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HomeMy Public PortalAboutGANGER - Filing 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): Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy Depository Office Party 2. me of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Z; code) HWJ ) No, Ocfa;1 81 vJ Gu)) -_ ICY trYj L 3��- j' j 4. Telephone 5. E -mail address ( 5W 7'Ols-- t^w I CLf, er'Chellsowttl,.1 ec 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if (W[. yn FYII S S/ ot-I e r applicable: ow,11 O�- Gm W -S 4ra(VI ❑ 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 ❑ No Party Affiliation ® Party candidate. 9. 1 have appointed the following person to act as my ® Campaign Treasurer ❑ Deputy Treasurer 10. Name pf Treasurer or Deputy Treasurer 11. Mailing Address I4q3 I\jd. C')Cleo/I ���� 12. Telephone (S4:,1 )Z7 71+ 7b 13 Cit S ar✓1 14. County Bala, Bead, 15. State R_ 16. Zip Code 3�¢� � 17. E -mail address �� ��� w b�(�.s'oz� f � , rle 18. 1 have designated the following bank as my M Primary Depository ❑ Secondary Depository 19. Name of Ban 20. Address '7Z 6 A4 (u. -i'N� Nr� erv� S'r f- lav1 �Lc ku 21. Ity . Ire, 2C�C I 2 Count / 23. State 24. Zip Code U Pit 'L_0 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 jo j 26.S I re of Candi t o X � �l1 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) D I, 1�, b E f?T W, (;-A N G"E J? do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer Deputy T asurer. Date Signature of Carfipaign Trea§Crer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. FORM 1 STATEMENT OF 2013 Please print or Type your name, mailing FINANCIAL INTERESTS address, agency name, and position below: FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME -- MIDDLE NAME: GMGL -12 P- 06E P,1 WARD MAILING ADDRES , /q43 / o. 6ceao &LL -e-var 1 Cu -F ST4qE &Ivy FL 33Y83 P/,q-tic P CITY: ZIP: COUNTY: NAME OF AGENCY: 70o,)N CDrmisS ION NAME OF OFFICE OR POSITION HELD OR SOUGHT: C©mmi SSION C P- 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 * * ** 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): xDECEMBER 31, 2013 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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: ❑ 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 "n /a ") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY DEUTCHE(3 NK QL 4Y �LvN f5�n� c�C�iyPL 33 `I� cusrvDIAL- Ac--cT — IRA and rcLera c of !E III -1 ivGN A5 GUSTDD 1 "Ptm -777 E451" ATLANTIC AVC DE -2A`l EArc -H FL 34 3 eu Acf-T— t32aCE2AC� WR reopS RC- T)P.cm&nJr T- PPEA5iDN �Ei �2R1- �UV'T Sc;-r-7 frusf 6an►cces CSf SocIA -L sncu�>l t� 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- 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. CE FORM 1 - Effective: January 1, 2014. (Continued on reverse side) PAGE 1 Adopted by reference in Rule 34- 8.202(1). F.A.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 IR c�-, c s��p6r Ito o���b),�) �rz s t - hLL +i ncts Mont LoL4 f invtstrr,, tT , No owr)e�s .tt3 Ov- ©1 eF a 11 /1-1 'S ras V uSlr- -en "y) mry .� Na.,1.c r�U S C " one /v �, GLCt t /J c�Y l 1 6 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 "nla ") BUSINESS ENTITY # 1 ADDRESS OF BUSINESS ENTITY I OWN MORE THAN A 5% 1 BUSINESS ENTITY # 2 IF ANY OF PARTS A THROUGH FARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE lfreauiredlk DATE SIGNED (required) 7sshe' blic accountant licensed under hapter 473, or attorney in good standing with the Florida Bar prepared this form for you, t complete the following statement: prepared the CE Form 1 in accordance with Section 112.3145, Florida the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. WHAT TO FILE: After completing all parts of this form, including signing 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, you must write "none" or 'Wa" in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form 1 for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. FILING INSTRUCTIONS: 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 officers /employees file 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 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 the "Who Must File" Instructions on page 3. Facsimiles will not be accepted. Date 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 prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates for publicly - elected local office must file at the same time they file their qualifying papers. Thereafter, local officers /employees, state officers, and specified state employees are required to file by July 1 st following each calendar year in which they hold their positions. Finally, at the end of office or employment, each local officer /employee, state officer, and specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. However, filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if he or she was in their position on December 31, 2013. GE 1-OHM 1 - Effective: January 1, 2014. PAGE 2 Adopted by reference in Rule 34- 8.202(1), F.A.C. Candidate Name Pronunciation Request 5510�- OFFICE SOUGHT: Name On Ballot I Pronounced As P0815QT- CYAN&EZ eA G e r 6ilynle- ; Wa Pronunciation Guide • In the "NAME ON BALLOT' column, enter the name as it appears on your ballot (First, Middle, Last). • In the "PRONOUNCED AS" column, enter the breakdown using the PRONUNCIATION KEY below. Capitalize STRESSED syllables, use lower case for unstressed syllables. • You should also add any notes such as rhyming examples, silent letters, etc. Also provide pronunciations for ambiguous place names, first names and surnames. Use dashes ( -) to separate syllables. Samples NAME ON BALLOT PRONOUNCED AS William Mishaud mee -SHO (V is silent) Sue Jahn HAHN (rhyme: fawn) Tim Beauprez boo -PRAT (rhyme: hooray) Robert Maniscalco man- uh- SKAL -ko Tangipahoa TAN- ji- pah -HO -uh Monte Anthony mahn TAI Tanya Smither TAWN -yuh (not TAN) DS -DE 105 07/10 it PRONUNCIATION KEY Stressed Vowel Sounds EE (FEET) feet I (FIT) fit E (BED) bed A (KAT) cat (KAD) cad AH (FAH -thur) father (PARR) par AH (HAHT) hot (TAH -dee) toddy UH (FUHJ) fudge (FLUHD) flood UH (CHUHRCH) church AW (FAWN) fawn U (FUL) full 00 (FOOD) food OU (FOUND) found 0 (FO) foe El (FEIT) fight AI (FAIT) fate 01 (FOIL) foil Y00 (FYOOR- ee -uhs) furious Unstressed Vowel Sounds uh (SO -fuh) sofa (FING -guhr) finger Certain Vowel Sounds with R AHR (PAHR) par ER (PER) pair IR (PIR) peer OR (POR) pour OOR (POOR) poor UHR (PUHR) purr Consonant Sounds B (BED) bed TS (ITS) its (PITS- feeld) Pittsfield D (DET) debt TH (THEI) Thigh F (FED) fed TH (THEI) Thy G (GET) get ZH (A- zhuhr) azure (VI- zhuhn) vision H (HED) head Z (GOODZ) goods (HUH - buhz -tuhn) (RED) red S 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) pet R (RED) red S (SET) set T (TEN) ten V (VET) vet Y (YET) yet W (WICH) witch CH (CHUCRCH) church SH (SHEEP) sheep STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) I, CDB02-q- lU' �,/ G ,e2 candidate for the office of TO(O N have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candidate JA/) 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 (05111) TOWN OF GULF STREAM, FLORIDA ELECTION -MARCH 11, 2014 NOTICE TO CANDIDATES The Logic and Accurace (L & A) Test of the tabulating equipment that will be used to tabulate the ballots will be held at 3:00 P.M. on Friday, February 21, 2014, 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 February 25, 2014, Tuesday, at 12:00 Noon. The deadline for receiving campaign contributions is midnight, March 6, 2014 for opposed candidates. The deadline for receiving campaign contributions is noon, February 11, 2014 for unopposed candidates. This is to acknowledge that I have received a copy of this NOTICE TO CANDIDATES. I ZS /i `f W Date Signature of Candidate CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY I OATH OF CANDIDATE (Section 99.021, Florida 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 16 L LI n Corn I�'l I ss, n (office) (district #) I am a qualified elector of PAZM 'EEAc (- (-,ciu 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. X 43et (610,-L70-7Y7 alj �n 1 Signature of Candidatd Telephone Number r Email dress )�N3 No. Ccea4 93e1_Q3 Address City St to ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): I IZ�q Z�3O 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): GANG - e- r- a[1-6 rre. /, 14AW EPLY l STATE OF FLq,�IDA COUNTY OF f ". vY Sworn to (or affirmed) and subscribed before me this ? day of 20. 1 �__ Personally Known: or Signature of Notary Public Produced Identification: Print, Type, or Stamp Commiss oned Name of Notary Public Type of Identification Produced: RITA L TAYLOR ilk * ft4Y COMMISSION # DD 949 F Po, uiu111y41,ZU14 DS -DE 25 (Rev. 5111) NondedThrug'd9etN0*0 _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 EE (FEET) feet I (FIT) fit E (BED) bed A (KAT) cat (KAD) cad AH (FAH -thur) father (PARR) par AH (HAHT) hot (TAH- dee ) toddy UH (FUHJ) fudge (FLUHD) flood UH (CHUHRCH) church AW (FAWN) fawn U (FUL) full 00 (FOOD) food OU (FOUND) found O FO foe El (FEIT ) fight Al (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 AHR (PARR) par ER (PER) pair IR (PIR) peer OR (POR) pour OOR (POOR) poor UHR I (PUHR) purr Samples: NAME ON BALLOT PRONOUNCED AS Mishaud mee -SHO ('d' is silent) Jahn HAHN (rhyme: fawn) Beauprez boo -PRAT (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 (DIET) debt TH (THEI) Thigh F (FED) fed TH (THE]) Thy G (GET) get 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) pet R RED red S (SET) set T TEN ten V (VET) vet Y YET et W (WICH) witch CH (CHUCRCH) church SH (SHEEP) sheep NOTE: This page should not be submitted to the filing officer. Page 2, DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.C. Transmission Report Date /Time 02 -26 -2014 01:35:48 p.m. Transmit Header Text Local ID 1 5617370188 Local Name 1 This document: Confirmed (reduced sample and details below) Document size : 8.5 "x11 " Fax APPOINTMENT OF CAMPAIGN TREASURER Total Pages Confirmed : 2 AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES I Job (Sectian 106.021(1), F-S.) Start Time (PLEASE PRINT OR TYPE) Pages NOTE: This form must be on rile with the qualifying Mode officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re -riling to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. e of Candidate (in this order. First, Middle, Last) 3. Address (include past office box or street, city, state, zip {J�_$ WF���D 2- code) iL+3 No, oc'na.r1 SIV4 GuI F Stltrn, f 33� -e � 4. Telephone 5. E -mail address ( 561 ) 17&-7Lf7s I t1J t1J1 2i'G�je1�SDU�I,. 11 B. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check If Cornm15s /brier 1 applicable: Town of­ GU I-r s h ra01 I] My intent is to run as a Write -In candidate. 8. If a candidate for a ap rtisan office, check block and fill In name of party as applicable: My Intent is to run as s ❑ Write -In L] No Party Affillalion ® Party candidate. 9. 1 have appointed the following person to act as my ® Campaign Treasurer Deputy Treasurer 10, Name pi Treasurer or Deputy Treasurer bef-F Gan cr 11. Mail' j� �,Ad�dress ''ti3 N6, 6C,60,1 j� Jr� 12. Telephone (SVW )Z78-7476-- 13 Ctt N S }�AN1 14. County (palm {Rate 15. tale 18. Zig Code 334 -8 3 17. E -mail address 2. A-L ie Ueusa(.g, Ile- 18. 1 have designated the following bank as my Primary Depository [] Secondary Depository 19. Name of Ban] j 20. Address '746 o A4 fa - * C1�'f GcG' /Yl ✓%I S� A' -h_ Ave 21. Ity Count 23. State 24. Zip Code UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSrrORYAND THATTHE FACTS STATED IN IT ARE TRUE. 25, Date r ST c Candi X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1, R�E�w , 6-A N GYE (� do hereby accept the appointment (Please Print or Type Name) d77��Iq a: P1 Campaign Treasureput. X Date Signatu re of Csf6paign Trearfirer or Deputy Treasurer DS -DE 9 (Rev. 10h0) Rule 19- 2.0001, F.A.C. Total Pages Scanned : 2 Total Pages Confirmed : 2 No. I Job Remote Station Start Time Duration Pages Line Mode I Job Type Results 001 1556 12726222 10 1:34:04 p,m,02 -26 -2014 00:01:05 2/2 11 JEC IHS ICP14400 Abbreviations: HS: Host send PL: Polled local MP: Mailbox print CP: Completed TS: Terminated by system HR: Host receive PR: Polled remote RP: Report FA: Fail G3: Group 3 WS: Waiting send MS: Mailbox save FF: Fax Forward TU: Terminated by user EC: Error Correct Palm Beach County 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 33416 Supervisor of Elections TELEPHONE: [561) 656 -6200 FAX NUMBER: (5611656-62B7 WEBSITE: www.pbcelections.org CERTIFICATION I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that Robert Ganger submitted 8 petition signatures for the office of Gulf Stream Town Commissioner. I further certify that 5 of those signatures 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 Robert Ganger is a registered voter in Precinct 4072, in the Town of Gulf Stream, Florida. S' ed, this the 10th day of February, 2014. SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY (SEAL) CANDIDATE PETITION Notes: -All information on this farm becomes a public retard upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 10.1.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. a6r--iZ1 cam• ,I t Xs ©A/ the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of 11�,6 QE Pr GA N G F—R , placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Nonpartisan []No party affiliation ❑ Party candidate for the office of T OWN1 C0r11(11) SS.(p1\I (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address ( 06 IV- 6?(2a A "' / 9.4 (MM /DDIYY) 6 4 t'rvG -f= s! R 4, 3 3 �O� City County State Zip Code Gums; STIPeAM PAt-M 13CA-CR 3S4ES Signature of Voter Date Signed (MMIDDNY) [to be yompletgpd by Voter] DS -DE 104 (Eff. 09/11 CANDIDATE PETITION Notes: -All information on this form 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] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. ifih e+j yl e {LVI s ley the undersigned, a registered voter (print name as it appears on your voter informatiwYcard) _- I in said state and county, petition to have the name of CbSEKT GA N.0 FER. placed on the Primary/General Election Ballot as a: [checklcomp/ete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of T I Li.��i C�mt�i 55.1 � Ill (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address y.7-40 p i i %vz 6 3 City County State Zip Code G(,LL.P STP -GAM F/Et -.M )3c&c* FLOP1©-A 3546-3 Signature of Voter Rule 1S- 2.045, F.A.C. Date Signed (MMIDD/YY) [to be completed by Voter] J� CANDIDATE PETITION Notes: -All information on this form 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 10.1.18.1, Florida Statutes] - If all requested information on this farm is not completed, the form will not be valid as a Candidate Petition form. the undersigned, a registered voter (print name as it appears on your voter information cat) in said state and county, petition to have the name of 1: �,6 L3 t-:= K r GA NG F_ R, placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of T I ��1�i C�m�1i ss foiu (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Vote ,Registration Number m7s ri1 x(MM /DDNY G ! T City County State Zip Code Signature of Voter Date Signed (MMIDDNY) [to be pompleted by Voter] DS -DE 104 (Eff. 0911 Je CANDIDATE PETITION Notes: -All information on this form 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] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1. /i� o f G the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of Rd (3f_ KT_ GA I w G F_ R_ placed on the Primary/General Election Ballot as a. [check/complete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (� (MM /DD/YY) O `"t Q � / r—� 30 3'. � `F S-��C3L n City County State Zip Code Signature Rule 15- 2.045, F.A.C. Date Signed (MM /DD/YY) [to be completed by Voter] o a c) 0201 S -DE 104 (Eff. 09/11 CANDIDATE PETITION ,f Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign ►pore than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. (Ie-I eel C the undersigned, a registered voter (print namee_ s it appears on your voter information card) in said state and county, petition to have the name of d 0 w E KT GA ( V,G placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Rule Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address R.�_acL (MM /DDIYY) 08 [8 4S 3��2 (2C.0 SfY� UYt City County State Zip Code Gums; S_TQeAM Pi M 13EA -Cff FLOP-iaR 3546-3 Signature of Voter Date Signed (MM /DDNY) [to be completed by Voter] 04-1 d 4 ao DS -DE 104 (Eff. 09/1 CANDIDATE PETITION Notes: -All information on this form 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] - If all requested information on this form is not completed, the farm will not be valid as a Candidate Petition farm. I. �-Al Jq the undersigned, a registered voter (print name as it appears on your voter information card) w in said state and county, petition to have the name of �b 0E t i �1 placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of T i v��i c�mm� ss pow (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or 1 / v Vote/ rr/.//.Registration Number Addrrei ' s s I %L r� L / �(MMIDDYY)a� 3 Y6 /3— 7 l City County State Zip Code GULP STPGAM QAALM 8 EA- Cff X40P.1©I� 334ss Signature of Voter �, D Rule 1S- 2.045, F.A.C. Date Signed (MMIDDNY) [to be co pleted y Voter] DS -DE 104 (Eff. 09/1 CANDIDATE PETITION Notes: -All information on this form 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] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I, k ; Q D I/1 i X � ��/ the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of �i3 UE K t r GA N.G 'E R, placed on the Primary/General Election Ballot as a: [checklcomplete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of T i OWN1 COMMI SS_10M (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address 2> `�'� U �/� Q (/,/I) / t 19 IV U (MM /DD/YY) � °� All C� j i � 'C —r' 2 L� (j r �,,,, 1 I ' '77 City County State Zip Code G UL.; STP-GA 1 Pr< I-M BCA—Cf f rtop.1D/� 3546-3 Signature of Voter Rule 1S- 2.045, F.A.C. Date Signed (MM /DDNY) [to b o pleted y Voter] DS -DE 104 (Eff. 09/1 CANDIDATE PETITION Notes: -All information on this form 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] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. i. S .- C. F p 41 A- /z- , -y the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of f�,b 0E RT GA N G F- R- placed on the Primary/General Election Ballot as a: [check(comp/ete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM /DD/YY) l ( ( b --v/ / 9 6 (.. 4' 2 4 C) Co u Al r°y R'-0 City County State Zip Code Gi,LL.t~ STPE/tn-\ UAI..M 13cA-CR FLOP -1©" �3- Signature of Voter Date Signed (MM /DD/YY) [to be cp3ple lied by Voter] DS -DE 104 (Eff. 09111