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Filing Papers THE CITY OF BOYNTON BEACH 2022 CANDIDATE NOTICE OF INTENT TO RUN Candidate's Name: - i- e-2 K.kA ey District 2 R6istrict 4 Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates (DS-DE 9) Ensure Candidate signs Block 26 FILED Ensure Campaign Treasurer or Deputy Treasurer signs acceptance OCT 05 2022 Ensure form is completely filled out Note: Only one primary and one secondary depository can be designated CITY CLERK'S OFFICE Vkppointment 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 Atatement of Candidate (DS-DE 84) I, Al uneL KQ , acknowledge receipt of printed copies of the following: g • Qualifying Information • 2022/2023 Calendar of Reporting Dates • Florida Election Code • Candidate & Campaign Treasurer Handbook 011�J4�1'l.P I Date: 46 l 5 Signature Comments: Checked41 2— Reviewed Date: /.2-01--. APPOINTMENT OF CAMPAIGN TREASURER FilLED AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES OCT 05 2022 (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) CITY CLERKS OFFICE NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): ❑X Initial Filing of Form Re-filing to Change: Treasurer/Deputy ❑ Depository l I Office U Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Aimee Kelleycode) 6901 Okeechobee Blvd., Suite D5-L92, West Palm 4. Telephone 5. E-mail address Beach, FL 33411 ( 561 ) 689-9787 VoteAimeeKelley@gmail.com 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Boynton Beach City Commisson, District 4 applicable: 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 I I Write-In ® No Party Affiliation Party candidate. 9. I have appointed the following person to act as my X Campaign Treasurer fl Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Kim LeeBove 11. Mailing Address 12. Telephone 9200 Belvedere Road, Ste. 202 ( 561 ) 689-9787 13. City 14. County 15. State 16. Zip Code 17. E-mail address West Palm Beach Palm Beach FL 33411 Kim.leebove@gmail.com 18. I have designated the following bank as my ❑X Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Wells Fargo 200 North Congress Ave 21. City 22. County 23. State 24. Zip Code Boynton Beach Palm Beach FL 33426 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. Si ture of Candid_ e Oe,160,ei 5 , P x WThtt • . Q, 27. Treasurer's Acceptance of Appointment (fill in the blanks and eck the apl o•riate block) Kim LeeBove , do hereby accept the appointment (Please Print or Type Name) designated above as: IXI Campaign Treasurer. 11 Deputy Treasurer. (0 6 / (3` X I I Date Signature of Campaign Treasurer or Deputy Treasurer 9P Y DS-DE 9 (Rev. 10/10) Rule 15-2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER F L E D AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES OCT 05 2022 (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): ❑X Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy H Depository n Office H Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Aimee Kelleycode) 6901 Okeechobee Blvd., Suite D5-L92, West Palm 4. Telephone 5. E-mail address Beach, FL 33411 ( 561 ) 689-9787 VoteAimeeKelley@gmail.com 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Boynton Beach City Commission, District 4 applicable: �I 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 n Write-In E No Party Affiliation I I Party candidate. 9. I have appointed the following person to act as my I I Campaign Treasurer IX Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Aimee Kelley 11. Mailing Address 12. Telephone 6901 Okeechobee Blvd., Suite D5-L92 ( 561 ) 689-9787 13. City 14. County 15. State 16. Zip Code 17. E-mail address West Palm Beach Palm Beach FL 33411 VoteAimeeKelley@gmail.com 18. I have designated the following bank as my 0 Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Wells Fargo 200 North Congress Ave 21. City 22. County 23. State 24. Zip Code Boynton Beach Palm Beach FL 33426 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. Stature of Cand' ate 27. Treasurer's Acceptance of Appointment (fill in the blanks and heck the opriate block) Aimee Kelley , do hereby accept the appointment (Please Print or Type Name) designated above as: n Campaign Treasurer ® Deputy Treasurer. 1 Lute Signature of C:mpaign Trus rer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF FILED CANDIDATE (Section 106.023, F.S.) OCT 05 2022 (Please print or type) CITY CLERK'S OFFICE 1, Aimee Kelley candidate for the office of Boynton Beach City Commission, District 4 have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X . , ,l , Qtu- S Signa ure of Ca •idate 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 nn .. " � Candidate's name: 'T'T�'r'^r - �t - City Commissioner: 0 District 2 ` rift 4 Qualifying Information dRidency Requirements Statement Article I ilis Appointmentif C mpaign Treasurer and Designation of Campaign Depository for Candidates (DS_DE 9). J0cla0a-v2 _ Candidate signature on Block 26 _ Campaign Treasurer signature on Block 27 _ Form is completely filled out N ote: Only one primary and one secondary depository can be designated Appointmentf C mpaign Treasurer and Designation of Campaign Depository for Candidates (DS-DE 9). /D75�010 cA,2 — 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 12Itatement of Candidate (DS-DE 84). /0/09-02'1' 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 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 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 COUNT), AND SIGNED BY TREASURER/DEPUTY TREASURER). Petit' n Handbook fFwenty-five (25) signed petitions that have been certified by the Palm Beach County Supervisor of Elections (i1 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 (Candidate must resign in writing from elective or appointive office no less than ten (10) days prior to the first day ,�offqualifying) (F.S. 99.012) I, Ifl ?P. 1 ft , acknowledge receipt of printed copies of the following: Ij F orida Election Code 10 123 Election Calendar Cr andidate & Campaign Treasurer Handbook B D signation of Poll Watchers C Popy of Treasurer's Report Documents Cj ' ection Code for the City of Boynton Beach I 'ode of Ethics for Palm Beach County MI :unshine Amendment and Code of Ethics for Florida Cj ity Map 0i Precinct List for Boynton Beach as of 11-07-2022 I Candidate Workshop by SOE-TBD Notice of Logic & Accuracy Test for Election and Run-Off Election- TBD Comments Candidate's Signature: Date: 1 I D Checked. Reviewed: Date: // r eP.2 RESIDENCY REQUIREMENTS I, Pomo, lei , candidate for (Print Name) J IYlm ISSI.oner -Disk-rid-1 `i- 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. Oirniu (Signatu e of Candida) (Date) CANDIDATE OATH NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) ca Check box only if you are seeking to qualify as a write-in candidate: Write-in candidate _ OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Aimee Kelley (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 Boynton Beach City Commissioner , 4 (Office) (District#) ; I am a qualified elector of Palm Beach 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): 112477841 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.] a-MEE kel-EE X . L 0P / (561) 309-8714 aimeek223@gmail.com Signature of Candi.:te Telephone Number Email Address 6901 Okeechobee Blvd, Suite D5-L92 West Palm Beach FL 33411 Address City State 1 ZIP Code STATE OF FLORIDA S �' Signatu a o' NSR is COUNTY OF Palm Beach Print,Typ o•St. qicarnj . /Name of Notary Public below: •gNsSION� •• Sworn to(or affirmed)and subscribed before me by means o = ,•• ��� 2,,,,;PV• s online notarization 11 OR physical presence = :z 4�� ' this Q day of KiDarn�'- , 20 ;* • Z arKo• t�7 02,'.�.4e,Panded^dc kr'c".••�O•�\� • Personally Known OR Produced Identification ��i, /•V lc. jg`' \\ Type of Identification Produced: Ifs ty 11'S L ICkn iittt�ttt� 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: Kelley Aimee Nicole MAILING ADDRESS: 6901 Okeechobee Blvd., Suite D5-L92 CITY: ZIP: COUNTY: West Palm Beach 33411 Palm Beach NAME OF AGENCY: City of Boynton Beach NAME OF OFFICE OR POSITION HELD OR SOUGHT: City Commissioner 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 check one): ElCOMPARATIVE(PERCENTAGE)THRESHOLDS OR n 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 Steinger, Greene& Feiner 1645 Palm Beach Lakes Blvd, WPB 33401 Law Firm 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 N/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"n/a") lines on this form.Attach additional N/A 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. • CE FORM 1-Effective:January 1,2022 (Continued on revere*side) PAGE 1 Incorporated by reference in Rule 34.8.202(1),FA.C. 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 N/A a _4 PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR Mercedes Benz Financial P.O Box 685, Roanoke,TX. 76262 Freedom Mortgage 951 Yamato Road, Boca Raton, FL 33431 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 N/A 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. © 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 nshe must complete the following statement: , prepared the CE v.il lM _au r / 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: ` J( 9'° C2-79- � I CPA/Attorney Signature: \J��\ I (J)' 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 pp/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).F.A.C.