HomeMy WebLinkAboutEvans, James Qualifying Packet - 2020 08 25CITY OF WINTER SPRINGS, FLORIDA
01 2020 GENERAL MUNICIPAL ELECTION FORM A
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'4, AFFIDAVITOFACCEPTANCE THIS COMPI ETED
FORM MUST BE
PROVIDED TO THE
ONJIpDISNZICf
CITY CLERK DUPINC
QUALIFYING
NAME: Date '� Time
.�.a. ................................ Review Started Page I of 2
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 TOR. DAND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALL APPLICABLE
REQUIREMENTS
The appolicant accepting this docurnent and the attachments should initial after each section as it is reviewed
QUALIFYING DOCUMENTS
The documents in thissection are due to the City ClerklDesignee no later than 72-00p.m. on the last day ofQualifying which is
Friday, August 28, 2020.
"Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates" [DS-DE 91
"Statement of Candidate" [DS-DE 841
I * "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"
L5 "Schedule of Campaign Finance Reporting Periods/Due Dates"
6
"Notice of Access to Campaign Finance Forms"
M
"Notice to Federal Government Employees (if applicable)
"Form T" - "Statement of Financial Interests 2019"
Accepted:
11 P ff
Q U AOL I I:: YY RUNWG
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 I landbook"
State of Florida Election Information Contacts
Accepted:
Revised 07/27/2020
RIECEI
C'1�1 Y (D 1: VVI N I r"j GO
iK
CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION
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NAME:
CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION
Contributions Returned" [DS-DE-2]
Envelopes of Checks/Receipts (2)
Accepted:
CITY OF WINTER SPRINGS INFORMATION
City of Winter Springs 2019 District Map
Accepted:
MISCELLANEOUS INFORMATION
"Statement of Ethical Campaign Practices" (From the Seminole County Supervisor of Elections
"Foreign nationals" - from the Federal Election Commission (6/23/2017)
Legal References for Qualifying Documents
Accepted:
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Page 2 of 2
The Candidate SHOULD NOT closeout their Campaign Bank Account before they are invoiced and payment is made
NOTE: 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 Qualifying Packet including the above referenced
documents
i-
d
„Y 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 of the Election Qualifying packet materials that have been provided to
mr e; and understand that it is my responsibility to comply with all Laws as they apply to the 2020 Election.
Signature ° .eeee..,_..._...._.. _ Date
a
Street Address City zip Code
State of Florida
County of _._._._
Sworn to (or affirmed) and subscribed before me by means of( �7-, ys)cal presence or—on/fine notarization]
pf � r
this �@ w! (U day of
by „r Personally known:
( d
(Print name ofperson making statement)..._,. .,,..._.
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l
Type ofidentification produced Signature of Notary Public - State of Florida
Revised 07/27/2020
publice of Florida
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CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION IZORM
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591 AFrIDA 1/17 OF Q(ZA I IF IED 7VO 7 ER S7A TU5 AND
11 HIS CCIAI[DILETED
07 YAMD D157 RICRESIDENCY
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I::::: JIVII: CP,ecii 11:::11�d< [)LJ1IZ1114G
ONi:: 1, S MCI
QUAII ill:�YING
do hereby state that I seek election to the City
. . . ...... . .
of Winter Springs' D'Mtdct Oine-o� DMilct'l' iree / I�)morct ii:we 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:
R) I am a qualified voter in the City of Winter Springs
( `V`� 2.) My legal place of residence is:
tP„ ArYNe (:;aY Alr,
(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:
!2 ... . ............ . ............ -L-L- --=-
6 A
State of Florida
Countyof
Sworn to (or affirmed) and subscribed before me by means of f—physical presence or—on1fine notarization)
this dayof 2020
i ifi d d d OR P k l Personaly known: Produced Identification
by Of� �,- ��' r % 1()" in(," "L
(Print name ofperson making statement)
L I
Jpe of identification ploduced Signature of Notary Public - State of Florida
PC* Notary PUDHC State of FlOrld
.
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Ch flan n My miss" 913234
Expires 09J15/2023
1J% FOR OFFICE USE ONLY
jCopy of Florida Driver's License provided for Item (5)
A
Other documentation provided for Item (5)
01
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Revised 07/27/2020
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" µ CITY OF WINTER SPRINGS, FLORIDA
"®rsswE
o _R� 2020 GENERAL MUNICIPAL ELECTION FO11�1. 2
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QUAII " i Ih,JG
do hereby state that I am a registered and qualified Elector of the
S
__.-City of Winter Springs and I am applying for the Office of
ict 01i���M' �:I.wu:u i ati, 1wr sae `° 6 ro...::, i c Five a four (4) year term, in the Election to be held
w
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.
YFOR OFFICE USE ONLY
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
1%ASSESSMENT -Commissioner. Campaign Account Check in the amount of $120.00 attached
r
(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 f0G Y�1`�/?iGI� �a
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CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION=:iIM
°ro w U U UIIS :OMPL I"ED
FORM MUU.U..IhE
PROVIDED ..0 O 1" H IE'
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��..�.—_�._ - -� QUmUA111-11I 'YING
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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
NOWL do hereby acknowledge on this date of
q
� x11 rep of (i,r ii ri or Iyr xe)
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."
FOR OFFICE USE ONLY
Attachment: Copy of Florida Statutes 106.1435
r r� '� �- Attachment: Chapter 16 from the City of Winter Springs' Code of Ordinances
Revised 07/27/2020
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CITY OF WINTER SPRINGS, FLORIDA
04� ,NsOp
2020 GENERAL MUNICIPAL ELECTION
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W 1459
07La CA RON FOR 0 ' 7C
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SCHEDULE
DURING/AFTER QUALIFYING*, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
THIS II N)II ETLll)
011l:ZII T iii BE
T"II"TKd II II )II::::11) TO T"Ih II II!1'.''
II... II'TII< DU11:ZNG
QUALVQ YIJIING
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 13, 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: October 30, 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 1, 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
„r ��, , , ,
if
. .� 2020 with my signature below that I received a written
S4 -,_
"Schedule of Campaign Finance Reporting Periods/Due Dates" (as noted above on this form).
orb
Revised 07/27/2020
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✓cur, xf'm' r f ,zI�� r, C, "ff_"t
ry®aT CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION
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��..
NOTICE
THS COMPLETED
l"ORM MUS1 BE
PROVi D ED TO TIM E
CrTY CLERK DldRIING
UAIII...6FYHg(—,
Please note that Campaign Finance forms are available at the following State of Florida Website address:
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 Ihereb acknowled e that on this date of Y g
f,17rii a or
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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:ate V'�iNiTIE` F( Gi
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CAND11-,,,,')A F,)E rii iaN FORM 7
*All intcrrnation on W5 form becornes a public. record upon receipt b),the Su;mna.'sor of Ele-cIfebris
I, Is a ciorre to kwvdnglystgn more thaw or,5 petition fora candidate[Section 7040851-lorlda Statutes) THIS COMPLETED
PW requestedYnO tion on ih,i,� form ii not complefed, the fbc,n iwill not ba, &,�sfld as a Canarditte Pedtwn For.n.
I, the undersflgrted, a rf,-.�gMeired FOPlA MUST BE
PIROMIDED TO TFiE
(Please print nanne as it appears on your voter information cwd) N C111Y CII IEPK DUMING
voter in said state anid co�.,Inty J(-, '0 �
I to Ihave the inarne of Oqe
'I .
j.,Aaced oin the GeneiiI Election I as a [check/cornplete box, as applHcalble] I QUAL IFYINC
.............. ........... oiarsan .... .......T/."............. lqojpar¢yaffifiatbn FN/A
IAppficaUe
. Candk1ate for the Office of
City of Winter SII - City Connimission District One
(Please kisert the tatle 0'OffIce and include Distvict, Orcuit, Group, Seat Number, if ajppficable�
Date of 1131irth, OR Voter Registraflon N7uinrnber Address
(1lvlMP"'(yy) Ar �n V
CRY
j 1.(
Signature of voter
IS-2.045, FA.C.
County
7 �fnn�r)pl(
Q CANDIDATE PETITION
Stag Zip Code
176�
Date Signed (MM/DD/YYYY)
[To be completed by Voter]
?'// Ili&
17
1 AP,nkirmuli::In 'vy 0:1& fw P71 4ocomes ti piubUcrecord upwl �ecOot bi, Me su'w ksop of 060Y)ns
*U isa cnme to'�,nm&qhP& sdqn rrwee fharr :mawtWon tar a camJh,UM,M?cubn W4 W 54afutcn� 'n ns MAR E . TIED
on Uris,rcirrrr, rs nW ccimplWea Me nbf�m wh) pxx 2V lieWhias a Gamfiouev PcUrkv) kvdn
the undersigned, a registered FOIR.M MU51 BE
(Please print name as it appears on your voter information card) cirry CILEI�X DURIIIINIG
voter in said state and county, petition to have the name of vi�e'S' In QUALIFflING
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation FN/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/DDA-M) V/9 1-715 1002 -Toproo+
City County State Zip Code
Uj.'nA'f- 'S Fl- SZ709
Signature of Voter Date Signed (MM/DD"
[To be completed by Voter]
Rule IS-2.045, F.A.C. A' IRK= F
CANDIDATE PETITION "7
All uMorenatidn on thh;lonn b4n.,onms a putdir rpcordupon aora�p� by tho, SdxF;&rv&m of 0ections
nis a crime to knowingt,r,,Cgr., rTYn'v1hHr7 owfjwfft�on f6l, a candpdata P;ncticir 704,785FAwnk Stal9deq]
Ilia 11requerred, infa), I narlon on thhs� fin,rn pX nor. ca,,rpjeq(-�cj, the fr�jn� �jjjlrpot Jwy vaMoliys a CWndidate PPIAAan Fbnr�p l] flS (X)Ilqll�ILE l ED
thie undersigned, a registered F�0111111A MUST BE
WMEDTO r1HE
A A� M
iDlease print name as it appears . on your tooter inforrnation card) I ly C111 IIIX DURIHNG
voteir in said state and county, petitlon to have t1he inan--ie of is,,, L"16" QUAl lFY1%llG
placed on the General ;:.E.Iection I13alltat as a I'Clheck, cornlplete box, as al;::spficable'
pp Nonl.onrtisan /A No party affiliation NoL Appkable F)ar(y
F. =� E= -
Caindidate foir the Office (:Yf
My of Wiiinteii, Slorfirigs - City Comirnission IlNstiriict Dime
QP: lease erase nthe title of0ffice and in !aide District, Cincult, GrOUP, Seat Nurnbeir, if al.-)JAlcable)
Date of Birth OJQ Valter Registration Number Address
(MIIA/DD/YYYY)
vj
of Voter
IS-2.0415, F.A.C.
N
CANDIDATE PETITION
state
....... . ........
... .........
Zip Code
2,
Date Signed (IAM/I::)D"
FTo be completed by Voter]
-Ad intorynation or this liarm bcrnmrs' a pvbfic record upon recpipt by the supero"'Of ofl.."Iections
a crime to knowjngysqn more than one petition fiar a candidate f5ecdon 704. Wil FXO?ida S'gagute.F)
ffal/ fequested intnimerion on Ou's Y" h a -'0Mj.')et d. the Yll MY not be valldes a Candidate Petition Form,
'o"\ the undersigned, a registered
dGlfa)e print narne as it. appears on your voter [inforrnatlorn card) . . . ......
voter in said state and coi..mty, petitlointo have the riarne of ve,
placed on t1r1e General I.:.-Jectlon Ballot as a [clheck/coryiplete lbox, as applicable]
FoRm `7
11-flS COMT)LET ED
T"ORM MLYS"ll'BE.
PROVIDED TO 11 IE
OTY CL.EPK DUPIN G
QUAI JIFYING
Nonpartisan No party affiliation Nor Applicable IDalrty
Candidate For IlJle Office of
City of Winter Springs C:ity Comirniissloin Mstiriict One
(Please insert Ole title rA (:)ffice and inch..ode Distdct, Orcuit, Groul.,i, Seat Number, if applicable)
-7 Date of BiirtVi 0['d Voter Registration Number Address
City ounty fst.te_� Zip Code
I
Signature of Voter Date Signed (M M/DDAIYYY)
[To be com p, ted by V
Rule 1S-2.0,1,5, F.A.C.
M',J,G 2
r Y Cif
C,A114DIDATE PETI"I""10IN Fowl 7
"All inforinallori on this frann becaerks's a pubUclou"010"upon rpCeipf bY0C5Up(.-,,1v;sw of EyecVom;
k, a Crime to knowy I kg1j, SiCyn I y1off" than 0126 Appt It lon tarp , a candleyate 1"Section 104,.M35 FlevAya 5 'taguee sy THIS COMPLF=
on iii& frrm Airs not, Mr form wfl'nnt be a (,'w%MJ&fe Pet ft rcn Fan�n ,
the undersigned, a registered FORIM MUSTIBE
PIROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CiLEIRIK DURNG
voter in said state and county, petition to have the name of � mes P1 Fw, - S
QUALiF:YUN(.;
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan [N/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 BirthAddress
(MM/DD/YYYY) /00—
OR Voter Registration Number
ll!y "-k�l
Signature of Voter
9 p CANDIDATE PETITION
-in
State Zip Code
:1 JFL ,,1 6> Z? a 7 0 d"
Date Signed (M M/DDA^NY)
[To be completed by Voter]
& - I r?,,-
FORm 7
'R A� V crimeW nnarii:� than one peribillon kv a cjnd�dpta PbcLk�n Y043W FADAM 598 tubobj
1 '11 IIIS N P l:::
on ehis Aw,i,n & nol comph?ieci Ow fiDnn w4l'notbr vasOdasa C��ndaWtil; PetiNcin Fbnw
D 1r / 11-01111M l IIBE
the undersigned, a registered
/ -11v 1�!111KNIDIllD 10 MI:::
(Please print name as it appears on yrAjr voter information card) C11 TYCL1:A:W I)U1I:%1NG
voter in said state and county, petition to have the name of C% Vi 's,
placed on the General Election Ballot as a [check/complete box, as applicable].
I�JX 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
(MM/DD/Y'M)
fV ter
U7
Rule IS-2.045, F.A.C.
ress
/671-,014001e,6407-
County —1
, YLji
1 1 '/,"1" �) 21 0"
� od
e
� 3-27d,ii? I
Date Signed (MM/DDIYYYY
[To be completed by Voter]
CANDIDATE PETITION 7
On M& J'Zpmr reconii''I"Pun rece'�Or 4ry„ of For:Wons
a is a crime W A nopvh7g6, s'��ry r7umv than one pe�Mkm rci�' '4 1&e:'9�on �0,1 iMll F�Orddj n' ata, if cS1
N� OHS l-' dgpa vvmoilc�vd I' 1w fu'rrn "48 r7mbi::� vand :i u CenaWYato Act,,V6,7 � orm 11 ]11SCOINV)ILEFED
11�:011�'ZIA 114USi
the undersigned, a registered 1 BE
TO T11 WE
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of C11 IN` CLH'�K DUII�ZH,4G
placed on the General Election Ballot as a [check/complete box, as applicable] Q yi
ll
F---XNonpartisan 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/DDNYYY)
0z/03/1q5-G
ounty 1 State Zip Code
I-e (I Sep, mi, 0 32
nature ofVoter Date Signed (M M/DDAIYW)
[To be completed by Voter]
e IS-2.045, FA.f,/!'
CANDIDATE PETITION POPIA 17
"AN bilk a rn ata""vo on 9 his forrtxxxm is'pubfie ?ecmd IMP rrr receot t�y Mo supen""or'l:of W. fac6ons
It de'v o' hi Pe wVn V77DIL thde? one petirlitn Aw-,lip ca?rdVatr,, PS�DcWftn 704 W5 FAi !awfutesy
it 10 roquesill id h tbrerwfhtn on thhF ibun is not con wpWed, thi:r P6p fn w#1 7ot be vaPid as a CWncW: ale f1iiiMOn Awm I I l il S CO llA 11!) 11::: 11 E D
the undersigned, a registered FORM IIVIUS� 1:iE
PR0Vfl)11::D i 0 TFiE
(Please print name as it appears on your voter information card)
voter in said state and county, petition to have the name of . .. .... 01Y CLEPK 11 WI:NNG
A QUAII 1111:�NHNIG
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan [:K/ANo 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/YWY)
0( IqC
City County State Zip Code
Signature of Voter
Z. IS-2 045,
AUG 2
Date Signed (MM/DDAIYW)
[To be completed by Voter]
CQ — 19 - 242-0
CANDIT)ATE FDET1 I FORM 7
'"All informavon on form becomes a pubfic record upon recept by the Surienrisof of Fiecfmns
1t ir as crin'le fo knowingly -sign rnorp than onapastor or, for a candlr.Mra(Sex,Wcn lae,MTFIbrida Stay utr..5]
natian on rM5 form .FnocomplPte&, the form M11nrf be valid are T11-415 COMPLETED
the uindersoqjned, a registered FORIM MUST BE
PROMDEDTO THE
—Plieaso pir�ri,triart�eai���tap�Deaqsoiuyouir,vote.i,iinfn.rrnationcard) MY 0 IERK DURING
voter �n sa�d state and couiray, petition to have the narne of e'-i rvs e S QUAILAFYIING
p1laced on the Generall Dectioin BaHot. as a Icheck/complete tmx, as applicaNel
F—= Nonpartisan WA No 1pa rty a ffi11 i a doin FN/A Not Appficable I —Pa—,ty
Candidate foir ffie Office of
City of Writer Springs City Coirrirn6ssioin District One
(PWase tlnsert thetide of0ffice and Urwliude. DGsbiict, Circuit, Giroup, Seat Number, ifappkable)
Date of IBirth Ort Voter RegNtration 11�q�urnber Address
L-
',S
City State Z11p Code
ti LS—;1
ssGqrlature of Voter Date SUqned QMMJI)D"Y)
iTo The cornpleted by Voter]
Rule nS-2.045, FA.C.
QCANDIDATE PETITION IIQII U7
'-X
1,11U Of1w,rMthv7 On dws I'm m beimpnes a pubbc, ecord upon reiceapl b)r th& SAWndsw o: rEvt 1Pbns
It tS's crpne to knom'M�p& Sign more, than one pv� ition yot a canakiarc% jSivc tion W04 M5 Firwida Simufaq/
�,rifura requested an rhhg tbrm A:�� not COM 4eieu.i tfw,e fur� vffl oct ba vaud ag a C�qne&wev Ani!Jlikin FbeTH IIIS C0111A111i'll 111::71 E11ii)
FORM MUST E1111i:
C"
Lur 144,'xx the undersigned, a registered P1:'z0Vlfl)EC11 [0 HE
(Please print name as it appears on your voter information card)
:7, 1 C11 N Cl. :: lit;", DU R11 NG
voter in said state and county, petition to have the name of nAf;' S , 12, a Q UA 11 V11 IN G
--L�z
placed on the General Election Ballot as a [check/complete box, as applical-fle]
X Nonpartisan E:NK] 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)
of Birth OR Voter Registration Number
'S
Rule 1S-2.045, F.A.C.
Address
[county Fate ZipCode
_N6 I I F-L- -Is a
Date Signed (M M/DD/YYYY)
[ro be completed by Voter]
CM ,, ")F' ,T
CANDIDATE PETITION LFORA 7
"fill information on this form becomes E public record upon receipt bvthe SLrparv!.-or of Elections
!S a rr7ms to knovllngtys!gnmora than one piafltfor, for a ciandidatf. j.5f,,,7t-`o:7 704JR5FIcrida statutes]
,IT&Yrequeslled inform E Vor, on this form !.,not completed, the form w1fincr be valln as a Ce r7cYidare Petlticn Form. THIS COMPLETED
PORM MUST BE
the t.lndersiginied, a regusl:ered I
11 )11C rq � -4-� PPOVDEDTOTHE
iP lease print manne a!!:;opeans onyourvener in form aflon card) CITY CLERK DURING
v�,:)teir in said state and courity., petition to have the narrie cf %QUALWYNC
p1laced oin l:he General Election Ballot as a d.dher;14VcornpAete box, as appficalolle]
Nonpartisan No -77 Not ApplicalNe -ty
EEK] Flq/A Paq
Candidate for the Office of
City of Writer Springs City Commission District One
(Please Insert the title of Office and incli..Yde DfstHct, Umuit, Gmijp, Seat Number, if applkable)
te of 13tt:h 01P Voter Regisltmdoin Number s
iNd/�:x.)Iyyyy) 2 . ...... . le /., - /Ikviadelv\ C4
.4-qo r:� 15
ounty
QuIle IS 2 045, FAC,
,S—
E,
Q CANDIDATE PETITION
Sr:ate Zip Code
ELL I-, o)
Date Sic,.3ned fl,4rvl/DD/YYYYj
[ro be cornpWited lay Vote n I
Z zo
FoRm 7
on thl's fo?'M 17PCerrd2F.ss^ 6 PUbfiC rucco, a, upz"I receipf bj"' air-, SUP&rvi.IRV
itr is u ./w,no to knrnWn," ystgr More than one peftibn lbi a ckmdkiarc. f5ectkwi 701,385 flvrlde Statutes)
thhEfOlMirS scar C';Vefer� 9hekenr willnof he tAefldasac�rndldstv Prtition form,
Ti IIS COMP11 I. -.-.-..TIED
I 97mthe undersigned, a registered FOPM "US"'I"BlE
() 0 G,4- <7
(:Please print rianne as it appears on your rmteir linforiinatiioncard) PROVIDED "TO THE
(,'111"Y CI EP:K E)UPING
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] QUALI FA 114 G
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
(MM/DDAIYW) - C)s - Z� - /q1i 5
of Voter
'i
Rule
I&I
ICounty
4", )E�' V, I
Address
Z—VT
N M6 RJVA C-V
NA 2 ZI"U
ISt-te Zip Code
L-Z�—
Date Signed (M MIDD/YYYY)
[To be completed by Voter]
S — 7-9 — ?— (2)
"ANDIDATE [DETITIOIII
N
"A UWwrmWon on cPtddr &)rrn bencrufnes a publicfecon'it*)&fj a'vcvijx by the Supend'.01 Of Elecdc"IM;
as cfirne- tc krwwoUr l'ysiqn inoic Mon onepp'lityr.mfur a czneYkq,0a ,jai r,cticn 704,hr, r1orlda Stiftute'sl
On '00, fbgp i.k' rint thr- f oxwP4# not be vaflolas, a C.mdfdaBe PvtWon Fb?rp.
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]
Date of Birth OR Voter P
(MM/DDA-M) 013
-Ity
UNI-ak r '-
Sig natu re of Vote r
Pule IS-2.045, F.A.C.
i xc" ,
6�
Forty 7
THIS COMIPL.E.TED
FOIRM MUST BE
PROVIDEID T0'rHE
OTY CLIERK DIANNG
QUAILIFYUNIC
Nonpartisan E:NKl No party affiliation N/A NotApplicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert thetitle of Office and include District, Circuit, Group, Seat Number, if applicable)
stratirn Number Address
"Z
K:�=, n I =�'
CANDIDATE PETITION
Zp ode
State C
I P,70
Date Signed (MM/DDA^M)
[To be completed by Voter]
16 -1 1
/2- 3
Fopm 7
" AfiirVbrrnaN6n on rh& funs becarrms a ptibfir ward upon recoot tui cd e a pa do ^arnr &0oclWnZ'
M d�5a vfme to Anownyvmgn more than onepetillon rorarandedate ISecricui 70&,J85f1r6dq slatutes-1
fwft*qufw?cqY1nf1z � �; I wrn ii n, f ,,orn) Pletod, thic Fonrn 011 not be w0das a C�Pndn�tp Petition Form, HIS COMP11 E � ED
F�0111FUA WJST BE
the undersigned, a registered PIPWDED
(Please print name as P, appears on your voter information card) UTY 0 1:::PK DUPiNG
voter in said state and county, petition to have the name of --io -e-S C--�CCVTS
QUAII WYNG
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation N/ANot 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 ofBirth OR Voter Registration Number Address
(MM/DD/YYYY) AA
"7 ZI-r
City County State Zip Cod
7 0
114-n-atureTer 11 Date Signed (M M/DD")
Pule 1S-2.045, F.A.C.
0 F V,1
I<
CAN DI DATE PETITION il�opiio
17n M& Avvn rvf:wptbjfhe,Supw, vi'�wi'�:n :V chn,M:ws
consetc, A: wyWrkg�6,s�gn nn:irip Nwn wwpvthibn fs�i a rwW&f3te, jserGon 704 Ms F�OdA:49 Statute!i),
*if a [I requefied in form affon on thik form is not cew I t d. th A rm wX ni:,,t bc, PaMY as a e�wndhJa te PinUbonHIIS 11:11ZHAM Ell ED
F:0111INA IAUM BE
1, w4 the undersigned, a registered PF400DII11) M"IHE
(Please print name as it appears on your voter information card) �::11 119, Cii EF�fll( DUF:fli�IIG
voter in said state and county, petition to have the name of QYU,AU11::YHqCl
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan FN/A--1 No party affiliation ''N/A I Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District One
(Please insert thetitle of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(M M/DD" �,� 1-71
1011�lmq 7 , 101- LAW) 0 Va
County [State Zip Code
)AI F-C-
...... . .. ..... .. .
Stu re of voup Date Signed (M M/DDtPM)
[ro be completed by Voter]
o� � 3 1611-Lud-0
IS-2.045, FA.C.
CANDIDATE PETITION
C LL-
1,411 inftmna6on ors Mks faym becomos a pubUr rrcvrdu,,von, rpce4pt b,!1,' Me supelvisv, r of ElecM"ns
i HS UAMPLIEI ED
& the undersigned, a registered
. . ....
(Pe P
Voter in said state and county, petition to have the name of Cjayvc- I—> L"f,a,S
placed on the General Election Ballot as a [check/complete box, as applicable]
;:op.m al BE
FMOVIDE[Yro n iii:".
Y C1 E1lZK Du JAIIIING
QUA11 iFY� ING
LL—L—
E XINonpartisan No party affiliation N/ANot 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
NNumm/b%er
/ I Address r(MM/DDNYYY) 0910 /7�L4 n b
city Count nty k Fst--t--� jZipCode
,1- 1 L5 �Z 7 0 b
- -,� n
kj
Signature of Voter r Date Signed (M M/DD/YYYY)
N. [To be completed by Voter]
Rule 1 S-2.045, FAC.
Farr^CAND11[.).A 1`11 F,,,) E rn iON
'. .411 information on the.s lbrin bprcyrw-wesa public record upon receiptl;y the Supiendsoe ofF.,lecgrom:
/t is rrirne to knowingtysign more, than one petitiort for a candicYate. jSecli'on 104.185 Fbrida Staftdes�
If �,?fl reqzjested intormation r.t n this, A cofrkplefed, Xhe form wffl nof be vaildas a Candidate Petition Fw-rn TlI flS COMPLET"ED
the Ljnde�s�giried, a reg�stered FOIRIIA MUSIF IBE
I" , t� — PROV111DED'I"O"]"FlE
] i)r. easft appearsonyour voter Wormation card) ....... CATY C ERK DUPiNG
voter k) saidstate and couint�y, ne ( , ..,btion to have the nair of QLJAi IFYUING
)0 aced ont1l'ie Generall Ellecdoin Rallot. as a [check/con-gAete box, as appficallille]
.. ..................
Nonpartisan = I No itairty alfffliation Not Appficat.fle Pairty
Candidate for t1he Office of
City of Winter Springs - City (.".ornirnilssion L)Strllct One
(IFIesse Msertthat turtle ofOffoe and oncNude ENstNct, Ciiicuit, oroulp, seat Numbeg, ifajpjpkabley
Datie of Blrthi OP Voter Pegistration NUrnber /kddress
(IlAMAM/YYYYQ jKA
city. ............................
a.
Sgrtatwe tot!' Venter Date Signed (WAJDDPIYYY)
A 11 To ee completed by Voter]
ry
PuVe'IS-2 045, IF.AC
CANDIDATE PETITION FORM 7
AE in tcrn7z4,Tvr7 on th?s folm bemnnzz to pkdbllc re"C"'7rd upor7 recl..'Ipt by tyre of Fie .!tions
14 is a crime to knoa&Irkqasrgn rrcr& then or7e pef9jorr Tors ceqrd!d&te. [Sertfon t04.885FicfiQ'a Stztutc'y
11'1'711regc�r f . nAurmilfcr On 1hiSfa)fna i-; nCt COMPletEd, the form Alclroot tar V016,1f C C.'EndfdPre, FetWo.,7 FormTHIS COMPLETED
1, the undersigned, a registered FOPM MUST BE
PROVIDED TO THE
(Please print name as it appearsVn- your voter information card) CITY CLEPK DUPING
voter in said state and county, petition to have the name of QUAURTAG
placed on the General Election Ballot as a [check/complete box, as applicable]
E= 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 Pegistration Number rddress
(MM/DD/YYYY) H I Ds 1 tq%� I 1z'Y
ity County Fst--t- Zipjde
Signature of Voter
Rule 1S-2.045, F.A.C.
Date Signed (MM/DD"
Fro be completed by Voter]
0.6 1 ?'-3 / zz)zr,)
`dq 4w� E�PRINGS
H� '��IIY F: I RK
Foizm 7
a All infaivriattan on this ford n becomes as pul"Miclecardupon recoipf by of Flecxiorps
.11 Is a cfime ).c k?wowdq.gtrSzq?1 frn.rIe Man o�wpplbbn frw a randidare, f5ection Y04,785
infewmavon cm xh,'u f6n,n Yr nat comp/rter.t the �"e,,wn will no! be vr,ildas- a, C"ancJh1ate Peziffon f.nfn, DAS COMPLETED
the undersigned, a registered i FOPIM 1AU5T IBIE
PROVI l.")EDTO"THE
�IlPlease pdnt narc, as it ap�'.�e Y&Jrin0rrnat�on caqd) YCIEW 1X.JPMj
Voter in said state aind Countyn, petffion to have tine narne of CITQULIAL.11MING
placed on t1he Geneirai DectJon BaHot as a [Clheclk/�,.-,onnpete box, «:Is applicalbliel
Not ApIpficable Nonpardisan =N/A Nolpanyaffiliadon FN/A Party
Candklate fov the Office ol
City of Wilinter Springs - Chy. COMI'MiSSiOl') Di.s-trict One
(PkN�se i insertthetMe ol'Office and 4nckgle Ustirict, Orcult, Groulp, Seat
Dal:e of 13kth OR Vater Q: egistratfon Number Address
7 it..Y Y
t V4, r
3ture of Voter
Pule IS-2.045,
� Q's" CANDIDATE PETITION
State Zip Code
7 cfz
Date Signed (MM/DDJYY"
No Ise completed by voter]
M& iwrn'tX-CCRmes'@Pc&Pe decwdupcvracc:Of bt,tho Swn::n,iso„ i4 Ckctkum
"If der anevwPegiN6n db'Rcaiwqh:fj�e jsa?cr06n RW wsrybur'aastaeulesl
on thibur ks mit cewrpWac4 rhv /fum not r i:vm;hfas a CenuYdWe F:Mfikm Fwsn T"I lM C01APLIETED
C— �\ QS 4 the undersigned, a registered F:01lVA 1AU0 BE
ry-, l)R0)111D11:::D1 0 7 � �E
(Please print name as it appears on your voter information card) (3 EFM DUMNI C'11 TY G
voter in said state and county, petition to have the name of <-) . . .... S QUALIFYIHIR-,
placed on the General Election Ballot as a [check/complete box, as applicable]
Not Applicable Nonpartisan No party affiliation N/A Party
E=� F
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
(MM/DDA-YW)
g - 0 k - �q 70
ress
\ \ 3 \ ID,-> r., C (3, n \'� r
City JCounty State Z!p7 Code
Signature of Voter Date Signed (MM/DDtYYYY)
[To be completed by Voter]
....................
Rule I S-2.045, F.A.C.
V'4
Q E
()FFICHII (Djr,y CL EIRn',,
")A' FOPM 1117
I �E PE� r it -i iON
A Hinforrn at xw on Out, fewn tPecarne I, a Public record upon receipf Ity the &q.xivisor of Oectkyns
it h5 a crfine to kiuwdr�glysz�qn dwom then 017"'� Petition ftv� a candk.fafe f5ecobn 104.185F'kwida Statutesl
corn te VaN r pqu sled inAvnnauon p 11 '- flofni, Is asset L pie - rY, Me tkwrn Yvill nof he vadd as a Candxiafe Petition H HS COMP11 ETED
�64r.
ttre unders�gined, a FORM MUSIFBE
. ............ i Wit ............ . ................ . ............................................. 1QOVUDED TO n lE
....................
...... ........................................... . ..................... ....... . ............
Pease print naime as it appears on YOUrvoter uua ormaftn cairdl
eir iin sad state and county, petftion to have- the narne of �AFFY CLEIRIK DUPING
vot
I V QLW lIFYING
IzAaced or) the Ceneral Election Ifi allot as a [dheck/corni(lete box, as aPjp11M1,.)11e]
. .............. i1qoinipairtis in A ............ . . l,,io party affiHationIt ArIFIA "a b e P. r ty
... . ....................... .. I ................................i................. ................
Candidate for the Offk:* r,:rf
Uty of Winter S11l.trilings .. City Corrirnissioin E.Astrict One,
(Nease Inse.rl trie tfte of oAfice wiid 'dndude District, Chcult, Group, Seat Number, 1'app hcaUe)
Date of Birth OR Voter RegsLiraticin Number
M �M/rtf.)/Yyyy)
I t22
77
y State Zip Code
eounCS
Date Signed (M M/DD/YYYY)
[To be cog1jed by Vler]
2A�Ov
Rule
g"'OER&
CANDIDATE PETITION F-0114rM 7
All Ofijemavon oq lrlda ?rwrrp becornes a public recwd upon ripowpf 4y Ift, Sup anikor ofr-Avc0ons
'fI07q to kfjouVftWjprofqjr nya nie than oe perithon fm a canck&fv, f&Rctwn 104URS florAfa,slatuie5l
'ffafl ieqqqrtecf inforn7awn on this Imm h; not compkterd, the formi vifinot be �,oWa,s a Candidah&� fletffic�n Foren. 111 HS COM11�3U:::� 11 II
JOP�1�4 11�41I)S F l 1:
the undersigned, a registered
110 V V 1 E
(Please print rja 'je as it appears on your voter information card) cw( C i rE P K D U P 11 N G
QUAII WYING
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]
E: Not Applicable Nonpartisan No party affiliation N/A Party N/A No F
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
(MM/DD/YYYY)
0 4 /
City
Signature
ckF' Rule IS-1.60, �' L,.'
1k, )PC
County State— Zip Code
FL- � 3:7
e Signed (M M/C
be completed h
CANDIDATE G. , fH —
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 C)E I C; E C2" :♦c
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
(Print name above as you wish it to appear on the ballot. if your last na
me consists of two or more names but has no
hyphen, check boxEl (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 j i�'i 4 y r i "° 0 d'1; g. i U.1
.w_.....
(Office) (District #)
am a qualified elector of k i i County, Florida;
(Circuit #) (Group or Seat #)
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):2
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.]
o°
e" w
Signature of Candidate
?. 14zi
Address
STATE OF FLORIDA
COUNTY OF�� tea
Telephone Number
City
Sworn to (or affirmed) and subscribed before me this
u �....... 2 day of �� ��, s � e �°�°� 20
Personally Known: or Produced Identification: ..
Type of Identification Produced:
......nm_�n .�..
Email Address Ua' t'Ry
..........4......Z.P Code
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
m
Notary Public State of Florida
Christian D Gowan
IdiMy Commission GG 913234
Expiros 09115/2023
DS-DE 302NP (Rev. 11/17) Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT OF 2019
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
\,/a lit 5 CA ✓Yl
MAILING ADDRESS
. w
�ZiC) X e rv1131!L(sl
CCl/I''TY ZIP: COUNTY:
l._(�'� C�� Win w"......... I'. 5...._
..
NAME OI AGENCY : I Ff"' " E I VE, D
r
NAME OF OFFICE OR POSITION..- -.... -� ,......,..,,,..._ .. -. _ AUG 2
�_ Utz, W1i 5
HELD OR SOUGHT:
C;'Y is V,h11"TE, E ,,ofX�*I a€�'-'3
..�..... _ _..n .. .......... .�����.� �,��.� � � w � � r --, , � � �. r w, i GI Y 'Y ': t l R.k d
CHECK ONLY IF X CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
MENEM010 J
**** THIS SECTION MUST BE COMPLETED ****
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 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 'Wa")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME j ADDRESS PRINCIPAL BUSINESS ACTIVITY
CA- UJS
.. _....
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'Wa")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
_...__R .............. . . . . . . . . . . . . . . . . . . . ..... ..... . . . ............................. ... ............................ ............ - - - - - - - - - - - - - - - - - -....
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] You are not limited to the space on the
(If you have nothing to report, write "none" or "n!a") lines on this form. Attach aMass
dditional
t sheets, if necessary.
Llh.f.._ .�w......ww.ri� ...._ _ .�......�.
FILING INSTRUCTIONS for when
and where to file this form are
.._.............�.... ... _.__. _................M....-.,,,,,,,,,,,,.............................. _ ..._...._ ......._._.. ..............mm- located at the bottom of page 2.
...... _.. �.m.._,. �,,,,-�g........................ _ _ _---------- ............. ......................M._._. ,.�._._................_.- 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 PROPE [Stocks, bonds, certificates of deposit, etc. - See it ;tions]
(If you have nothing to report, write: "none" or "n/a")
TYPE OF INTANGIBLE
0
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or'Wa")
NAME OF CREDITOR
a%r
r
61
BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
ink"; nCP,A1~h �J�l1�`t5h
ADDRESS OF CREDITOR
154—
LJ I
'[-t ! S �t ct u� r" 1�c 4-e i S e( j'Ac f 3 2
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")
...� .I..t . BUSINESS I
NAME OF BUSINESS ENTITY .................... _.--........ .—_.... ................... .... - .... -
ADDRESS OF BUSINESS ENTITY
_—__ _ �--------------- ,.
PRINCIPAL BUSINESS ACTIVITY P�Ct-}mmmmm - �m� m� p
POSITION HELD WITH ENTITY-� - WWWW .__ .......... _______.._____.___..._._.
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS , O U %d 0LVf1ex!—
NATURE OF MY OWNERSHIP INTEREST i ✓ r.,„; u,
PART G — TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
Ll I CERTIFY THAT I HAVE COMPLETED THE REQUIREDT II .
IF ANY OF PARTS A THROUGH G1 ARE CONTINUED ON A SEPARATE S PLEASE CHECK HERE
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. Do not email your form to the Commission on Etbk5 ...jt-VYil t
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 CEForm1@leg.state.fl.us and retain a copy
for your records Do not file b, ,„ both mall and email. Choose only, ppp
filim me,thgd. Form 6s will not be accepted via email.
Lei -_ . •- - •
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:
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.
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 I - Effective: January 1, 2020. PAGE 2
Incorporated by reference in Rule 34-8.202(1), F.A.C.
CITY OF WINTER SPRINGS, FLORIDA
QUALIFICATION REQUIREMENTS FOR OFFICE OF
THE MAYOR AND CITY COMMISSIONER
NOTICE TO FEDERAL GOVERNMENT EMPLOYEES
As a courtesy, the City of Winter Springs hereby advises Federal Government employees
that in some instances, Federal Government employees are not permitted under the Hatch Act to
run for elected office. See S U.S.C. § 7321 et seq.
If you are a Federal Government employee, you should consult your employer or attomey
to determine that you are permitted to run for the office of Mayor or City Commissioner in the
City of Winter Springs, Florida before executing qualification papers to run for said office.
By executing the qualification papers for the office of Mayor or City Commissioner, you
will be representing that you are duly qualified to run for elected office including, but not limited
to, compliance with the Hatch Act.
Acknowledgment:
AUG
¢,Yk i rkV� W'v'IYl1i 'G"I Ild�" `> n l
a
Print Name of Candidate: wl(ell h 5