HomeMy WebLinkAboutMitchell, James Q. Qualifying Packet - 2020 08 28CITY OF WINTER SPRINGS, FLORIDA
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The following information is provided to you to assist in your campaign for Pui lic OEfZce; 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 RESPONSIBILITYTO READ AND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALLAPPLICABLE
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 72.•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 1I"Notice of Political Campaign Advertisements/Signs"
5 "Schedule of Campaign Finance Reporting Periods/Due Dates"
6 "Notice of Access to Campaign Finance Forms"
7 "Candidate Petition"
* Candidate Oath
"Notice to Federal Government Employees (If applicable)
"Form 1" - "Statement of Financial Interests 2019"
Accepted:, w ;
QUALIFYING DOCUMENTS
WITH AN *ASTERISK MUST
BE COMPLETED IN FRONT
OF THE CITY
CLERK/DESIGNEE DURING
QUALI"EYI,N9
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 l3:Other Disclaimers"
"Electioneering Communications Organization Handbook"
State of Florida Election Information Contacts
Accepted:
Revised 07/27/2020
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CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION
"Contributions Returned" [DS-DE-2]
Envelopes of Checks/Receipts (2)
....... __...._
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CITY OF WINTER SPRINGS INFORMATION
City of Winter Spring s 2019 District Map
Accepted: "
MISCELLANEOUS INFORMATION
I"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:
The Candidate SHOULD NOT close out 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
have on this date received the forms and information
Name ofCandidate(Prmt 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
me; and. understand that f,itis myf sponsibility to comply with all Laws as they apply to the 20PO Election.
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Signature Date
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State of Florida
County of
Sworn to (oraffirmed) and subscribed before me bymeans of f hysical presence or_onlline notarization)
5 & this a day of
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by f,p'WY il° ". p ,T li i /�1f ) Personally known:
(Print name ofperson making statement) t
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Type of Identification produced Signature ofNofary Public - State of Florida
Revised 07/27/2020
Na lfy, Pull Stitt of Flonda
�Flii�ti8h � �Ovven
My dotltiniall GG 913234
Expres 09/15/2023
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°----- -y do hereby statethat I seek election to the City
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FFICA MUST I3
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`II II U/ C II I;ARK I °,uU IIZIING
QILJ)V lllli'-'"SING
of Winter Springs' City . SI:i' ct <.),,n : / �jlst lc r lni,,,,,f I.z st ct 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:
(1.) 1 am a qualified voter in the City of Winter Springs
(2.) My legal place of residence is:
(3.) Length of time of residency in the City of Winter Springs is:
(4.)
(5.)
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Length of time of residency in Winter Springs District: is
.": .
I a two attachingt() documents, one to be a Florida Driver's License as verificat )n of furry resid cy I l h�
Cityof Winter Springs.
prin s. The second document is: 1
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State of Florida
Counryof rUaFlo1 t�`//7�'
Sworn to (or affirmed) and subscribed before me by means of 0-"physical presence or_onlline notarization)
1,
this r�' T„v dayof �fi' f,� �I 'i�" ,2020
Y
Personal) known: OR Produced Identification
y " I name ofperson making statement) <m
,;" �,..w ,r;✓ �� ypt ,�P,°Y ' ' k
@, Type of Identification produced `"" Signature of Notary Public - State', ;kv(ch,
R#F N4�, Notary Public State of Flonde
Christian D Gowan
My Commission GG 913234
Expires 09N512023
FOR OFFICE USE ONLY
Copy of Florida Driver's License provided for Item (5)
r e
•-- Other documentation provided for Item (5)
Revised 07/27/2020
R IS C E I V1i��
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m, comm IIssnf N' I: as i ;zVc r ONE Rol "i II II ISTR C II I w VE ii III °III^I�flll�lIG
? 2,!!�do hereby state that I am a registered and qualified Elector of the
City o(winter Spring and I am applying for the Office of
iouuiG i I iiuc.� f. ustt Ic i"Iv4r,i, 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.
FOR 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
(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
CITY OF WINTER SPRINGS, FLORIDA
Rs� 2020 GENERAL 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
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City of Winter Springs
Municipal Elections Offical/Designee
t CITY OF WINTER SPRINGS, FLORIDA
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2020 GENERAL MUNICIPAL ELECTION
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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]
CKNO 71- DGMENT
�'� �" � ° do hereby acknowledge on this date of
_V lla Te ,Ri irfl(,1at ��>i I� xk� oi,
, 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
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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
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2020 GENERAL MUNICIPAL ELECTION
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AND ELECTIONASSESSA4EN7
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SCHEDULE
DURING/AFTER QUALIFYING*, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
FORMS 5
T111flSCOIM111 11 II I4 D
I sROV111 DED 110 THE
M(CLIEEPIK DUIRING
i1QU_uAU...IFYU G
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: 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 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
7AC�OWLEDGMENT
' ��_
do hereby acknowledge that on this date of
mI)e,. �r1,
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
R E CE I V i a„
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C)I FIC le01 'IEff (;11'v G IeG)6t
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CITY OF WINTER SPRINGS, FLORIDA
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2020 GENERAL MUNICIPAL ELECTION
NOTICE OFACCESS TO
IN
CA MPAICIV FINANCE FOPA4S
0I'°II Y CQI°I II'VI E11i&0'14' II IV . V i' Q m,'i" ":XlV1
NOTICE
FORM MUST BE
Please note that Campaign Finance forms are available at the following State of Florida Website address:
i ��. f 4�� IG.a;.,C i,6.Jl Y .r�l�.dk l l Y.:, fir[ ImrifF r J��n G �.,,/f` ,t' /
;a, r, °,�c.a,af rf, ile..r4°,ff�.r �.r f'
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
w do hereby acknowledge that on this date of
-'d •er (ID] f��:7nj
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."
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it is a rrrrarme to know xrmsdwjysa Ira more than one pxetftfon Fora cin ddrdate. (,Dtertaon 1474185 FIoficde Statute j
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tfRraAdreays.u�es�tr���rarad'braa:�ateo�n an this rra�s ia r�cvk`ao�rrm�rtt:�a� the form adra'6Jnot bedPdes' a G."ersa"fl'rdate d�eddt`�rore Form,
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voter in said state and coa�nty, pntiflon to haHE
nve tlhe u"name� � Y � � �II1Y Cq II ::V'�K DURING
orn card
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�Ilaced on the Gerierall E:Vecdoru Il3ail of as a check/darn fete box, as � � � �� QUA.�...VIf�� ING
V' � C �� �; appVpa..rsi:Dpe]
........ _. ..... AV
,NonpsartOsar No rai ty adatoor /I4A o:paaIcabe l:aarty
Canndidate foir the Office of
Cpty of Winter Springs - City C'om i nilissilain IDiistrilct "three
pg: Waame lnseirt tine tMe of (Dffuce and iiirn¢ iucde [)istinic t, Circuuk, Group, Neat INurnber, of appllllcabie)
Date of Birth OP Voter Registration INurttroVaer res, a
(M M/IGD ICD/°.a'd"Y""e'') "
City
G1.'�t€/Z S'rc /
nature of Voter
Rule 1S-2.045, FAC.
County State
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CAN DI DATE PETITION
Code
32-7a Y
Date Signed (MM/DDAy M)
[To be completed by Voter
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*,AUdnfnrrnatdanonthis fMrntbcca„rruesapubfir,re wso"uporrrecerfattrvtMe"kwrgumv1sorofiNeutdnn^
tt hr a crime to Mno, a^r"rrwpd-a'swaan enure tdwur r oray. ,aaatfta �.. . au l
" vwmar for nann:teatatr ";"eozfsraa tG✓f.tti:z a�t�rtw,awa,.'tatsater
d'P"aatf rF"rpuasl'r*o+psa brma t,bn an fMi, fawrnl & slop" a nunWirtewd„ the f"r+wM Add uaa°rt tV va4'trd as ra F' Ilti'c n forn. ,
I, .%~v®Y /n R 1 jr Xz,0 tv ✓ the undersigned, a registered
s it
s on your voter
ion
p card)
w print name
apetition have the nameof
ca��;Ili�'"
voter in said state andcounty,
placed on the General Election Ballot as a [check/complete box, as applicable]
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V":f"::,tRlllvll lIA f.Y°fi T BE,
f'Dp°MYVII DNlm D T&'"t "'f"W i"
GII"V""Y C31 i i':;fV,.Di"tllifG
QUALIFYiN 'D
Nonpartisan N/A No party affiliation iN/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert -the title of Office and include District, Circuit, Group, Seat Number, if applicable)
)ate of Birth OR Voter Registration Number Addreesss �i C� y�-�f /J s
MM/DD/YYYY) 31�lS G U ` SX1 � b e%Y� X``
Rule 1S-2.045,
Count p
State Zi Code
e Signed (M M/DDA^M)
be completed by Voter]
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CANDIDATE PET[T0N Far4im "7
AN iniormal.Jbn errs this to"n becolnes apublic ieco,,dujoon receipe bk, the Sul.ww5w afLkctions
&;a ci !me wknoiwkkglrsign irywe I han one petWon foi a candidate f5ectfon 16,6385 Ficrida SIatutes/
lrardd
TM as a Candidale Ft&Utwon Foern, 71 flS (':OMPLE , I ED
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ase tint name as it ashe undersigned, a registeredG'le � � � � ' appears on your�ie� information card) PIPOMIDIEDIOI 11 RH
0'ry (11EIRK DUPUNG
voter in sa G"11 QUALIFYING
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 Three
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration N7uEmbe�r Address,
(MM/DD/YYYY) 0 'S
('c
- ----- ----
County
ofvWod Date Signed (M M/D7 by VoteD/YYYY)
[To be c I d r,
7<
Pule IS-2.045, FA.C.
CANDIDATE PETITION
AflinformaNno on this form becirnnei; a puh&ntoord upon recelpi ty the Suporv&or ofrtac6pns
"U, & 10 clave to kyoi'wngtw" Sur mole than onippebtibn fnr a candidate jnoctibn ?04 WS Florede Sgaeurr.sj
*1T151Y1n,4t 6yaed information on this ISrnt ig not comp(eled, the fe:%M? 911,'111 not be vaildas a canoydow OeUVon fb�r�?' T ll HS C0NJjl>jl
1, Z// the undersigned, a registered F:ORM MUST II II
P1!:Z0V0E1) M Mil::
(Please print na�Z, it appears on your voter information card) "d '-ts UrY C1 EFlK DURNG
1111P
Al"I
voter in �5' id state and county, petition to have the name of QkJA1 WYING
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan No party affiliation Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(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)
city
t
ou nty �#F IState
Co
Zip Code
asol
Signature of Voter
Date
Date Signed (MM/DDIYYYY)
Signed 'MM/D
omp d
r[To be completed by Voter]
F.A.C.
E 1 V, II, EED
EF�
psi 1�1
'All Information on IhIsfbimbecanies a pubfie.
1, js: a cringe to knawiikglysqn rn,we than arw�wtfthm fvr a candichite, jSeczlon W-IYWFkrIgJa SfateAcky
Hyis foiro ismeat completed, theforrn willnot tv va&J as a Csneiiryate Pov,11km I-e)rm'111 HIS COFAIPLE I IIED
the undersigned, a registered RARIM l : AUS7 BIE
(Please print name as it appears 6iiyour voter information card) D,ro'IIHIE
Vol , 1, 11 Z �' CHYCI IIEF11K DUIRIIIING
Voter in said state and county, petition to have the name of It - 161� QUALiFYiNG
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan N/A No party affiliation 9A77 Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of off -ice and include District, Circuit, Group, Seat Number, if applicable)
to of Birth OR Voter Registration Number Address
M/DDAA(YY)
(Dr
of voter
IS-2.045, FAC.
County
<
State Zip Code
. . ...........
Date Signed (M M/DDAYW)
[To be completed by Voter]
CANDI DATE PETITION mpm 7
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Afl?nh:»,inwtkn, cqMa�"r krmbecomes a pubflc n?COM, VAXV7?&Cwipt 4»Ir the Sul.,mlid, Visor of Eh?ctkns
ft,rs a 4nme eci kn0w09Ij(S,&:i1rd nw::Ii IS, V:ori :Iiwpe9'4A:v7 tW a aMncfldWJZ e SnYcbbn )04 MU/ hilifilYa 5rehaes/
ffaU req.jested fnfnrmatke? on this, form is no' cc mpleged, the form m,111 not be vsMd as-, a Cn ndfdax t-%-UGon Form, THS COMPLETED
1, -e, the undersigned, a registered FORIM MUST BE
(Please print name as it appears on your voter infc��tion card) PPOVlIDED'TO"rHE
CII CLERK DUPING
voter in said state and county, petition to have Chia . . .... . IT QUALlFYIING
naFre of
placed on the General Election Ballot as a [check/complete box, as app , Illic blef"
Nonpartisan N/A No party affillatlon EE= No'r Applicable Party
Candidate for the Office of
City of Winter Sprfings - City Commission District"Three
(Please insert tine title of office and include District, Circuit, Group, Seat Nurnopir, if applicable)
Date of Birth OR Voters
Address
Registration Number o L (M M/D DA-YW)
Ig4 u i 1A, 0
City
wv--C>pq-i
Signature of Voter
Rule IS-2.045, F
Count 5 e Zip Code
I CAIWI—i � � g *--0 9
Date Signed (MM/DD/YYYY)
(To be completed by Voter]
RMCEIIIED
RM
AU(i, 8 2020
r I TY �,`0 '41 F R, PF"H N (I S
f- f I C; F C, ) F E; (. Il Y C, f E R,K
F'ORM 7
.All information on this fdim becomes & pubfic record upon leceiipt bj, the SuperyiRw of Oec?,Ions
It, if, a crime tvkxjvl#W9ysbgn mons than orwe peWt.fon for a canarldate j5pclirm 7oz,,iss rittrida st,1M1j1f2Sj
Ifali requesterY tt feytmatkw,, on this forrn 6 wl compteled, thr Awn wN nrlbe vw1d as a Ownbidale Pef!Uun Forrn, IMSC00ARIE1111ED
0?f IFOPM MUS'll BE
the undersigned, a registered
99' " jl'�IRCMDEID M 11111E
of 'Ir
(Please print name as it appears on your voter information card)
TY IR14 ' DUI�!NING
voter in said state and county, petition to have the name of j q
QLJ'All 11l!MNG
placed on the General Election Ballot as a [check/complete box, as applicable]
I Xf -N/A Not Applicable Party
L A Nonpartisan E=N o party affiliation i ation
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDAYN)
city
1A/ �i�l
�"p --------- Tj
Signature of Voter
Rule 1S-2.049. FAC.
County State
Q CANDIDATE PETITION
Date Signed (M M/DD"
[To be completed by Voter]
1A # h7ft, nmatkv r cin 2 hZs jiur? F7 becon Yes & pubde esswrid upw Yripe: e qw bY she 5%,,AeTvh;i:V VIE Awteons
/Z & a crirnc to kw' 74:11 vvmg " slrqi r v n m Y v Man :me Awt Mbn 1hr a -w wdjdate /Spe: I wn 104, M Fkvida Stut a rt
ff a It rnw� msted �hbrn w tior, 4v � 2 17& fi7rew 7 nple fee�, N w fb� ri�, � iddY no r be va Was io cmdkm t 0 Fe Utibn Por I
rAxln the undersigned, a registered
(Please print name as it appears on your voter inf,r,,t',,,5d,)
of 0�11
voter in said state and county, petition to have the name Ci
placed on the General Election Ballot as a [check/complete box, as applicable]
Code
FOIRJI�A 7
THS
F°ORIA I1AU,kST BE
P1l!�(�)Vfll)1l:::D M iHE
C11 11"Y C11 EPK U)U11'i)1lN('
QUAl fll��!YKG
Nonpartisan No party affiliation 1N/A= Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
of Birth OR Voter Registration Number
ure of Voter
1S-2.045, F.A.C.
Address
'�' "?", "L A, ) R" (41I( �f'
County State --7
t
Zip Code
2
Date Signed (MM/DD/YYYY)
[To be completed Voter]
�111 !"1"', 0!"1", EUVIII, I
C M, Y' `1 1=111� �ODFNI'4�'
'All inkumae.lonon thkfarn,w belcornes a rectr09 tr tile rqjP,,f,�,,,r at, Ejr',Ct,6"r,
If IS a more thanonepoUbonfing, a cancIa�don WMS 17ofidaTsfawtc'sj
"If all M& n,V �wnpleted, Me fram will) aoe. be vaild as: a C�unefik.Mee Pleiiaon / ann� I Fi HIS CIOF111A MOMPUM- LEITE[)
E31i::
11, \IJ the undersigned, a registered
PROADIl D M T1 UE.
ey 1
(Please print name as it appears on your voter information card) C � T il-R K J
voter in said state and county, petition to have the name of '111 1, , II I'm till, )v
Placed on the General Election Ballot as a [check/complete box, as applicable] QUAII P i ING
WYNCi
--j cable_ Party
�otAppri
Nonpartisan F—N/A No party affiliation
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of office and include District, Circuit, Group, Seat Number, it applicable)
Date of Birth OR Voter Registration Number
(MM/DD/YYYY)
(::> 1,/ 1 '5 1 L+ 57
Pule
re of
Address
CANDIDATE PETITION
C e
Zip Code
'92-70'W
Date Signed (MM/DDAIM)
[To be co feted by Vcwter]
2-7
ar bWs fnfm a pceb(k rocap a Lipon rece;pl by thip &q:1an,h;o: i ol EkcLk:�ns
It Is a crime go knowlrk.r7�.Yriqn mcre than n,,w putfIribn frw- x mnd)dafe, (Sec0loin 10I F!ILrteS,1
'fe vq(rl.ql dinfbirrN900170 forni Yd af �1.n&date petititw? rc,m.
Compla�&d the Foi t77 ivilf n,,D2 be v,
PY, Y Ane UF-4�rsigned, a registered
r,
I le,
(Pieaselpii�q/ 1,,. 1, Pears 01 I,Vy,o LA r vo�', -,,/forrrat—ion card)
vote in Said state a nd coun�y, petition to Ihave the ria me of
pl@(::�ed on the Genera� l-lection IF: as a [check/coirnplete 1,.,)ox, as applicalole'l
FOPM W7
THIS C011AF)ILE'TED
F011 M IMUS'T BE
1::M:OV111:'. AED TO D 1E
CITY CLEPK C'U'UNG
QUALill:MING
Nonpartisan =IN/A No party affiliatfon —A,011-11ticaiple g::aarty
Candidate for t1he Office of
City of Winter Springs - City Cornlinission Distvict. "T"hree
(Please insert the tide of Office and 'nclude District, CiiI Group, Seat Number, lfaloplicabIe)
i
Date of Birth OR Voter Pegistiradon Number
rer
(MM/DD/Y"Y)C-s s'
Rule
coun
'0 ;k. L Zip �0 d
I-- 08
oJ
)ate signed 0A Vl/l::x)/YYYY)
Ober p e Ad I VoW7
Ile'
("wl r E'F VVIN",
F i C I.
IIIII
CAN [")ATI,,: PETITION 1117
"Alf informaVon or, this fafm b&carnes a pvtok eecoidupr)n rvcei�w day ow s'upenLror of E)Dc'Uons,
Jr a crime to knowinglyw;rd morp than anopp A Xon fbi a Ca n didaw, IsrCtIon 704 TaS F-forlda F'faT I 96j
*If FYrequPrf.ed: vdbtrnzit in rp on rhi.,; foina in, rare thp ry I M wfflnor be vaidw; a Condidate P: erft;,tr Forrn, 11111S WIMP LETEI::)
FOMA MUSI Bl.:i
C-1 ( ered the unders�giried, a . reg�st PPOVI DED 10 T1 �E
iplease prinInavine as iit appears an your voter information q r�j
CITY C11 E.PK DUFUNG
voteir in said State and COUnly, petidoin to have the narne of . : LL4 QUAII lFYi1MG
l:Aaced on tl'w Generai Election 13allot as a [clheclk/comjp�ete box, as appficaUe]
Nonpalflsan 11,lo partyallfilliatlon Not ApIpIllicaNe Pairty
......... . ... . ...... . ...... .... 0'""" 1== Fd/7
Ca lididate for the Office of
City of Winter Springs - City.t'.Iity. Cornimksllon District. "T"hree
0:a lease lnsert the tltle of Office and lnclude INsurict, CiRcuft, Group, Seat Nurnbel, If a ppHu.lble)
Date of Bin.h OR Voter Pegistraflon Nury-lber
(fAM/D11tYYYY)
V2
S
o7ter
IS-2.045, FA.C.
CANDIDATE PETITION
Date SBg ned (11A Mxx:�/YNy)
[Ilo be completed by Voter;
*AflinfoirnaVon ort Ws tbrin tmcoPYmia;:odjflr recordupon rocz,4pt, bjrhe Supwv,-"w
1,Pt irs crIrrieto than one peeftion for a candidate, fC&cNvn 704,786 f7vfida not wcs,�
Ira,// esquested infonratfonr on the Form ti,,Wrwot bevs#daz a CandidaleAn,!4fan For'7"
11�„„,V,rl 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
T6
placed on the General Election Ballot as a [check/complete box, as applicable]
P Code
'I 11111S COMPi ET"EID
1::0PM MUST BE
P1,40VIDEDTO TV CE
CV"r':Y C11. l PK [AMMG
QUAI IFYUSIG
X Nonpartisan No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(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)
I I 'm M) q 1 —7
City
IIA.) % n
Signature of Voter
Pule IS-2.045, F.A.C.
Address
r'
f 37
County
Si
FSt-7-7 Zip �Code
- - --------- - -
Date Signed (M M/DDA^YW)
[To be cm pleted by Voter)
ON
AIJG 2 8,
J!!0PIM 11117
"ll in1ormation on this, )brrn becornes a pW:Ific re canf eipan reccUpt bV the OP Elt'cejgns
it, i;a a crime knowiekq1jesegn nyore ? han one petftion tor a randidate j5ectton Mde, 05 1 Ira irla,51,ae uY esl
If aff teqiesled inkpowarion ort ihis fry nw hs not rainpleged, th e form wyll nv� be, lakY as a CancMIate Atetie. ion f 'rw i �111's C01MR ETE.Ii�)
fdA' R)RM MUS'I'BE
C the undersigned, a
1, 01 Q I registered
FeROVIDEID'ro rHE
Tlease print name as it appears on your voter information card) 10
,',l � I X! PIK � Yl UNNG
voter in said state and county, petition to have the, name of
Q, �A Lll FM tic;
placed on the General Election Ballot as a [check/complete box, as applicable)
Not Applicable
Nonpartisan No party affiliation N/AParty
Candidate for the Office of
City of Winter Springs - City Commission District Three
(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)
of Voter
le IS-2.049. F-A.C.
Fco--�t-yl
Till
CANDIDATE PETITION
Zip C de
3' 7
MI Or, ,
Date Signed (M M/DD/YYYY)
[To be completed by voter]
() K //10 �Lo
"API Mfvfmatirdn on etw� forpr8 be'noires a publifr I't"Cora, 4, fpon mcelpt cY the SI qoarvhsoi of EircV'ons,
re It it a celene to knmvdp glj, seqp enamMan ane perMon fw a candidare pnctlon 704. 7,91, frjoobe. Sj_'tjj2r7,j
If & ff requestery Information On th1rhwrn h; noe conploptod, the Ibfm P'vffl tics.„ varid'rM a cand)dale Potiflon Fol n9
D IS COINAPLE � ffl'')
F�OPM lAUF;r BF�
1, the u nclersig ned, a registered
PROVIDIR) F0 71 � l::'
(Please print name me as it appears on your voter inform atio n,carall, M
I 1 1 '11 11
�1
UY 0 j:JW DUIFNkM
voter in said state and count y, petition to have the name of � n" � � 110'. 1111 '10
Y 011go, '5
QRJAJ �FMNG
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan No party affiliation N/A Not�Apprica�ble.
Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(M M/DDA-YW)
County -� State r!
of Voter Date Signed (MM/DDI"
I � [To be completed by Voter]
Rule IS-2.045, FAC.
RECEIVED
M,k 2 r V"J'20
C IT"I W1 N1 1:1111, Cr G F, 1:
I= rrj C C) J: p'j E. C I
R E 4%.", E I V E D
(1111 Y 01: WN i�: R �', Fi:`H�IJJG',
I: � i�7 T C i'� I<
CANDIDA PE r[ 1� ION FORm 7
All in foren a tion on th & aFbrm becomes a pub,"ir Y r c o rd upon rerpipt by 9 h a Supc r vhwe of Flec fkm-';
It ew a crime to knowingly s�qn mole than one peeftion for a candidate, 104 185 Florida stgt�jtegj
'it all rf. ques-ted rhformaV6n on thh; form is, not compretear the form MY not he voifd as a Can&dafe Petition Font�, THM COMI:N ETED
FORIA MUS'"r IBIE
oc the undersigned, a registered PIROV11DIED TO THE
(Pleose pdrit nanne as it appears on your voter information cardi
Voter in said State arid county, pedtion to have-� the nairT'ie of CITY Ci ERK DURIIING:
QUAhUFYIIING
placed on the Generall IEllecdon IBallllolt as a [drieck/cornplete bf,:)x, as a
Noripardsan [:]ED No party affMatioin INot App: Hcata,Ile Party
Caindidate for the Office of
City oh' Winter SpHrigs - Cfty Coirnmpssioin Mstdict'Thrpe
(P lease 4,iserttliretare ol'Office sinid rinclude Disci ict,Orcuit, Group,Seat Number, tiffalpioHimble)
Dare of Birth, 0,1R Vot.er IRegistratiaalrr 117;ljurriber Address
pM/l:x)/YYYY) W
q < Pin 0
`7
County
Pure IS 2.045, F.A.C.
'i'r 1� III TF'riON
CANDIDATE,
State Zip Code
rL- 33-�64?
rlc�'
Date Signed (M M/DDA^(YY)
[To be completed by Voter],
0 3 /a L /Q o
'A#Wittmatlonon thisfom bew.mes'apubhrrccona up ,orp mceipt bX the Supwvisar ofEfecifions
it is a crinne io A'n0i'Vhqr1 , J"Signmwe than onspernion fare candidaw. fSection StarutasF
lff&Yiequested lrrojrivrmarlrn or, th,"sIbrm hinatcompletedthe forrn wayOwe Saar vallolese CandidatoPatitlon Forn'7.
l, 170 9 E 2AAL- the LJir'ideirSji:3ned, a registered
(Rease print nam as it sopears on Your voter inform.'aflon q�ard�
voter in said state and county, petftion to have lthe iniame of Z-Ofmie'.'e, .)# �e
placed card the Gen eral If lectioin IBalllot, as as I.checlik/cornplIete box, as applicalbiell
T] HS COMP11 ETED
F RI IMUST 13E.'
PIROV11DIED '11"O'n 1E
CiTY Ci EIRK DUMING
QUAL.AFYNG
Nonpartisan NapartyaMadoin EE:D Not AppficalNe l3art�y
('.::andjda1l:e foir the Office of
City of Winter SpHrigs - City ComimisMon IDllstdct "Three
it,iease insert the title of Office and in lude DiMrict, Circuit, Group, Seat Number, if applicah: re)
of Birth OP Voter Pegistiration Nurnbeir
us I ofs � 101 (0,3
Address
,4-7S &'LEv)2M
Courity
'S-Ei'vyk tc4q, =LCI
............
. ...... ..............
;hate Zip Code
..................................
1::)ate Sig ne,"I (M MIDEVVY"00
[Vo be rcarr pon tt'd by VAerl
2 0 2-0
M�11'6 2 �1 '�',!JJ21
C1 , Y 01:: nrWl inr Pftlt i�:;S
RF-CE111VED
CAND111 C.lrYf,)F Wr4T1E[l SPIRiW. S
1',,)ATE PDE I I 10N nr`�- I CE, OF i'HE CiTY CLE RIK 1: 011411A 17
'AflinArmallon on this form beco.mes a pubAc: rerordapon YPcejpr by rheSupeneisor Of EIections
It h; a crime ex, knomdnglyslign more than one peUtior, to/ a candidate. [Secrion 104.1es Florida Starue.esl
lft�resead inliw r f t , A n ic noppeMph, t. a d, r h e form ii n ot he vis Ild as z C"a n dida r, a Pat iNo n f.errr#.
411S COMPLEETIED
FORM mu Fail -
the undersligned, a registered
.1WM PROVIDEDTOrHE
i1slease print rarne as it appears on your voteii infoirrniction, card) ClTY CLERK DUir4lING
voteii,��isaiid��tateairidC(:)k.l�ity,petitiol�itoll-iavetlheii')aii"Y')eof,,5 placed on the Gn eeral Elen ctiol3allllot as'a �crlheckkornplete Ibox, as applIkablell QUALWYNG
Not ApplicaNe
E= Nonilmiidsan Nopairtyaffiliatioin N/A Party
Cartididate for ll ie Office of
Oty of Wilinteir Spirlings - City Commisslion IDistrict Thiree
pPlease linsert the"fle of Office and nnciude E)iStillift, CirCUrt, GilOUP, Seat Wirnber, if applicable)
Date of B'uirth OP: Voter Reglistradon Nurnlr)eAdc.kess
r
r
(M11,A/DD/YYYY) rjj
le %.Z04S, F.AC.
CAND11 )ATE P)E-'T ITION
Da'te.Sligumed
rfo be me
'All in0brmatirdn on this form becwrips apublk terord upon Peceypt tyrhe SupeMsor of0ections
It ic a crime to knovvinglyriqn n?o,,e than one petWcri fora candlda le, [SectIon 104, WS Flcfid.a Statures]
frak' requested'informavon on this form Ir not con?plePgp the lbern wW not be vaild as a C'and9data, Petition Form.
eP
the undersigriied, a regl�stered
(Prease pv int narne as it appears on your voter finformadion card)
wtter in said State and county, pedflon to Ihave the na rne of'—) -0, Q 4-1z� /I C.
p1laced on the Geinei'M E.Aectior-) l3aflot as a [check/coli ll,-.)ox, as applicabIle.]
�- D
n ills C011APLETIED
F,Onim MUST ICE
PRONIll DED TO T� lE
CilTY CLERK DUPING
QUALWYlING
Nonl1frartisan No party aff!!Hatioiro- 1EH= Not Ajj,,.)jpficaHe lDairty
Candildate for t1he Office c..,af
Clity of Winter Spirings - Cat y Cornrnllsspon Dilstirfat '11"bree
(Please iiaa^seirtthe title of Office a rol include Dkatrict, Circuit, Group, Seat Nkayflner, if a pr3ilcable)
Date of Birth OP Vote R 'stratici Nur-ir-ilber Addres a
(r,d1Nd/1rx)/YYYY) / 6 F 7 'All
�7
'Ity <I�N Zip ode
El 11.�) ZAI(llf, I
City /V 171P W
Af k, ry . F-IYS
Sig natu ire of Voter
Rule IS-2.04S, F.A.C.
D.I. signed �NAM/[)D/YYYY�
[To be cornpleted Voter)
so
RECEIVED
AUG
ul C') ll-�F G1 lY CA"ll-HK
F
RECEI''I'VED
C I T Y C) F VA IJI ER S FR, I P"JIGS
OR1114
CAN [,,',,')ATE ITION IF
Mall intbrrym tio? i on thh's laim becornex, a pa bik record upon recerpt by the Supervisor of Ejections
it is a crjrrw to knownpgy A1.4n mare than one petition fbi a candidate jSecglon 104. M5 Fion&J StatgaesJ
THiS COMPLETED
�quasl �v a to n, n a V ory o � P t hh" ob rm a7�' 0? "Ale � e 0, th d. foi a � will ry v t b a � �,,a ild a., a C e r, alida re Petit. io, , �y fo � n?,
the undersigned, a registered F"ORM MUST Bi:'.'.'
PROVill )EDTO TFIE
Piea se piri nit no r ne alit a pp: ea rs ofn yo u r voteolo, motio n carat) ii cl) MY CLIERK DURNG
voter in said state and couinty, to have the narne of \rot QUAi 11FYMG
placed oiri the Generai Ellection BaHot as a jcheck/roirnpete box, as applicablIel
EX-D Noinpwtisan EBNHD INo parry affifiation INot Apap ficaNe T-0 —rt y
Candidate for the Office of
City, of Winter Springs City Cornimission District r1hree
NPlease Msert the btle of Officeand indude Dlsnict, 0irouit, Carnup, Seat NUMLier, 9 appkcabie)
Date of 151irth OR Voter Regstradon Number ftess
iMM/DDNY"
le I5-2.045.
caa
CANDIDATE PETITION
p Cb6e
347
LE7P
—
11:)ate Siig v eat U M M/D DYYYYY)
j[ib be 3 corn1r,2e. ed by'Vo 22'.
IAP,'nfarrnatian on this form becomes, pubk., recordii,epan receipt Lpy the Supervisorof0ections
now?j �ign me.,ro I ofu "etat n foor a candidate. 15ection W4.185 flMd.aStagures]
"Z1,d 1h. 16. .18 .1 Ae ve#d as a Candidale Pethion Form.
Ira, k-Mat!on C 0"Ar , rry) .0
the undersigned, a reqist(:..,red
Mbilas' printinarneasit
voter in said staite'and cm.mty, pe-ftion to have the narne of
placed on the GeinevaN li::.Aection Baflot aas a �Check'/corrplete I,-)ox, as applicable
�1
THS COMN E-rED
FOPM MUST BE
PPOVI DED TO TH E
CIFIFY C11 EP.K DUMNG
QUM WYNG
N. Nonpardsar, No party affiHadon ---] Not Ar,:)pficalbie Party
1= F/A
Candidate for the Office of
City of Winter SpHrigs City Comffftsion EAstrict"IFhree
(i::Ileareinseirt. the tittle oi`Officeand include DMruct, Cir,:iuit, Group, Seat Number, ifalpIzAcable)
E)ate of 113,irth OR Voter ::Zeglistratiori Nurnber
NMM/DID/YYYY)
n
Signature
15-2.045, F
Addrevs
..................... ] UOd Z 1 p Cc� :e,
9,10;
Date SRgned iMMADD/YYYY)
iTo be oni npleted XVaMr]
RECEIVEt:-"'
W/V;7O.Vo
AIJ,G 2 8 21,'Y�0
C
CANDIDATE OATH —
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
I
n�
E/` r'f�Y Isom f4�1",g li+,xwz� Ufy,� Wa,l41� �'.' Y�,Yooj
�U� �' Itt� ,r ti 1, . E�mi1l
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
OFFICE USE ONLY
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
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 "' r'°i fi
(office) (District #)
am a qualified elector ofow f
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):
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ell, used by persons with Oisabiliti 7,{see instructions on page 2 of this form): [Not applicable to write-in candidates. ]
Ir ballot as my Abe � s I � I���I. . . ....................... . . ............ . ...................... . .. . ........ . ... ...... .
S' nature of
...........ww....�
Candidate
^,.."
�w
Address
STATE OF FLORIDA
COUNTY OF
4 )
Telephone Number
City 4Z_02�
Gat(
Sworn to (or affirmed) and subscribed before me this
day off �" 20
—� ....
Personally Know or Produced Identificatiom,' n'.
Type of Identification Produced: "'; ; Pa
Email Addre.<�s
�44
. AA
y
ZIP Code
r
Sigheiture of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
,eN R Notary Public State of Fbnde
Christian D Gowan
My Commisaion GG 913234
Expires 09115/2023
DS-DE 302NP (Rev. 11117) Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT
;
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:
u
MAILING ADDRESS
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U�,�1 IC Yip.. r IN, 1i"
CITY ZIP: COUNTY
.. -. .� ME OF AGENCY
�:1rI it st rrir ClE°,I 1�ir
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NAME O OFFICE OR POSITION HELD ORSOUGHT.-
I p roi .tsr
CHECK Ol IF ❑ CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** 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
�—PA�RTA -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
571/
......
0 '.
ommmmoom
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
.... ...._.. -- ..._... �. _ .. � .....
��
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] You are not limited to the space on the
you have nothing to report write "none" or n/a) lines on this form. Attach additional
- sheets, if necessary.
.-...- ....... �gri,,, ...-........ _.
N FILING INSTRUCTIONS for when
and where to file this form are
r
...�...�� �u
W.�..a-..._...._.._.._....._ nnnnnnnn...�..� .....-�...... �-,ri� ��..n� _.._.. - ........_... located at the bottom of page 2.
.�.. ...................._......._........._.... mmw.,..a,,... mmw..... 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 I
Incorporated by reference in Rule 34-8.202(1), F.A.C.
PART D — INTANGIBLE PERSONAL PROPE [Stocks, bonds, certificates of deposit, etc. - See ir,... jctions]
(If you have nothing to report, write "none" or "n/a")
TYPE OF INTANGIBLE
,y
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "nla")
NAME OF CREDITOR
BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
ADDRESS OF CREDITOR
_._. ...
�.
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions]
(if SAO 7n/9
ENTTY#2
you have nothing to report, write none or
NAME OF BUSINESS ENTITY �I SS„ITyY # 1 BUSINESS
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
10
)
PART G — TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
Date igned00, : n
:�
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 emai,,;our,,,,orm„_to the ommis,sion on thicsiwt,wwi,l[be,
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. Donut fi)e f� �o#h.mai ,egd rp it oose...on y orle
filing„ methoI Form 6s will not be accepted via email.
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), F.A.C.