HomeMy WebLinkAboutWatkins, Barbara Qualifying Packet - 2020 08 25CITY OF WINTER SPRINGS, FLORIDA
0m. 2020 GENERAL MUNICIPAL ELECTION FORM A
AFT'If,)�IVIT'OF"ACC'L"T)TAN CE THIS COMPLETED
FORM MUST BE
PROVIDEDTOTHE
C1 Y COMI'A S&OhIIll)ISTI!IICT Ot4E I'll)IS l l!tdc-7 I l ll l S'l l Zk, "I ll]VIll, CITY CLERK DU PING
QUALIFYING
NAME: Date &Time
Review Started Page 1 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 RESPONSIBILITYTOR EAD 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 ClerklDesignee no later than 72-00p.m. on the last day of Qual/61ing which is
Friday, A ug us t 2- 8, 2 02- O,
"Appointment of Campaign Treasurer and Designation of Campaign Depositary for Candidates" [DS-DE 9]
"Statement of Candidate" [DS-DE 84]
* "Affidavit of Qualified Voter Status and City Residency"
"Application for Office and Election Assessment" (WITH a check drawn from campaign account for the Application Fee
2
:AND the applicable 1% Assessment OR "Notice of Undue Burden")
3 "Notice of Testing Tabulating Equipment"
4 "Notice of Political Campaign Advertisements/Signs" QUALIFYING DOCUMENTS
5 "Schedule of Campaign Finance Reporting Periods/Due Dates" WITH AN *ASTERISK MUST
6 "Notice of Access to Campaign Finance Forms" BE COMPLETED IN FRONT
7 "Candidate Petition" OF THE CITY
'LCandidate Oath CLEPKIDESIGNEE DURING
"Notice to Federal Government Employees (if applicable) QUALIEYINQ
.'Form V - "Statement of Financial Interests 2 1 019"
Accepted: F
STATE OF FLORIDA INFORMATION
]"The Florida Election Code, Chapter 97 -106, Florida Statutes [08/20191 (includes Chapter 106 which addresses Political
Advertising and Disclaimers, etc.
-------- — ]"Candidate and Campaign Treasurer Handbook" (10/3/2019) (Which includes "Chapter 12: Political Advertising" and
"Chapter 13: Other Disclaimers"
"Electioneering Communications Organization Handbook"
State of Florida Election Information Contacts
Accepted:
1-1117
Revised 07/27/2020
RECEIVED
AUG215 20Zf]
OF f ' iE, col I y
"%1AreR1,° CITY OF WINTER SPRINGS, FLORIDA
o t m 2020 GENERAL MUNICIPAL ELECTION
uyb w N
CllyC01411�it";sjol,(�l,)IS'li l ,ll f 6\/
NAME: f'°
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
Stl:aterrnent of I:.:thiic:all Campaign Practices" (Promo Lhe Serniinoie County Supervisor of ff: iecdons
° 1 ( . F'orr�V< in irnat0oraadsa`° - ffruirta tllnu; I en[z:iral If:::Ic:ca.'uoun e„:r,:sirrorrroiss¢nro Fa%1:Sf201"d)
Legal References; for Q; ivaiifying Documents
Accepted:
l:oi::lm
u li II Is C 01M II 11 II 1 "i III -.II:)
: 011411 I'4US f i
ff' OVIII ID11 11) 110 "1111 fll:ii
amR (;:i EQ111f 11)U1114111II4r,
L,a),ll.....l V::: Yi Iiqa,
is"a n. ol:2.
NOTE: The Candidate SHOULD NOT close out their Campaign Bank Account before they are invoiced and payment is made
to the Seminole County Supervisor of Elections for verification of Petition signatures
The following signature area is to be signed upon receiving the 2020 Election Qualifying Packet including the above referenced
documents �., .., ���'' iR ...„�
�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
me; and understand that it is my responsibility to comply with all Laws as they apply to the 2020 Election.
signature Date
Street Address
State of Florida
Countyoft;a
Sworn to (or affirmed) and subscribed before me by means of A...physical presence or_onNine notarization)
this e"i )�" � a day of
V
code
by k'� w tf'a,.a'`; w. ,)m,. ii i.) Personally known: vj �(Ct�dr,tir
_._
/ (Print name a per on making statement)
e s /'
Type of/dentification produced Signature of NotaryPublic - State of Florida
Revised 07/27/2020 -
Notary Pubifo State of Florida
• Christian D Gowan
• ,� My Commission GG 913234
Expires 09/15/2023
I,{�)r 4 rrzra let 1 `�;, %' (III HTJI
V,i �14u, "w„_rol (� vu �P" `V'��� �,.w»i p, JJr
AUGU2 i i 20N
& tl t C l::v VVIN,
CITY OF WINTER SPRINGS, FLORIDA
o 2020 GENERAL MUNICIPAL ELECTION
MM ��
n s l FIC;4VITOFQt1"L.1 1::D i^"O M 7,97, T(IS AMD
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Dlorlllwflr" � i,�Rl'^��I �i a gyp p II v p
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y Ep
L
r . V �M II (�:� ,II'. Ii z- f do hereby state that I seek election to the City
�r III a ICI it
Idt�rrrNa rJ oa �dk$ ( v,raor iti lad)
of Winter Springs' I )IStrk:t (?Ile r Di ,I fct I hi ee Disnlct Rve a four (4) yearterm
in the election to be held in the City of Winter Springs, Florida on Tuesday, November 3, 2020. 1 further swear or affirm:
(1.) I 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: r M dI V
(4.) Length of time of residency in Winter Springs District: is
(5.) 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:
State of Florida
rt
County of
Sworn to (or affirmed) and subscribed before me by means of f J,,,rhysical presence or_onlline notarization)
� u
this A�,M day of �./w.��.iu u 2020
by �, "Y� �tpi ga p;� 7� ,p '+t" Personally known: OR Produced Identification
(Print name ofers p on making statement)
� rn�
Type ofldentification produced Signature of NotaryPublic - State of Florida
Notary Public State of Flonda
Christian D Gowan
My Commission GG 913234
00,E Expires09/1612023
u `i� i 1�)
FOR OFFICE USE ONLY
Copy of Florida Driver's License provided for Item (5)
�" � /E
Other documentation fi' Y° a°^° ,+� / A �,Y provided for Item (5) �y
���#6� i�@oi �meNlY I�.. ��m 1M1" ;'hu�� �dlt�o ����� Yi
��IYi ��i� �u� )flrrMrl II ai
Revised 07/27/2020
f VYh"rrl vvR,P n 4r i 1tt if u
Y.ar C'1cf.. O 9°IE C1 i C 4, apM;
" r►r e ° CITY OF WINTER SPRINGS, FLORIDA
o .,gip 2020 GENERAL MUNICIPAL ELECTION FORl�'1
"„ oIw�Tav AP . A'A TION /..' ' " J" ........ TFiQS C^C MpLE.V..ED"
r AND
^' ,r ,✓^ p g�^^y�, g
l" 16M W+C������ !'. a,,. S.If�uuus B BM���w�d'� S ,' SIW tl
FORM MUST r E
C I Y CO M IVSSl0@°1: mrlSll:f 11"IE 4r1 '.l:��V"
1I ICI 1°°w r
ITf CLERK DUF11°4 G
QUAUFYHNG
11 I
I, , )��,���� r do hereby state that I am a registered and qualified Elector of the
City of Winter Sprin, ps and I am applying for the Office of
r 1: nul uss"uo1 i a�:r°;u°i+;Ii ie 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
Y P?
(Check should be made payable to the City of Winter Springs) Check #
AND
fb 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 r o� m' Rf"�A' �J"'"q
Cni �1 ���I �u�,���
Revised 07/27/2020 A f 0 „e i, Z0ZI
(;: 1"f r 0 F 'VAf N) t i, `r 1'I I N (31
P) r 1�`I `.:C, cJI "l`i r In r ' C i C.I;�K':
ma`s eR� CITY OF WINTER SPRINGS, FLORIDA
o` p 2020 GENERAL MUNICIPAL ELECTION MAIM
1 II II IS C0110I1 �LII III III
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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
TI M E: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
R.11`�`i
,iJl f ;f 5 Z02(J
City of Winter Springs
Municipal Elections Offical/Designee
�y®rirE CITY OF WINTER SPRINGS, FLORIDA
®F 2020 GENERAL MUNICIPAL ELECTION p:i'1II'
�A
M Z
w
��� �.��.. �� p a p �y � p p
U e M "�`/w �...A Po' : ��. I�,,��M" � m�"�SE SAIII .' �Y �.
O WHO F.01U4 U 13II":.
011Y / O11 4111 IIS,'/IIOII : ONE I IS IIZCT I 111�ZEE L IISI IIIZCI FI II C11IY F:III 'JI�'11U DU5`MINIIG
Q,UAL.UIF°"'YllI II 'u
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
do hereby acknowledge on this date of
',4airi
- , 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."
r
(uP(,
FOR OFFICE USE ONLY
L„„' Attachment: Copy of Florida Statutes 106.1435
Attachment: Chapter 16 from the City of Winter Springs' Code of Ordinances
Revised 07/27/2020
i1,rts
�ill o�ni i � V � � wuoigll
�) ��u� Wr �,r sN fib,'" ���n I `�� �'� ���� � �,���)a�
I Y Cfly rP4Y r l Iv
CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION
• issro�,APP1,1CARONFOROFF
a;:I°"IC""i�Llill��II'�P"°��SII��Im IL111 GC°III"III..""I"" Vll Vdll��.""V III II�PII'�: / II,1111a1 VrV4;'"II' II �II'�'��
SCHEDULE
DURING/AFTER QUALIFYING*, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
THUS COM11311 II I aD
I1RM IIM Li S SF
PII�Zovll II II I13 II 0 II `I1 III !!C
i[ C IL II II111K II J1II�11hIIG
QUAII..VII::Y11IIING
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
°'111 �
ACKNOWLEDGMENT
'( �do hereby acknowledge that on this date of
���������
VYJ
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
AUG it 5 NO
OFF-En';,i I-
CITY OF WINTER SPRINGS, FLORIDA
2020 GENERAL MUNICIPAL ELECTION
9
C1AI Al F1NAN(7E'FCWM5
1111 Y.QII' fi ASSI III" : 1 011`4 E/ I' "IZII('T ]il " "14
NOTICE
V i HIS C� 11141IY3II IY::jE.D
P11ROVIIIIIIf)IIIiiii:D TO rl 1I11i'.
C �11 I Y ( �� I .E R K D I 111 IN G'
QUAL VF"(l VC
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 Ihereby acknowledge e that on this date of...................................
, 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
new M
[J 1,�
I
CANDIDATE PETIF-C)RM "7
AffhIfOrMa9t(,rn ran itis faf7rp becompsapublic recwW cr.xw,receqr1 L,Yttyc w Ehx Superiwisof -twns
it hs a crime fu rrrr
moie Mau onperitiof6r a candidata� J�kwllor? W4JEU Florida 5 toe we4' HIS (X)MM ETH)
on Misformit not comoplel.od,n Owetorm w#1 riot be wfild as a i"ariffidatePetWon Fomm "I
the undersigned, a registered F(YRIM MUM' BE
PROVIDED T'0 F111E
(Please print name as it appears on your voter information card) CIFIN CILEIRIK DURAING
voter in said state and county, petition to have the name of QLAR-11IFYNG,
placed on the General Election Ballot as a [check/complete box, as applicable]
Nonpartisan F N/A I 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 Address
(MM/DD/YYYY) I
of Voter
Rule IS-2.045, F.A.C.
County
CANDIDATE PETITION
Date Signed (M M/DD/YYYY
[To be completed by Voter]
*A# inflWmation on th,,s&rm becornes a pubik record uM.va Perript 4(n' the.Supervis'w or0ertkos
h ts scrhyne to know(ngysic gn more thTan one put Won for a candtdale, 15ection 704165 Ffortda StaftUC4,
ff all requestod information on this form YF not ccn7jr7k; ev d, thr fr-r wR7f rant be 've0d iin,- a randidate dDzt&ar Form,
1, the undersigned, a registered
(PieaFe, p0nt u' arne as it ap I pears on your voter in9bunaflor cardi
voter in said state and couinty, petition to have the narne of
Placed oin the General Fvlecbon l3aflot as a [i:::Jhef,'-,Ik/cornpIete Ibox, as appHoalLAn]
Code
FOPM 7
Tf flI% COMPLUED
FOIRM MUM' BE
PROMIDEDTO'T'HIE
�MY C11 ERIK DURING
QUAI lFYING
Nonpartisan =WA lqca party affHii:Aion ---] Not ApplicaUe
FI/A F'7111t4/
Candidate fror lthe office of
City of Winter Springs - City CornmisMon Ustrict 'rh ree
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date Of EIrth OR Voter IReglsl:ratoon INuaamber Address
City
re crj Voter
Pule IS-2,045, F.A.C.
County State Zip Code
Date Signed (MMIDDIYYYY)
[To be completed by Voter]
voi E 113
MJad ';'2, l y 2GN�
C1 F,1 0 F V%lj 4.1. 1"d " J� '' "t j C;
2 '� "'I I �4
fl�")F � THEE -1 � I , --
C,III DIDA I F][ r"101q F70RM III,,,,,
All information on rhy,foy'r" b&C0jnj.%,., a pribIts, recc)fdupon receil.71 fxy fhe G'qps rwn ;,r of Clectfonj
ty �t is a rdr7ye to kno.arc
wrrWnys�qnstmbfonre kMNan conmepp,e,&fido,n hfoe,r a;rcannfirJ/anticet [Seevalid
dad'. 185rforicla 5ytcatugers)
MWasaCandWzta:ffionFom,. THIM COM11:4.F11 i:11)
-slgined, a iregisteired FORM MUST BE
the under
PR0VUD11:..:.D TO THE
(Plleame pHint name as of a p1peeirs, or'a your voter infotmabon cairdq 01 Y CL.ERK DURING
voter, in said state and County, pe�titioin to have the narne of
QLJAi iF.-MING
paced on tl-e Generall l..:,1ecdon i..:aillot as a [dheck,/cornpiete lbox, as appkable]
..................... . ...
Nonpairtkon p F l�,4o 1party afflfiatVoin Not Apprcable 4iaa7ty
. ....... . ... ............. x
Candidate foir the Office of
City of Winter SpHngs .. City Cor-runission District"Three
(POiease finsertt* tMe of Office and �11CLVde [Xstiftt, CirckAt, Group, Seat Number, ifappilcabe)
of lBrb"a OR Voter PegNtratlon Nwnber 1� Address
of Voter
Rule IS-2,0415,
CANDIDATE PETITION
�Ste¢a.
. . . . . . .. . . . . . ... . . . . . . . . . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . ..
Date Signed OAINAJEX)1M W
(Io be cornplezed by VoT,er)
1AMft?h,7rM8UrWU,19 1h,15tofm bex:vjnesa cifLle�::dor?s
1 h; a iy,rMp to k'?Toiviyag& Srgn nxvp th,?n one XvAkabr fora canckrate (Srwuon 704 195 FhnkO Stagutervi
on thh; ftrw:� hs d"01 e7onVM:rev11:11, Me An, wov not ore vaNY Rs a Cwa6dele PeUeian ):bj� en
the undersigned, a registered
(Please print name as it appears on your: rioter 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]
Code
FORM 7
THIS COMPLETED
FORM MUST BE
PRWDiED TO THE
CITY CLERK DURNG
QUALIFNING
J X Nonpartisan No party affiliation [N/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, Circu!t, Group, Seat Number, 11'applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDNYYY)
city
of Voter
F.AC.
lCounty
L I
r:1 Zip Code
Date Signed (MM/DD
Fro be completed by Voter]
FCECEJVEM�')
Cj T1 01 V10 IN) 1° F R SPR i `5
C!') F F I C "'. F 11, i E C s -,, C i, H rK
''M ["IIIE 1')E','Fl I ION 7
CA�M
............
'M WOMIUtk�,'On t1bVIMM twcwnes z jxd)hr record iiijon iecvq�l by he: � SuMnMwf of Efewtions
It ft a clime to incyro than one petif !on Aw a c7mr1kia?a I.Srclian 104,M rlofirij S�.afteeeqj
If all fin CiA's Awn is nor. ,an-iA*ted, tj7v forrn wdfinol Iwo va9d as a Ctnyefidate Pelition fex!J,,J, T� �M COIAIPLEII:�D
FOIRIM MLJS� 13E
the undersigned, a registered PPOM[AEIDTO I'HE
(Please print name as it appears on your voter information card) CTIN CILIHIRK DUl'NING
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] QLWJIFYINC,
X Nonpartisan No party affiliation Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(P!ease insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDA'YYY) I
nature of `Doter
Pule IS-2.04S, F.A.C.
County
CANDIDATE PETITION
State 17
Date Signed (M M/DD/YYYY,
[To be completed by Voter]
1! ORIA w 7
"I'All 0tbin7alArm im M& foerra becojes a pub,6c iecord uklew a ecooZ bY',he SuA>wV1,10i OfEAvv?iom
Off &a rrime to kncAwirkq6rs4n moMan one pat0cnrandVdWo j3ecl)bn ?04 7051 Hadda Slatutw) THIS CC DI" ETED
h" aflroqueWod k7ftrna6nn on thh: Anm & not cmr)pkte9 the foren whi nw be vaddes, re Candidate Petiflon Fwrn
the undersigned, a registered FOMA 11AUS'll ffl:�
Pii:zoviii)izIll) ro 111 E
(Please print name as it appears on -your voier information card)
are cii EPK, 11'�AJMNG
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]
X Nonpartisan N Not Applicable
E N/A No party affiliation [�/A 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
DD/YYYY)
nature pf Voter
Rule IS-2.045, FA.C.
Date Signed (MM/DDIYY"
[To be completed by Voter]
AW 2 5
Code
y C) F ",AA P41 F R S f 7 R 1 4'4 G �'
E EK
'C 'D t:� Ft E C IR
rrr iaN
q' CAN DIHDAT'f�II'.
*Aflinfomiation on rhA ftwnrr becornes a public record upon rece4st by the Supervisol ofE!&CV6r;s
It is a crane to knoivvhkq�ysign more than one petirJor, for a candidate [Section hlf,�.785 Florida Statwesj
*if all ieqfrerf(,,,rd h�tormation on 1,hir form is not oornpfcrrz;d, Me forin whinot be vaild is a Candidate Petition Form-
(, the unideirsigned, a Ireglistered
(Please print nairnie as k appeaTs oinyouO votmr inforimadon caircq
vote,ir lnsalid state and county, IpeltftuoIra to have the Irnlarrne of
placed off the Generall Election F.3,allllot as a [check/comprete box, as ap,plicatAell
1-1 HS COMIP11, Fi"E[)
FOIR11A MUST BE
CIFTY C11 EFZK DUIR: i tq� G
Q,UAiiFYING
E
----7 -
Wonp7 airbsan Mo party affWadort rN/A Not ApjpficaNe Party ................ " ' Cancfldate for thie office of
City of Wiritei, Springs - City CoirnirnisMon District Three
]please inseirt the rifle of Office and snciiude District, CircUit, Group, Seat Nurnbeii, if appiicade)
Date, of 13uirtlr'n OR Voter IRegiatration Nurriber Address
iMM/IDEVYYYV�
of Voter
Pule 11S-2.�',AS, FA.C.
county.
CANDIDATE PETITION
St tat ..... .. ....
Date Signed (M MjD1D/YYYY,'
Ob be completed by Voter)
'Afl h-1ofilwailion on dib abfm bvcopnvs a;;4jb& Yecrr,dupran bfthe &vpm u450r ofElecbr„ ?%s
It A; a cm%ip to kno7A4q_qA,,s!gd0 mom than one PoMbn 1br a candkbta A;ectian 1154 1,115 Awde.stun utes]
ff'oh peq,uesteii mowwt?ar on Mts ronn & 11,709 ahe farm wfflnot be vaAd as Cawrd&!Fge Pei!Uvn Qlfrn
the undersigned, a registered
I Please print -name as it appears of i 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]
Code
FOrZiM 1117
ED
FORM riAUS11 BE
art" Cil 1EPIK DUPMCA
QUAII I IFY11 NG
Nonpartisan No party affiliation KA= Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title ofOffice and include District, Circuit, Group, Seat Number, if applicable)
of Birth OR Voter Registration Number Address
DDNYYY)
nature of Voter
Pule IS-2.045, F.A.C.
County State
Date Signed (MM/DDAYW
[To be completed by Voter]
JR,r=CEIVED
Code
01" . .. .. 0�:: V4�ji,j li E. RINGS
01FVI. U:: J"lJE ICI FY C1 EI:U'4'
1 F I ION
CA �N I I il 7
"flinformation an this form bec-owes as pubiicracoydupon rerrVpt by I. heSol.w.rriwisor of I. lecdons
it scar
; a c'rirnie ur know#�q1yrign nyone th,in onepel.Xion fiara candidate. J�Serdrpn 1r)t,78's flolay'7tature-sl
An UMS form Ic not Co"TqVered, me forin wiff not be veil
as a C-andI 12rrl.Won Fo,-ry,, T'l flS C�OMI!l
FORM MUST K
1K.)Vl TO r�-ill
the undeTsigned, a re(listered
( cIase prlint nairne as in: alp: l on your voter Our ormaoon cardlI C11"1ly C11-Ill DURING
voter of said state avid counity, l to Ihave the inaime of QUAII IFYIIINC
placed on, the Generall Ellectl 1.3a1l1l(-)t as a [61I111plete box, as appllkablle]
....... ........
NoinpriNo miryl✓ 0t pli°a avtasol y
Cairldidate for t1he Office of
0ty of Wilinter Sl _ Cjjty Cornrnll Dlistoct r1hree
iPllease inser-tthe title of()ffice and linch.Hle 1"Nstricy Chculit, Group, Seat Nurnber, iajppficabve�
Date of Birth 01vZ Voter Regl Number Ad I erns
112 1 If i
City Fc---Tt-y State Zip Code
F44 3 Z7 OSI
UJI-1y4ey o I
Signature of Voter Date Sig ned (M M/DD/YYYY)
[To be completed by Voter]
ft4-4X 0 F/Ig
Pule IS-2.045, F.A.C.
CANDIDATE PETITION
AW inhamatfun on fh1l, form belcorres to pubfic recard uppon recei):ft ij;;, the Suporvisoi ofEklcfirms
*11 is a cr,"Mc to knrrwifyqtv skr;tr fruve Uvn one petition for a randjaWer. joection 704,M 177orhoa StafuteV
on this form M not completed, tho ft,,w? wall nol bc toMdes a C'Prullegale PeUrion rii ns COMIN F 1:1)
yr- F�014M MUST IBE
., f I- � V� 42, �,the undersigned, a registered PPOMIDED mmiE
(Please print name as it appears on your voter information card) cirry CLEFRIK DUPING
voter in said state and county, petition to have the name of Q41ALAFYNG
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District 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)
County
of Voter
Rule 1S-2.045,
State Zip Code
Date Signed (M M/DD/YYYY)
l be completed by VoterI
0 s a�
Y l Z '9
RECEIVED
F,, S1 IRR4GS
THECIT"'CI, EIRK
CANDIDATE PETITION I Wcn 6!!C)PM 111171
'Vidinft,math:nn an th,65 6:vm inrvcvn III: rilldr,:6:1�w t�s"th,dd supwn'Am, of 1 0 �s
�t is Il rrymo It Anvlg&' sLtp � dni:n 6, lh,ud � one,peinhw? oweMl�tfrl, f5pctl4on W4 A65 FlordbW 5,W: gddeq
ffadY nIquill l,vmon not lr,,�, Ix'eu,U, eite fbr m w1fin,ril be twArlas a CmdAbure FkWrkwn Fad d n p n US C0111,4R E lll
i!!0PM 111,MUS11 11:�W:
1, the undersigned, a registered lqOWDIIIL�t M ll HE
(Please print name as it appears on your voter ,rvormation card) MY it ERK 1YJ1i'UNG
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]
X Nonpartisan No party affiliation E/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)
Date of Birth OR Voter Registration Number Address
(MM/DD")
County State Zip Code
Signature of Voter
Pule 1S-2.045, FAC,
6 r
CANDIDATE PETITION
Date Signed (MM/DDA^(YY)
[ro be completed by Voter]
I Ahl iMbrmathDn an ehIs Abroi becadnas, i, dlt,vb+l,,recoaJ upon n?ce4W lzy thvsrfpwl,Isod Olt Ihtcthms
*ft h;a crime? to kncmdrv)j/ sdgn more rhon orw pe0h:wlI rbra,!:wndd7eti. JSuuvkw ?04 AWrfwAla Sta",Ie!y
.ffafleequesled hlfbdmaebn On th,ls rorin to not cornphnet!Y, Me omm I'A mt be wWdSI, a PeU!dl jrbrrn
the undersigned, a registered
(Please print name as it appears on yourvoter 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]
FOIRM 17
THIS COMPLF FED
FOPM MIll BE
l)ii4ow[Mz() io'u,iiE:
CITY CILEI:W Il.X.MUIING
QUM lFYIING
Nonpartisan No party affiliation N/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)
Date of Birth OR Voter Registration Number Address
(MM/DD"YY)
County City
Signature of Voter Date Signed (MM/DD/YYYY)
[7o be completed by Voter]
... . . . . .............. .
Pule IS-2.045, F.A.C.
R E C 1E I °I'YV E D
AUG w r . ... . ))' MO
C 7 Y OF "Aldi NwH 11 ST 11: 1 1,N , S
CF: FZ r r'l:z r ', r 7 1 I p < I 8 "" I lz rj l",
FORM `7
CA114 [1), 1 IDA rE PE"n ria,4
"All infofmatiorp an th& t6fin be',come; a public recoid warren frocifit by fho�.^ .5c, �perv&oi of Elcrctiorrs
1, is as ce Ime to gn more than one petition foi a candidate 155ectibn 104.185 FAWrIa Starute.51
hi, ali 1equestery MforrTAROOrp On this, Av'r" & nor con laeto.,rd, the form umrilt not be vaild as a Candidate J',elition Fbrr?7. 11-AS C"0110 PI FITED
l MUST BIE
1, the undersigned, a registered PROV11 DEDT01 fill:
(Mease pirlintnarne as ft alopears on yow voter information card) MY (:N E R IK D LJ FU Iq G
Voter Jin said state and courity, petition to have the irarne of —4— QUALWYN(D
placed on tl-iie Gent vall Ellection l as a [chec1k/coirqAete l as apjrtOablle]
Pa r ty
NOnpaii il E= Nolpaftyalfffliatlon Not Allplpficable
Candidate Irtalr the Office of
City of Whriteir Springs - Cft.,y Corranission District Three
N ease 11 nse irt t he title:' of 0M ce aria i r nd u d e M;t1jr I Ct, Chi cu 1 t, G cup, Sect N u i, in be R, 1 If a p pl, Ice lo Ile)
IDate of Birth 01" Voter Pegi%vation INu.uirilher Address
(M M/1D D/ 'VYIYY�
County
Signature of Voter
Rule 15-2.045, F.A.C.
CANDIDATE PETITION
fr
State Zip Code
Date Signed (MM/DD/YYYY)
[To be Col fr;y Voter]
*Afi infoirnation on this form beromew as public record up,on iacelpt by the Supervedoi vhFI(ecdons,
it Is a crime go knowinqjysLqn more Man one �.wrirlor? for a ranididate, I.Section ?04.3851 Florida Statuterl
Itall requestedinformation ory this fbrm is not completed, the form vvill not be nail dasa. Candidate Pelftion ron
the undersigned, a registered
i1alease print ranne as itappears on your voter inforrinaflon, card)
voter In Said state airld County, peddon to have the inarne of
placed on the Geinerall IElection lBalllot as a [diiieck/cort-Ilplete lbox, as applicalNe]
l 17
Tll HS C011AIP111 ETE11i:)
l MUST BIE:`
PROVIDED 'ro rii IE
CiTY CLEIRIK DUIRUNG
QUALIFYING
.................... No pairtty affaton VIA, Not Applicablie Party
Candidate for the Office of
City of Writer Spirlings - City ComrnlsMon l T1.1ree
;,Please insert the title ol'Office and include Dist.irlct, Circuilt, Group, Seat Number, if appflcablep
Date of Bllirtlh OR Voter PegIrtradon Nuiinber Address
(MMjs::x:)/YY)()
City
Signature Voter
Pule S-2.045, FA.C.
County State Zip Code
Date Signed (MM/DDNYYY)
[To be completed by Voter]
M�J)G 21i"N"ID
, . "1 1 1114�-C�
()f; v\mq 1E, P l'', ;1,3
y CU',iaht
IIII DA I E
Wonnation on this fo,,rn es not cornpletrd, tfnrform will ricr bu vwd as u Candidate flv6l.iury inrnn i HS 0'XiAlN EMD
FORIA PAUSI BIE
the undersigned, a registered PiRoNnw:r:) iio nE
(Please print narne as it jppearson your voter it 4ation card)
voter in said state and county, petition to have the name of C11 IFYCLEPK DIURA1140
Q1 lAll AIFYMG
placed on the General Election Ballot as a [check/coirnplete box, as appHcable.1
Nonpartisan ENo party affiliation EE::]��otAppl�icable -Party EEI
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)
[)are of Birth OR Voter Registration Number Address
(MM/DDP(YYY)
County State rode
Date Signed (M M/DQjYYYY'
[To be completed by Voter]
Rule 11-114611
/"OFR'�
Vi CANDIDATE PETITION
*A#dnfbr1'r=kPn (n a Min Wbrrn becornew a pubhe teconY orecep,' 69,, the supe,roozip of:DOWDns
R d.,, a ci Tine I& knorwdrig6v spn awore Own one perWon altar si caj TdWate j5vc6on ?04,M5,r1wAdq reatutes]
*tf allrc,,quasicd h7formation on t ays ?orrn Is nog compipled, the kwrri wfrl not be vaiid as a CondAMP Pintheon Fti�rta. p11111 S CO IIA 11�!!) Lll::::l 1111::: D
FOFN INIUS1 BE
11, the undersigned, a registered i31110WID11211l) il'O i Ili 11:1
(Please print name as it appears on your voter information card)
C111Y CL1:::i:W J 11:111 ING
voter in said state and county, petition to have the name of QUAILHYlllll(j
placed on the General Election Ballot as a [check/complete box, as applicable]
X Nonpartisan No party affiliation F= 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
County
Signature of Voter
I Date Signed (M M/DD/YYW
completed by Voter]
Rule IS-2.045, F.A.C.
a IE C E I %if Ex. 0
cirYc": 'M I E.')i 0 P FU t' i G S
,,) P 1 rt , )- 1 i EhC t TY C, L E FR 11'r,
i:�04Z%411117
'All k0brination on UP& faim becornar a publir rexmniqpon recvlPt bY1he5?1fen1i50f Of hyacnons
it, is a cthrm to hnowinglygyn fryorr than one;,wtilhm for Fy (mpndkApee, [S�vcfleyn JCl4MS flandi stansf Ilil Ills CC) IAF�Lll:E l-E`[)
r� r� Miss form is, r�rp I, Ce%7)pjrq(�rj, Hw rm en wifl not be, vaild as k CwPoldst- ;4,1 ft ion Poi-w
FORM MUST U:3E
the undersigned, a registered
l)PCV11D1l1,) T(�) 111 H:i
(Please print name as it appears on your voter information card) 0 N CI KEIPW DUI[VING
voter in said state and county, petition to have the name of
QUAL H:°YINK,
placed on the General Election Ballot as a [check/complete box, as applicable]
Party
Nonpartisan N/A FN /A
E= No party affiliation Not Applicable
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)
City ounty Zip Code
Signatwe, of Voter Date Signed (M M/Dl
[To be completed by Voter]
Rule I S-2.04S, FA.C.
CANDIDATE PETITION
1AP hdwn�atk,n On Mis yore ry b&r,,)mw.,,;,a pubfir m:::4:;rd uc upon re 4y,, ryas? Sm ijpenr coE�Scgibns
or An a aPne to kwoni#V"v s4?nrrara than ii:we apOlAw rfv? a randk!pte fsocbbn RM 785
On M& form ;s nor czimplv4ed, the form �4,1111 W9 be Valid aS E� Candidate Potirion F'orm, I HiS COPAPLI::7ED
F:IORIA MUS 11 BE
the undersigned, a registered I ROW )ED � �O THE
--(Please print name as., "appears or, your voter information card) ,
CITY CLII:::::: IlN< lXJ1l!4i?qG
voter in said state and county, petition to have the name of Q�JAIJI:!!Y�NG
placed on the General Election Ballot as a [check/complete box, as applicable](
Nonpartisan No party affiliation N/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)
I D I ate of Birth OR Voter Registration Number (Address
(MM/DD/YYYY)
City County nty
. . . .............. . . ..... r7pcod
Signature cfVoter .......... Date Sighed �(Ml
S M M/DD [ ITO completed
To be completed by Voter]
Pule IS-2-045, F.A.0
� F, P i CE, CII)F I HFI I Y
)ATIE, PFT.�-] ON CANDII. I FORM 7
.AfliMbimagibi I oil it1h fbn77bew,,%wrY?aL a pubficiecoidupon ieceipt bpr the SupeMsof of Elecljons
dt is as C"111no r.0 knolwinglysign inewe than arse petition fm a cand'Yelaze, J!Sectivn 101"M5 171olidd '151arate.51
'If on Fh& fewm& not the frorm will not be vaikias a Candiefal, a PeUtion Forryl, VIMS COMPLETED
1, 14=J the undersigned, a registered FOPM MUS'FIBE
PIPOVIDED R)TRUE
(Please print name as it appears on your voter information card)
CK
voter in said state and county, petition to have the name of 11Y CLEIRIDURING
QUAI.II IFYING
4 :)laced on the General Election Ballot as a [check/complete box, as applicable]
[=X= Nonpartisan No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number dress
(MM/DD/YYYY) r
Pule
County IState p Code
57
CANDIDATE PETITION
Date Signed (M MJDD"
[To be completed by Voter]
O'k,
'All PVbmw1nn on thii fin ni becomeraptlWA, rccord upon recrdpt Aythe Skiperviow ofElections
tt As as cwhpe go knowinglys4gin inare thion one pet.Ufm fof a candidate, f5ectlan M4,WS Horlda 59stuteq
'd riot rorWkrvd, the toner willnot taros -ri,s '01MIPILF: Tli:.DI 1, A0 — 4 /4�1 registered F!014M MUSTIBE
tt
; � <2,z-AY` the undersigned, a reg PP,0VMED'T0 T� I
(Please print name as it appears on your voter information card)
CiTY CUMP, IAJ Rri ING
voter in said state and county, petition to have the name of e IJAII.II FYING
placed on the General Election Ballot as a [check/complete box, as applicable]
L---X --1 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 Address
(MM/DD/YYYY)
...........
City County ZIpCode . .............
C1, L
Signature of Voter Date Signed (MM/DDA^fYY)
[To be comp ed by
0111
Pule IS-2.045, FAC.
2, (3 2,020
%PqirJ I, ER GPw'"4�;S
OF 0;: p4E CT( C4 e-Rll'<
CANDIDATE PETITION
"Ifinformation an thisfiNM b&CW17ei., a ;)ub#rrrccwdq;wf? feceepe hi�tbaS",00Msor Of Emct&MN
lit it, a cjjrrry to ?<n�pw�rW4Vsqn rnme than one per. ition for a candkMtejSecdan
On t'fdaTM, rorm,,s nof ron-pleted, the fewn willnog be wpildasa ('�Dndi�Yagv �>rtftirjn Foetry fll4MC0Ml)LE' M
FORIM 11AUS1 3E
the undersigned, a registered IP Tli lE
(Please print name as it appears on your voter information card) CITY C1 E111411K 111.0111,1ING
voter in said state and county, petition to have the name of QUAII Jll::::YI1114G
placed on the General Election Ballot as a [check/complete box, as applicable]
X
---j, Nonpartisan 4rty affiliation Not Applicable Party -1 _L_/A No pa
Candidate for the Office of
City of Winter Springs - City Commission District Three
(Please inseh, the title of office arO include District, Crcijlt, Group, Seat Number, if applicable)
Date of Birth OR Voter Registration Number 7'k-
(MM/DD/YYYY)
nature of Voter
Rule IS-2.045, FAC.
1 —771
CANDIDATE PETITION
In
Date Sig ned.(MM/DD/YYyyj
[To be completed by Voter]
'Ad Wbrrnad(Vr 0?1 thA'g orerrdt becomes a pfiblic re coref gipon iecOt by Me S1WNrv150r Of VOCNO,'Is
I it is a rjimo 10 ke?o more than one pot1tion fat, to canefiria ta i3ect lon 104. M35 F If Sf,9z4't&q
ffaM te�quested inhw matien on rhM fbpm 45r n C,77,P1,164j, f,17& forrry MY not be Vallel of 6 0?#7fJW,?tf? PeUtIon F crept,
the undersigned, a registered
(Please print na,rr(e 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]
Code
F70FIM 117
'11 HS CXWF)Lll° I E[)
FOIN l64USr'FM-'
PIROVIDEDTO 11 HE
UTY (1 EFIK, IIAJFW11G
QUALIFYUNG
Nonpartisan No party affiliation N/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)
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY)
,iature of Voter
e 1S-2.045, FA.C.
Stare Zip Code
Date Signed (MM/DDIYYYY)
[To be completed byVoter]
y F VV t" it '10'qRH"*S
� (6. " c,
0 u �'-- �' � �'
CAN,
�W
'ArA,�nformation on this fom
•!t is to knowinglysign
a cnPhw
'!Pall requested inwr atlon on this
(Please print name as' appe
voter in said state and county, petitio,
placed on the General Election Ballot
X Nonpartisan
City o9
(Please insert the
Date of Birth OR Voter Registration Numbe
(M M/DD/YYYY)
County
of Voter
Rule lS-2.045, FAC.
FORM 7
es]
,n Fd7p,°"
THIS COMPLETED
FORM MUST BE
.registered
PROVIDED TO THE
y�
CITY CLERK DURING
QUALIFYING
)plicable
Party
-le)
Date Signed (MM/DD/YYYY
(To be completed by Voter)
Code
f
CANDIDATE PETITION FORM 7
*All information on this form becomes a public record upon receipt by the Supervisor of Elections
It is a crime to knowingly sign more than one petition for a candidate. [section 704.1a5 Florida Statutes]
!fall requested information on this form is not completed, the farm will not be vaild as a Candidate Petition Form. THIS COMPLETED
FORM MUST BE
i° f a !!o the undersigned, a registered
PROVIDED TO THE
(Please print name as it appears on your voter information card)
\Amur CITY CLERK DURING
voter in said state and county, petition to have the name of w�
QUALIFYING
placed on the General Election Ballot as a [check/complete box, as applicable]
= Nonpartisan N/A No party affiliation N/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)
Number Address
Date of Birth OR Voter Registrationrqe
(MM/DD
61
of Voter
1S-2.045, FAC.
Coun State
DDate Signed (MM/DC
compt be leby
rrn r
In EIl�a.a ,'ilk' E. 1 V 0 LF
M
W
ap Code
l'3a-0ak
.,CEIYED
AUK"' 9 �' 2020
CITY OF ti/NTER SPRINGS
'?FFicF dF THE CITY CLERK
CANDIDATE 0..,rH —
Efin'', °;;i"�
tn,
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
) )"AY") II
�I _4 ," kr JJ I,IVvI xr t 7 Al
AUG 2 ; H20
VV, dI I "idl fZ ^Ilf.;Cii
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 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
(Office) �....... (District #)
^ ; I am a qualified elector of County, Florida;
(Circuit..#) ( ........,.. roup or Seat #
G.,...., _)
G
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
ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
S',anature of ITIT Candidate
........
Address
STATE OF FLORIDA
COUNTY OF
Telephone Number
Email Address
City I State ZIP Code
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me this
day of 20 11
Personally Known: or Produced Identification: '
Type of Identification Produced:_
Of E%Notary Pubic Stefe of Honda
Christlan D Gowan
My Commission GG 913234
jd; Expires o9/i&2o23
DS-DE 302NP (Rev. 11/17) Rule 1S-2.0001, F.A.C.
N'GFORM 1STATEMENT OF
2019
Please nntortMMMe our name mailing FINANCIAL
p p y
FOR OFFICE USE ONLY:
p n below: address, a enc name, and osr4io
agency
.��m
FIRST NAME MIDDLE NAME
NA/E-
cl .)
M.............................._�.........
_. —.1
AILING ADDRESS.m......._._....._ .......�_ ..._.....�
-L
CIT.�����
ZIP : COUNTY
_._
GENCY:
NAME .IFA�
d` p
NAME OF OFFICE OR POSITION HELD OR SOUGHT
CHECK ONLY 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
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 "IrI
NAME OF SOURCE SOURCE'S
DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS
PRINCIPAL BUSINESS ACTIVITY
w
n to.. ° � � �.��........
P �. �. P
�� ,
��..
..:.....mm__
.. _
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
� � _. ........ .................... ._ .
. ...WW.................. ..WW... _. __—..W...__._....._... _. ....................... ....._
... _............ ... _....... ............_ �.....mm...-.....— ...mm— ------------------- -� __�.......
.....� W,.....,. �.
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions]
You are not limited to the space on the
�If Y reportwrite "none" orn a
you have nothing
lines on this form. Attach additional
t i - j �.,.....* ...n .. ...........
u _
sheets, if necessary.
..
FILING INSTRUCTIONS for when
and where to file this form are
.......n. ...... ....
located at the bottom of page 2.
........... _........ _.._...__............. ..... ...._._..... _........... ........... ...... ......... ...._................. .....
INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM 1 - Effective: January 1, 2020 (Continued on reverse side)
Incorporated by reference in Rule 34-8.202(1), F.A.C.
PAGE 1
PART D — INTANGIBLE PERSONAL PROPE [Stocks, bonds, certificates of deposit, etc. - See ii z;tions]
(If you have nothing to report, write "none" or "ril
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
:...:,) ,-I ,.
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or 'Wa")
NAME OF CREDITOR ADDRESS OF CREDITOR
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions]
(If you have nothing to report, write "none" or "n/a")
BUSINESS NTITY # 1 BUSINESS ENTITY # 2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY—'1��°.i
PRINCIPAL BUSINESS ACTIVITY { _ "; „� t,.."I n� "'� �„ f"-) e", ,'"�Cj r N) it. e,
POSITION HELD WITH ENTITY (yk,,,,,,o y'\"....
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G — TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
164 4
.4 . .... ...
Date Signed:
FILING INSTRUCTION
If you were mailed the form by the Commission on Ethics or a County
Supervisor of Elections for your annual disclosure filing, return the
form to that location. To determine what category your position falls
under, see page 3 of instructions.
Local officers/employees file with the Supervisor of Elections
of the county in which they permanently reside. (If you do not
permanently reside in Florida, file with the Supervisor of the county
where your agency has its headquarters.) Form 1 filers who file with
the Supervisor of Elections may file by mail or email. Contact your
Supervisor of Elections for the mailing address or email address to
use. D,o not,emall, Q Ir form..to the_Co.t 1[I2. s io o _ thics- t wil]_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 CEForml@leg.state.fl.us and retain a copy
for your records. Do not file b,y_both.ma,il,and „email Ch.o.....o....s...e...only, Pine
ftlwiny, method. 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:
I, _ , prepared the CE
Form 1 in accordance with Section 112.3146, 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.
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 5 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:
t
Y CLERK ."
Pant Name of Candidate. � �