CANDIDATE QUALIFYING CHECKLIST
Candidate's name: ro&) 1--\Oui
City Co 'ssioner: District 2 District 4
Qualifying Information
TrRe 'dency Requirements Statement
Article I
Appointmen ofcampaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9). l¢,\ 'a. fap2'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
Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates
(DS-DE 9).
_ Candidate 'gna re 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
St ement of Candidate (DS-DE 84). `a-t\
Oath of Candidate (DS-DE 302NP). (Accepted at time of qualifying)
Note: the Candidate prints name as they wish it to appear on the official ballot
UrSt ement 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
ACOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
Election Assessment Fee for City Commissioner= $223.69 (1% of salary-Commissioner salary=
Election
$22,369) (Check made out to City of Boynton Beach). (Accepted at time of qualifying)
CHECK MUST BE FROM CAMPAIGN ACCOUNT (EXAMPLE: JOHN DOE CAMPAIGN
ACCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER).
_Petition Handbook
tfwenty-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
lia
FORM 1 STATEMENT OF 2021
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LAS NAME--FIRST NAME-MIDDLE NAME:
/1 V 2-00etpg0 44J Z k
MAILING ADDRES
FILED
A,y,17' $cfl �' 373-3 /3512,-, 1���4c
NOV 14 2022
CIN: � P COUNTY
G� ���''' '/ �6`) CITY CLERK'S OFFICE
NAME OF AGENCY:
ce.i r�.2SS ld ,,e P_t5TPz cT 2- `�:Ola Pm
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
CHECK ONLY IF,CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
�,���,�```���"`"''''111111
t
**** 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 check one):
COMPARATIVE (PERCENTAGE)THRESHOLDS OR g 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"nla")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
SSj) FrEp b it.
XE_`rt.a Efr T U/ - T47� iL
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"nla")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
A/14 A/4_ 2v,"' A1/9--
PART C—REAL PROPERTY (Land,buildings owned by the reporting person-See instructions] You are not limited to the space on the
l (If you have nothing to report,write"none"or"n/a") lines on this form.Attach additional
l' 142 2/2 7//G;(),. --2_4s A 06--, sheets, if necessary.
-' FILING INSTRUCTIONS for when
�Or��ljp� `7� � Rr� �j� 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 1•Effervive:January 1.2022 (Continued on reverse side) PAGE 1
Inco'poralec by reference in Rule 34.8.202(1).FAC.
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
/V/Y, /4/.///I
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
/V /4
(47 '449--
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
ADDRESS OF BUSINESS ENTITY4 ?(//1/ --
/11
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.
IX 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: I 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
j�i 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:2_L Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment.
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing address or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter,file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
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:January 1.2022. ?AGE 2
Incorporated by reference in Rule 34-9.202(1),FA.C.
CANDIDATE OATH
NONPARTISAN OFFICE FILED
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a NOV 1 4 2022
write-in candidate: CITY CLERK'S OFFICE
_ Write-in candidate
3 �ao-Prn OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a),Florida Statutes)
I, , f),:f,op e 2, f/vy ,
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box (see page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of �wj y, -SSx�,s1L, 2 ,
(Office) (District#)
I am a qualified elector of �� ,23&'--)4C/1/ 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):
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.]
17 :, — ,e,a f/ y
X A9,/,3,--,e,-, (5_I) .316 •—7o 3Toc,p 204p,gm.. 26M
Signature of Candidate Telephone Number Email Address
27/�GdS rifh veil- Af)/v7iv' X ./4/7
FL 33
ddress City State IP Code
STATE OF FLORIDA ,•is
0
'—
Signat 1.1•4' Notary Public
COUNTY OF� W1-------- 2,9,O) P$. • Ya Commissions ame of Notary Public below:
Sworn to(or affirmed)and subscribed before me by means of a �N••ePR 2
online notarict-thzation — .` QJ l ..
❑ ( OR physical presence - ;
this 1 day of J [ kY ibel' 20z*• ttk\s_k- 961 -•o
y':Loaf Bonee.,„..T•,4��
Type ofPersonldentifi ation Prod lly Known ORd Produced Identification ❑ / /ItYo...gt\\\o\\\��
///111111111111
DS-DE 302NP (Rev.08/2021) Rule 1S-2.0001, F.A.C.
RESIDENCY REQUIREMENTS
FILED
NOV 14 2022
CITY CLERK'S OFFICE
I,
/Ze,,x0, , candidate for
(Print Name)
tom -s� ���� �Tr����-� 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.
I,
eiAld
(Signature of Candidate)
/ „ �dz�
(Date
A
V
CITY OF BOYNTON BEACH
REPRINT
*** CUSTOMER RECEIPT ***
Oper: BYB2VLJ Type: OC Drawer: 1
Date: 11/15/22 01 Receipt no: 66491
Description Quantity
99 MISCELLANEOUS Amount
Trans number: 1.00 $4.20
G/L account number: 9891839
00100003691000
W00DROW HAY
CERTIFICATION OF ELECTION
PETITIONS
Tender detail
CA CASH
Total tendered $5.00
Total payment $5.00
Change $4.20
$.80
Trans date: 11/14/22 Time: 15:10:39
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYYNTON BEACH
V BEACH
CITY OFST BOY RE Drawer: 1
** CUSTOMER RECEIPT ***
Type: OC g7: 1
Date: 11/15/22 U1 Receipt no:
Date: 576
Amount
uantity
Description MISOCELLANEOUS
1.00 $25.00
Trans number: 9893014
G/L account number:
00100003691000
WOODROW HAY
CITY FILING FEE TO RUN
DISTRICTIIIIONER
1 $25.00
Total
Tender detail $25.00
CK CHECK
Total payment $25.00
Trans date: 11/15/22
Time: 9:39:45
THANK YOU FOR YOUR PROMPT PAYMENT
CITY OF BOYNTON BEACH
ptN
�y gE ***
V OF 80'0041 6 POC Dr aW 6�5Z6
*1*T IC31 .V Re e:�Pt no:iti Amount
Op r.' gyg�5J22 O1
Date, OUant NEtjOS 9ag3 t
99
Description MISCF.�C 00
99 tuber:number:
GIS-
account
�3691000
W0�OW HAV
C
aNI
`ESV,O0N SLE
DI1R1A 1.1
lender detail
2 X2
23'6
9
� taltendered $2g9
'oka\ Payment $
23
9
Srans date:
11151 Lo lime: g82
UFR y PRMPPp0MENI
C1jl OF 6006 WO