HomeMy WebLinkAbout2018 2 - Application and Assessment For 3 rev 2018 08 09CITY OF WINTER SPRINGS, FLORIDA
2018 GENERAL MUNICIPAL ELECTION
APPLICATION FOR OFFICE
AND ELECTION ASSESSMENT
QUALIFYING FEE: $150.00 AND
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FOR OFFICE USE ONLY
I,
Elector of the City of Winter Springs; and am applying for the Office of
City Commission: District Three
Circle As It Applies To Candidacy
to be held in the City of Winter Springs, Florida, on Tuesday, November 6, 2018.
I, further agree to pay the following Qualifying Fee AND applicable Election Assessment:
THE BELOW ELECTION ASSESSMENT
ELECTION ASSESSMENT - COMMISSIONER: $120.00
Each Commissioner receives: $1,000.00 per month
$1,000.00 x 12 months = $12,000.00 annually
The 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.
Signature
AND
or, if applicable
Revised 8/9//2018
Name of Candidate (Please Print or Type)
APPLICATION FEE: Campaign Account Check in the amount of $150.00 attached
(Check should be made payable to the "City of Winter Springs")
1% ASSESSMENT - Commissioner: Campaign Account Check in the amount of $120.00 attached
(Check should be made payable to the "City of Winter Springs")
Completed "Notice of Undue Burden" Attached
CITY COMMISSION: DISTRICT THREE
Circle As It Applies To Candidacy
- a two (2) term, in the Election
do hereby state that I am a registered and qualified
Date
Check #
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