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Q. o _ 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, O je- e (100 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 Martz Samuellan placed on the Primary/General Election Ballot as a:[check/complete box,as applicable] Nonpartisan ❑No party affiliation 0 — Party candidate for the office of Miami Beach City Commissioner,Group II (insert title of office and include district,circuit,group,seat number,if applicable) Date of Birth ior Voter Registration Number 11 Address gifi0/0 l L _Ofin COI/015 five # City County State Zip Code Miami Beach Miami-Dade Florida 33/70 Signature of Voter Date Signed(MM/DD/YY) 6eI [to be completed by Voter) Rule 1S-2.045,F.A.C. j DS-CE 104(Eff.OW71) PLEASE FILL OUT THE FOLLOWING: t J� EMAILADDRESS i 0 yahoo,cop, 365- 93-3 6. 7H CELL PHONE NUMBER ❑ I am interested in volunteering with Mark. ❑ t would Nbe lo display a campaign sign on my property or at my business. CHECK ALL THAT APPLY How to submit your petition: Verify that you have both signed AND dated your petition Mail your completed petition as soon as possible to: Mark Samuslian Campaign 10 Venetian Way,#1502 Miami Beach,FL 33139 POLITICAL ADVERTISEMENT PAID FOR AND APPROVED BY MARK SAMUELIAN FOR MIAMI BEACH CITY COMMISSIONER, GROUP II,NON-PARTISAN f a) )' II a) = �� . , _C qi N X m ``�' ,L.� �� 4 cok1 1 N I U } U \ _ m m \ B . t E E . a) m m s o c v 2.�` c l �pn C) ONQ il M 0 rM ,�L v !1 1 1.1 CO O N mg in N / aC—NN \ M .a) 2 o � T.D. 'Ni'yas > c E V R tca c 1 o - c c c c O.c i t E as m (- a N v 0 q W co v U v o 0 v LL.Ui U a1 a I m d • d a: f m ' 03 .ti�V C N co N i, co 0 N 1 W u1 L W • 'D C7 O C m % N i, ( ii + N N N To' t To N dd wre, a U - • . . 3 - f a) I a) j� N T O .15 C"�/ �. y O _O O O O O r 4 O O <ILI =f ` = U U o f U V i U U U Y V v O 07 CO E r E N mw E - `�] "O j "O V 'L3 . 'O i . 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