HomeMy WebLinkAboutGeoff Kendrick - Seat Five - Qualifying Documents RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN * °r' ' 1
DEPOSITORY FOR CANDIDATES CITY OF VANTER SPRINGS
(Section 106.021(1), F.S.) 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. 9HECK APPROPRIATE BOX(ES):
I Initial Filing of Form Re-filing to Change: F] Treasurer/Deputy Depository Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
/ code) ,
(7eic on e 1� Li
4. Telephon 5. E-mail address
����'`
(ye ) ` :� c?�} K�'hd^��k -� tie,.. -.�►
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
l applicable:
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
Write-In F] No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Ef Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Addresd 12.Telephone
13. City 14 County 15. State 16.Zip Code 17. E-mail address
Zd-1. ,i,-:- S`,;-,- , ,1 -F7 Lz ?& e eor /� .7�E��-:c. i�io4, ry►
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19;,,Name of Bank 20.Address
21. City 22. County 23.State 24. Zip Code
UNDER PENALTIES OF P RJURY,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. Signa e.of Candidate
27. Treasurer's Acceptance of Appointment(fill in the blaAland check the appropriate block)
I, r ✓`e W, e_ - do hereby accept the appointment
(Please Print or Type Name)
designated above as: 8_<ampaign Treasurer ❑ Deputy Treasurer.
X
Date S–Ignat6X of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATEj,
4 �aTY OF\MNTER SPRINGS
(Section 106.023, F.S.) -,"10F OF THE CITY CLERK
(Please print or type)
1, Cam' c���✓'� �v�
candidate for the office of r
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X / ice
19nature of Candidate 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)
J��NTER CITY OF WINTER SPRINGS, FLORIDA
o— N-1� 2016 GENERAL MUNICIPAL ELECTION
u * \ 0 1 —AFFIDA VIT OF ACCEPTANCE Page 1 of 3
i�monua --
7959
"oo WE�aJy� CITY COMMISSION SEAT ONE / SEAT THREE dacy SEAT FIVE
(iicle Which Applies 1 o Candi
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 Official/City Clerk/Designee
providing these documents, should each initial by each item (in each block) as reviewed:
DL/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)
e,44 9°`e LG
Y "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).
deb L��J 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 Clieck drawn from Campaign Account or "Notice of LJndue 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"
_1 9 - "Notice Of Political Campaign Advertisements/Signage"
10 - "Schedule Of Campaign Finance Reporting Periods/Due Dates"
11 -"Notice Of Access To Campaign Finance Forms"
EZI 12 -Petition
"Notice to Federal Government Employees" (lf Apphcablc)
"Form 1" - "Statement Of Financial Interests 2015"
Revised 8/10/2016
CITY OF WINTER SPRINGS, FLORIDA
o--- s 2016 GENERAL MUNICIPAL ELECTION
u *,l I —AFFIDA VIT OF A CCEPTANCE Page 2 of 3
ro�oy�
1954
t
~GDD WESRVS
State of Florida- Information:
4 O
"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
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:
J "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)
0 2016 "Voter Guide&Florida Voter Registration Application" (from the Seminole County Supervisor
of Elections)
Revised 8/10/2016
sy�NT R sA CITY OF WINTER SPRINGS, FLORIDA
o -- -- 2016 GENERAL MUNICIPAL ELECTION
*l 1 -AFFIDA VIT OF A CCEPTANCE Page 3 of 3
m_c a
1959
~C01)WEYPJ9
J
City Information:
X "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)
t� 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, � �r�L�— have on this date received the forms and information,noted on these
Name ofCandidate(Please Prim 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 Laws ;—hey apply to the 2016 Election.
Signature ofCandidate
�LG�� �L7 ✓L'l.i�Gt o'� i/�L��
Street Address
State Zip Code
262/;ao /
/ Datc
STATE OF FLOR/DA
COUNTY OF� ,t Q°- U-
Sworn to(or affirmed)and subscribed,under penalties of perjury,before me this
of �� ,201 _,by=-�'T � "A)` as
(Print Name of Person Making Statement)
Notary Public-State of Florida
0, Notary PtrtNic State a ure e otary Public
=411 Lorenzo-Luao88
My Coromiuioo FF 218019 (S L)
e.1., Expina 0810942019
(Print Name of Notary Public)
Produced OR Personally
Identification Known
Type of Identification Produced /.l L� ''
Revised 8/10/2016
F SA CITY OF WINTER SPRINGS, FLORIDA
o 2016 GENERAL MUNICIPAL ELECTION
y 2-AFFIDA VIT OF CITY RESIDENCY AND
—,1459 • QUALIFIED VOTER STATUS
-V,zoo WF:,v
CITY COMMISSION SEAT ONE / SEAT THREE SEAT FIVE
Cuele Which Applies I Candidacy
"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]
do 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 / eat Five -a four(4)year term, in the Election to be held
Circle Which Applies to Candidacy
in the City of Winter Springs, Florida, on Tuesday, November 8, 2016. 1, further swear or affirm:
(1) 1 am a qualified Voter of the City of Winter Springs
(2) My legal place of residence is: 1 �O�W�}� ffG ate {,n � FL
Street Address City T State Zip Code
(3) Length of time of residency in the City of Winter Springs is: (/Ga.-J,
(4) 1 am attaching two (2) documents, one to be a Florida Driver' License, as verification of my residency
in the City of Winter Springs. The second document is:
Signature
Street Address
Otrlf State Zip('ode
;4z)/4/,
Date
STATE OF FLORIDA, n
COUNTY OF
Sworn to(or affirmed)and subscribed,under penalties of perjury,before
Mme this
-y of ,201 .by "�-�vVt
(Print Name cY Person Making Statement)
Notary Public-State of Florida
#0"N Notary Pubfic State of Florida Si toe of Notary Public
Andrea Lorenzo-Luaces
e My Commission FF 218019 SEAL)
or a Expires OSAW2019 (Print Name of Notary Public)
Produced OR Personally
Identification Knownf A
Type of Identification Produced
FOR OFFICE USE ONLY
Copy Of Florida Driver's License Provided For Item(4).
� Provided For Item(4).
�" Other Documentation, �-�� ��-cam-( �.
Revised 7/21/2016
F��NT�Rso CITY OF WINTER SPRINGS, FLORIDA
o —,--- 2016 GENERAL MUNICIPAL ELECTION
t *l ci 3-AFFIDA VIT OF RESIDENCY-DISTRICT
u u,
incoro 1959
~Q00 WET -c CITY COMMISSION SEAT ONE / SEAT THREE SEAT FIVE
Circle Which Applies To('andidacy
"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, f) do hereby state that I seek election to the City of Winter
Namc of k andidate(Please print or Type)
Springs City Commission Seat One / Seat Three / S�Five four(4)year term, in the Election to be held
('ircle Which Applies To('andidacy
in the City of Winter Springs, Florida, on Tuesday, November 8, 2016. I, further swear or affirm:
(1) My legal place of residence is:
Street Address ('itv State Zio Code
(2) Length of time of residency in the City of Winter Springs is: 44 y, >
(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 I.,icense, as verification of my
residency in the City of Winter Springs. The second document is: -e✓
Signature
l zap
/ J Street Address
City— State Zip Code
STATE OF FLORIDA f Date
COUNTYOF }z
Sworn to(or affinned)and subscribed,under penalties of perjury`,before me this
'day ofv 201 ,by
I
? (Print Name'of Person Making Statement)
Notary Public-State of Florida
Notr.ry PubNe St � lati� of tary Public
y cyAndrea Lorenzo-L aces
�g My ComnVuilon FF 218MAL)
+�d��,cP Expires 05109J2019 (Print Name of Notary Public)
Produced OR Personally
Identification Known L
Type of Identification Produced_
FOR OFFICE USE ONLY
® Copy Of Florida Driver's License Provided For Item(4).
�y.. Other Documentation-. 0 U�^ ice{ `t; Provided For Item(4).
Revised 7/21/2016
.t�XNTe;?s CITY OF WINTER SPRINGS, FLORIDA
Ok , a 2016 GENERAL MUNICIPAL ELECTION
• 0 4-APPLICATION FOR OFFICE
u u,
• I— 1959
'~C'bb v„ETaJy�C CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE
Circle Which Applies I 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. 14.01.(b)Charter,City of Winter Springs][2-87.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."
12-88.(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]
11 � Lmay,e� ,.: 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 To Candidacy
-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 Qualifying Fee:
QUALIFYING FEE: $150.00
Signature of Candidate
Date Document Signed
9e 9e 9e 9e 9e it 9e nY �t 9t �F 9e nF 9c �e 9e ie � 9t �e 9c * 9c 9e 9e �Y �c 9e 9t �F �Y 9e � * * �e 9e 9e �t 9e it 9e �e 9e 9e it 9e 9e � * * * * * 9e
FOR OFFICE USE ONLY
F ' Campaign Account Check in the amount of$150.00 attached(Check should be made payable to the
'' "City of Winter Springs")
or, if applicable
1-1 Completed"Notice of Undue Burden"Attached
Revised 7/21/2016
%NTERS` CITY OF WINTER SPRINGS, FLORIDA
o� 2016 GENERAL MUNICIPAL ELECTION
* y S-ELECTIONASSESSMENT
1959
• "��o CITY COMMISSION SEAT ONE / SEAT THREE / EAT FIVE
Circle Which Applies To Candidacy
"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 I
"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." 199.093(2) Florida Statutes I
I, 6 �O Ff � �,a Z�.._ do hereby state that I am a registered and qualified Elector of the
Name of(andidate(Please Print or'I ype)
City of Winter Springs; and am applying for the Office of City Commission Seat One / Seat Three SeaFive
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. 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
Signature of Candidate
ate Document Signed
�Y 9e 9c �e 9e �e �r �t �e �e 9e 9e >F * * 9e 9e 9t 9e �e 9e 9e 9e 9e 9e 9t 9e 9t 9e 9e * �Y 9e �Y 9e �e 9e 9e 9e 9e 9e 9e 9e 9t 9e 9t 9e 9t �t 9e 9e 9e 9e 9e 9t 9e
FOR OFFICE USE ONLY
i
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")
or, 1 applicable
❑ Completed"Notice of Undue Burden" Attached
Revised 7/21/2016
�.{a�NTER sA CITY OF WINTER SPRINGS, FLORIDA
° 2016 GENERAL MUNICIPAL ELECTION
� z
~ 6-OATH OF CANDIDATE
°
U mro,1959 y
/~C'Op WE,rRily-C CITY COMMISSION SEAT ONE / SEAT THREE SEAT FIVE
('irn le Which Applies I Candidacy
"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:" 199.021(1)(a) 1.Florida Statutes]
STATE OF FLORIDA
COUNTY OF 4 5i 100V
'Before me, an officer authorized to administer oaths, personally appeared
�z k
� . ., At A. � ,
to me well known, who, being sworn, says that he or she is a candidate for the office of
City Commission Seat One / Seat Three Se lve; t he or she is a qualified elector of_G at, ;i,
Circle Which Applies fo('andi
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."
Sienature of Candidate
Street Address
City State Zip Code
Sworn to and subscribed before me this J7/ day of a 201 ,
at Seminole County, Florida. i
f
(Signature and Title of Officer Administering Oath)
/J
Revised 7/21/2016
�st�ttTERsA CITY OF WINTER SPRINGS, FLORIDA
2016 GENERAL MUNICIPAL ELECTION
7-LOYALTY OATH
0
L) Incorpora[etl to
1959
'~GGD WE:-0 y CITY COMMISSION SEAT ONE / SEAT THREE SEAT FIVE
('ircle Which Applies io Candidac)
"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]
pFE 4?o ,A,c- 4 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
Street Address
State Zip Code
STATE OF FLORIDA C,
COUNTY OF
Sworn to(or affirmed)and subscribed,under penalties of perjury,before me this
,x
day of �7 201 ,by
r / (Print NaiW of Person Making Statement)
1 Notary Public-State of Florida
tary Public
Notary Public State or FJ¢ ! 1 I -
4 Andrea Lorenzo-Luat�"Y) .. L V't� � 2< 6
My Commission FF 218019 (Print Name of Notary Public)
0i utidp Expires 05/09/2019
. OR Personally
Identification Known
Type of Identification Produced
Revised 8/10/2016
4�1�NTER sA CITY OF WINTER SPRINGS, FLORIDA
2016 GENERAL MUNICIPAL ELECTION
* , 8-NOTICE OF TESTING OF TABULATING EQUIPMENT
1959
~GOD WEtRJ�� CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE
Circle Which Applies I Candidacy
"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
Fr' ,��,,�,, �,� do hereby acknowledge that on this
Name of Candidate(Please Print or Ivpe)
date of j , 201 45� , 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 of Candidate
&
Date ILaunu•nt Sirncd
Revised 7/21/2016
��N reRS CITY OF WINTER SPRINGS, FLORIDA
o� -,-- 2016 GENERAL MUNICIPAL ELECTION
~ 0 9-NOTICE OF POLITICAL CAMPAIGN
u
1959 195 � ADVERTISEMENTS/SIGNS
t
X000 WETRJ9
CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE
('ircle Which Applies 1'o Candidacy
"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, rF 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".
Signature >fCandidate
&LIA/I-Z-T>14�1
Date Document 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
��NTEtgs CITY OF WINTER SPRINGS, FLORIDA
2016 GENERAL MUNICIPAL ELECTION
� z
10-SCHEDULE OF CAMPAIGN FINANCE
1959 REPORTING PERIODS/DUE DATES
tiGO�WET¢Jy
c
CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE
(ircle Which Applies To Candidacy
"The Fling 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 t
"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, �eorf ,�'e"�,',,� do hereby acknowledge that on this
Name of Candidate(Please Print of"I Nile)
date of _ /� , 201 i�, , I received a written "Schedule Of Campaign Finance Reporting
Periods/Due Dates" (as noted above/on this form).
Ikitr l)n,unicm�icn:d Signature of Candidate
Revised 7/21/2016
CITY OF WINTER SPRINGS, FLORIDA
o� 2016 GENERAL MUNICIPAL ELECTION
u *l 11 -NOTICE OFACCESS TO CAMPAIGN FINANCE FORMS
��1959
000 WE WETPJ�� CITY COMMISSION SEAT ONE / SEAT THREE / SEAT FIVE
Circle Which Applies fo Candidacy
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.shtmI#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
do hereby acknowledge that on this date
Name of Candidate(Please Print or Type)
of �,� , 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
Date Document Signed
FOR OFFICE USE ONLY
Attachment: Ordinance 2014-11
Revised 7/28/2016
CITY OF WINTER SPRINGS, FLORIDA
2016 GENERAL MUNICIPAL ELECTION
* 12 -PETITION
U U1
�nroro•��a
• 1959
'~000 WETRV 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]
do hereby state that I seek nomination 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
Circle Seat Which Applies To Candidac
in the City of Winter Springs,Florida, on Tuesday,November 8, 2016. I, further state that:
(1) My legal place of residence is: ,ZX/ //a—nwjv1c) 77LYP eL, _7276p,
Street Address City tate Zio Code
(2) Length of time of residence in the City of Winter Springs:
(3) City of Winter Springs Registered Voter: Yes No
Date
Si tore of Candidate
-ti-I 171 k!z:;�!
Street Address
City 60' State Zip Code
We,the undersigned qualified Electors, residing in the City of Winter Springs,Florida,nominate:
���FAG for the City of Winter Springs'
Name of Candidate(Please Print or Type)
City Commission Seat One / Seat Three / Seat Five
Circle Seat Which Applies To Candidacy
(1) Er►n I�, 1`�Ch�rr C ��-� �� o � mini�tG
(Please Print or Type Name) Signature Date Petition Signed County
!1!K4-Tr4wcod B) 'ij F� 70 61A)7.5
Street Address City I j State Zip Code Voter Registration Number OR Date Of Birth
(2) Gt G��� r`�� G ! .29/&/
(Please Print J Type Name) Signature Da a Petiti Signed County
Street Address Ci State Zip Code Voter Aegistrition Number OR Date Of Birth
Revised 7/21/2016
�`t4TiE CITY OF WINTER SPRINGS, FLORIDA
o s�,� 2016 GENERAL MUNICIPAL ELECTION
12-PETITION
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1959
i,VCOD WETS Jy.(
NAME OF CANDIDATE: �FF ke l:✓ Page 2 of 5
ame of Candidate(Please Print or Type)
(3) g av-v----- g 40 i vz0 E'-
(Please Print or Typ ame) Signatu Date Petition Signed County
Street Address City State Zip Code Voter Registrati n Number OR Date Of Birth
(4) 'a-mJ 1*G P. Acd u'�� 4A z.' +9 Z4 AeAy P-Xt/�-!!o v e_M j r7&I�
(Please Print or Type Na� Signature I Date Petition Signed County
Street Address OF State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Name) Signatur Date Petition Signed County
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Street Address City / State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Types me) Signature Date P'ettitionCSig/ned County
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(Please Print or Type Name) Wfature Date Petition Signed County
Street Address City State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Name) Sigtature Date Petition Signed County
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Name) [ure Date Petition Signed County
Street Address City State Zip Code Voter Registration Number OR Date Of Birth
Revised 7/21/2016
�,aTER s CITY OF WINTER SPRINGS, FLORIDA
2016 GENERAL MUNICIPAL ELECTION
z 12-PETITION
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NAME OF CANDIDATE; L+'+°o F � a"� Page 3 of 5
Name of Candidate(Please Print or Type)
(10) r�
(Please Print or Type Name) Si ature Dad Petition Signed County
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Street Address City State Zip Code Voter Registra ion Number OR Date Of Birth
(Please Print or Type Name) ignamre Date Petition Signed County
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
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Street Address CiK State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Na e) gna Date Peti lon Signed County
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Stree Address City State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Name) ignature Date Oetition Si�ned County
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Street Address City State Zip Code Voter Registration Number R Date Of irth
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
Revised 7/21/2016
�XNTE/,? CITY OF WINTER SPRINGS, FLORIDA
o4 s p� 2016 GENERAL MUNICIPAL ELECTION
12-PETITION
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NAME OF CANDIDATE: �����'��i�,r✓� Page 4 of 5
Name of Candidate(Please Print or Type)
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(Pleas rint or Type Name) Signature Date Petition Signed County
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
(Please Print or Type Name) Signature Date Petition Signed County
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
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(Please Print or Type Name) Signature., Date Peti County
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Street Address City State Zip Code Voter Registration Number OR Date Of Birth
(20)
(Please Print or Type Name) Signature Date Petition gigned County
Street Address City State B
Zip Code Voter Registration Number OR Date O irth
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S et Address City state Zip Code Voter Registration Number OR Date Of Birth
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Street Address City to Zip Code Voter Registratid Number 6R Date Of Birth
(23)
(Please Print or Type Name) Signature Date Petition Signed County
Street Address City State Zip Code Voter Registration Number OR Date Of Birth
Revised 7/21/2016
,-
FORM 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--MIDDLE NAME :
MAILING ADDRESS :
G�
I220f
CITY: ZIP: COUNTY:
N E OF AGENCY: �^
�r✓�li� J
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF g'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):
❑ DECEMBER 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 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 (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")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
y T ff
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
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 1,2016 (Continued on reverse side) PAGE 1
Incorporated 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
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"n/a")
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 IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G—TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
❑ I 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:
I, , prepared the CE
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/Attorney 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,
signina 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: State officers or specified state employees Thereafter,file by July 1 following each calendar
A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer year in which they hold their positions.
of another public position must file a copy of 15709, Tallahassee, FL 32317-5709; physical Finally, file a final disclosure form (Form 1F)
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 1 F(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 in 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.