* DEMocRATTc pARTy - euEENS couNTy #

Designating Petition
40th Assembly District
To the Board of Elections in the City of New york:
l, the undersigned, do hereby state that I am a duly enrolled voter of the Democratic Party and entiged to vote at the
next primary election of such party, to be held on September 12, 2O17; that my place o1 residence is truly stated
opposite my signature hereto, and I do hereby designate the following named p"i"on (or persons) as a can@ate (or
candidates) for the nomination of such party for public office or for eleition to a party posit'lon of such party.
NAME(S} OF CANDIDATE(S) PUBLIC OFFICE(S) ! PLACE(S) OF RESIDENGE

BILL DE BLASIO Mayor of the 442 11lh Street

City of New York Brooklyn, NY 11215
I DO HEREBY APPOINT. NAMES ADDRESSES
Chirlane McCray 4421lfhStreet, Brooklyn, NY 11215
Marian G. Fontana 465 Henderson Avenue, Staten lsland, NY 10310
Beth A. Green 104-20 Queens Boulevard, Apt. 6U, Forest Hills, NY 11375
Lynn P. Radov 346 Coney lsland Avenue, Apt. 101, Brooklyn, NY 11218
Sylveta A. Hamilton-Gonzalez 1280 Union Street, Brooklyn, NY 11225
Arline T. Parks 607 East 139th Street, Apt. 2D, Bronx, NY 10454
Charles D. Roos 306 West 100th Street, Apt. 31, New York, NY 10025
all of whom are enrolled voters of the Democratic Pa(y as a Gommittee to fill vacancies in accordance with the provisions of
the Election Law.
/ NAME OF CANDIDATE PUBLIC OFFICE PLACE OF RESIDENCE
PUBLIC ADVOCATE 296 Lafayette Avenue
V,,,,,oJAMES OF THE Brooklyn, New York 11238
CITY OF NEWYORK
I do hereby appoint:.
GALE A. BREWER, residing at 29 West 95th Street, New York, New York 10025
MARCOS A. CRESPO, residing at 880 Boynton Avenue; Bronx, New York 10473
JOSEPH CROWLEY, residing at 48-24 65th Street, Woodside, New York 11377
JOHN P. GULINO, residing at 66 Douglas Road, Staten lsland, New York 10304
DEBORAH L. ROSE, residing at 30 Macormac Place, Staten lsland, New York 10303
FRANK R. SEDDIO, residing at 2333 East 69th Street, Brooklyn, New York 11234
KEITH L. T. WRIGHT, residing at2225 Fifth A,venue, New York, New York 10037
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Public Office in
accordance with the provisions of the election law.
r -!HME OF CANDIDATE PUBLIC OFFICE PLAGE OF RESIDENCE
COMPTROLLER 25 Broad Street, Apt. 125
SCOTT M. STRINGER OF THE New York, New York 10004
CITY OF NEW YORK
I do hereby appoint:
JERROLD L. NADLER, residing at 315 West 70th Street, Apt. 3C, New York, New York 10023
WETTE D. CLARKE, residing at 260 Midwood Street, Brooklyn, New York 11225
JOSEPH CROWLEY, residing al 48-24 65th Street, Woodside, NewYork'l 1377
HAKEEM S. JEFFRIES, residing at 35 UnderhillAvenue, Apt. A2A, Brooklyn, New York 11238
NYDIA M. VELMQUEZ, residing a|275 Gonover Street, Apt. 5I, Brooklyn, New York 11231
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Public Office in
accordance with the provisions of the election law.
NAMES OF CANDIDATES PUBLIC OFFICES PLACES OF RESIDENCE
BOROUGH PRESIDENT 6742lngram Street
f,d,n,oo Borough of Queens Forest Hills, County of Queens
^or. Gounty of Queens, New York New York 11375
JUDGE OF THE CIVIL COURT
.of the City of New York 30-26 149th Street
6th Givil (Municipal) Court District Flushing, County of Queens
County of Queens, New York New York 11354
Assigned Vacancy Number 17
I do hereby appoint:
JOSEPH CROWLEY, residing at 48-24 65th Street, Woodside, County of Queens, New York 11377
VIVIAN E. COOK, residing al 1264 144th Street, Jamaica, Gounty of Queens, New York 1 1436
KAREN KOSLOWITZ, residing at 69-39 Yellowstone Boulevard, Apt. 521, Forest Hills, County of Queens, New York 11375
FRANGISCO P. MOYA, residing at 102-111 46th Avenue, Corona, County of Queens, New York 11368
MICHAEL A. SIMANOWITZ, residing at 65-24 162nd Street; Apt. 58, Fresh Meadows, County of Queens, New York 11365
all of whom are enrolled voters of the Democratic Party as a commiftee to fill vacancies for the above Public Offices in
accordance with the provisions of the election law.
NAME OF CANDIDATE PUBLIC OFFICE PLACE OF RESIDENCE
CITY COUNCIL MEMBER 170-12 32nd Avenue
PAUL A. VALLONE 19th Councilmanic District Flushing, County of Queens
Queens County, New York New York 11358
I do hereby appoint:
JOSEPH CROWLEY, residing at 48-24 65th Street, Woodside, County of Queens, New York 11377
MARY ANN DORSA, residing at 33-05 158th Street, Flushing, County of Queens, New York 1 1 358
TOBY ANN STAVISKY, residing at 66-36 Yellowstone Boulevard, Apt. 3G, Forest Hills, County of Queens, New York 11375
CAROL A. GRESSER, residing at 2 Bay Glub Drive, Apt. 3G, Bayside, County of Queens, New York 11360
EDWARD C. BMUNSTEIN, residing at 16-30 1 66th Street, Whitestone, County of Queens, New York 1 1 357
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Public Office in
accordance with the provisions of the election law.
NAfiTE OF CANDIDATE PARTY POSITION PLACE OF RESIDENCE
Assembly District Leader (Male) 145-21 29th Road
Flushing, County of Queens
W.c.Lru 40th Assembly District, Part A
Queens Gounty, New York NewYork 11354
 II4ARYANN DORSA, residing at 33-05 158th Street, Flushing, County of Queens, New york 1I358
GHARLES APELIAN, residing at1454A 29th Road, Flushin!', Gounty of Oueens, New yorf fiii4.
..
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party position in
accordance with the provisions of the election law.
PARTY POSITIONS

Delegates to Democratic Judicial Convention from the 11th Judicial District

from the 40th Assembly District, Queens County, New york
DIDATES PLACES OF RESIDENCE
11355

residing at 14340 41st Avenue, Apt. 3H, Flushing, County of Queens, New york 113SS {
g at 40-05 College Point Boulevard, Apt. 4A, Flushing, County of Queens, New York 11354

C/rlternate Delegates to Democratic Judicial Convefition from the 11th Judicial District
G a---
from rL-
the 40th Assembly District, Queens Gounty, New York
TES PLACES OF RESIDENCE
DEZ, residing at 33-30 149th Place, Flushing, Gounty of Queens, New York 11354
residing at. 1434A 4lstAvenue, Apt.3H, Flushing, Countyof Queens, NewYork 11355
N, residing at 148-09 Northern Boulevard, Apt. 2M, Flushing, County of Queens, New York 11354
AYNE, residing at 40-05 College Point Boulevard, Apt. 6E, Flushing, County of Queens, New York 11354

I do hereby appoint:
JOSEPH CROWLEY, residing at 48-24 65th Street, Woodside, Gounty of Glueens, New York 11377
JOHN C. LlU, residing at 145-21 29th Road, Flushing, County of Queens, New York 11354
MARY ANN DORSA, residing at 33-05 158th Street, Flushing, County of Queens, New York 11358
MARTHA FLORES-VAZQUEZ, residing at 1434A 41st Avenue, Apt. 3H, Flushing, County of Queens, New York 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature.
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 MAt(Y ANN U(rt(sA, resrolng ar JJ-u5 'l5utn ltreer, Ftusnlng, uounty or Llueens! New yorK 1.tJcu
MARTHA FLORES'VAZQUEZ, residing at 14340 41st Avenue, Apt. 3H, Ftushing, County of eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for itre abovi party positions in
accordance with the provisions of the election law,

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year piaced opposite my signature.

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frt, k- f,ATEMENT OF WITNESS

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I am a State New York and
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am an enrolled voter of the Democratic Party. I now reside at T-
in the City of NevlYprk, in the County of Queens. Each of the individuats whosetl'i'ff[:^tJlT'subscribed to this petition
sheet contain,nnr*J*,signatures, subscribed the same in my presence on the dates above indicated and identified himself
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall me to the same penalties as if I had been

'r",^')'*"'6
/ 15 ,^, of Witness

sheet to be valid.

City: City of New York County: Queens

BROOKLYN, NY (718) 443-7500 PAGE No. I

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all of whom are enrolled voters of the Democratic Party as a commiftee to fill vacancies for the above party positions in
accordance with the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the dby and year placed opposite my signature.

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am an enrolled voter of the Demo run
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in the City of New York, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet contai ning 1.C signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill in Number)
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if ! had been
duly sworn.

Date .,2017
of Witness

sheet to be valid.

City: City of New York County: Queens

,lrT I,-. - PARKSTDE pnrrurrHC cb., lNC., 538 JOHNSON AVE.. BROOKLYN, NY (718) 443-7500 PAGE No. 7
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MARTHA FLORES-VMQUEZ, residing at 14340 41st Avenue, Apt. 3H, Ftushing, County of Queens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year plirced opposite my signature.
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STATEMENT OF WITNESS
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t, JCr*s &\ Lr n. G. state: I am a duly qualified voter of the State of New York and
am an enrolled voterof*ie O"rnoJritic Party. lnow reside at le: F. lzo*L 5I. lr+"t^l-l(fr---.Pr. Li;+.-f Pu L
in the City of New York, in the Gounty of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing cI- signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill ,n Number)
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.

Date l, / 1o ,2017

Witness identification information: The following information for the witness named above completed prior to filing with the Board of Elections in order for this petition
sheet to be valid.

City: Gity of New York Gounty: Queens

PARKSTOE PRiNTTNG CO., tNC., 538 JOHNSON AVE., BROOKLYN, NY (718) 443-7500 PAGE No.--:-3
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all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.
.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature.
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STATEMENT OF WITNESS
state: I am a duly qualified voter of the State of New York and
am an enrotted voter of,,1Xffi'#[:'l"tic Party. I now reside a1 rg'l R tz,.,tt^ .st A?,1,-lkr--{1,- l^,^^-l ?"-tl,
in the City of New, Y4rk, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing t \ signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill in Number)

or herself to be the individual who signed this sheet. I understand that this statement wlll be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
iluly sworn.

o*, (a
/ 1o ,rofi Signature of

Witness identification information: The following information for the witness named above completed prior to filing with the of Elections in order for this petition
sheet to be valid.

City: City of New York Gounty: Queens

PARKSIDE pRtNTtNG CO., rNC., 538 JOHNSON AVE., BROOKLYN, NY (718) 443-7500 PAGE -" +
 MARY ANN DORSA, residing at 33-05 f 58th Street, Flushing, County of eueens, Nerjv york 11gsg
MARTHA FLORES'VAZQUEZ, residing at14340 41st Avenue, Apt. 5H, Flushing, county of eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacaniies foritre above party positions in
accordance wiih the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placea opposite my signature.

NAME OF SIGNER bwn or City

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STATEMENT OF WITNESS
l, lrl AWY CoN frtY
(Nare of Witness)
stite: I am a duly qualified voter of the State of New York and
amanenrolledvoteroftheDemocraticParty. lnowresideat llQ-a?Sa,,fop five* fLusll:att"- N/ ,{35-5-
ine
in the City of New York, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing "2'D signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Flll in Numbe0

or lrerself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.

oate }a"*zg
-7-- ,ro'r,

sheet to be valid.

City:

::Y:*, ^
':Lu.:'
City of New York County: Queens

PARKSIDE PRINTTNG co., rNC.. s3B JoHNSoN AVE., BRooKLyN, Ny (718) 443-7s00 PAGE No, 5
 MARY ANN DoRsA, residing at 33-05 ,56th Street, Flushtng, county ot (lueens, New yorK
1135u
MARTHA FLORES'vAzQUEz, residing at 14340 41st Avenie, Apt. 5H, rlustring, County of
eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill ,r""n-"i". tor
itre a5ove earty eositions in
accordance with the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year piaced opposite my
signature.
NAME OF SIGNER Enter Town or
DATE
(signature required) except in NYG
enter C
>2 .zo,tz County of Queens
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STATEMENT OF WITNESS
m AP-|
I COd A31 state: I am a duly qualified voter of the State of New York and
(Name of Wllness)
amanenrolledvoteroftheDemocraticParty.lnowresideal fi-' ,F/r.;tr's"t NY
/4'/'a7-Sa,,for"'o 1n"ffi 1t355
in the City of New York, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet contai ning ' /"C signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill in Number)
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.

Date ,20'17

sheet to be valid.

City; City of New York County: Queens

-rS:Y};,* eARKSTDE eRINTTNG co., rNC., s38 JoHNSoN AVE., BRooKLyN, Ny (718) 443-7s00 PAGE *, J4-
 drii#;t6ft;-r,AzAU;2,;;;;;';;i;;;;i ,;iil;;;/il'inl'ni*r'i,;, i;;"t';i d,lJJn", New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for itre above Party Poditions in
accordance with the provisions of the election law.

lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature:
Enter Town or City
DATE except in NYC
enter Coun

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Printed Name I
*99!&"t, County of Queens
Gity of New York

2017 County 6? Qu""n"

Printed Name ) City of New York

County of Queens
Gity of New York

County of Queens
City of New York

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City of New York

County of Queens
City of New York

County of Queens
City of New York

8.6 County of Queens

City of New York

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6f New York

10. ounty of Queens

$t City of New York

11. County of Queens

City of New York

2017 County of Queens

Printed Name i City of New York

13. County of Queens

Printed Name I City of New York

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Name ) Gity of New York

of Queens
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STATEMENT OF WITNESS
r, I\a r state: I am a duly qualified voter of State New York and
,
am an enrolled voter of the
Each of the individuats whose'ffiffi[flH"'

or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of air affidavit and, if it contains a material false statement,,shall subject me to tlq same penalties as if I had been
duly sworn.
-7t'r
oarc // (z? ,zott
Signature of Witness

sheet to be valid.

City: City of New York County: Queens

",:331.3r"- PARKSTDE pRiNTTNG co., rNc., s3B JoHNSoN AVE., BRooKLYN, NY (718) 443-7500 PAGE No.
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*QN1700044*
NOT FOR REPRODUCTION
3t2ot17 12:46 pn| 1643 I 5675 | FrankA. Eolz lll, Esq. (DEM)

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