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Home My Public Portal AboutFiling DocsAPPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. ECK APPROPRIATE BOX(ES): Initial Filing of Form Re-filing to Change: [3 Treasurer/Deputy ❑ Depository 0 Office Party 2. N;7 of Candidate (in this order: First, Middle, Last) P 1 L�rrC/ 3. Address (i ncclluude postofficebox orstreet, city, state, zip code)Z / ! /(, HCl t"G Ue -> 4. Telephone 5. E- all a ress 6. Office sought (iJude di rict, circuit, group number) 7. If a candidate for a nonpartisan office, check if /Ocs�iV t//Q7T):r%i[ SS�O�/t?d%— applicable: My intent is to run as a Write-In candidate. 8. If a candida f a pa Isan office, check block and fill in name of party as applicable: My intent is to run as a Write-In ❑ No Party Affiliation D Party candidate. 9, 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or eput Trea rer 11. Mailing Address 12. Telephone' . City 14 my 15 tate 16. Zip Code 17. -mail address kl �Jf, Z 49.11 . 1 hay designated the following bank as my Primary Deposit rySecondarypository 19. Name of Bak 20. Address 21. City 22. n 23. St 1 24. Zip Code UNDER PENS OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF N CAMP GEASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT FACTS STATED IN IT ARE TRUE. 25. Date 26. Sig a of Ca date 27. Tea urer's Acceptance of Appointment (fill in the blanks an eck the ropriate block) ��1�11/do hereby accept the appointment (Please rent ype e) designated above as: Campaign Treasurer putyTr surer. zz�j X ate S gnature of Canpaipeasure,r eputy Treasurer DS -DE 9 (Rev. 10/10) Rule iS-2.0001, F.A.C. FORM 1 STATEMENT OF 2016 "ease print or type your man, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agency name, and position below: :, LAST AME —FIRST NAGE — MIDDL AMnll MAILADDRESS AU r AYe ZIP: COUNTY: `OFA�UNOYY: NAM NAME OF OFFIC R P.7 nO CD OUGHT: You are not limited to the space on the lines on this form. Attach additional sheets, If necessary. CHECK ONLY IF ❑ CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED *kkk DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR QN A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER ( st check ane): DECEMBER 31, 2016 QE ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:__ 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 ASED ON PERCENTAGE VALUES (see Instructions for further details). CHECK THE ONE YOU ARE USING (must check one): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS ,_R 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 "n1a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY 6� / All PART 8 -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See Inslructions] (If you have nothing to report, write "none" or "Na") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE 1 'ti PART C — REAL PROPERTY (Land, buildings owned by the reporting person - See instructions) (If you have nothing to report, write "none" or "nla") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS an who must file this form and how to fill it out begin on page 3. ICantinued an ravens side) inmryamted by nranrce n Rule ]eA 20]It 1 , FAC I PAGE I PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none' or ••nla") TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE,PROPERTY RELATES PART E— LIABILITIES [Major debts -See instructions] (If you have nothing to report, write "none" or "nla") NAME OF CREDITOR ADDRESS OF CREDITOR 12 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/e•) ENTITY # 1 19911111IN 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 I PART G—TRAINING I For elected municipal cars required to complete annual ethics training pursuant to section 112.3142, F.S. I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. I IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature- Date Signed: W/— e� WHAT TO FILE: After completing all parts of this form, Including sianina and datino it send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, write "none" or "We" in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer Is not required to fife with the Commission or Supervisor of Elections. Facsimiles will not be accented eon -e2=11.FAL WHERE TO FILE: 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. CPAIAttorney Signature: Date Signed: 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. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not pemmanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address. 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see page 3 of instructions. WHEN TO FILE: Initially, each local ofiicerlemployee, state officer, and specified stale 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 1F) within 60 days of leaving office or employment. Filing a CE Forth 1F (Final Statement of Financial Interests) does 041 relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2016, TOWN OF GULF STREAM, FLORIDA ELECTION -MARCH 14, 2017 NOTICE TO CANDIDATES The Logic and Accuracy (L&A) Test of the tabulating equipment that will be used to tabulate the ballots will be held at 10:00 A.M. on Friday, March 3, 2017 at the Supervisor of Elections Facility at 7835 Central Industrial Drive, Riviera Beach, Florida 33404. - - - - - - - - - - - - - - - - - - - - If you plan to have a poll watcher/s, the name/s must be turned in to the Gulf Stream Town Clerk's Office, 100 Sea Road, Gulf Stream, Florida 33483 no later than Tuesday, February 28, 2017 at 12:00 Noon. The deadline for receiving campaign contributions is midnight March 9, 2017. 1 This is to acknowledge that I have received a copy of this NOTICE TO CANDIDATES. Date 0 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Sec n 99.021, Florida Stalut �, au dim (PLEASE PRINT NAME AS YOU WISH IT Th APPEAR t^E BALLOT' — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) 1 am a candidate for the nonpartisan office of /)7n , (�o e%) (district#) I am a qualified elector of / L�/ �� L� 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. (s6�7 i2_YZl .<9�S�a Telephone NumberSignet f Can ate Email Address Addres City Stat& ZIP Code- o eCandidate's Candidate'sFlorida Voter Registration Number (located on your voter information card): //-!Z// Z// 7rj ' Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): 4 r C— i h F STATE OF FLORIDAf` n�1 COUNTY OF!" 1_14 V eIC.k Sworn to (or affirmed) and subscribed before me this Tih day of / eA . 20 17 n Personally Known: X_ or ature of Notary Public Produced Identification: MITA L. TAYLOR P , Type, or Stamp Commissioned Name of Notary Public ~l�al y Notary Public - State cl Florida Type of Identification Produced: w<� My Comm, Expires Mar 10, 2018 9915 DS -DE 25 (Rev. 5111) Rule iS-2.0001, F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, /✓ah, candidate for the office of OFFICE USE ONLY have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. x / ''!il � Signature of Candi a bate 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). TOWN OF GULF STREAM 100 SEA ROAD GULF STREAM, FLORIDA 33483 cm, I om o a s m m z z 9 m m o i m I n I 000 y ammo = n o oo°mm 0 m y 9K z m I T v i I I i J � I Palm Beach County SUSAN BUCHER Supervisor of Elections cl�prr"v1Qnn r. :!.FtrT10; 2017 J,A;'d 12 AM 9: 45 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 3341 6 TELEPHONE: [561) 656-6200 FAX NUMBER: (561) B5B-6267 WEBSITE: wwvv.pbcelections.org PETITION SUBMITTANCE FORM NAME OF PETITION OR COMMITTEE: OFFICE TITLE, DISTRICT, GROUP, SEAT NUMBER (IF APPLICABLE) NUMBER OF PETITIONS SUBMITTED: ADDRESS: TELEPHONE: NAME OF PERSON SUBMITTING PETITION: SIGNATURE: DATE: Staff Initials: fz(_ OSMAREVVAWF0 WVhim Su Porn REVD 01 2012 dm � A. - ° w YL CO to (MIF 3' o r' -e ►— I a (STREET) Gvf� 0 ?—k n 3W-) (CITY/ZIP) 5v 2-76- !W 9E OF FSO AL OF PA Palm Beach County SUSAN BUCHER Supervisor of Elections CERTIFICATION 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22305 WEST PALM BEACH, FL 33416 TELEPHONE: (5B13 BS6-6200 FAX NUMBER: C5131) B56-B2B7 WEBSITE: www.pbcelections.org I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 5 signatures on the Petition for the office of Town Commissioner, of PAUL A LYONS JR, are registered electors in the Town of Gulf Stream, according to the registration records on file in this office. This is to further certify that PAUL A LYONS JR is a registered voter in Precinct 4072, in the Town of Gulf Stream, Florida. Signed, this the 12th, day of January, 2017. SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY (SEAL) CANDIDATE PETITION v Notes: -All it fornnation on this join 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] - ]fall requested information on this form is not completed, the form will not be valid as a Candidate Petition form. name as it appears on your in said state and county, petition to have the name of the Primary/General Election Ballot as a: [check/complete box, as ®No party affiliation ❑ the undersigned, a registered voter zi�� Party candidate for the office of Date of Birth or /Voter Registration Number Adddrgssss `p ^ / jlll CiG zj��r �� Coun "Alwt !/ State Zip Code Signature of Voter Date Signed (MMIDDIYY) [to be Go plate by Voter] G CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor ofElections. - It is a crime to knowing(}, sign more than one petition for a candidate. [Section 104.185, Florida Stables] - Ifall requested information on this jorm is not completed, the Joan will not be valid as a Candidate Pelition jarm. (print name as it appears on your voter infotyfay titin card in said slate and county, petition to have the name of 10 L( placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Eponpartisan ❑ No party affiliation ❑ (insert title of office and include district, circuit, group, seat Date of Birth or Voter Registration Number Address [I�foo , % 535 "W Sign@ of V ,. , ,,.. the undersigned, a registered voter Party candidate for the office of if County S e Zip Code Date S�ignpd (MM/D ,m e[forj 0C 2-6 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supei- ism- of Elections. - It is a crime to knowing!}, sign more than one petition for a candidate. [Section 104.185, Florida Si, tutesj - 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 i[ appears on your voter inf tion c in said state and county, petition to have the name of placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of pnben ufro of Unice ana mcivae aisinct, circuit, group, Seat nu er, if liGa, Or —_ Date of Birth or Voter Registration Number Address (MOM/ D - 35�5� cul FST�Rm 12ot�p i;a7kv1 n State/ V Zip Code Voter Date Signed (MM/DD/YY) [to be c mplet d by Voter] JLl 3 17 DS -0E 104 (EH. 0911 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 knofvinglr sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - Ijall requested information on this jornf is not completed, the form will not be valid as a Candidate Petition fornf. (print name as it appearh on you voter in said stale and county, petition to have the name of /✓azz placed oil the Primary/General Election Ballot as a: [checWcomplete box, as applicable] �f No rtisan ,o party affiliation ❑ — the undersigned, a registered voter Party candidate for the office of (insert title of office and include district, circuit, group, seat nurp er, if ap able) - X— - Date of Birth or pVoter Re istration Number _ Address[✓! (/�7 (MM/DD/YY) V/c)7 0 ��117 3JvD C—bLFs/"'�'f''[ I IrJ City n U 1 � VCopunty State Zip Signature of VotDate Signed (MMIDDIYY) [to be completgd by Voted /? 1 CANDIDATE PETITION vp< Notes: -All information on this fawn becomes a public record upon receipt by the Supervisor of Elections. -!t is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -!fall requested information on this jorm is not completed, the john will not be valid as a Candidate Petition form. t, sthe undersigned, a registered voter CHuy�E2 bt2T/SS erten,/ n g g (print name as it appears a your voter 4lez, �d) // in said state and county, petition to have the name of /�11_ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] partisan ❑ No party affiliation [s -P1441.1 arty candidate for the office of ��rr �"U�orGGdy1� lam' q (insert title of office and include district, circuit, group, sea umb appli le) Date of Birth or Voter Registration Number Address d (MM/DD/YY) 3.x60 CIIALPSTMG FH iZo, ru r.F S7rc{A-t'1 07 t7/l�i�� FL 33VS3 City ! County State Zip Code C ULF STRX*" Rkm aclu + Signature of Voter Date Signed (MM/DDrM [to be completed by Voted 0//03/2.0/7 CANDIDATE PETITION Notes: -All information on this fain 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 104.185, Florida Statutes] -1jall requested information on thisforrn is not completed, the john will not be valid as a Candidate Petition form. name as it apoeaz on in said state and county, petition to have the name of /yC{ / placed on the Primary/General Election Ballot as a: [checklcomplete box, as Nonpartisan ❑ No party affiliation ❑ (insert title of office and include district, circuit, group, Date of Birth or Voter Registration Number Address (MMIDDIYY) s IIj-9 r ysfl City XtM_"6:?_ State IG411t)otam LIT r -L K Slgnatof oter _0 Lib - j��740 VI� r r1 the undersigned, a registered voter J Party candidate for the office of Zip Code Da . ned (MMIDDIYY) o be completed by Voter] 771 Q Cf) Q r{ oJ 01 Q N Z � C` 1 i �c 'm ¢ Y >�h = U y W zo wQ Q U m Ox O 2000 Q KT OOO W uZ W �o 0 1,g( SS m ¢ a 2 or, sews v01HO-13 ' WE'dis 3"Flo avow v3s OOH wv3-lls lino :jo Nmoi.