HomeMy WebLinkAboutBenton, Matt Qualifying Packet - 2020 08 24e7 so CITY OF WINTER SPRINGS, FLORIDA
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The following information is provided to you to assist in your campaign for Public Office; however, please note the documents
in this packet of materials are not intended to be a complete digest of Florida's Election Laws.
IT IS YOUR RESPONSIBILITY TO READ AND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALL APPLICABLE
REQUIREMENTS
The appplicant accepting this document and the attachments should initial after each section as it is reviewed
QUALIFYING DOCUMENTS
The documents in this section are due to the City Clerk/Designee no later than 12.-00 p.m. on the last day of Qualifying which is
Friday, August28, 2020.
"Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates" [DS-DE 9]
"Statement of Candidate" [DS-DE 84]
1 * "Affidavit of Qualified Voter Status and City Residency"
2 "Application for Office and Election Assessment" (WITH a check drawn from campaign account for the Application Fee
AND the applicable 1% Assessment OR "Notice of Undue Burden")
3 "Notice of Testing Tabulating Equipment"
4 "Notice of Political Campaign Advertisements/Signs"
5 "Schedule of Campaign Finance Reporting Periods/Due Dates"
6 "Notice ofAccessto Campaign Finance Forms"
7 "Candidate Petition"
* Candidate Oath
"Notice to Federal Government Employees (If applicable)
"Form 1" - "Statement of Financial Interests 2019"
Accepted:
QUALIFYING DOCUMENTS
WITH AN *ASTERISK MUST
BE COMPLETED IN FRONT
OF THE CITY
CLERK/DESIGNEE DURING
QUA,U[FYING
STATE OF FLORIDA INFORMATION
"The Florida Election Code, Chapter 97 -106, Florida Statutes [08/2019] (includes Chapter 106 which addresses Political
Advertising and Disclaimers, etc.
"Candidate and Campaign Treasurer Handbook" (10/3/2019) (Which includes "Chapter 12: Political Advertising" and
"Chapter 13: Other Disclaimers"
"Electioneering Communications Organization Handbook"
State of Florida Election Information Contacts
Accepted:
Revised 07/27/2020
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4 ` I y OF ` VI j, F 1 N
a w CITY OF WINTER SPRINGS, FLORIDA
® r ihz 2020 GENERAL MUNICIPAL ELECTION
�.��rar ld�,".,ii.l VE
NAME: I/\ a
CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION
�"Contributions Returned" [DS-DE-2]
I Envelopes of Checks/Receipts (2)
Accepted: F-7 P �^
Accepted:
CITY OF WINTER SPRINGS INFORMATION
of Winter Springs 2019 District Map
MISCELLANEOUS INFORMATION
lent of Ethical Campaign Practices" (From the Seminole County Supervisor of Elections
n nationals" - from the Federal Election Commission (6/23/2017)
Legal References for Qualifying Documents
Accepted:
:o it u.11'wl
tlI1HSC0V4U[ V'iED
0VZ lA A li.Q„ T l
CITYCLE11Id I11l)UPVV',VC
age 2 of?
NOTE: The Candidate SHOULD NOT close out their Campaign Bank Account before they are invoiced and payment is made
to the Seminole County Supervisor of Elections for verification of Petition signatures
The following signature area is to be signed upon receiving the 2020 Election Qual/tying Packet including the above referenced
documents
c \ -I f° w have on this date received the forms and information
Name of Candidate (Print or Type)
noted on these two (2) pages, and agree that I will read all ofthe Election Qualifying packet materials that have been provided to
me; and understand that it is my responsibility to comply with all Laws as they apply to the 2020 Election.
Signature
2 y / 'L a
Date
y cedes ( - � L .) ;.A4`-,- s,�,i' s 3 -i- -? a,?
Street Address city V Lp Code
State of Florida <111111
County of yie'ell e., 1r',
Sworn to (or affirmed) and subscribed before me by means of;E: yphys/cal presence or_onlline notarization)
this e a� day of r" " i �t ,9: rt , ° r,
by0. V'u,". (�4 �,V <y W Personally known:�
(Print name of person making statement) }
d� d
OP
Type of/dentification produced (, Signature of Notary Public - State. Florida
Revised 07/27/2020
Notary PUb11C State of Fbnda
Christian D Gowan
My Commission GG 913234
Expires 09/1512ID23
ilFz 1 �
CITY OF WINTER SPRINGS, FLORIDA
0 2020 GENERAL MUNICIPAL ELECTION
rr+iotA1:TZ124V17 01--QIIAL.11:71:71101ER57A71)5-1kND
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01Y Cil:,IRK DURIIN(.'�
E:,)/ D6TMC'lT1l KZEE / Disri!!zi(--,T i::ivil
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QUAIIJIFY11ING
1, /V\0- -V �- ", do hereby state that I seek election to the City
..................
N;. 'r
of Winter Springs' Oty r �E.u[+�s lrlr; M, is !luau. )�Strkft l, a four (4) year term
in the election to be held in the City of Winter Springs, Florida on Tuesday, November 3,2020. 1 further swear or affirm:
I am a qualified voter in the City of Winter Springs
(2.) My legal place of residence is: 2-?
Vn A,
(3.) Length of time of residency in the City of Winter Springs is:
. ..........
(4.) Length of time of residency in Winter Springs District: Is
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:
. . .........
y,�( Ca--j
State of Florida
County of
Sworn to (or affirmed) and subscribed before me by means of (7. physical presence or —on/fine notarization)
this
? rc0 . . ........ .
day of A), 2020
Jby Personally known: OR Produced Identification
(Printname ofperson making statement)
t S
Type of identification produced
UOV91./6o soil AA do
tFCzCI,60E)UO.199IUj=,M A
/ IN:
u9mo0 a uensuqb '
spijoij ;o apriS oqqnd A)IRON 1004
FOR OFFICE USE ONLY
Florida Driver's License provided for Item (S)
4",
Signature of Notary Public - State of Florida
r. Notary Public State Of FlOnda
Christian l!)Gowan
MY Commission GG 913234
a, Expires 09/15/2023
ri
documentation provided for Item (5)
F1 E
Revised 07/27/2020
............. . .
`sar' CITY OF WINTER SPRINGS, FLORIDA
o `µ 2020 GENERAL MUNICIPAL ELECTION
Af�,RJCA TION fZW.,. ,. OFFICE �mr��B�llloi�:zim
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�I�'"^I���,4:I�w�":.I.a'I'II�II�11FY II�UI1ZIIqC
a „ do hereby state that I am a registered and qualified Elector of the
N n l l)/',l
ty of Winter Springs; and I am applying for the Office of
f tio1l e i VnG)a,;t [ct C 7,�,ee a four (4) year term, in the Election to be held
in the City of Winter Springs, Florida on Tuesday, November 3, 2020.
I further agree to pay the following Qualifying Fee AND applicable Election Assessment
QUALIFYING FEE: $150.00 AND THE BELOW ELECTION ASSESSMENT
ELECTION ASSESSMENT- COMMISSIONER: $120.00
Each Commissioner receives: $1,000.00 per month
$1000.00 x 12 months = $12,000.00 annually
The 1% Assessment amounts to: $120.00
NOTE: "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]
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.
G
FOR OFFICE USE ONLY
C a" APPLICATION FEE: Campaign Account Check in the amount of $150.00 attached
(Check should be made payable to the City of Winter Springs) Check #
AND u
%ASSESSMENT - Commissioner: Campaign Account Check in the amount of $120.00 attached
(Check should be made payable to the City of Winter Springs) Check #
OR, IF APPLICABLE
Completed "Notice of Undue Burden" Attached
Revised 07/27/2020
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CITY OF WINTER SPRINGS, FLORIDA
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2020 GENERA MUNICIPAL ELECTION
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NOTICE
Please accept this notice that the tabulating equipment to be utilized in the City of Winter Springs, Florida's 2020
General Municipal Election will be tested on:
DATE: Friday, October 9, 2020,
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]
Revised 07/27/2020
1 i.,1
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City of Winter Springs
Municipal Elections Offical/Designee
CITY OF WINTER SPRINGS, FLORIDA
a� 2020 GENERAL MUNICIPAL ELECTION=PIM
._ 111-16 COM1PI 1 1fF:D
FORM M US Ii RE
CITY' C� III" V'' I a 711';:7111"; .. F IF��",1fII 1E11F� IC�� 1f �� "
.��� .. �..w..,..�:��� i ��OI���TIIE���� I III�'ILIL....... Il..�,,,pITII;�'II .��.. II�mmIIIS'"IIII:� �"" IIII1��
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QUA1..11F YIII G
Please find the following documents/information/references related to Political Campaign Advertisements/Signs
in this Notice:
Copies related to Political campaign Advertisment/Signs attached:
(1) Copy of Florida Statutes 106.1435
(2) Copy of Winter Springs Signage Information (Chapter 16, City of Winter Springs Code of Ordinances)
Information/References related to Political Campaign Advertisements/Signs:
(3) "The Florida Election Code, Chapters 97 -106, Florida Statutes" - August 2019 (included in Qualifying Packet)
(4) "Candidate and Campaign Treasurer Handbook" - Revised 10/03/2019 (Which included information from
"Chapter 12: Political Advertising" and "Chapter 13: Other Disclaimers") [Included in Qualifying Packet]
ACKNOWLEDGMENT
i do hereby acknowledge on this date of
"J rlie C "lii("'kd ale(,(�)rinV or lyl'e)
2020 with my signature below that I received a copy of
Florida Statutes 106.1435 and a copy of Chapter 16 from the City of 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,
specially as related to Political Campaign Advertisements/Signs. Also with my signature affixed below, I acknowledge that I
will comply with all laws related to Disclaimers as explained/noted in "The Florida Election Code Chapters 97-106, Florida
Statutes" and the "Candidate and Campaign Treasurer Handbook."
_�...__to
.......ww................ __��_���
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FOR OFFICE USE ONLY
F�wp•z- Attachment: Copy of Florida Statutes 106.1435
E ` Attachment: Chapter 16 from the City of Winter Springs' Code of Ordinances
ERK
Revised 07/27/2020
CITY OF WINTER SPRINGS, FLORIDA
0 2020 GENERAL MUNICIPAL ELECTION
Y"S14 XS-ls.�.�ll�l"��`fll�lla�.�"I
SCHEDULE
DURING/AFTER QUALIFYING*, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
Fo wU
U"II° HS MARI E U ED
F011!NA MUST BE
I II O II Ih 11E
CII""P 0II II I`GIIA UII'UI1NV;
Report Due Date., October 9, 2020
- shall contain information regarding all previously unreported contributions and expenditures from October 1, 2020 -
October 2, 2020
Report Due Date., October 73, 2020
- shall contain information regarding all previously unreported contributions and expenditures from September 1, 2020 -
September 30, 2020
Report Due Date., October 23,2020
- shall contain information regarding all previously unreported contributions and expenditures from October 3, 2020 -
October 16, 2020
Report Due Date: October30, 2020
- shall contain information regarding all previously unreported contributions and expenditures from October 17, 2020 -
October 29, 2020.
A Final Report shall be filed 90 days after the General Election - on or before February 7, 2027
- shall contain information regarding all previously unreported contributions and expenditures from October 30, 2020 -
February 1, 2021
*For Unopposed Candidates
Report Due Date., November 27,2020
- shall contain information regarding all previously unreported contributions and expenditures from August 1, 2020 -
November 27, 2020
ACKNOWLEDGMENT
do hereby acknowledge that on this date of
2020 with my signature below that I received a written
"Schedule of Campaign Finance Reporting Periods/Due Dates" (as noted above on this form).
Revised 07/27/2020
P"ad
CITY OF WINTER SPRINGS, FLORIDA
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2020 GENERAL MUNICIPAL ELECTION
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NOTICE
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Please note that Campaign Finance forms are available at the following State of Florida Website address:
r
AND/OR
through the Seminole County Supervisor of Elections Office when using their "Online Treasure Reporting System." and/or
may be requested through the City of Winter Springs' Municipal Elections Official/City Clerk/Designee.
ACKNOWLEDGMENT
� do hereby acknowledge that on this date of
it r � yj,..;...
2020 with my signature below that I am to comply with the
provisions of Section 2-97. Winter Springs Code, which states, "All Candidates for elected office in the City of Winter Springs
shall electronically file their campaign treasurer's reports required by state law utilizing the Seminole County Supervisor of
Elections Office's electronic filing system. The electronic filing deadline for a completed campaign report shall be the same as
the deadline established by law for filing an original paper copy of the report with the City's filing officer."
Revised 07/27/2020
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CANDIDATE PETITION l:::oRm 7
A#inforrratjon on I hj,'r forni beromes a vubMc recofd upon recelpt by the SuperylsorofElections
*R & a crime Incre than onepetiIiary for a candidege, t5ection ?04,785 Florlcfa, Seetutesl
If afl on 2hks Awrr Is not I hp rrwrr w(flnot be vaild as a Candh1ale Petiffon ronn HM COMF)LE1 IED
FOPM MUSI'113E
the unders'igined, a Ireistered
PROVlDl:..:A::) "TO TIHE
0:)1ease prii nairne as itappean.., on your voter armor card)
voteir un said state aind couirity, pedflon to Ihave the nan--m of . ... .... ... CU UY C1. l:.:P1K DUPil'4G
placed on the General Decdoir) [WIlot as a [chieck/cornjplete lbox, as applicabIle] QUALIFYINC
Nonl:)arflsain No party afflHado: n Appfic. blIe party
Candidate for the office of
Oty of Writer Sli:wirigs - Oty CoirnrNsslioin Distrk:,.t One
QPleasp insert the title of (Mice and include Dvstdct, OmUlt, Group, Seat Number, if a jjppficab[e)
Date of Birth OR Voter Registradon Nwnber
(MM/DD/YYYY)
of Voter
1, 1 ............... " I",
Pule IS-2.045, F.A.C.
Coun State Zip Code
Date Signed (MM/DDP(YYY)
[ro be completed by Voter]
CANDIDATE PETITION i:op.m '17
'All Wntmation an this fonn becomes a pu&k rrrr>pd upon rec&pl bj,lhe n$PefVjXyV?r r ,fklacelbns
It h, a cilfne to krwwir?g)ys4n mwe than one pi.,bbon tsar candidatc,% jlyralbn W4 IRS FkMrM StativW1
11fah, Mqua;Ud lnftwrrwrivn an Mis lufne is not coYnpivjC,,d, Im vaddgs, a Cbmfidnfie PpUfrian FvitM 1 HIS COMI)ILETED
1, r4 "'A 4" the undersigned, a registered F014M II 1111�E
(Please print ;am�as it appears oIn'�cur voter informati I on card) PIRCMDE D TO '!I i flE:
voter in said state and county, petition to have the name of (1W C1 EIRK lXAMG
placed on the General Election Ballot as a [check/complete box, as applicable] YliI
-
Nonpartisan /A No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
City
Signature of Voter
as
Rule IS-2.045, F.A.C.
AIJI,','i', "r1, 41,
Fstate--� Z!, P de
Date Signed (MM/DD"
[To be completed by voter]
CANDIDATE PE'M ION zm 7 FOT
, Afl;Mbrmation orp this form becomes a public record upon receipt by theSupel afFlertiorss
U & a rrime to knolls#ng�ifsign awre, than oneperition for a cancfidatc. [Section 104.185FkWiria Statutel
,ffail reawleste-dinfbIrmation on thisforni knot romplerrd� the Forrr will not be vaildar a Cundl Pethean Forn7, THiS COMPLE"T"ED
FOFIN4 MUST BE
the unders0gned, a re:!gistered
l3POV0EIDTO THE
iclease priJint name as it appears oin your voter information card)
CITY CLEPIK lDU RUNG
voter in saidstate and county, petitioin to have the i of 13
1placed oin the Generall EUecdfl on Baot as a [checkill /rolbox, as ai,,.)jpHcah11e] QUAI 11 F:Y� N G
Ncsr)p:mrtisarii N =/A Nopairtyaffifiatioro N/A �)tAp�jplicableParty
Candidate for die Office of
City of Winteir Spir-Angs - City Cornimlission IDistrict One
(Please insert the U He of Office and i r nciljde DvAct, CircW L, G rou it, Seat N u rn ber, R' a apflica Ue�
Date of 811ribi OR Voter Registraidi(-.)n hiumbeir
(1viM/D1DA1YYY)
V W-- e-7) IAIrL-P.- ��AKJAJ C-,S
Pule -S-2.045, F.A.C.
Aldp CZ Ile, . ...... SA
,Tate Zpcode
32�7
4-6
CANDIDATE PETITION
[)ate Signed (MM/DD/WYY�
Ro be cornp eted lby Voter]
�2
FOFNV� 7
"'IM Infirinsaglec a 4V7 th& Fonr bLcornes a pubffitecard IJAMI a recvavl 0"J/ the Sqpplwf511:w of Eo�,Ctibrz
'ft (a a crin7v lo Anown)bpjy sign mcvv than w:wv pelftion ?ot a �wndk�WT* 1S�?cdon ?W,,M Fyondq Ytl?tuti:�Sl
ffWf r&qu&M&d Orbrnta6on an thh; f6rM & nM cvfnpWaq, the form "'ffl oot be vand as a CendWet&,Q&Mkw r Foin 1111 HS CO)^LiPLIETED
L9 '1� "All I FOMA PAM Bi:��
I, 4e 111111111 1 � , the undersigned, a registered 11,) IiMlli D 111!�� D TO Ti .11 ll�
(Please print name as it appears on your voter information card)
CIITY T': IIL..EPIK 14DURiNG
voter in said state and county, petition to have the name of /V\ MT W QUAl i1iiiY111ING
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation Not able Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Pegistration Numbe r Address
(MM/DD/YYW)
. ..... .......
Jill
City County
State ZIpCode
. ... ..... .
0
Signature of
Vot r Date Signed (MM/DD"
(To b c v eted by Voter)
Rule IS-2.045, F.A.C.
MIG 2 1,
-M-0 CANDIDATE PETITION
, , VMS wbprr? bea:Cvnesapubk: rcavrduluon nicm�vl by of Ejorkvu
crime fokxwinq�ywgn mo)v,!han onepot"'to"r fm a ewWkWe �Serfkm RKA!:15 Fffi�;:, Ragunusl
fr7FMPa1A7n rdlds hqfn iY not etuvw1olea firm 1,1,,fMwX be 11639da's 4:1 f��encA:M,!e fWAkm flupm THIII:; COMP11 ETIID
✓POP111,4 W l�I!rT 113F
1, to,42iw,F E the undersigned, a registered
.t- -�4 �S- 111!r11!�O"vl E)111[:Ii 1110 111 E
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of 0I "III I All IMAPI1111,40
— (,X lAll l F:Y1 I'll 0
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
ate of Birth OR Voter Registration Number Address
4M/DDAIYYY)
ligil Ci�DIeLozob (2,7—
..........
Ity State Zip Code
1 0-7 E)
le
FM
CANDIDATE PETITION
Date Signed (M MI
[To be completed by Voter]
IhAs revmbacrifnes apubft ecv)dupon svcsl1ptAy?h&5qpeivesw OEA?cdom
ft hie ctime go knowhig& 54n mare Own cwe petffl6n hw,& 1041U5 ;-hvkA9:IR1,?tutLs?
Irild" h�rbrrrx9r,,Fv,,r, on than Rum Is nol rcvnp)&9ed, the kipm "47 nipt M? vadd as a Avrith:m Foren
the undersigned, a registered
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of /10,/4TT-
placed on the General Election Ballot as a [check/complete box, as applicable]
T HIS C01111,111DII ETED
11:01111111A 1111AUST BE
DROMID111! - !10 T1 11 E
Cl IIY CLI1::P1l< 111�)LHZ11111G
()uAUF�!YH,llG
X j Nonpartisan NKl No party affiliation E= Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number jAddress_
(MM/DDAIYW)
I Co
unty State Zip Code
nature of Voter Date Signed (M M/DD/YYYY)
I [To be completed by Voter]
Pule IS-2.045, FA.C.
a
CANDIDATE PETITION U7
.4,Y i IgrrmaVOIT 017 thiS fa 1M becomos a pub recofpe by !hv Supanhwr of0b0wrw
Us a admie aw,::wethlantiropetfthwr rbracarrcdvlvj5ctk2,7 704 785Fk1ridaSlatutesl
H�OUmlr,dqle��i SPLETEK)
FOIZIIA MUM Blll:0
4
the undersigned, a registered Pil.�UVI DII�EWII 0 11111 lE
(Please print name as it appears on your voter information card)
'I i)(CII ERIK I�X,H!111111,410
voter in said state and county, petition to have the name of S3 QUAUII!�rYIING
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan F N/A No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DD"
41
Inature ofVoter
kl_41-1�
Pule 1S-2.045, F.A.C.
County
CANDIDATE PETITION
State Zip Code
132-2 0 F—
Date Signed (MM/DDA^"
[To be completed by Voter]
� /2312,:,,
11 Ail informe rIon on t hk, fom7 bewflTes a public e eco?d upon recelp t b+ , She Svpc_". rn..r ot rh..,ctrons,
It k,, a crime to know ifjgdys4q.n mon:-., Umn acne pee' Von for a canddddjtv, XwCalco 704, T&6
'T 0requested rnfewmzthon on thfsforn? is note compleged, the to rer wWnot be iwWalar a Caroidate Fs tie !on Fo,rm, THS CO IN r..T11:.,T,)
ILI tNz .2 A/ _776) U--ie udersuneda reistered ing, gFORM MUSTII.�IE
_ .6,1-- PR0VII11)l1D'T0 TAIE
(P lease print name as it appears on yodr voter information card)
A:S� CiTY CLERK DUMNG
n
Voter in said state and county, petition to have the arne of /K QUAI IFYNG
Placed on ffie General Election Ballot as a [chedk�compk.:R:c-.� bO:K, as applicable]
L_X
No party affiliation Party E= 1EE=
Candidate for the Office q-yf
City of Winter Spriings - Chy Commission District One
(Please insert. the title of office and include District, Circuit, Groi..tp, Seat Number, if aprAc able)
Date of E3irth OR Voter Pegist.iratim t IN umber
(MM/DD/YYYY)
M4
My
F�1g77—y�-;,77ter kf
Rule I5-2.045, FA.C.
Addvess
&4,6-cr -S
ky
C07t Zip Code
F -76
....................... .............
Date Signed (M A/DD/YYYY)
74 [l o be completed by Voter]
C
r CAJ1I 14DI"Illllm III, CI
*Aellrjfoinwtlon on thisformbe"Pines a plibfir I of Flectirwis
'if, hi;a crime frp knownigIv Y�7ry inwe than aryepefitean k., a randWale, 15a'vdon 104,2851Wk?�� SViaturcw
thAnn, &nal theform willnotbe va:0 as a f�en&kfsre)oefftion I urfm 11 � ls com Pi E T 1: D
F011111M lAUgi BE
f"ROVID[ED R)TIHE
the undersigned, a registered
7-(Piease- print namfr as it appears on your voter information card) 011YC A
voter in said state and county, petition to have the name of lE1W 1NAANK5
placed on the General Election Ballot as a [check/complete box, as applicable] QUAIJFYIN�:o
—
Nonpartisan No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(Mlvl/DDA--(W) I /(� CqI091IC14 -7 44),l X e n't-) A 8
County State lZip I I Code . . . . ........... .
of Voter Date Signed (MM/DD"
)To be completed by Voter) 0
Rule IS-2.04S, FAC.
. ge CANDIDATE PETITION FORM
95
*N
r, 11ted, 9 m )I
-AS C0iA1l1 ETED
Ifed yea, unsfed imlbrmar;an ca 0A's ftwm is nwcg P f4 I not be vski fis a Candidate Petition
OPIA MUST BE
I the undersigned, a registered
(lDlease print Jame as it appears on your voter information card) PROVQI:..�D TO Tl--iE
voter ii-t said state and county, petition to have the narne of A1\AT-rj3 E,N-76 A/ CITY CLEPIK DU11::HING
placed on the Geneiral ::.::.Iection Ballot as a [check/complete box, as applii::::able] QUALH::YING
Nonpartisan No party affiINot Applicable llation [�/A 7. Ity
Candidate for the Office cyf
City of Winter Springs City Cornmission 113istirict Oine
(Please Insert the title of Office and i n c, I ud e D! L, Circuit, G ro u In, Sea U. N u i, v i be r, it al p9 i ca bl e)
,aLe of Birth OR Voter Registration Number Addres!:..,
4lM1lDl:::)tYYYV) �<-, -111�1
............ ity Zip Code
ryry�..............................
A)
re of Voter
I
Rule IS-2.045, F.A.C.
Z' Z�11/11
Date!SIgned (lAM/DD/YYYY)
1'ro be cornl::)lered by \toter]
CAN I �DA I� �E�, ri"'Ir ION
' AN intbrination On [gals- fore n beCORTOf a pubfir record upon receipt by the Sqpf'vviqcrof F lections
It is a rrime w knovving�jresign nwie than onepetivon for a candidate [Secrion 10313,5 Florida
On thisforni h., not' ran2pleted, the Aviv will nett ts, vaild as a Mandid�7te Petition, Foriu?. Tl IlS C011MIPLIETED
I 'L FORM MUST F311
�'\ 4- M I CT T the undersigned, a registered PIROMIDED TO "rll.IE
iPleaire iadnt rorre aspp,ears onyow vc�er infoRinnation cardl CITY CIJERK DURUNG
voteir iin said statc..a and county, petition to have t1he narne of /V%A-(
p�aced orl the Ceinerai Ellection i3alillot as a �clhecWcornjjplete lbox, as applicable�
NonpartisanE= affillialk)n EE::a [:]�E] No (Party Appficab e il-
Cari&date for the office of
City of Winter SpirIngs - City Cornirnis.Mon [>11strict. Oine
. ..........
QPiease finsert the tWe ofOffiice and indude District, Cimult,GVOUP,Serat NUMber, Tfapjp:Hcalble�
Date of Birth CR Voter Reiyistiratioirn Nuirrilbeir Adatress
(MINI/DD/YYYY�
4..) 00 t
city "blunty State 2.ip Code
IS-t
&pr t Ilr-lvt 15 rl�
Siginature off voi0l�"Date Vgned (MIM/DD/YYYYp
[ro be completed by Voter)
ajoot;) 0
Pule IS-2.045, F.A.C.
2
CANDIDATE PETITION
FORm 7
THIS COM11i'Ti'lli: M
the undersigned, 2 registered FORIIA RAUST BE
) 0 IIE
(Please p.t�lr) name as it appears on your voterinformation card) PPOVIDE111T�
Ury 01.111:JW DLMUNG
voter in said state and county, petition to have the name of ""'JALIFYING
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation N/A Not Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDA'YW
A If
city rf: F-
7Zip Code
45
of Voter Date Signed (MM/DDA^NY)
(To be completed by Voter)
R
:
(",`A IN D I ['11"A r rr'no. is`J 7 FoRm
"'All information on XhIs fbnw beecomes a public Pecordupon recelpti'sy the Superosw of Elections
It L a clirnp to more than one pefftinn fora randidete, )'Sectlor 7CX385Florlda 5fat utpAj
all on th if formL, no. compleged, the fi'mn w0wtbp vvkYas a Fomn, 1111IS C011APLIFrED
FORM 11AL)ST BE:,
ell
v tlr"oe Undersigned, a registered PIROMDED TOTI1111E
ease r;rInt nagre, as IV lears on Your voter Wormation card)
voter in said state and courity ii E N"I ON 0TY 0 ERK 11'.)UIRIING
. , pet flon to have the narne of \5 -z QLALiFYIING
1piaced on the Genera� I Baiint. as a [check:j`corniDiete box, as applicattle]
Not AjI-.)jj-.)flCa1Ne Nonpartisan No party affifiation NIA
Candidate for the Office of
City, of Winteir Sp Hings .. Clty Comi-rdsskrin [Astirict One
pPease unsert the fltle of G,Xfice and hdude iNstii ice, Climuit, 0oulp, Seat Number, of arnrkahIe)
Date of Birdh OP Voter Registration Number rAdr�ftes�;
�MIM/Crl[.)/WYY�
9: 1, 4
nty State Zip Code
nature,Voter Date Signed (MM/DDAI(YY)
[To be comple)ed by Vote)
19 :2, 0o�o
III III lII IIITION
Fam 7
*All inforeration on tVq &rrn beconors, a pubfic, recarc svpon, recielpt by the Supendsoe, off.5-larricn.s
It ii a crid,ne ro knowdy%q¢irskgn more Man onepedbon for as candidate. [Section 104385 Flofida Statutes-1
Ifah' requested information on this fomi, is not cornpietrd, rhe ftwm wiffnat be vaUd as a r.'andids.te A-IW'on Foren. rL..NIIs COMPILE.71ED
I tune undersigned, a registered FOPIN11 NIUSTIEPIE
PROMIDEDTOTHE
[Pease phint nairne as it appears onW.)uir voteir infoirinnatJorh card)
voter- hir said.state aind county 'N r 'r�3 6 Aj'T_61Y MY C11 EIRK EYLAIIII
petliflon to Ihave time inair-ne of
I QUAIl IFYIIIING
p1laced oil the Generall E.Aectlion Mk:)t as a [checkicceirriplete lb-ox, as applicaNe]
Mr,.)n partisan 1:1�� No Ilia rtilaffill kation H= Not Appficalblle 'Z-1ty
Carx:fidate for the Office of
City of WiiI Spiriings - City Cornin-tissioin District One
(Please iirnsert the tide of Office and Include Urtrict, Circuit, Group, Seat Number, lfappkablep
of Birth OR Voter Registration Number Address
DID,"Y Y11
Count y Y, Code State ; �pZi
ofVp'jer Date Signed (MM/DDA^YW)
[To be corn ple�,,d by Voter]
OZIC>
20N
CAN DI DATE PETITION RA4M U7
,,A Y;, 11!'n cnhF h7r,r be::'n "'esR 0i0o,- rtza"p, by the Supairksi:v iV MwImas
N IS,q Chn'Te U� more Mmw oriepetkhw wcit a (MFCM7,1r +(KM5 d, lmkO RaWfinol
�N,Y reqU&SI 'd, wev"n I',, 4ellb,10 Cin rr,& �,I:wm is ?x:it con wMteg �he fiwn yvfflnc�� be pwikY as a C�R,,dddqre IWIM2n Rwn 11 HIS C011WI)II ETEX)
fvl 3 a �s A/ I!!011-1&11V1 III 1113E
the undersigned, a registered
l);10Vl1[)ED R�) [Hllll
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of Mill, CU El!8�c IDUIlU111410
/V'�, a :� QUAII lIll"liNG
placed on the General Election Ballot as a [check/complete box, as applicable)
Nonpartisan No party affiliation Not Applicable
FN/A Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
)ate of Birth OR Voter Registration Number
MM/DDA'YYY)
112-
2 6,
nature ofyµi4er
IS-2.045, FA.C.
County �� State
,611 —
Q CANDIDATE PETITION
Date Signed (M M/DE
[To be completed by
,F// it
Zip Code
101// mfcudn i,Mkm on 216/sbecon",,4,s a A.wb(ic tsvcwd uw "ap? recoa k"y Me? Supinw)(5m offmcthw'15
it is,,; :„nryw to knowi%W Sik?rr MMV than :we perffiew fm a tani!Abbee /50CV6n doM5 FW&Al statueev
"fah, requfftod inftwwbn on IMS ft:,rm as oWnamwW" the frrm iAa,,I not w,a vabV as a Cimd,kWe A-Zffibr itrd,r) -(1Ih i 115 C01114l)l Ell ED
:
1, the undersigned, a registered 117OFMI lo411.JgT 11111
11
((,1ease pint name as it appears on your voter information card) PROVIJDIII" 1110 11+l
C11 Pe CLEMI� DUPN��
voter in said state and county, petition to have the name of
All 1-11UNG
placed on the General Election Ballot as a [check/complete box, as applicable] LLL I
EKINonpartisan No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number
(M M / D Dr)/ , ,) j`�!! I/ &
jllvl-er�41?, S?R /PJa<
of Voter
le IS-2.045, FA.C.
County
ress
P
2 4:
Sta Zip�COe
Date Signed
rro be com plptb� by Votry
I`11-110N
CANDDATIPEI E T7ORM 17
"411af7t6ffnatton on th Is fewn becomes dipub*� recoydupon iv. ceiptby the Sijpeirisoj o1cleolons
140 h a eviirw ?,o knvw)nL74,sgn mc?e Vlzwl 4.)r a cwndirjatf.13ecgfem MM, I&; r-louda 5 tag Was,j
c.n ghll; AWM iE ?70? cornplipteri, Me Awnp willnot &0 w.WrIalsa Candiciate llethwn Fvri„w THIS COMPLETED
N/ 1W -S, the undersigned, a registered FOPM MUST BE
z n/0
PROMIDEDTO THE
(Please print name as it appears on your voter information card) voter in said state and county, petition to have the name of CITY CLERK DUMING
placed on the General Election Ballot as a [check/complete box, as applicable] QUALFYING
Nonpartisan No party affiliation RA= Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY) '7 2j
I V. vv-r t?7p, f S; 1k7ri,146
Pule 1S-2.045, FA.C.
County
-,-t CANDIDATE PETITION
Zip Code
rE N1
Date Signed (M M/DDAIYW)
[To be completed by Voter]
CD --2- CD
*Ott mfimmatrkin c,? MA5 Pour? hwomes a putillomcmdupon riee:llfpt t�nKlhe!Svpervworart Ftections
'if 15a clime u10A,noi&Pkgiysown ln!%Vthan 0n&Xwr&k:1'7 10r& camkilvte 150:1clAin Ux Ms I -le
onilhts Mnyi, ts nmcvrrW1efv,r4 the krm offlnot I:* WDWas a
eii r, 'e,- ,,"the undersigned, a registered
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of
placed on the General Election Ballot as a [check/complete box, as applicable]
ii'011!1%111A 0 7
1l flS COMP11 ETED
FOM%il 111%4LIST BE
11,111ROVIDED TO 11 Hill:
UTY C11 OW DUFUNG
Q1LJAU11-YHqG
Nonpartisan No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title ofoffice and include District, Circuit, Group, Seat Number, if applicable)
of Birth OR Voter Registration Number
County
Rule 1 S-2.045, FA.C.
. . ........ .
State JZ!p�Co�do , e, e,
Date Signed ("M/DD/YYYY)
[To be completed by Voter]
r- I'll --70�157
CAN Di [DE I 117101N
' All information ora thisfbrm becornes a public recis!'d upon recwgttbj,'the ,5ijpwYisor of EleciYor's
*it is a crime to knoiwlngljes�qn nxxe than cyne peg Wan for a candidof.ra 1:5ect. ion 104.185 Florida se.3tutes]
If all requestrdO)mrnadon on Mks formisnot completed, the fcrm i4,111not Ise nafidas a Candid., re Petition form, TIHiS COM11311 ETI!'wID
FOP M MUST BIE
the undersigned, a reglstered
11,
(Please pOnt narne as it appears on your voler"infonrnation card) PP OWDELYTOTIIIIE
votel �n said state and county, peddon to have fl'-ie name of IVI ON 0TY CII EiRK DURING
pBaced on the Generall F:Uecticiin Baliot as a [check/coirnpIlete box, as applicali::wUe]QUAi IFYING
L-
114onpartlisan No pairty affiliatilon Not Applicable plarty
E= F/A
Cainididaire foir the Office of
City of Will-iter SPIIIII-IgS - City.COIITlimission EAStrict Orle
(Pease insert the btle of0fficeand include Dstflctxiircuit, Croulp, Seat Number, iii pli aWe)
Ste of IBlIrth OP Voter F2egislrrabon Nwnber AddTess ro
W/DID/YYYY)
Pule IS-2.045, FAC.
CAN YIDATE RE TI nON
State 'Zip code
9 L
Date Signed (M M/DD/YYYY)
(To be completed by Vat F]
Cq � zo ?-J.) -2— C)
A 11 M fornta tion on 0 0,' forn r become a a pudWr r ecc rd t tpon rk"'Celpt by nhe 54"Per V;s cir of 1-1ections
It its e crime to kravintly Sign f nol C. than rv7 e Pe f rb'cn trig a candfdal e. Mecz ion 704 W; r7'rx, fe, a Statu
le
Ifell requested Worrnarion on this fbrn'a if, not cgwnplefve� the lbrm wfflnot I;& villd as a randidwe r2etttfon Arjmt
1, D. �z �-i the undersigned, a registered
(Please print name as it appears, orlyour voter infrarmatbn card)
voter in said state and county, pedtion to f'Yave fl"te name of -7--,4AAI
plla�::::ed on the GeneraElection Ballot as a [clheck/( oirnplete box, as applicable]
IFIIIIIS C0IlIAF)LII:..:.TIE D
11:"ORIIIA MUST 113E
PROVDED I'D THE
0TY 0 EIRK DURING
QUA[ ff:YING
Nonpartisan [— =N/A Nopartyaffillation FL/A ---j Not Applicable Party
...... . ..... . ...... �� I ............................
Candidate for the Office of
City of Winter Sprilings - 0ty Coirnimhssion Distrilct Oirle
(please Insert, the title of0ffice anci inch.ide District, Circuit, Group, Seat Number, if applicable]
[gate ===— —
Date of Birth 10AP4 Voter Registration Number Address
(MM/i:::lr:)/YYYY) r
1 0 / 'R n f P 01 vi 0
Au re of Voter
Dk ./ j d e C ),T- 'q
IS-2.045, F.A.C.
State Zip ECode
32-770
Date Signed (M M/DDA^(YY)
[To be completed by Voter]
OZI 9- D 120 Z 0
C
CANI uIN�
CG
' rill informarion on thi0brm becon-wes a pi.'Lik facofd iioon receipt b.Y the
'it 4r a v one to knowIrkqdys4qn rnofe than one jeebtfon fnr a can dide. te. lscctlon XXW'S F&WHR sfaf.)w'r 51
ffall requesred infoimation an this forrr, is nof c�wnpfefad, bre forfrr M11 not be vaddasa', C�amfidatp irr.;fRion Forro, FHIIS C01MIPLEII' ED
the uindersigni.i.d, a registered F011RIM IMUST BE
1, Y1 K'z
PROViDI: D TO "rIHE
i[PIlease briint narne as k appears on youir vo ter lnformation cardi CITY C11 ERK IDUFUNG
voter in said
state arid courity, petition to have the name of
6 " T 1pQUAII IIFYUNG
�aced can Gerlerall Electioir� Ballot as a [checo k/cmplete l:)ox, as appIllicalbIle]
........ .......
.1 Nonpartisan No pairty aff flation Not ApIpficalbIle Party
............. ........... E= I=
Carldidate for the Office of
Clity of Winter Springs - City Cornmisslon IDIIsTrIlct. One
(Prease insert the Title of office and include IINstrict, Orcult, Giroulp, seat Number, lfapploable)
Date of Birth 01P Voter Pec. lstration IVUrnllneir t., .Press
ess
iMM/DID/YYYY) -7ZK
77 Zir..) Co de city
L ",_'3 -2� . .... . 7 zr-�
_VY% I
of'noter Date Signed (MM/D(r(Yp
U'o be completed by Voter]
le 1S-2.045, FAC.
CANDIDATE RE, n TION
I AY frdfw*ma Von on this fbr n t ivzo P nes, are pubfir rvc oid upc n rvcvpt tdy the SLupei Wsor of riectiorw
k a rfirne to knowiitg4, zqlgr moffe Than onus* pethion fut a cad & [Seck)cn 704.W Rosy Stat e;tcsj
11", all i v qA rat, tod infitrn7arion an r�jj�q forrn jr r7*4 compkrad, I h e form v,117 not &-, vekt'vs a Ca ndWa!e P v tfficn riornx THIS C011AP11 ETEID
C the undersigned, a registered FMA 1AUSTBE
PROMDED TO 11 HE.
;—)leas/c, ws on your voter information card)
voter in said state and county, petftlon to have the rlarne of /Y\A'-T"2i3 CITY CLERK IDUPING
placed on the General 11::.�Iection lBallot as a [checlk/complete box, as applicable] QUALIFYIINC
Not Applicable
.............. =]R Nonpartisan =N/A No pany affihation F/A Party
Candidate for the Office of
City of, Wir-iter Springs City Cornirnissior-n District Oirle
(Piease insert the title of office and incMde District., Circuit, Gmup, Seat Number, if applicable)
Date of Birth OP Voter Registration Nurnber Addvess
lal
CountV � � ��"�~IM
Zip (,ode
. . .. ......
1
Signature ofVoter .�—) De Signed 0,AM/DD/YYYY)
/d atFFo be completed tray Votert
le
Al 2 21 Ar
....................
CANDF
All infiwmalwn on this finin becornes aputdic ruccuidepon ruce,47t 1�ythe Scupenrifiar tub Flecthvw
It & a crime tar knowingo, s�qn n7ofo I h ary onepel it, On for a candidatef5ccl ion 7040,06 rkwida Sta I Wuwj
IffaYieque - i HM COMPLIETE111l)
,901v4�&'iformatAwc )UMstarinisno!
1
FoRM PAUSP'Bll:� -71
the undersigg ned, a reistered
PIROW)EID rOTHE
(Pllase print name as it appears on your voter information card)
voter in said state and county, petition to have the name of Cil Y DIUR11111l'Ka'
placed on the General Election Ballot as a [check/complete box, as applicable]
=X Nonpartisan No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address(MM/DD/YYYY) 'o7 61 1�
Zip Cc
Co nth iState ET;I:T
Code
3 -27, db
Date Signed (M M/DDHYYY)
[To be cornplety(J by Voterj/
Pule IS-2.045, FA.C.
CANDIDATE PETITION FORM
'Ali adnrr aBtP.. viVvt� kwnbrqccn?e!va riubik mcor4kqxvi r,Pceipt bj,, the 5Kjp4,v1,1..w, vf0cc9pons
onepetWon hArecaneficivraAseclk"n
on th�?wnl the Pbvrm wifino"rtree voildes zC&ndtrjWe
the undersigned, a registered MU!; B l:'�
PRUADE11) 0 THE
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of W C1 E14K DUMNG
placed on the General Election Ballot as a [check/complete box, as applicable] QU/0 11 FY11 M�#'
X Nonpartisan No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDA-M) 9LI -30 & C h) 6 7� d
3
kv 1") t ell -5 t- f, /) C, S
Signature of Voter
IS-2.045, F.A.C.
1 County State
_J42",j / ho /--Z-
Date Signed (M M
[To be completed
Code
-?,3 ;V Y
Vote r]
/�/
41 11,i 2 4
CANDIDATE PETITION FORM 7
All 016nnat,"on or, Md" fiwm bocomes a pubhc rnrardqpwr mri*t by tho SuAvomOr of Eloct,ons,
Ilysmp?tfieon ba dear secion pp saWte5(ft v.- a rfirnclokno�w4ngh7r
"flaYroquPstao n7fornotdon on t/70 �onn &wt compAiNcd, the lbnn wfflnorbe va&Y as a,��qncfidw& Cet,�t�:m � brm 11 SIBS C011',411311 ETE11)
RNRM MUS11 BE
the undersigned, a registered
�kjr � PP('YAD1::D TOTHE
�Pkmsc jjxln� ii i a ii no aq h appeals w � You I! votor �1'11fo� mafloii 11 sqic4
0 11 �Y CL11=11l�fl< III WFflNG
voter in said state and county, petition to have the name of /0?-77'
placed on the General Election Ballot as a [check/complete box, as applicable] W.IFYING
Nonpartisan No party affiliation N/A Not Applicable Party
E
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter // Registration Number ess
(MM/DD/YYYY) 1 1 67 FHL-47 dARI
0 (0 7-
7 / 9,5-�
County
�IW7-Z-P- SPALAJ
ure of Voter
IS-2.045, FA.C.
'I"CANDIDATE PETITION
,
State Zip Code —
JZ707
Date Signed (MMI
[To be completed by Voter
""AN intrddynatton an M& Imm twcomes o pub#c recarri upon eemirpl 4v, the Supan,': *i of Evctiopys
1/r i�a cilinc, ftpkno,tdrpglysdgn rnam' than 0nV;*tfthDn J&'Won 7C74,385 FfvriWsetatweqj
4 'aL4
�� , '� b L), ��) () ' the undersigned, a registered
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of
417' V
Dlaced on the General Election Ballot as a [check/complete box, as applicable]
Ft; pm 7
i HIS COMI)LE FEIII)
FORM MUST l3E
PROW)ED I (�) 1111 E
CA"i Y CLEW [)UMNGA
QUAl 11IFYUNKO'
X j Nonpartisan No party affiliation RANot Applicable Party
—
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
............. —
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY)
41 V/Z4
Count
.5 1 state I Zip 6 ode
re of y;�%o r' Date Signed (MM/DDNYYY)
lj
[To be completed by Voter]
CANDIDATE OP%TH —
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a
write-in candidate:
❑ Write-in candidate
If,J, fli „ ; 20 ,;f
i;' I1 i 9F \AA � f. I,
t;tf!°,EC,F 1fflzr"CA, P,
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
OFFICE USE ONLY
kp gy `y
(Print name above as you wish it to appear on the ballot If our last name consists of two or more names but has no
Y p Y
hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of �� _ t r ^, � 1 �A,' ��. 1 s r" o n�
(officr't' (District #)
am a qualified elector of,y
(Circuit #) (Group or Seat #)
County, Florida;
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I
have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office
I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes;
and I will support the Constitution of the United States and the Constitution of the State of Florida.
Candidate's Florida Voter Registration Number (located on your voter information card): -7
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
n (—
x ' r";e.ti
Signature of Candidate
( 4®, ) s`-.�L9 - S, I y
Telephone Number Email Addre
C—
Address City
STATE OF IFLOIRIIDA
COUNTY II
Swonn to (or affirmed) and subscribed before me thus °-
day
Known. ..:...... �
Y �...»�a�i m:� h._�. oir...20...
' y Identufr�caUo :
�...... Type of Identification Produced:.e�...d
ZIP Code
Sigrit�ure of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
or Expires OOMS12023
r
IDS -DE 302NIP (Rev. 11117) Rule 1S-2.0001, F.A.C.
FORM 1
STATEMENT OF
2019
Please print or type your name, mailing I FINANCIAL INTERE STS
address, agency name, and position below:
LAST NAME -- FIRST NAME -MIDDLE NAME:
d
MAILIN�GADD�RESS :
J (
I "I C r, i r W CSC) c, CG-� V
CITY: ZIP: COUNTY:
♦ 1,k�s.ti (` \ rN,As 3Z7 b
NAMff OF AGENCY : �....- MMM.M......a ...............
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
WrAlry S r�/-,R S C, Corr.M', si-, e^C..,
CHECK ONLY IF ad(CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** THIS SECTION MUST BE COMPLETED ****
FOR OFFICE USE ONLY:
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019.
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 heck one):
[:1 COMPARATIVE (PERCENTAGE) THRESHOLDS OR F 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 'Wa")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME q ADDRESS PRINCIPAL BUSINESS ACTIVITY
......... 1..� �—,xv A "AK..n 6k.. "L
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 "nla")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME l 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 "nla")
ti /-,
2
You are not limited to the space on the
lines on this form. Attach additional
sheets, if necessary.
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, 2020 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1), F.A.C.
PART D — INTANGIBLE PERSONAL PRO TY [Stocks, bonds, certificates of deposit, etc. - Ser ructions]
(If you have nothing to report, ►...te "none" or 'Wa")
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 'Wa")
BUSINESS ENTITY # 1
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.
BUSINESS ENTITY # 2
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PANTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER:
Signature:
Date Signed:
FILLNG INSTRUCT,,I..1:
If you were mailed the form by the Commission on Ethics or a County
Supervisor of Elections for your annual disclosure filing, return the
form to that location. To determine what category your position falls
under, see page 3 of instructions.
Local officers/employees file with the Supervisor of Elections
of the county in which they permanently reside. (If you do not
permanently reside in Florida, file with the Supervisor of the county
where your agency has its headquarters.) Form 1 filers who file with
the Supervisor of Elections may file by mail or email. Contact your
Supervisor of Elections for the mailing address or email address to
use. D_Q-not email ,your form,.to,the mmission on Ethics, it will.�e
returned.
State officers or specified state employees who file with the
Commission on Ethics may file by mail or email. To file by mail,
send the completed form to P.O. Drawer 15709, Tallahassee, FL
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200,
Tallahassee, FL 32303. To file with the Commission by email, scan
your completed form and any attachments as a pdf (do not use any
other format), send it to CEForml@leg.state.fl.us and retain a copy
for your records. Do not file b,,,,,bot,h.,.mail,_awnd...emai] Choose one
filin,(l method,. Form 6s will not be accepted via email.
CPA or ATTORNEY GNATURE ONLY
If a certified public accountant licensed under Chapter 473, or attorney
in good standing with the Florida Bar prepared this form for you, he or
she must complete the following statement:
1 — -------------,_ 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.
CPA/Attorney Signature:
Date Signed:
Candidates file this form together with their filing papers.
MULTIPLE FILING UNNECESSARY: A candidate who files a Form
1 with a qualifying officer is not required to file with the Commission
or Supervisor of Elections.
WHEN TO FILE: Initially, each local officer/employee, state officer,
and specified state employee must file within 30 days of the
date of his or her appointment or of the beginning of employment.
Appointees who must be confirmed by the Senate must file prior to
confirmation, even if that is less than 30 days from the date of their
appointment.
Candidates must file at the same time they file their qualifying
papers.
Thereafter, file by July 1 following each calendar year in which they
hold their positions.
Finally, file a final disclosure form (Form 1 F) within 60 days of
leaving office or employment. Filing a CE Form 1 F (Final Statement
of Financial Interests) does not relieve the filer of filing a CE Form 1
if the filer was in his or her position on December 31, 2019.
CE FORM 1 - Effective: January 1, 2020. PAGE 2
Incorporated by reference in Rule 34-8.202(1), FA.C.