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HomeMy WebLinkAboutPam Carroll - Seat Three - Qualifying Documents APPOINTMENT OF CAMPAIGN TREASURER RECEUVED AND DESIGNATION OF CAMPAIGN 1-[Ill .I .1 0011 DEPOSITORY FOR CANDIDATES (Section 106.021(1).F.S.) CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK (PLEASE PRINT OR TYPE) NOTE: This forma must be on file with the qualifying officer before opening the campaign account OFFICE USE ONLY 1.CIjECK APPROPRIATE BOX(ES): - Initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy 0 Depository 0 Office [] Party 2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city,state,zip 3am-e-lat.- A"tn Carr6 (i code) g(D 5 D V S O Vt V it i V-e-, 4.Telephone 5. E-mail address (A} (`Vl+r P je_ (S P'�� t- ("7 )35q 7800 P�a+rraU 777Zaol .� 3 2`14 81 v 6.Office sought(include district,circuit,group number) 7.If a candidate for a nonpartisan office,check if W(jAte r Seri&%f{ S e.t'kV C o Wl{M I SS C 00 applicable: Q.t r 3 E] My intent is to run as a Write-in candidate. 8.If a candidate fora parUsan office,check block and fill in name of party as applicable: My intent is to run as a D Write-in 0 No Party Affillation ® Party candidate. 9.1 have appointed the following person to act as my Campaign Treasurer 0 Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer 11.Mailing Address 12.Telephone 9 > -z--) (-/67) 1- -7 7. ��1'0 13. City 14.County 15. State 16.Zip Code 17. E-mail address �If-S0 ­�r 32-7,) � � �• Ju2'�Z� 18.1 have designated the following bank as my Primary Depository [] Secondary Depository 19. Name of Bank 20.Address S u vx Tras+ l a v,i - 5 115 iRect b u9 41a - RO OJ 21.City 22.County 23.State 24.Zip Code I�t•e it SPIrtoAs Seuv�tKo[e o v- t�d a�. 3 2.70 UNDER PENALTIES OF PERJURY,I DECLARE THAT 1 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. nu r of Candi ate o (P � 24 1 � -z-0 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) 1, 1 S 13`� ,do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer 0 Deputy Treasurer. Date ignature of Campaign Treasurer or Deputy Treasurer DS-DE 9(Rev.10/10) Rule 1S-2.0001,F.A.C. APPOINTMENT OF CAMPAIGN TREASURER RE N`1l tai AND DESIGNATION OF CAMPAIGN ,_rj" _ ., DEPOSITORY FOR CANDIDATES ' °A! ' 'fl% (Section 106.021(1),F.S.) CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK (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: 0 Treasurer/Deputy 0 Depository 0 Office (3 Party 2.Name of Candidate(in this order: First,Middle, Last) 3.Address{include post office box or street,city,state,zip - a,me.lc- Ain C o v—6 (1 `ode) `�G 5 D y s 0 V% V iriv-e, 4.Telephone 5.E-mail address W CVtt-e'r S Pi✓ P,,-(�� ! ! ("7 )361-78001 awr0t17'77a &2c1•� 3 2708' j 6.Office sought(include district,circuit,group number) 7.If a candidate for a nonpartisan office,check if W mime-r- G pr i 1ft 3 S C.t tO Wt Wt(SS 10#1 applicable: Q.l) r -' 3 [] 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 a Q Write-In [] No Party Affiliation Q Party candidate. 9.l have appointed the following person to act as my 0 Campaign Treasurer [g,' Deputy Treasurer 10.Name TMVww 4r Deputy Treasurer • Yv1 Cam.i0. V1 N �GC v'1!'e 11.Mailing Address 12.Telephone 0 (0 5 DYS6 h `.l7 rc v e. 1 (4D7) 3,9'T-"760b 13.City 14.County 15, State 1 16.Tip Code 17.E-mail address v-&Af Se nA(Ko(e F L 3 Z•76$ I 'Pc a rrai 191 r7a)00 1.cb 18.1 have designated the following bank as my Primary Depository Secondary Depository 19.Name of Bank 20.Address S uin'Cv-(a.S+ lam - 5 '7 '7 5 Rza b uuA 1-ac�e RoOj 21.City 22.County 23.State 24.Zip Code W IBC eir Sev-WI s ISew 410(e I Flo v'tda. 32.70 g 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 � � ` � 26. of Candi ate Ok 27. `�Treasurees Acceptance of Appointment(fill in the blanks and check the appropriate block) 7 I, \ a-m 1,I, Avi� Cjax ro (( ,do hereby accept time appointment (Please Print or Type Name) designated above as: 0 Campaign Treasurer uty Treasurer. 2-111 Za( (4 X Date Signature of Campaign T-reeewwr or Deputy Treasurer DS-DE 9(Rev.10110) Rule 1S-20001,F.A.C. OFFICE USE ONLY STATEMENT OF CANDIDATE RECEIVE (Section 106.023, F.S.) =:f= ,: ;?r11p (Please print or type) CITY OF WINTER SPRING OFFICE OF THE CITY CLEF K candidate for the office of w�V&-V- Sar11aGs y�wiw►cs5tova,�P_GC,� have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. ' 0 ,4,A e-& z r 2 o t Signature of Candidate bate 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) �y,NT CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION u I —AFFIDA VIT OF ACCEPTANCE Page 1 of 3 �5 1959 �G00 WE SaJZ� CITY COMMISSION SEAT ONE / SEAT �ies R / SEAT FIVE Circle W iicli ApTo C andidacy NOTE: The information provided to you in this packet, and the documents listed on this sheet, are provided to you to assist you in your campaign for Elective Office, however, the documents in this packet of materials are not intended to be a complete digest of the Elections Laws. IT IS YOUR RESPONSIBILITY TO READ AND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALL APPLICABLE REQUIREMENTS. The Applicant accepting this document and the attachments, and the Municipal Elections Off cial/City Clerk/Designee providing these documents, should each initial by each item (in each block)as reviewed: Date/Time Review Began Date/Time Review Concluded Qualifying Documents: (The documents in this section are due to the City Clerk/Designee no later than 12:00 Noon on the last day of Qualifying- Friday, September 2,2016) v "Appointment Of Campaign Treasurer And Designation Of Campaign Depository For Candidates" [DS-DE 9] "Statement Of Candidate" [DS-DE 84] 1 - "Affidavit Of Acceptance" (Must be completed/signed in front of the City Clerk/Designee). 2 - "Affidavit Of City Residency And Qualified Voter Status" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 3 - "Affidavit Of Residency-District" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 4- "Application For Office" (With Check drawn from Campaign Account or "Notice of Undue Burden") 5 -"Election Assessment" (With Check drawn from Campaign Account or"Notice of Undue Burden") 6-"Oath Of Candidate" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 7- "Loyalty Oath" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 8 -"Notice Of Testing Of Tabulating Equipment" 9 - "Notice Of Political Campaign Advertisements/Signage" 10 - "Schedule Of Campaign Finance Reporting Periods/Due Dates" 11 - "Notice Of Access To Campaign Finance Forms" 12 -Petition "Notice to Federal Government Employees" (If Applicable) "Form 1" - "Statement Of Financial Interests 2015" Revised 8/10/2016 .t��NTeR CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION 1 —AFFIDA VIT OF A CCEPTANCE Page 2 of 3 1959 tiCOD WEI 0 State of Florida-Information: "A Compilation of The Election Laws of the State of Florida" -July 2016 "2016 Candidate&Campaign Treasurer Handbook" -Revised 1/22/16 (Which includes "Chapter 12: Politica Advertising" and"Chapter 13: Other Disclaimers") "2016 Electioneering Communications Organization Handbook" -Revised 1/27/2016 State of Florida Election Information/Contacts y -- State of Florida-Division of Elections Campaign Finance Information: "Contributions Returned" [DS-DE 2] [Florida Statutes 106.07 (4)(c)] 2 Receipts Envelopes Electronic Filing Information: Letter from the Winter Springs City Clerk to "Candidates for Elected Office" (Re: Electronic Filing of Campaign Finance Reports)[(and Ordinance 2009-09] "Online Treasurer Reporting System" [Guidelines for Campaign Finance Electronic Filing of Reports] from the Seminole County Supervisor of Elections / Miscellaneous Information: ` "GUIDE to the SUNSHINE AMENDMENT and CODE of ETHICS for Public Officers and Employees" (2016) — "Foreign Nationals" -July 2003 "Statement of Ethical Campaign Practices" (from the Seminole County Supervisor of Elections) 2016 "Voter Guide&Florida Voter Registration Application" (from the Seminole County Supervisor of Elections) Revised 8/10/2016 CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION y I -A FFIDA VIT OF ACCEPTANCE Page 3 of 3 1-M-t a 1959 t ti�a0 WE tt:vy 'e 4` �0� City Information: "Charter" of the City Of Winter Springs "Chapter 2-Administration" from the City of Winter Springs Code of Ordinances City of Winter Springs Ordinance Number 2008-16 (also noted in Chapter 2 of the City of Winter Springs'Code of Ordinances) I sX� l City of Winter Springs Ordinance Number 2009-14 (also noted in Chapter 2 of the City of Winter Springs'Code of Ordinances) 2016 General Municipal Election"Information" _ City of Winter Springs [July] 2016 District Map The following signature area is to be signed upon receiving the 2016 Election Qualifying packet, including the above referenced documents: I, SIM ��(111r'C�' 1 have on this date received the forms and information, noted on these Name of Candidate(Please Print or Type) three(3)pages, in addition to any other Election materials that I may have previously received from the Office of the City Clerk for Winter Springs; and agree that I will read all of the Election packet materials that have been provided to me; and I also agree that it is my responsibility to comply with all La apply to the 2016 Election. xL90 Sitniat eof('andidate Cv 5 fl D r ' Street Address ('ity .late Zip Code 2 l Date STATE OF FLORIDA _ COUNTY OF �3 2 N Sworn to(or affirmed)and subscribed,under penalties of)fp�eduu y,,before(me this 7 day of r 201 1� ,by Y (�`f�`w► L" —n (Print Name of Person Making Statement) Notary Public-State of Florida ro7 Notary PuOd,, d otary Public Ar&"mr Expires 0 (Print Name of Notary Public) OR Personally Identification Known 7}pe of Identification Produced Revised 8/10/2016 Jy�NTERSA CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION ~ * l 2-AFFIDAVIT OF CITY RESIDENCY AND U rp 1959 'n QUALIFIED VOTER STATUS /~G,0 WE tRV�I( CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE Cntle Wltiel,Applies To an acv "Eligibility.Only qualified voters of the city shall be eligible to hold the office of mayor or commissioner." "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall have resided in the city one(1)year prior to the time of qualifying. Each candidate seeking the office of city commissioner shall be a resident of a designated commission district established by ordinance and shall have resided in the designated commission district six(6)months prior to the time of qualifying." "All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk..." [4.01.(b)Charter,City of Winter Springs] I, 'Ta.(A Carta I I do hereby state that I seek election to the City of Winter Name ofC andidatc(Please Print or Type) Springs', Cite Commission Seat One / Se�Ihree / Seat Five -a four(4) year term,in the Election to be held Circle Which Apacy in the City of Winter Springs, Florida, on Tuesday,November 8, 2016. I, further swear or affirm: (1 ) 1 am a qualified Voter of the City of Winter Springs / 7-� (2) My legal place of residence is: S O h� V ���� 1►'l S 3 Z ! 6tT Strcel ddress Otv Zip Code (3) Length of time of residency in the City of Winter Springs is: 2—y kle-a l/1J (4) 1 am attaching two (2) documents, one to be a Florida Driver's License, as verification of my r-y1w+& SV (idency in the City of Winter Springs. The second document is: ew Lilts Signature to U oo, 'D Y'l V 2. StreejAddress e'er 45,E�l,� & 3 2 7b City State Zip Code Date STATE OF FLORIDA COUNTY OF Swots to(or affirmed)and subscribed,under penalties off perjury,befo(re�me this day of 201�,by r (Print Name of Person Making Statement) Notary Public-State of Florida r ture of Notary Public r % Notary Public State of Fbrida Andrea LorenzaLuaces � EAL) y My Commission FF 218019 0 019 (Print Name of Notary Public) o u e OR Personally Identification_ Known Type ofldentification Produced FOR OFFICE USE ONLY Copy Of Florida Driver's License Provided For Item(4). r % r 1 Other Documentation � � �A Provided For Item(4). t Revised 7/21/2016 st�►''TR 3A CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION 3—AFFIDA VIT OF RESIDENCY—DISTRICT U '��•�1959 D WE Tf+ "�o CITY COMMISSION SEAT ONE / Si!ci / SEAT FIVE Circle c� "Eligibility.Only qualified voters of the city shall be eligible to hold the office of mayor or commissioner." "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall have resided in the city one(1)year prior to the time of qualifying. Each candidate seeking the office of city commissioner shall be a resident of a designated commission district established by ordinance and shall have resided in the designated commission district six(6)months prior to the time of qualifying." "All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk..." 14.01.(b)Charter,City of Winter Springs] I, ! to M (� " Ido hereby state that I seek election to the City of Winter Name of Candidate(Please Print or Type) Springs City Commission Seat One / Seat Three)/ Seat Five -a four(4) year term,in the Election to be held r Circle Whic 7 pp ies o(arndidac) in the City of Winter Springs, Florida, on Tuesday,November 8, 2016. 1, further swear or affirm:eL (1) My legal place of residence is: E 6 5j D SQN ,V 1/. t✓S ?2,70 Streb Address City State /in Code (2) Length of time of residency in the City of Winter Springs is: (3) Length of time of residency in Winter Springs District is: (4) 1 am attaching two (2) documents, one to be a Florida Driver's License, as verification of my residency in the City of Winter Springs. The second document is: W&Ae,Ir �1 �� S `S 4 Signature 5z 15 'vs zi K 'D-y,-1 v- , Street Address =`�' t vflo 'F L 3z �o� City I 44te /ip Code 21 1 Le STATE OF FLORIDA I Uate COUNTYOFt1c� Swoo to(or affinnetl)and subscribed,under penalties of petjury,before me this t day of 4-14-1 1' ,201 i (Print Name of Person Making Statement) t Notary Public-State of Florida f Notary Public Not"Pub'c Ste*Of Andrea Lorenz-Luaoeg%E MY Commission FF 218019 (Print Name of Notary Public) OF Expires 0&0912019 OR Personally Identification Known Type ofldentification Produced FOR OFFICE USE ONLY Copy Of Florida Driver's License Provided For Item(4). Other Documentation L ra f Provided For Item(4). Revised 7/21/2016 ,�rNTERs CITY OF WINTER SPRINGS, FLORIDA o`` __ 2016 GENERAL MUNICIPAL ELECTION * 4-APPLICATION FOR OFFICE u v, 95 1459 �THRE'N00 WETRJyCITY COMMISSION SEAT ONE / � / SEAT FIVE Circle Which Applies To Candidacy All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk and shall file qualifying papers in accordance with state statutes and pay the qualifying fee and election assessment provided for in section 2-88. Such application shall be filed and the qualifying fee paid during regular business hours any time after 12:00 noon on the first filing date,which shall be seventy-one(71)calendar days prior to the municipal election,but not later than 12:00 noon on the sixty-seventh(67) calendar day prior to the municipal election. [4.01.(b)Charter,City of Winter Springs] 12-87.Code of Ordinances,City of Winter Springs] "All candidates for city commission and mayor,qualifying as provided in this Code,shall pay a qualifying fee of one hundred fifty dollars ($150.00). The qualifying fee and the election assessment shall be paid to the city clerk and be paid by the clerk into the general fund of the city." [2-88.(a)Code of Ordinances,City of Winter Springs] "Pursuant to F.S.99.093(2),candidates who are unable to pay the election assessment without imposing an undue burden on their personal resources or resources otherwise available to them shall upon written certification of such inability given under oath to the city clerk be exempted from paying the election assessment. Any candidate exempt from the election assessment shall also be exempt from the city's qualifying fee." 12-88.(b)Code of Ordinances,City of Winter Springs] I, '?a V y' Cay m do hereby state that I am a registered and qualified Elector of the Name of Candidate(Please Print or Type) City of Winter Springs; and am applying for the Office of City Commission Seat One / "Seat Three / Seat Five Circle Which Applies I o Candidacy -a four(4)year term, in the Election to be held in the City of Winter Springs, Florida, on Tuesday, November 8, 2016. 1 further agree to pay the following Qualifying Fee: QUALIFYING FEE: $150.00 (:�:2Q4,Q�L �11 At at_ Signature of Candidate 2- 1 1 1 L Pate Document fired 9: 9e � �: � 9e9t9e �c � 9e � 4e �e9e �F9e � 9t3eeF �: �e � * * * * * * * * * � * � * * � 9e +Y * 9e 9e �e �Yat �: � �e9e �t 9e 9t 9e 9e FOR OFFICE USE ONLY Campaign Account Check in the amount of$150.00 attached(Check should be made payable to the "City of Winter Springs") or, if applicable ❑ Completed"Notice of Undue Burden" Attached Revised 7/21/2016 F NTER so CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION * l y 5-ELECTION ASSESSMENT tn�orPOr.t� 1959 °OOweTa`�y� CITY COMMISSION SEAT ONE / EAT THREE SEAT FIVE Cirele uc acy "Each person seeking to qualify for nomination or election to a municipal office shall pay,at the time of qualifying for office,an election assessment. The election assessment shall be an amount equal to 1 percent of the annual salary of the office sought." [99.093(1) Florida Statutes] "Any person seeking to qualify for nomination or election to a municipal office who is unable to pay the election assessment without imposing an undue burden on personal resources or on resources otherwise available to him or her shall,upon written certification of such inability given under oath to the qualifying officer,be exempt from paying the election assessment." [99.093(2) Florida Statutes] I, �Z WA CCAV-CO do hereby state that I am a registered and qualified Elector of the Name of Candidate(Please Print or Type) City of Winter Springs; and am applying for the Office of City Commission Seat One / Seat 7'hre / Seat Five C ircle W hic i pp r o Candidac, -a four(4)year term, in the Election to be held in the City of Winter Springs, Florida, on Tuesday, November 8, 2016. I further agree to pay the following applicable Election Assessment: ELECTION ASSESSMENT-COMMISSIONER: $120.00 Each Commissioner Receives: $1,000.00 per month $1,000.00 x 12 months= $12,000.00 annually The I%Assessment amounts to: $120.00 L, am,_ Signature of Ca tdidate ZD l Date Docume t Signed FOR OFFICE USE ONLY For Office of Commissioner-Campaign Account Check in the amount of$120.00 attached(Check should be made payable to the "City of Winter Springs") M, applicable 1-1 Completed"Notice of Undue Burden" Attached Revised 7/21/2016 Z TR SA CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION �- z ~ 6-OATH OF CANDIDATE U y n.�o*vorerea 1959 /1,'%o Wr.-rFV�A CITY COMMISSION SEAT ONE / EAT THREE / SEAT FIVE Circic N'h ic i pp i s o an a acy "Each candidate,whether a party candidate,a candidate with no party affiliation,or a write-in candidate,in order to qualify for nomination or election to any office other than a judicial office as defined in chapter 105 or a federal office,shall take and subscribe to an oath or affirmation in writing. A copy of the oath or affirmation shall be made available to the candidate by the officer before whom such candidate seeks to qualify and shall be substantially in the following form:" [99.021(1)(a) 1.Florida Statutes] STATE OF FLORIDA 1 COUNTY OF e IM i yI o l^� 'Before me, an officer authorized to administer oaths,personally appeared a ztr,, p to me well known, who,being sworn, says that he or she is a candidate for the office of City Commission Seat One / '"eat Three Seat Five; that he or she is a qualified elector of ���'�/(LAD Circle Which Applies o andidac� County, Florida; that he or she is qualified under the Constitution and the laws of Florida to hold the office to which he or she desires to be nominated or elected; that he or she has qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with that of the office he or she seeks; that he or she has resigned from any office from which he or she is required to resign pursuant to s. 99.012, Florida Statutes; and that he or she will support the Constitution of the United States and the Constitution of the State of Florida." (IM V 0 Signature of Candidate (0 5 .5 0V­% `D Y k V-e- t Street AddrV U I, Aeo&ov-,L&W , L- City I gJate 6 Zip Code Sworn to and subscribed before me this , day of `7��`X,�'�„ 201 `J at Seminole County, Florida. r l ignali0e and Title of Officer Administering Oath) Revised 7/21/2016 NTERSA CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION � z y 7-LOYALTY OATH 1959 •"C00 WE iaJy� • CITY COMMISSION SEAT ONE, / EAT THREE / SEAT FIVE ircle Which pp ies o anc a acy "All persons who now or hereafter are employed by or who now or hereafter are on the payroll of the state,or any of its departments and agencies,subdivisions,counties,cities,school boards and districts of the free public school system of the state or counties,or institutions of higher learning,except candidates for federal office,are required to take an oath before any person duly authorized to take acknowledgements of instruments for public record in the state in the following form:" ]876.05(1)Florida Statutes] Vv-t cpa-lre) � , a citizen of the State of Florida and of the United States Name(Please Print or Type) of America, and being employed by or an officer of the City of Winter Springs and a recipient of public funds as such employee or officer, do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida." Signature Tv ia Street Address � � �✓ � r `.L 32`7 City S ate Zip Code STATE OF FLORIDA COUNTY OF ` Sworn to(or affirmed)and subscribed,under penalties of pg�ury,before me this day of 2011,by ��y 1/� e e.r✓1 c �. (Print Name of Person Making Statement) ;i Notary Public-State of Florida YRO I t o otary Public State of Florida nzo-LuaC�EALon FF 218019 (Print Name of Notary Public) /2019 OR Personally Identification Known Type of Identification Produced Revised 8/10/2016 �I�NTERS CITY OF WINTER SPRINGS, FLORIDA �� t- - 2016 GENERAL MUNICIPAL ELECTION Z * 8-NOTICE OF TESTING OF TABULATING EQUIPMENT 1 59 4,-oa WEICL CITY COMMISSION SEAT ONE / SE �po E / SEAT FIVE ('ircle Which ddacy "On any day not more than 10 days prior to the commencement of early voting as provided in s.101.657,the supervisor of elections shall have the automatic tabulating equipment publicly tested to ascertain that the equipment will correctly count the votes cast for all offices and on all measures. If the ballots to be used at the polling place on election day are not available at the time of the testing, the supervisor may conduct an additional test not more than 10 days before election day. Public notice of the time and place of the test shall be given at least 48 hours prior thereto by publication on the supervisor of elections'website and once in one or more newspapers of general circulation in the county or,if there is no newspaper of general circulation in the county,by posting the notice in at least four conspicuous places in the county. The supervisor or the municipal elections official may,at the time of qualifying,give written notice of the time and location of the public preelection test to each candidate qualifying with that office and obtain a signed receipt that the notice has been given." [101.5612(2)Florida Statutes] NOTICE Please accept this Notice that the tabulating equipment to be utilized in the City of Winter Springs, Florida's 2016 General Municipal Election will be tested on: DATE: FRIDAY,OCTOBER 14, 2016 TIME: 10:00 A.M. The aforementioned test will be held at: THE OFFICE OF THE SUPERVISOR OF ELECTIONS FOR SEMINOLE COUNTY 1500 EAST AIRPORT BOULEVARD, SANFORD,FLORIDA 32773 (407) 585-VOTE [8683] City of Winter Springs Municipal Elections Official/Designee RECEIPT I, a- �� (( do hereby acknowledge that on this g Name of C'andidale(Please Print or Type) date of 2 , 201 , I received written Notice (as noted above/on this form in the highlighted block of the date,time, and location)related to the "Testing of Tabulating Equipment". Signature ofC'andidale 2 '::T 20 Uai.I�n,uon°ni tiiu cd Revised 7/21/2016 �,�>✓TeRS CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION * l 9-NOTICE OF POLITICAL CAMPAIGN 1959 ADVERTISEMENTS/SIGNS tiCOD WE'CRJ9 CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE Circic uc 's Tb Cans acy "The officer before whom a candidate qualifies for office shall notify the candidate,in writing,of the provisions in this section. 1106.1435(4)Florida Statutes] NOTICE Please find the following documents/information/references related to Political Campaign Advertisements/ Signs in this Notice: Copies related to Political Campaign Advertisements/Signs attached: (1) Copy of Florida Statutes 106.1435 (2) Copy of City of Winter Springs Signage information(Chapter 16 from our Code of Ordinances) Information/References related to Political Campaign Advertisements/Signs: (3) "A Compilation of The Election Laws of the State of Florida" -July 2016 (Chapters 97, 98, 99, 100, 101, 102, 103, 104, 105 and 106) [Included in Qualifying packet] (4) "2016 Candidate& Campaign Treasurer Handbook" - Revised 1/22/16 (Which includes "Chapter 12: Political Advertising" and"Chapter 13: Other Disclaimers") [Included in Qualifying Packet] ACKNOWLEDGEMENT I, 1/Vl COL�rm ( I do hereby acknowledge that on this date Name of Candidate(Please Print or Type) of ,201 , I received a copy of Florida Statutes 106.1435 and a copy of Chapter 16 from Winter Springs' Code of Ordinances,and with my signature affixed below, I understand that it is MY responsibility as a Candidate for Elected Office to comply with all Laws, especially as related to Political Campaign Advertisements/Signs. Also with my signature below,I acknowledge that I will comply with all Laws related to Disclaimers as explained/noted in "A Compilation of The Election Laws of the State of Florida" and the 2016 Candidate&Campaign Treasurer Handbook". r,44,orc( Signature ofC didate 4:g 2 l 2-a l %Date Documen Signed FOR OFFICE USE ONLY Attachment: Copy of Florida Statutes 106.1435 Attachment: Chapter 16 from Winter Springs'Code of Ordinances Revised 7/21/2016 ,N.NTE�R CITY OF WINTER SPRINGS, FLORIDA 0 t --� s 2016 GENERAL MUNICIPAL ELECTION } z 10-SCHEDULE OF CAMPAIGN FINANCE 1959 REPORTING PERIODS/DUE DATES tiGOD WE'�RJ� �Appl�ic,CITY COMMISSION SEAT ONE / / SEAT FIVE Circle y "The filing officer shall provide each candidate with a schedule designating the beginning and end of reporting periods as well as the corresponding designated due dates." 1106.07(1)(e)Florida Statutes] "Any candidate or political committee failing to file a report on the designated due date is subject to a fine..." 1106.07(8)(a)Florida Statutes] SCHEDULE DURING/AFTER QUALIFYING*,THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE: Report Due Date: September 12, 2016 -shall contain information regarding all previously unreported contributions and expenditures from August 1, 2016 -August 31,2016 Report Due Date: October 11, 2016 -shall contain information regarding all previously unreported contributions and expenditures from September 1,2016 - September 30,2016 Report Due Date: October 14,2016 -shall contain information regarding all previously unreported contributions and expenditures from October 1, 2016 -October 7, 2016 Report Due Date: October 28,2016 -shall contain information regarding all previously unreported contributions and expenditures from October 8, 2016 -October 21,2016 Report Due Date: November 4, 2016 -shall contain information regarding all previously unreported contributions and expenditures from October 22, 2016 -November 3,2016 A Final Report shall be filed 90 days after the General Election -on or before February 6, 2017 - shall contain information regarding all previously unreported contributions and expenditures from November 4,2016 -February 6,2017 For Unopposed Candidates -Report Due Date: December 1, 2016 -shall contain information regarding all previously unreported contributions and expenditures from September 1, 2014-December 1, 2016 ACKNOWLEDGEMENT I, V ( do hereby acknowledge that on this Namc of Candidate(Please Print or IT pe) date of , 201 , I received a written "Schedule Of Campaign Finance Reporting Periods/Due Dates" (as not d above/on this form). I)atc 1) umrnt tii!m d �i•naluc ((;m;l�datc Revised 7/21/2016 �%NTER CITY OF WINTER SPRINGS, FLORIDA o s 2016 GENERAL MUNICIPAL ELECTION c 11 -NOTICE OF ACCESS TO CAMPAIGN FINANCE FORMS • �nro.°1959 CITY COMMISSION SEAT ONE / EAT THREE / SEAT FIVE Circle Which App i . n idacy NOTICE Please note that Campaign Finance forms are available at the following State of Florida Website address: http://election.dos.state.fl.us/forms/index.shtml#can AND/OR through the Seminole County Supervisor of Elections Office when using their"Online Treasurer Reporting Sys- tem" and/or may be requested from the City of Winter Springs'Municipal Elections Official/City Clerk/Designee. ACKNOWLEDGEMENT 6 V��b i do hereby acknowledge that on this date Name of Candidate(Please print or Type) of 2 ,201_�_,with my signature below, I acknowledge that I understand that I am to comply with the provisions in Ordinance 2014-11; and in addition, I acknowledge that I have received this Notice that Campaign Finance forms can be accessed at the above noted State of Florida Website; and I also understand that State of Florida Campaign Finance forms are accessible through the Seminole County Supervisor of Elections Office when using their"Online Treasurer Reporting System" and understand that State of Florida Campaign Finance forms can also be requested from the City Clerk/Designeefor the City of Winter Springs. Signature of Candidate zq / 1 (0 Date Doan ent Signed FOR OFFICE USE ONLY Attachment: Ordinance 2014-11 Revised 7/28/2016 �t�NTER� CITY OF WINTER SPRINGS, FLORIDA 0�--� �, 2016 GENERAL MUNICIPAL ELECTION '= 12-PETITION 1959 "QOo WEIR CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE Circle Which Applies To Candidacy "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall file a petition signed by fifteen(15) registered voters of the city with the city clerk" 12-87.Code of Ordinances,City of Winter Springs] m Ca r r o I ' do hereby state that I seek nomination to the City of Winter Name of Candidate(Please Print or Type) Springs', City Commission Seat one / eat Three / Seat Five a four(4)year term,in the Election to be held Circle Seat W is Applies To Candidacy in the City of Winter Springs,Florida, on Tuesday,November 8, 2016. I�,�fpurther state that: C t-� Q� (1) My legal place of residence is: �4 D y$OVt D r l V2 W 04i-f-lr SnrlVlt�$ r L, 3 Z ` Q O Street Address Citv State Zio Code (2) Length of time of residence in the City of Winter Springs: e&y-5 (3) City of Winter Springs Registered Voter: Yes No a Signature of Candidate IMP 5 s a vi D rj e, t Street Address U1 t vt}�r Sy im is FL 3 2 7©s City State Zip Code We,the undersigned qualified Electors, residing in the City of Winter Springs,Florida,nominate: :j:)Q,W\ C exy- O (' for the City of Winter Springs' Name of Candidate(Please Print or Type) City Commission Seat One / eat Three / Seat Five Circle Seat Which Applies To Candidacy (Please Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (2) N 1t (Please{Print or Type Name) ' Signature Date Petition Signed County 4 5 SSQ,uS13r �) v, Q8 S � Stree Address City State Zip Code Voter Registration Number OR Date Of Birth Revised 7/21/2016 `t1�NrERS CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION Z 12-PETITION —1 9151d9 ,/,,COD WE-T%"% C NAME OF CANDIDATE: ?Ol,M CAT-rD ( I Page 2 of 5 Name of Candidate(Pleas T nt or T (3) 6'4'a jo-y UY�J (Please Print or Type Name) Sigripw Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (Please Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (5) •j��11-1 14. S f-(\� —7 l(l f %1 (Please Print or Type Name) Signature Date Peti ton Signed County Scu 0V'k ,), 0F Stre Address City I1 2 State Zip Code Voter Registration Number OR Date Of Birth (6) (Pie s Print or Type Name) / A�{j tore Date Petition Signed / /County 7 / Street Address City State Zip Code Voter Registration Number OR Date Of Birth (7) f1 (Please Print or Type Name) ture Date�Petitichi Signed County 76L' A Str9t Address City State Zip Code Voter Registration Number OR Date Of Birth (8) Ann nn ,1, 5ti'&r c C. r 1 Please Print or Type Name) Signature Datj Petition Signed County S05- !2�,.sg^ Dr'vt Lot r s �� 3?wg 01-17— 115-19 Street Address City State Zip Code Voter Registration Number OR Date Of Birth r a �1� g , L� IK (Please Print or Type Name) Signature Date etition Signed County 5 b� `tom �' fL 'zo� 107733 95' eet Address City State Zip Code Voter Registration Number OR Date Of Birth Revised 7/21/2016 aa�NTFRs CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION 12-PETITION u _ W Inwrp 19 9 •'~Q00 WETF�Jy� • �� NAME OF CANDIDATE: t �-� ��Y- Page 3 of 5 Name of Candidate(Please Print or Type) 7PAY�� e -14-1(p (Please Print or Type Name) Q� Signature Date Petition Signed County p Street Address City State Zip Code Voter Registration Number OR Date Of Birth (Please Print or Type Name) Si Datelpetitiysigned County z �,0&1 e /4k 40 Li r 0 U, Street Address City State Zip Code Voter Registration Number OR Date Of Birth (Please Print or Type Name) ignature Date Petition Signed County t W v� ±--L, ( _ _j Lr „� Street Address 11Q City State Zip Code Voter Registra ion Number R Date Of Birth ct(13) - i O(Z y116:, )e'-',�h'3(P (Pleas Print or Type Name Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (14) A I�PT-J<k--Sr A/ 1 'j/i 01-/6 — (Please Print or Type Name) Signature D e Petificz Signed County Street Address State Zip Code Voter Registry on Number OR Date Of Birth /�7 Vl7 7 s (15) ;a ANkF— 14 SZt'11NoCt- (Please Print or Type Name) Signature Date Oetition S fined County '-I I L- SA 1A CfZ I �C,1-Pry�►-t (T ,LODZ— ���l i.�� �� 3270 3 t Street Address City State Zip Code Voter Registration Nudber OR Date Of Birth (16) 6�r�� : (Please Print or Type Name) Signatures .y Date Petition S fined �1 County woro"*" "ere Street A dress City State Zip Code Voter Registration Number OR Date Of Birth Revised 7/21/2016 t4TE� CITY OF WINTER SPRINGS, FLORIDA 2016 GENERAL MUNICIPAL ELECTION Z 12 -PETITION V 1—rpor•red • 1954 CV� �~G00 WEIRJy� NAME OF CANDIDATE: �Q Page 4 of 5 Name of Candidate(Please Print or Type) (17) �. (Please Print or Type Name) Signature Date Petition Signed County 41 Street Address City State Zip Code Voter Registration umber OR Date Of Birth (Please Print or T Name) Signature Date etitio i e County Z/ 3 F� 3a�08L-- zo A ; A7 Street AdIress City State Zip Code Voter Registration Number OR Date Of Birth (19) �e 61 8l 41116 Ye4-t ,, o (Please Print or Type Name) Signature Date Petition Signed County Street Addre City State Zip Code Voter Registration Number OR Date Of Birth P (20) Z 4e l%n L - 't- ;M o u (Please Print or Type Name) Signature Date Petition Signed County T 0 SM14Jr- t� (A IV «. L4V'� -r Sir. 7L 3a�� q 43vI a3 Street Address City State Zip Code Voter Registration Number OR Date Of Birth (21) 'qj�j 10 S-p r-1 it) 6/-(, L14 (Please Print or Type Name) tore Date Petition Signed County '7 C4 QSn.4' Sfr'mgf t G 3,?76,� 2-11 Street AAress City State Zip Code Voter Registration Number OR Date Of Birth (22) d r-r :2 11A - -em no le- (Please Print or Type Name) Signature Date Petition Signed County 2 To,Ve- f Phi wli?ke ,z?Og c i //M Street Address City State Zip Code Voter RegIstration Number OR Date Of Birth (23) (Please Print or Type Name) /? Signature Dat Petition Signed County Street Address City State Zip Code Voter Registration Nufnber OR Date Of Birth Revised 7/21/2016 ORM 1 STATEMENT OF 2015 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDQLJ NAME : MAILING ADDRESS: CITY; ZIP: COUNTY: *. w I vile tr rt ng-s NAME OF AGENCY: NAME OF OFFrCE OR POSITION HELD OR SOUGHT: cn = C urt vr+ i .Siomer Se&-+T- r e 5 You are Cot 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, 2015 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE 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(must check one): ❑ 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") ,X NAME OF SOURCE SOURCE'S DESCRIPTION OFTHESOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY ara dV% ro Vats 3 o6 o Id LAKC Mdxv Ed " Y_ rr ' ' 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 E TITY 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. 2 9 0 INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2016 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-6.202(1),F.A.C. INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions] (if you have nothing to report,write"none"or"nia") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Li c o w c 1 aa- > X PART E—LIABILITIES [Major debts-See instructions] (if you have nothing to report,write"none"or"nia") NAME OF CREDITOR ADDRESS OF CREDITOR i Su K .0 zz zz'? :r u o L 3z,%6Pz 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"nia") BUSINESS ENTITY#1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5%INTEREST E BUSINESS NATURE OF MY OWNERS INTEREST PART G—TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. t CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473,or attorney Signature: in good standing with the Florida Bar prepared this form for you,he or she must complete the following statement 1, , prepared the CE L1, /�n�A A Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form.Upon my reasonable knowledge and belief,the disclosure herein is true and correct. Date Signed: CPA/Attomey Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form,including If you were mailed the form by the Commission Initially,each local officer/employee,state officer, signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they Prior to confirmation, even if that is less than section(s)- permanently reside. (if you do not permanently 30 days from the date of their appointment reside in Florida, file with the Supervisor of the Candidates must file at the same time they file NOTE: county where your agency has its headquarters.) their qualifying papers. MULTIPLE FILING UNNECESSARY file by July 1 following each calendar A candidate who previously filed Form 1 because State officers or spewed state employees year in which they hold their positions. file with the Commission on Ethics, P.O. Drawer of another public position must file a copy of 15709, Tallahassee, FL 32317-5709; physical Finally, file a final disclosure form (Form 1 F) his or her Form 1 when qualifying.A candidate address:325 John Knox Road, Building E, Suite within 60 days of leaving office or employment. who files a Form 1 with a qualifying officer is 200,Tallahassee,FL 32303. Filing a CE Form IF(Final Statement of Financial not required to file with the Commission or Interests)does not relieve the filer of filing a CE Supervisor of Elections. Candidates file this form together with their Form 1 if the filer was iii his or her position on qualifying papers. December 31,2015. Facsimiles will not be accepted. To determine what category your position falls under,see page 3 of instructions_ CE FORM 1-Effective:January 1,2016. PAGE 2 Incorporated by reference in Rule 34-8.202(1),F.A.C.