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HomeMy Public PortalAboutFiling 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. CHECK APPROPRIATE BOX(ES): 9 Initial Filing of Form Re -filing to Change: C] 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 SUc,de) ht b 1 U �`ij(��1' I uC 1.� a . q qL)t= Aj L I 33Y $3 4. Telephone - C r 1-( 5. E-mail address CU ) !;)3- M \ SnAm 1oS`t }lrooCol� 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: 01,1JW o`M -s uc E] My intent is to run as a Write -In candidate. 8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a E] Write -In ❑ No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer *(\\o (XL - 11. Mailing Address 12. Telephone 5m 'aVoo- Go'vv\ (50 ) Sl?r-sSfl 13. City 14. County 15. State fL 1 16. Zip Cade -9'3`I5 17. E-mail address -Ymni Ct\f 5 �( ?4\VA /ovi 6 Lip4r(ot, 18. 1 have designated the following bank as my Lel Primary Depository Secondary Depository 19. Name of Bank 20. Address I' 21. City22. �z County �� 23. State 24. Zip Code 1 vi rn L. 33 UNDER PENALTIE 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. Sig15 lure of Candidate 27. Treasurer's Acceptance of Appointment (fill in the blas and chec th appropriate block) U I, 7 01 o do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer Deputy Treasurer. 12\a'02ol S X Date Signatur Ca aign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. 7^ DEPOMED Julio Mario Martinez, CMF Oncology Sales Speclallst T 510,744 B000 N" Gateway Sutte 300 M 561.523.6881 Newark, CA 94560550 lullo.martlnez®depomed.com www.depomed.com FORM 1 STATEMENT OF 2016 Please print or type your namemailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agency name, and Paeidon below: LAST NAME — FIRST NAME — MIDDLE NAME: � � •. ,r,-� X11. � i MAILING ADDRESS : it SLA CITY: \ ZIP COUNTY j `ju)l-� <:�. IL�� IM1 NOF AGENC ,: 2QD NAM0 FIC OR POSITION HELD OR SOUGHT: 1 uwo You are not limited to the ccon the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF NDIDATE OR El NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ***� DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): DECEMBER 31, 2016 Qg ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATAREABSOLUTE 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 QR C3' 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 orn RC"i-jit-1 05LA PART B -- SECONDARY SOURCES OF INCOME b NiC—' (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 "Na") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE PART C — REAL PROPERTY (Land, buildings owned by the reporting person - See instructions) (If you have nothing to report, write "none" or "n/a") 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. D )0n.)tr 4aS /JL L, 33 InyrocnueC by reference n Rule N -e 2021 n. FA.C. ICanlinuad an revane aka) PAGE t PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, (if you have nothing to report, write "none" or BUSINESS PART E— LIABILITIES [Major debts -See instructions] (If you have nothing to report, write "none" or "rile") NAME OF CREDITOR etc. - See 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 "nla"1 BUSINESS ENTITY# 1 OF 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 required to complete annual ethics training pursuant to section 112.3142, F.S. BUSINESS ENTITY # 2 Er 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: j[ Ir I yl Date Sign d: aIa,II WHAT TO FILE: After completing all pads or this form, )ncludino sinning and dating It send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, wire "none" or "n/a" in that secdon(s). NOTE: MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer Is not required to file with the Commission or Supervisor of Elections. 20M U-8202111 FAC 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: I prepared the CE Form 1 in accordance with Section 112.3145, Flodda Statutes, and the Instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein Is true and correct. CPAIAttomey Signature: Dale Signed: WHERE TO FILE: 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 officerslemployees rile with the Supervisor of Elections of the county In which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees Me with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Road, Sugding 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 officer/employee, state officer, and specified state 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 pdor 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 Firing a CE Form 1F (Final Statement of Financial Interests) does all relieve the Mer of filing a CE Form 1 if the filer was in his or her position on December 31, 2016. © Bank Aandraf Mmt CW.Wdant lent• CREDITLINE - 00004530381766 CREDITLINE 00004530381766 Account Activity Account Details Statements & Notices Account Details for 00004530381766 Account Name/Account Descrlptlon CREDULINEt Next Payment Due Date 02/19/20171 Account Number 00004530381766t Next Payment Amount Due $0.00t Interest Rate 3.25%t Last Payment Received Date 02/02/2017t Interest Pald YTD $638.50t Last Payment Amount Received $14.701 Interest Paid Last Year $11,908.241 Current Loan Balance $169,054.731 Available Credlt $245,945.271 t t i p A,rk u +� I "I o I RoAE 7 o G- CNI";'Mq +-IMI �Ew ;tNSvj I oga3y SSS-�SI-'1000 IM Bank MuAiaY Man &..W t 4nk- CREDITLINE - 00004530381766 CREDITLINE 00004530381766 Account Activity I Account Details Statements & Notices Account Details for 00004530381766 Account Name/Account Description CREDITLINEt Next Payment Due Date 02/19/2017t Account Number 000045303817661 Next Payment Amount Due $0.00t Interest Rate 3.25%t Last Payment Received Date 02/02/20171 Interest Paid YTD $638.501 Last Payment Amount Recelved $14.70t Interest Paid Last Year $11,908.24t Current Loan Balance $169,054.73t Available Credit $245,945.27t t t 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. This is to acknowledge that I have received a copy of this NOTICE TO CANDIDATES. Date OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) , candidate for the office of -Tow.#) C0 Np1IS5/0,ytA . rrU J have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. x w 7 Signature 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 (05/111 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Fladda Statutes) (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT' — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of —TOW W COMM I s51oA*7t.- (oHice) (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; 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 Stale of Florida. X \� (SU) Sx3-W21 J mrl1PInSS U tOr7 ignature-of Candidate Telephone Number Email Address fur qu st)41l c7Jf g�krrkl rL 3x3,6 Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): � D 1 ' Please print name phonetically on the line below as you wish it t0 be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): 1 iJ _. Uv '• b aif.'1 My — 'L STATE OF FLORIDA COUNTY OF' - �-e L� �i LL Sworn to (or affirmed) and subscribed before me this 3 J day of /�<: P , 20I IJ i / Personally Known: or ; ature of Notary Public Produced Identification: RITA L. TAYLOR Pri Type, or Stamp Commissioned Name of Notary Public •' otary Public - State of Florida M �, ,,• y Comm. Expires Mar 10, Type of Identification Produced: COm 2018 FF 09" 15 DS -DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C. INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO BALLOT Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames. Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes (-) to separate syllables. You should also add any notes such as rhyming examples, silent letters, etc. PRONUNCIATION KEY Stressed Vowel Sounds PRONOUNCED AS EE FEET feet I (PAHR) FIT fit E BED bed A KAT cat KAD cad AH (FAH-ihur) father PAHRpar AH (HAHT)hot (TAH - dee Todd UH (FUHJ) fudge FLUHD) flood UH CHUHRCH church AW FAWN fawn U FILL full 00 FOOD food OU FOUND found O FO foe EI FEIT fight At FAIT fate OI FOIL foil Y00 (FYOOR-ee-uhs) furious Unstressed Vowel Sounds uh (SO-fuh) sofa (FING- uhr) finger Certain Vowel Sounds with R PRONOUNCED AS Mishaud AHR I (PAHR) Dar ER PER air IR PIRpeer OR POR our OOR POORpoor Z UHR PUHRpurr Samples: NAME ON BALLOT PRONOUNCED AS Mishaud mee-SHO (d' is silent) Jahn HAHN (rhyme: fawn) Beauprez boo-PRAI (rhyme: hooray) Maniscalco man-uh-SKAL-ko Tangipahoa TAN-ji-pah-HO-uh Monte Mahn -TAI Tanya TAWN-yuh (not TAN) Consonant Sounds B BED bed TS ITS its PITS-feeld Pittsfield D DET debt TH THEI Thigh F FED fed TH THEI Th G GET et ZH A-zhuhr azure VI-zhuhn vision H (HED) head Z (GOODZ) goods (HUH-buhz-tuhn) Hubbardston HW HWICH which J (JUHG)jug K (KAD) cad L (LAIM) lame M MAT mat N NET net NG SING-uhr singer P PET et R RED red S SET set T TEN ten V VET vet Y YET et W WICH witch CH CHUCRCH church SH SHEEP sheep J.W I _. 111M Paye snows nor oe suomiaea to the ni ng officer. Page 2, DS -DE 25 (Rev. 5111) Rule 1S-2.0001. F.A.C. -crTBANK, N.A. R P.O. Box 790110 St. Louis, MO 63179-0110 Citibank, N.A. Account 2908530336 JULIO M MARTINEZ 2564 AVE AU SOLEIL DELRAY BEACH FL 33483 Summary of Account Activity Previous Balance $96,676.42 Payments (-) $8,931.83 Other Credits (-) $0.00 Loans/Advances (+) $8,450.00 Other Debits (+) $0.00 Fees Charged (+) $0.00 Interest Charged (+) $219.25 New Balance $96,413.84 Credit Limit $100,000.00 Available Credit $3,805.41 Statement Closing Date 12/08/16 Days in Billing Cycle 30 For Billing Inquiries Or Credit Bureau Disputes Write To This Address: For Billing Inquiries, Calling Or Sending an E -Mail will Not Preserve Your Rights. CITIBANK PO BOX 769004 BAN ANTONIO, TX 76245-9004 Statement Period November 8, 2016 Page 1 of 4 December 08, 2016 Summary of Current Minimum Payment Due Amount Payment Due Date 01/09/17 Total Scheduled Payment $219.25 Past Due Amount $0.00 Current and Past Due Fees $0.00 Minimum Payment Due $219.25 At Cifi, we value you as a customer and appreciate the opportunity to assist you Win all of your lending needs. If you have any questions regarding your account ar to learn more about haw our lending products can help you make a smart decision about borrowing, stop by your nearest Citibank branch today or call 800-321-CITI (2484). Hours are Monday thru Sunday 8AM - 1 OPM CST. Home Equity Line of Credit Account Number 2908530336 Effective Date Description Amount 11/10/16 TRANSFER ONLINE ONLINE Ref# 004629 - Thank You 11/10 11:02P EST -$5.00 Applied as follows: Interest $ 5.00 11/14/16 TRANSFER ONLINE ONLINE Ref# 000291 - Thank You 11/14 10:04A EST -$223.01 Applied as follows: Interest $ 223.01 11/14/16 TRANSFER ONLINE ONLINE Ret# 000292 - Thank You 11/1410:07A EST -$1,909.69 Applied as follows: Principal $ 1,909.69 11/14/16 TRANSFER ONLINE ONLINE Ref#00028911/1410:OOA EST ####8382 $3,500.00 Applied as follows: Principal $ 3,500.00 11/15/16 TRANSFER ONLINE ONLINE Ref# 000528 - Thank You 11/15 4:54A EST -$3,058.57 Applied as follows: Principal $ 3,058.57 11/15/16 TRANSFER ONLINE ONLINE Ref# 000830 - Thank You 11/15 11:43P EST -$567.00 Applied as follows: Principal $ 567.00 11/16/16 TRANSFER ONLINE ONLINE Ref# 00107811/167:09A EST####8382 $4,800.00 Applied as follows: Principal $ 4,800.00 JULIO M MARTINEZ Account 2908530336 Page 2 of 4 Statement Period - November 8, 2016 - December 8, 2016 TRANSACTIONS (Continued) 1128/16 TRANSFER ONLINE ONLINE Ref# 002816 - Thank You 1128 11:OOP EST -$130.00 Rate Applied as follows: Principal $ 130.00 Number of Days 11/30/16 TRANSFER ONLINE ONLINE Ref#000439- Thank You 111309.46A EST -$3,038.56 Balance Applied as follows: Principal $ 3,036.56 (APR) 12105/16 TRANSFER ONLINE ONLINE Ref# 002529 12/04 10:52P EST ####8382 $150.00 Charge Applied as follows: Principal $ 150.00 11108 - 12107 2.74 % ( V) Interest Charged 0074863% 12108/16 Interest Charged $219.25 TOTAL INTEREST FOR TENS PERIOD $219.25 Total Fees Charged In 2016 $0.00 Total Interest Charged in 2016 $2,407.49 INTEREST CHARGE CALCULATION Your Annual Percent a Rate APR is the annual interest rate on vour account. Type of Rate Annual Percentage Rate Number of Days Dally Balance Subject to Interest Balance Period (APR) Rate Applied Periodic Rate interest Rate Charge Variable Rate Balance 11108 - 12107 2.74 % ( V) 30 0074863% $97,622.43 $219.25 (V) - Variable Rate JULIO.M MARTINEZ Account 2908530336 Page 3 of 4 Statement Period - November 8, 2016 - December 8, 2016 IF YOU HAVE QUESTIONS ON: YOU CAN CALL': Home Equity Line of Credit 1-800-685-0935 Financial Associates Are Available Monday Through Friday 7:30 AM TO 10:00 PM CST TDD -Text Telephone 1-800-945-0258 (For Speech And Hearing Impaired Customers Only) FOR BILLING INQUIRIES/ For Billing Inquiries calling or e -mailing will not preserve your CREDIT BUREAU DISPUTES rights 'To ensure quality service, calls are randomly monitored MialsiftiEbbtbfUw, and mail with your payment PAYMENT TICKET: Home Equity Line of Credit YOU CAN WRITE: CITIBANK PO BOX 769004 SAN ANTONIO, TX 78245-9004 CITIBANK PO BOX 769004 SAN ANTONIO, TX 78245-9004 AecaxrNNuatihet 3temthfer[:xWeim Dots, 2908530336 December 8, 2016 January 8, 2017 $96,413.84 $219.25 ■ ��� - A�c�yn�! , ,m`�:va�� n�.-.....'e�`.:!�x ��?6i?�ryw° m w t� : �°�� i".`ia� • •• Make check payable to - Check here for address/phone change and note on back •• CITIBANK, N.A. JULIO M MARTINEZ 2564 AVE AU SOLEIL AZ 8 - q P.O. BOX DELRAY BEACH FL 33483 PHOENIX AZ 85062-8005 $219.25 2n 1 R nnnnnnn9RnR.r•Rn.ggR 9841 RR4 nn91 w.ri 101 nRR JULION MARTINEZ Account 2908530336 Page 4 of 4 Statement Period - November 8, 2016 - December 8, 2016 Interest Charges (Periodic Finance Charges): For each advance, Interest charges begin to accrue on the date of the transactlon (for Ready Credit and Custom Credit Line, the date of the transacllon Is the day we pay your check or otherwise make funds avallable to you through your Account). For Ready Credit Accounts, Custom Credit Una Accounts, former EAB Credit Accounts, former EAB Home Equity Credit Accounts, and former Cal Fed Home Equity Una of Credit Accounts, we figure Interest charges on your account by applying the daily periodic rate to the "average dally balance" on your account. To get the "average daily balance" we take the beginning balance on your account each day, add any new loan advances, and other charges (other than late charges, credit file Insurance, unpaid Interest charges, or annual lees), and subtract any unpaid Interest, or other finance charges and anypayments or credits. This ghes us the dally balance. Then, we add up all the dally balances for the billing cycle and divide the total by the number of days In the billing cycle. This gives us the "average dally balance." To calculate the Interest charge, we multiply the average daily balance by the number of days In the cycle and than multiply the result by the dally periodic rate. For all other accounts, we figure Interest charges on your account by applying the daffy periodic rate to the "dally balance" of your account for each day in the billing cycle. To get the "daily balance" we take the beginning balance on your account each day, add any new ban advances, and other charges (other than late charges, credit life Insurance, unpaid Interest charges, or annual fees), and subtract any unpaid Interest, or other finance charges and any payments or credits. This gives us the dally balance. Interest Charges may he calculaled or determined by (1) multiplying each of the average dally balances by the number of days each dally periodic rate was In effect (2) multiplying each of the results bythe applicable dally periodic rate, and (3) adding these products together. (All of these numbers can be found In the table called "Interest Charge Calculation". Each average dally balance is disclosed as Balance Subject to Interest Rate. The dally periodic rate is the Annual Percentage Rate divided by 365, except in leap years when It will be divided by 366.) For at I accounts except Fixed Rate Ready Credit accounts - the Dal ly Periodic Rate and the corresponding Annual Percentage Rate may vary, We may report Information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit repwL PAYMENT OPTIONS: Citibank offers many payment options Including: - Citibank Auto Deduct: I you do not already have our automatic payment option, you may enroll by calling Customer Service at the phone number listed on your statement. - Mall: Send your payment to the address found on the front of the payment coupon. Please note that you may not male a payment to your loan account with a check or advance drawn on your loan account. Checks drawn against a business account are not acceptable as payment for a personal loan obligation. Please do not remit cash. - BIII Payment: Online Payment & Transfers: Through Citibank Online, you can schedule one -lime or recurring bill payments. I your line or loan Is linked to your Chlbank ATMMebil card, you can make payments Immediately simply by transferring funds from checking. visit www.ciflbankonline.com for details. -8peedpay: it you would like to make a payment by phone, call 1.800-685-0935 to authorize Immediate payment using funds directly from your checking account for a nominal lee. Payoff Balance Inquiry The actual payoff balance on your account may be obtained by contacting Customer Service at the phone number listed on your statement. Request for Credit Balance Refunds: If your stalement shows a credit balance it means your loan payments have exceeded the total amount you owe. You may request a full refund of the credit balance by writing to the address In the "Customer Service Information" section of the statement. Billing Rights Summary. What To Do If You Think You Find a Mistake on your Statement 8 you think there Is an error on your statement, write to us at the address shown below: CITIBANK PO BOX 789004 SAN ANTONIO, TX 78245-9004 In your letter, give us the following Information: -Account Information: Your name and account number -Dollar amount: The dollar amount of the suspected error - Description of the Problem: I you think there Ism error on your big, describe what you believe Is wrong and why you bellow it Is a mistake. You must contact us width 60 days after the error appeared on your statement You must notify us of any potential errors in writing. You maycall us, but 8 you do we are not required to Investigate any potential errors and you may hake to pay the amount In quesllon. While we investigate whether or not there Ism error, the following are true: - We cannot try to collect the amount In question, or report you as delinquent on that amount. The charge In question may remain on your statement and we may continue to charge you Interest on that amount. But, If we determine that we made a mistake, you will not have to pay the amount In question or any Interest or other lees related to that amount. While you do not have to pay the amount In question, you are responsible for the remainder of your balance. - We can apply any unpaid amount against your credit limit. Is your address shown correctly on the front side of the Statement of Account ? If not please enter your correct address below and check the box on the front of this coupon Name Street Address city State Zip Home Telephone () Work Telephone (� If you send an eligible check with this payment coupon, you authorize us to complete your payment by electronic debit. If we do, the checking account will be debited In the amount on the check. We may do this as soon as the day we receive the check. Also, the check will be destroyed. i 0 TiOWN OF GULF STREAM 100 SEA ROAD GULF STREAM, FLORIDA 33483 n m n D < T c i 9a m ~ ~ m o Z T 1 O 000 »2o = > o°mm m, - o _ am< A ED o � n O O � y 0 Z ahalm BeachCounty 2017 J;;d 12 "iii 9: til. 6 SUSAN BUCHER Supervisor of Elections - - - •..:;-� 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 3341 5 POST OFFICE BOX 22309 WEST PALM BEACH, FL 33416 TELEPHONE: (5B 11 656-6200 FAX NUMBER: 1561) 65B-6287 WEBSITE: w vw.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 )n'L c_ Ll9MMEH1UFo=i WhiW Su t Poem REV OS OI.]OReec JUi; a /` CJVV h e;2�-7 �-- 1.3 ,1+V'e AL) SGffr'[ (STREET) Gulf 14\ 33h' 3 (CITY/ZIP) tiP.( ALFt09:., l �V ry OF PP�,..... Palm Beach County SUSAN BUCHER Supervisor of Elections CERTIFICATION 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22308 WEST PALM BEACH, FL 33416 TELEPHONE: (5B1] B56-6200 FAX NUMBER: (5B 11 B56-6287 WEBSITE: www.pbcelections.org I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 13 signatures on the Petition for the office of Town Commissioner, of JULIO MARTINEZ, 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 JULIO MARTINEZ is a registered voter in Precinct 4072, in the Town of Gulf Stream, Florida. Signed, this the 12th, day of January, 2017. 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