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DS-DE 125 Perez DESIGNATION OF POLL WATCHERS FOR: Run-Off Election Day,November 17,2015 (Specify Applicable Election) Pursuant to Section 101.131, Florida Statutes, I request that the following persons (none of whom is a candidate or a sheriff, deputy sheriff,police office or other law enforcement officer),who are qualified and registered voters of the county in which they will serve,be approved as poll watchers for(check only one): E EARLY VOTING 17 ELECTION DAY 1. Printed Name: Judith Rosen Date of Birth(mm/dd/yy): 09/06/1938 Address: 5055 Collins Avenue Miami Beach, Fl 33140 Location of Polling Room or Early Voting Site: All Election Day Precincts 2. Printed Name: Alejandra Avellanet Date of Birth(mm/dd/yy): 05/16/1984 Address: 7111 Bamboo Street Miami Lakes,Fl 33014 Location of Polling Room or Early Voting Site: All Election Day Precincts 3. Printed Name: Renee Rovelli Date of Birth(mm/dd/yy): 10/11/55 Address: 6381 North Bay Road Miami Beach,FL 33141 Location of Polling Room or Early Voting Site: All Election Day Precincts 4. Printed Name: Marilyn Sheffman Date of Birth(mm/dd/yy): 04/26/1953 Address: 500 W.49th Street Miami Beach,FL 33140 Location of Polling Room or Early Voting Site: All Election Day Precincts NOTE: If more lines are needed to designate poll watchers,use DS-DE 125 continuation page(s) and attach to this page. Only sign this top form,but the page count entry must be completed on the bottom of this page. *•**•••**••***************•*****************•****••*•*****•*********••*•**•*********••*** Check applicable box and fill in the blank lines: 1-' I am a candidate for Miami Beach City Commission,Group 4 in this election. E I am the chair of the County Executive Committee of the Party. I! I am the chair of Political Committee. Elizabeth"Betsy"Perez ���� 1*7 /$ Printed Name Signature e 7605 Collins Avenue Miami Beach,Florida 33141 305-442-2200 Address Phone Attention: This form is due to the Supervisor of Elections: • For Early Voting, no later than noon of the 14th day before early voting begins. -= • For Election Day,before noon of the second Tuesday preceding the election. _" (This form becomes a public record when submitted to the Supervisor of Elections.) Page 1 of 2 pages. DS-DE 125 (rev.05/2011) DESIGNATION OF POLL WATCHERS — Continuation Page (Enter Page Number on Bottom of Page) This form becomes a public record when submitted to the Supervisor of Elections. 1. Printed Name: Juan-Carlos Planas Date of Birth(mm/dd/yy): 07/17/1970 Address: 9530 SW 51 Street,Miami,Fl 33165 Location of Polling Room or Early Voting Site: All Election Day Precincts 2. Printed Name: David Rene Custin Date of Birth (mm/dd/yy): 11/02/1969 Address: 6401 SW 113th Place Miami,FL 33173 Location of Polling Room or Early Voting Site: All Election Day Precincts 3. Printed Name: Matthew David Monica Date of Birth(mm/dd/yy): 11/17/78 Address: 19321 NW 19th Avenue Miami Gardens,FL 33056 Location of Polling Room or Early Voting Site: All Election Day Precincts 4. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 5. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 6. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 7. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: fl f-° - ". 8. Printed Name: Date of Birth(mm/dd/yy): ff 7 Address: Location of Polling Room or Early Voting Site: 9. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: T DS-DE 125—continuation page(rev.05/2011) Page DESIGNATION OF POLL WATCHERS FOR: Run-Off Election Early Voting,November 14 and 15 (Specify Applicable Election) _ Pursuant to Section 101.131, Florida Statutes, I request that the following persons (none of whom is a candidate or a sheriff, deputy sheriff,police office or other law enforcement officer),who are qualified and registered voters of the county in which they will serve, be approved as poll watchers for(check only one): 17 EARLY VOTING E ELECTION DAY 1. Printed Name: Judith Rosen Date of Birth(mm/dd/yy): 09/06/1938 Address: 5055 Collins Avenue Miami Beach,Fl 33140 Location of Polling Room or Early Voting Site: All Election Day Precincts 2. Printed Name: Alejandra Avellanet Date of Birth(mm/dd/yy): 05/16/1984 Address: 7111 Bamboo Street Miami Lakes,Fl 33014 Location of Polling Room or Early Voting Site: All Election Day Precincts 3. Printed Name: Renee Rovelli Date of Birth(mm/ddlyy): 10/11/55 Address: 6381 North Bay Road Miami Beach,FL 33141 Location of Polling Room or Early Voting Site: All Election Day Precincts 4. Printed Name: Marilyn Sheffman Date of Birth(mm/dd/yy): 04/26/1953 Address: 500 W.49th Street Miami Beach,FL 33140 Location of Polling Room or Early Voting Site: All Election Day Precincts NOTE: If more lines are needed to designate poll watchers, use DS-DE 125 continuation page(s) and attach to this page. Only sign this top form,but the page count entry must be completed on the bottom of this mge. ***************************••*************•***•*•**•****•*••*•***•************** ****** Check applicable box and fill in the blank lines: _ • I am a candidate for Miami Beach City Commission,Group 4 in this election. E I am the chair of the County Executive Committee of the Patty. E I am the chair of Political C-ommiftee. Elizabeth"Betsy"Perez Printed Name Signature D to 7605 Collins Avenue Miami Beach,Florida 33141 305-442-2200 Address Phone Attention: This form is due to the Supervisor of Elections: • For Early Voting, no later than noon of the 14th day before early voting begins. • For Election Day, before noon of the second Tuesday preceding the election. (This form becomes a public record when submitted to the Supervisor of Elections.) Page 1 of 2 pages. DS-DE 125 (rev.05/2011) DESIGNATION OF POLL WATCHERS — Continuation Page (Enter Page Number on Bottom of Page) This form becomes a public record when submitted to the Supervisor of Elections. 1. Printed Name: Juan-Carlos Planas Date of Birth (mm/dd/yy): 07/17/1970 Address: 9530 SW 51 Street,Miami,Fl 33165 Location of Polling Room or Early Voting Site: All Election Day Precincts 2. Printed Name: David Rene Custin Date of Birth (mm/dd/yy): 11/02/1969 Address: 6401 SW 113th Place Miami,FL 33173 Location of Polling Room or Early Voting Site: All Election Day Precincts 3. Printed Name: Matthew David Monica Date of Birth(mm/dd/yy): 11/17/78 Address: 19321 NW 19th Avenue Miami Gardens,FL 33056 Location of Polling Room or Early Voting Site: All Election Day Precincts 4. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 5. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 6. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 7. Printed Name: Date of Birth(mm/dd/yy):- CD Address: - Location of Polling Room or Early Voting Site: -o 8. Printed Name: Date of Birth (mm/dd/yy): Address: Location of Polling Room or Early Voting Site: 9. Printed Name: Date of Birth(mm/dd/yy): Address: Location of Polling Room or Early Voting Site: DS-DE 125—continuation page(rev.05/2011) Page