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McCray, Mack THE CITY OF BOYNTON BEACH 2022 CANDIDATE NOTICE OF INTENT TO RUN ✓Candidate's Name: \-ncvc\i-, `crlc( TC / ✓District 2 _District 4 Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates (DS-DE 9) Ensure Candidate signs Block 26 nsure 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 _ Statement of Candidate (DS-DE 84) I, cc`C,\IN i\ c_CA-o�1 , acknowledge receipt of printed copies of the following: • Qualifying Information • 2022/2023 Calendar of Reporting Dates. • Florida Election Code • : • d': . to ampaign Treasurer Handbook 4 ,, / ______ __ Date: C` `3 �// gnature Comments: 5 • Checked: l/ Reviewed: 1Z Date: , RECEIVED }o--1.S SEP 1 S 2022 Cll'Y OCivCLERK'F BOyNTSONOFFBEP`ICECH RECEIVED ` c) .S APPOINTMENT OF CAMPAIGN TREASURER SEP 13 2022 AND DESIGNATION OF CAMPAIGN 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. C CK APPROPRIATE BOX(ES): Initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidatayie (in t is order: First, Middle, Last) 3. Address (include post office box o stree city, state. zip /Z code) / 44/ )/ 7�G�17 4. Te phone 5. E-mail addrels 77glivA) Rae/ W 3373- a() �3t icy �I���c 0 #6e, cpz, 6. Office sought (include distr(ct, circuit, group umber) . 7. If a candidate for a nonpartisan office, check if 6 I _ applicable:flAnd SS;mo 1.)-1!51( -e 0 My intent is to run as a Write-In candidate. 8. If a candidate for a artisan 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. 9. I have appointed the following person to act as my FriCampaign Treasurer ❑ Deputy Treasurer 10. NameM.Treasjarer o uty T easurer Ric" / ( 6f 11. Mailing Address 12. Telephone e , .„ ( ) 1 ity 14. ty 15. State 16. Zip Code 17. E-mail address ' ) l � ge • �" 70)ori% vm ,Viet r�r,i,', 18. I ave designated the following bank as my [E Primary Depository ❑ Secdndary Depository C-6,_ 19. Na., a-oftan 20. Address 22. u y/ te-- 1- il-/t/ , 23. State 24. Zip, odd /0 ,,, 'V zt/ /2/1, £ 53 UNDE 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 T- 25. Dat 26. S' ature of� ., • -te 4 . �� ' / /�/ /_ 27. Tre uJI/( s ice nce of Appointment (flit e blanks and check the approprife block) 1, ii: / ,ffi v/ , do hereby accept the appointment t� (Please Prinyor Type Name) designate above as: Campaign Treasurer a 9:, ty -asurer. /3 , x /I Date / ..gnatu • o Camp . Treasurer o e ty Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF RECEIVE' oS ( Or CANDIDATE SEP 13 2022 -71__5 (Section 106.023, F.S.) CITY OF BOYNTON BEACH (Please print or type) CITY CLERKS OFFICE I //fCi j( kg1 candidate for the office of 4p/)?/��j; �/ ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. — 7 : 9/ f, d g atu4 . . i idate Da e 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: Ctet V. . JO NO015 22 9:29AM City Commissioner: District 2 QDistri. 4 C:I T'Y CLERK • Qualifying Information BOYNTON BEACH _ idency Requirements Statement Article I IAppointmeof ampaign Treasurer and Designation of Campaign Depository for Candidates (DS-DE 9). 9 /3 (90?-„1, _ 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 S-DE 9). 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 Statement of Candidate (DS-DE 84). p/(43/?0,03—D- 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 (Stat1tfinent 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 /CCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER). Election 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) CHECK MUST BE FROM CAMPAIGN ACCOUNT (EXAMPLE: JOHN DOE CAMPAIGN ACCOUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER). dPetition Handbook wenty-five (25) signed petitions that have been certified by the Palm Beach County Supervisor of Elections (ii a cost of 10¢ per name. (As of 2021, Candidates are RESIDENCY REQUIREMENTS 9 3BA M CITY CLERK BOYNTON BEACH � f q II `` ti C r, , candidate for (Print Name,)( % ,SS (Print : i#44;� iI 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. (Signature of Candidate / - /5 , c 7 (Date) CANDIDATE OATH NONPARTISAN OFFICE riU'..J 1.5 .22 9:30HI't CITY CLERK (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a BO''i't'NTON BEACH write-in candidate: 1 Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a),Florida Statutes) tvfk Me1a (Print name above as you wish it to appear o the ballot. If your last name consists of two or more names but has no hyphen, check box in (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 Q/ /n, 55 )is ' 'i' (Office) (District#) ; I am a qualified elector of 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; 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): `lot/cap,�iU 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.] kici i/' (41),06- //Y.] tine(i '/1-Q 1h11 Signature of Can.'•. e Telephone Number Email Aditress 111 6 Al rGlqr 1 C 'V 1(41 Ge 3 3✓✓ S / Address ZIP Code STATE OF FLORIDA \ 004, Signat e • otary Public COUNTY OF r - Print,Typ , • p Commissioned me of Notary Public below. Sworn to(or affirmed)and subscribed before me by means o online notarization ❑ OR physical presence this fc.441 day of k)Diery r ,20101-7 Personally Known D OR Produced_Identification Type of Identification Produced:PL �l ucX�ve15 l.te'i'1 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 NAM —FIRST ME—MIDDLE N ME Cvfilida. t l l_Ii:11 rJ' pis 9:29AM MAILING ADDRES : 6 I /,)t /? Sr.a't CiT',� CLERK ,k' e ft)) J� n E�k!YNTON BEACH fail ri 336- r/-C.o'�CITY. ( ( ZIP: TY: ii , 7).64. NAME O A ENCY: I NAME OF OFFICE OR P SITION H D OR SOUGHT: e/0 ci UNG �S7AIC1~ . 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 eck one): i ! 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"nla") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOMEADDRESS PRINCIPAL BUSINESS ACTIVITY /t1.:x`ti++ ti kfl.t 13dO71/4)J kkJ/ rii, /Ali `f Y3311 m=et-ft/ . 30/14-464.141/9 kafihe,Ai PART B— SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (tf you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINE S E TITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE fl. 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 port,wipe"nopp"o n/a' _ lines on this form.Attach additional 'p G AA id, ifrf gl 66yl 4 be 33(13o sheets,if necessary. �a/)(,{ Al, 1 , Fl i{ FILING INSTRUCTIONS for when _ - N l Al W r /� alie. jo4 f/V 'j?qj V 3Vw and where to file this form are 'v'1 /u� GUS /0g �wt. ANA'U /Ma i L� ` w� INSTRUCTIONS olocated at the tn hotom fmust fpage ile this form and how to fill it out begin on page 3, CE FORM 1-Etleetive:January 1,2022 (Continued on reverse side) PAGE 1 Incorporated 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 I T NGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES fr PART E—LIABILITIES [Major debts-See Instructions] (If you have nothing to report,write"none"or"n/a") 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"n/a") BUSly 1NTITY#1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY /11 ADDRESS OF BUSINESS ENTITY /47 PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5%INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST /it PART G—TRAINING For elected municipal officers,appointed school superintendents,and commissioners of a community redevelopment agency created under rt III,Chapter 163 required to complete annual ethics training pursuant to section 112.3142,F.S. 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 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: 1/— /S 9-; CPA/Attorney Signature: V 44 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. PAGE 2 Incorporated by reference In Rule 34-8.202(1),FA.C. 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 15th to help ensure they are certified prior to the end of qualifying.) Resign to Run (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, , d U i ` , acknowledge receipt of printed copies of the following: 4 ' orida Election Code 5 023 Election Calendar I andidate & Campaign Treasurer Handbook 5/ 0 esignation of Poll Watchers I ' opy of Treasurer's Report Documents J . l•ction Code for the City of Boynton Beach 5 ' s de of Ethics for Palm Beach County 3 : i nshine Amendment and Code of Ethics for Florida 2 ity Map 4 Precinct 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 Signator: - ` Date: <! 115• -" ayei,x Checke Reviewed: Date: (/ /5-/Xo1d--