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HomeMy WebLinkAboutMorrisey, William - Application for Office of the Mayor - 2021 04 01 CITY OF WINTER SPRINGS, FLORIDA QUALIFYING APPLICATION FOR APPOINTMENTTO MAYOR SEAT THE ORIGINAL QUAUFYING APPLICATION AND ALL OTHER DOCUMENTS MUST COMPLETED WITH ORIGINAL SIGAtATURESANDMUST BEFILED IN THECITYCLERK'S OFFICE BYNOON ON THURSDAY,APRIL 7,2021. Qualified candidates may attach a resume, references, recommendations, or other such documentation that the candidate desires to have the City Commission consider before making an appointment to fill the unexpired term of the Office of Mayor. The Mayor serves on the governing body of the City subject to the duties and responsibilities specified in the City Charter. Please be aware that documents submitted to the City are public records available for inspection to the extent allowed by Chapter 119, Florida Statutes. Please complete the following in the space provided: A GENERAL AM _ c.� 1. Name: 2. Home Address: 3. Occupation: 4. Telephone -M 'telephone (other): S. Email: 0 Yot V\00 a Cz VV B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on the City Commission: la. Are you duly registered to vote in Seminole County: (Y)V- (N) 1b. Are you duly registered to vote in the City of Winter Springs? (Y)X (N)_ 2a. Do you live within the City limits of Winter Springs: (Y)� (N)_ 2b. What district do you reside in? (1)— (2)— (3)— (4)— (5)-1--- 2c. How long (years and/or months) have you resided in the district selected in 2b? G 2d. How )on 1-years and/or months) have you resided in the City? 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction?Any plea of nolo contendere (no cont$st)shall be considered a conviction for purposes of this question. (Y)— V-1 APR 0 12021 r-1TY0jF WNTER SPRINGS 4a. Do you presently serve on any other City of W7,kter Spri1a9S�E00aTdcj-oTCLERK committee? (Y)— (N)A 4b. Please list each: 11 5. Do you have any private or personal interests which might conflict with serving the City's interests, if you were to be appointed to serve on this board or committee? (Y)— (N�L, 6. All persons applying for a City Commission Seat must voluntarily consent to a standard criminal background check before being appointed. Do you voluntarily consent to having a stqp ,dard background check being performed on you by the City of Winter Springs? (Y)2 ,(N) 6a. Are you related to a City of Winter Springs Commission member by blood, adoption, or marriage? (Y)—(Nx 6b. If yes to 6a, please provide relation: 7. 1 have read the attached information detailing the duties and powers of the Mayor and the Rules and Procedures of the City Commission. (Y)-X (N) NOTE: The City of Winter Springs'City Commission has requested and encourages you to submit: 1) A brief Bio (to include background information, information related to any applicable qualifications and current/previous community service) 2) Information related to whyyou would be a good candidate to fill this open Mayor Seat YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS UNDER PENALTIES OF PERJURY THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS, AND THE FLORIDA SUNSHINE LAW, WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO SERVE AS MAYOR. IF APPOINTED IT IS YOUR SOLE OBLIGATION AND D UTYT COMPLY WITH SUCH LAWS. Signature. Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708 2799 THE ORIGINAL QUALIFYING APPLICATION AND ALL OTHER DOCUMENTS MUST BE COMPLETED WITH ORIGINAL SIGNA TURESAND MUST BEFILED IN THE CITYCLERkCS OFFICE BY NOON ON THURSDAY, APRIL 7, 2027 FAILURE TO TIMELY FILE AN APPLICATION MA Y RESUL T IN YOUR APPLICA TION NOT BEING CONSIDERED BY THE CITYCOMMISSION. i, - ­ _111- -- 11 � CITY OF WINTER SPRINGS,FLORIDA 2021 MAYOR APPOINTMENT THIS COMPLETED 9S9 AFFIDAVITOFQUALIFIED VOTERSTATUSAND FORM MUST BE CITYAND DISTRICTiqESIDENCY PROVIDED TOTHE CITY CLERK NO OFFICE OF THE MAYOR LATER THAN NOON ON THURSDAY, APRIL 1,2021 I, W(*Aw 4 do hereby state that I seek appointment to the City Name of Candidate(Print or Type) of Winter Springs' Mayor of the City of Winter Spring= to complete a four(4)year term previously held by Mayor Charles Lacey for the City of Winter Springs,Florida.I further swear or affirm: (1.) 1 am a qualified voter in the City of Winter Springs (2.) My legal place of residence is: (0 S _56:Quo(6VP U)(106Z,4;�s FL StreetAddresscity zip code (3.) Length of time of residency in the City of Winter Springs is: �O (4.) 1 am attaching two(2)documents,one to Florida Driver's License as�verific tion of my residency in the City of Wit qr Springs.The sec ndcloc t is: Signature 571--lD 00 0� StreetAddress city State zip Code State of Florida Countyof Sern),Vv le- Sworn to(or affirmed)and subscribed before me by means of4physical presence or—on1line notarizationj 1 -2 a Z) this d"y of 0r, ) 2020' by -A10 rri-r e Personally known: OR Produced Identification /Icl (Print name ofperson mixing statement) flo j)'d;f �r;veef Zl'e&nj if 4�LL 'oe Type ofloentification produced -Signature of Notary Public-state of Florida Or Notary Public State of FWWa Christian D Gowan My Commission GG 913234 Expires 09115/2023 FOR OFFICE USE ONLY 1Copy of Florida Driver's License provided for Item(5) Other documentation provided for Item(5) Revised 03/23/2021 1v ,. APR 0 12021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK awl DVPVUCEWA gd i wA 07'M&1273+1W-A 9M teat. Nr1N2*U Loma, ir.01- t ��' ��teas- a■s«o A {a'fb MtA��ftB pp�ra of a a.ata.N4�M,:A+ae.<..r�s ' tlal�IIIE•�aarata Y1t'K7+ "�,3'mY �p�l1[SR CITY OF WINTER SPRINGS Summary of Payments and Charges DUE UTILITY BILLING ACCOUNT NUMBER 17835-001 • a' MON-FRI8-5 1126 E STATE ROAD 434 SERVICE ADDRESS 965 SEQUOIA DR PHONE:407-327-5996 PAST DUE CHARGES $403.26 IMMEDIATELY 39fi9 FAX:407-327-4753 UTILITYSILLS@WINTERSPRINGSFL.ORG PENALTIES $5.00 WWW.WINTERSPRINGSFL.ORG/UB ADJUSTMENTS $0.00 PAYMENTS ($82.02) CURRENT CHARGES $60,44 4/20/2021 TOTAL OtIA'. Charges Breakdown_ (Current Month) WATER BASE $6.18 MONTHLY WATER USAGE (in gallons) WATER USAGE $4.07 71473650 WATER TAX $1.03 SEWER BASE $12.14 12000 10000 SEWER USAGE $13.42 8000 STORMWATER SASE $5.50 6000 4000 � � � � � � SOLID WASTE BASE $18.10 2000 0 /'F �}�+,�j��J /�/++� O O O O O y N N N N �ON N TC#T1 L`CtiRRENT CHARGES` $6(}.44 N N ON ON N E N N OE N �N N 2 N R M 0=6 z 0 IT m Q ¢ O M g Scan this code to Meter Reading Information make a payment r r - From To Daus Meter# Previous Current Usage with your 2/9/2021 3/12/2021 31 71473650 753,810 756,640 2,830 smartphone or tablet todayl .� L "News You Can Use" Payment Options(Use Account Number 17835-001);See back for more! c Self-Pay by QR Code Scan the code above Please have your trash and �* recycling out at the curb by Self-Pay by Website eservices.winterspringsfl.org H 7AM on your scheduled pick- Online Bank Pay See your bank's website up days.Bulk pick-up: 2 large Self-Pay by Phone 407-327-5991 items max on your 2nd Call Center _ _ 407-327-5996 scheduled trash day.Call 407 �M -327-5996 to schedule appliance disposal. Please detach and return the bottom portion with your payment(Make Checks Payable to City of Winter Springs) — — — — -- — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — . CITY OF WINTER SPRINGS Summary of Payments and Charges DUE UTILITY BILLING MON-FRI8-5 ACCOUNT NUMBER 17835-001 * ;v 1126 E STATE ROAD 434 SERVICE ADDRESS 965 SEQUOIA DR ter, PHONE:407-327-5996 FAX:407-327-4753 PAST DUE CHARGES $403.26 IMMEDIATELY _®M1 UTILITYBILLS@ W INTERSPRINGSFL.ORG WWW.WINTERSPRINGSFL.ORG/UB lCURRENTCHARGES $60.44 4/20/2021 � TOTAL DUE" $443.7Q WILLIAM MORRISEY CITY OF WINTER SPRINGS UTILITY BILLING 965 SEQUOIA DR 1126 E STATE ROAD 434 WINTER SPRINGS, FL 32708 WINTER SPRINGS, FL 32708-2715 00000178350010000046370 NOMINATION PETITION 'Affinformat,on on this form becomes a public record upon receipt hvthe Supolwsnr ntfiections THIS t'OMPLETFD 'tt is a crime to knowinglystgn more than one petition for a candidata JSectin 1104 7RS Flooda Sranrrua/ '!fa)!Zoe eSted lnforrcyyrion on thi formisnotcompleted theform will not be vartd as a Card>oate nentwo F:xrn �'OP'A"�"1`�^c'T BE re ?/_J PPOVIDED TO THE 1 o 6 t � theundersigned, a registered CITE t.')_ERK NO (Please print name as it appears on your ester information card) / i A7i;R THAN NOON voter of the City of Winter Springs,nominate t{ ;;N THURSDAY, o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number I Address (MM/DD City �we Zip Code 5 k]figs [ounty 5nrfrfk�'' '� 3z� 4 At Signature of voter2 Date Signed Mte IMMIOONver) IT.be ample by Voter) /ol l / Rule iS-2.045,FAC. NOMINATION PETITION 'AllinformationonthisformbecomesapublicrecorduponreceiptbytheSupervisorofEjections THIS COMPLETED it is a crime to knowingly sign more than one petition fora candidate[section 104.185Florida statutes] Ifall requested information on this form is not completed,theform,willnotbe vaildasa Candidate Petition Porm FORM MUST BE PROVIDED TO THE the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate W + t F ON THURSDAY, t " j in � A` f eCr fa APRIL 1,2021 to complete the unexpired term of Office of Mayor of Winter Springs recently vacated byform r aydr Lacey. Date of Birth OR Voter Registration Number Address (MM1DDA YM City IState Zip Code fIZ/� M ' S Signature of Voter/ bate Signed tMM]ODM'YY) fro be completed by Voter] 2 Rule is 045,FAC. R E C E I APR 01 1021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION .Affinforrinatfor,on this tormt becomes a public record upon receipt tvthr Supe—,sor THIS COMPLETED it is a crime to knowingly sign more than one petition for a candidare/Section 10z tPrFlofitia5rawroc1 I`-OP:-4 MVST BE Itallrequesred information an this form is not completed,the form will not be va,ld as a Candid ate Pe(iNo-ro", 1,-POVOED TO THE I, the undersigned, a registered CLEPIK NO (Please print dame as It appears on your voter information card) i-ArER THAN NOON voter of the City of Winter Springs,nominate U)4 1 I'A-M A ON IHUPSr)N( o complete the unexpired term of Office of Mayor of Winter Springs recently.tracated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address (MMA:)DjYYYY) 0 4/o LI/I C, oun late lZip Code Signature of voter Date Signed(tAMIDDIVYYY) [To be completed by Voter) 03/3 1 /10-2- 1 Rule 1Ass, AC. 71 NOM I NATION PETITION 'All information on this form becomes apublic record upon receipt by the Supervisor afElections THIS COMPLETED ,is a crime to knowingiy sign more than one peritrio,)for a candidate,[section 104.185 Florida Statures) •lrallrequestedinli:prmapon on this form is not completed,the form will not be vaildas a Candidate Petition Form. FORM MUST BE PROVIDED TO THE C4 tj C(!(-Cc.o/\ p the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate 0 CCJ ON THURSDAY, to complete the unexpired term of office of Mayor of Winte Springs recently vacs- eW,V-1y APRIL 1,2021 Lacey. bate of Birth OR Voter Registration Number Address (MM/DQ)YYYY) Se V 0 at" 0-A ,2s/161 q 6 City knty Ptate Zip Code r IOU Jr I I eL ( SIZ7LIbe Signature of voter Date Signed(MMA)DA-M) rro be completed by voter) 0 3/ 3 lRule 15-2.045,FAC. P. APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATiON PETITION 'Alltnformahon on this form becomes a public record upon r eceipt by the superwsor et£'lectlons THIS COMPLETED 1t is a crime to knowinglysign more than one petition for a candidate.(Ser.tinn 10Z les f'lorrda Staturs•:f -11'all requested information on this form is not completed.the Form,will not be vadd ac a C"andrdate Petsf an Form POP M MUST RE V14O,VIDED TO THE I, f j�tM dcctndon M�,-.haG? Morr�.l� ' the undersigned, a registered ZIT,`CLERK NO (Please print name as It appears on your voter information card) ;.,k T c P THAN NOON voter of the City of Winter Springs,nominate �}X11 jt i4PON THURSDAY o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey, APPiL 1,2021 Date of Birth OR Voter Registration Number Address {MM]OD/YYY1ry ��S �1y fj��� Q�i1• ()J /) /)`'10 city �ounty tate Zip Code -5t'Al;'n0 le, I r� 327 8 Signature of VotW Date Signed(MM/DDM'YY) y / (Ta be completed by Voter] ----�27S (33 Rule 1S-2.04S,FAG. NOMINATION PETITION .Allinformat,on on this form becormsa public record upon receipt bythe Supervisor ofElections THiS COMPLETED • it is a crime to knowingly sign more than one petition fora candidate.(Section 104.185 Florida Statutes] lfalt requested information on this form is not completed the form wilt not be wrild as a Candidate Petition Form. FORM MUST BE the undersigned, a registered PROVIDED TO THE g CITY CLERK NO (Please print name as it appears on your voter information card) f ti{A • ,A�a rp LATER THAN AY, voter of the City of Winter Springs,nominateUj t (IJr� / ,r ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by form4r Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MMIDD C t`3 ' -- , City rnty 1,aze Zip Code Signature of Voter Date Signed(MM]DDA Y" ,S, [To be completed by Voter] d Rule 1S-2.045,FAC. S C E I V APR. 01 1021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION 'All information on this form becomes a Public record upon rec"Pr l'V file-sup'-wsor otflperiorl` THIS CO;M—PIFTFD isacrime to knowingtisign more than one petition fora candidate 15,ect'w'10�7i?50110"'on 51awlesj Iffallrequestedinformaricin on this form is not completed the form wdl not be vallida-la I-ORM MUST BE PPO'ODIED TO THE - the undersigned, a registered I-TY(-LFPK Nn Please print name as it appeals on your ester information card) i,AT;7P THAN NOON voter of the City of Winter Springs,nominate W i I [t 0 A o THURSDAY, o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/DDtyyyY) C City [wnty late Zip Code w"N-SQ r '� � 1 F',— I3 it(.)1� Signature of Voter Date Signed(MM0QjvYYV) fro be completed by Voter) Rule IS-2.045,FAC. Ty" NOMINATION PETITION .All information on this form becomes a public record upon receipt bythe Supervisor of Elections THIS COMPLETED is crime tokno1TqtVsj0nrnore than one petition for a candidate]section 704.785 Florida Statutes] ffall ple#ed,the�m*vbe r1dasa Candidate Petition Form FORM MUST BE '?'C'.igned, a registered PROVIDED TO THE 1, TCITY CLERK NO (Please print name as it appears on tout voter information card) LATER THAN NOON Vil-U64m A . 'v voter of the City of Winter Springs,nominate r I w I orns6l ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated byformer Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address EN jL_Vte S2 uric 6tate J jZi p code r PF signature voter ti Date Signed(MKIDD [To be complei:j by vote 3 S11 &[ lRule I5-2045,FAC. RRECEIVED APR 012021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION 'Allinformation on this tort"becomes a Public record upon receipt hvrhr THIS COMPLETED it is a crime to knowingly sign more than one petition for a candidate 1.4er 1—104 1ps Florida 5ra wrn •Ifailrequested information an this form is not Completed.tire for")A,#not be vaid as a Cand:tltr Pei 4w- NOPM IAUST BE PDOVIDED TO THE 1, the undersigned, a registered CIT/(":LEPK NO (Please priAt name as it appears on your ester inforr,nation,card} iAT-P THAN NOON voter of the City of Winter Springs,nominate AM N 7HLJPSDAi% Wtir Ut' A - Ale rrtr67,Y -1 o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Binh OR Voter Registration Number Address-, seq U0�(D' L'Art V-0(p/ 1,18te Ll- %-11 �oun��tlo `a, Zip CodeL Sigm repI'Vore Date Signed(MMIDDIY" rr be plet-A by Voter) t NOMINATION PETITION .Allintbimarion on this-form becomes a publXrecord upon receipt bythe Supervisor of Elections THIS COMPLETED •Itis a crime to*nowjngr1Vsign more than one petition for a candidate./Section 704.785 Florida Statures/ Wall requested information on this form is not completed the form willnot be vaildas a Candidate Petition Form. FORM MUST BE I, L au*a%.., t�an� the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your Wer information card) CITY CLERK NO LATER THAN NOON voter of the City of Winter Springs,nominate ON THURSDAY, w (-1,(el+t% A - M to complete the unexpired term of0fificeafMayor of Winter Springs recently vacated byformer mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MM/DDI"" Se-j"iA br City my tate Zip Code w'I A41r S I v, 1 1 3 T Signature of V er Date Signed(MKIDWYYYY) (To be completed by Voter) (3 t Rule 1S- 845, Z3 IL RNE C E IV E D APR 01 2021 CITY OF WINTER SPRING S OFFICE OF THE CITY CLERK NOMINATION PETITION 'Allinformation on this form becomes a public record upon receipt bvrh-Sure—icor O(Efectfjns THIS COMPLETED it'a crime to knowmg,�vsr4w more than one petition for a candidate j!;rr Nnn 10-c FPS FloruM 5rarurrotj ed i fi marion an this form not coTplefed.the 16fm will not be vaddas a Cand4ate Petition f'orin l-ORM MUST BE PPe'.)VIDED TO THE the undersigned, a registered J,0 P1 QL!iiPK NO (Please print name as it a(!'pears on your voter inf6imation card) i,AT-R THAN NOON voter of the City of Winter Springs,nominate U a ON THURSDAY, Uj VFAA Marr(�a( o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/DD/Y" I Q) 5o" icm Ci ty e cunt p Code '13z VA 6 tate I r5 Signature of voter Date Signed(tAMIDDAWY) [To be completed by Voter) 1Rule LS-!(04S,F-kC. NOMINATION PETITION ZO 'All information on this form becomes a public record upon receipt by the Supervisor of Elections THIS COMPLETED it is a crime to knowngtv sign more than one ped6on fora candidate[Section 104.185iclonda Statutes] frallr:q i1 fo rma Mon on this form is not ccmplered,the form will not&-va ild as a Candidate Petition Form. FORM MUST BE PROVIDED TO THE I t-,fe S� 0—) 4'A C, the undersigned, a registered CITY CLERK NO (please print name as it appears on your votA information card)eLATER THAN NOON voter of the City of winter Springs,nominate W1, 1114m A . ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address city tountv tate Zip Code If Signature of Voter Date Signed(MM/DD" fro be completed by Voter} I.0 ■ I Rule 7S-2045,FAC, r RECEIVED APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION .Aflintormation on this form becomes a Public record upon receipt 1�v thp THIS COMPLETED •it isacnme to knowonglysion mare than one pr0tion for a candidate ifSrrefnfl roz w5Flnfl4fa 5tartilp-4 Ifalfrequestedmformation on this form rs nor completed,the form mil not be vaAYas 1 Cand4we Periour.1arn I-ORM MUST BE VQO`,/IDrD TO THE kt C-c/ the undersigned, a registered CIT�CLERK NO (Please prim name as it appears on your voter information card) ER THAN NOON voter of the City of Winter Springs.nominate W( th'Apti A - VK01TcWf ON THURSDAY, o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Binh OR Voter Registration Number Address (MM/bDt^NY) Tnr ke"i yo,A.W, C f'fes, cZiRCode ity r-unty lstate Wl'l 01) &0 3?,70 f Signature of vote, Date Signed(IAM/DDA'V'iM [To be completed by Voter] Rule IS-2.04S,FAC. NOMINATION PETITION *Affinformarian on ths form becomes a public record upon recefpt bythe Supermor ofElections -i[isacrime toknowInglysi4n more than one petition for a candidate-fSettion 704 785 Florida Statutes] THIS COMPLETED llraflrequ::[ead' rmarion on thisform isnotcomplated.theform"Inotbe vaidasa Candidate Petition Form. FOAM MUST BE -- --;2 PROVIDED TO THE 4 1-14-Z ZA'c i//- - / the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information lzard) M 0 LATER THAN NOON voter of the City of Winter Springs,nominate WiLls'Awk 0(yj 5..- ON THURSDAY, V7 to complete the unexpired term of office of Mayor of Winter Springs recently vacated byformer Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address -/ w (MMMD �'&) IYYM Le r5- 2 ;;% C/� CityISI Zip Code �une-� l`/70 le tate . Signature of Voter Date Signed(M"DNYYY) [TO be comp"by voter] Rule 15 2 APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION 'All information on this form becomes a public record upon receipt hymp Surrllww o(Efectrons THr S COMPLETED it is a crime to knownglysign more than one petition for a candidwe t.5cc1;n!,10.IFSFtonda 1;ratur�-j '!fall requested information an this form is not completed.the corm Will not be va'ld a, 'n -OWA MUS r BE PPOVIDED TO THE 0mu'-4 C- :Srws cip,(W—ip, the undersigned, a registered r-l-rt'(A EPK NO (Please print name as it appears on your voter information card) ;A F7P THAN NOON voter of the City of Winter Springs,nominate 'wj(vA-rA A, ro 0N THURSDAY. o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address (MMIODAIYM 01Q. OR I lo 1 mrvp City [ounty [we Zip Code wlt0u, S(--W4oL6 VL 1344og Signature of Voter Date signed 0AlvA:)Dl?Vv`YV) [To be completed by Voter) 491 -� 03 1311 aO 2-1 [Rule IS-2.04S.FAV NOMINATION PETITION 'All information on this form becomes a public record upon receipt by the Supervisor ofElections THIS COMPLETED it is a crime to knomngfy sign more than one petition fora candidate f5ection 104-18S Florida Statutes] itall requested information an this form is not completed.the form v%W//not be vaildas a Candidate Petition Farm FORM MUST BE I, r\PMA-,j00-1A M- the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON voter of the City of winter Springs,nominate V) i ((('h-^ ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayl APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MM/DO/Yyyyj 0-4 1101 10CU COOL SC()U()1A Dv-. citynty tate Zip Code wit4*Ken s9f-wX-1� ru SEMI mbLE kt,:rL i I I IT Signature of Voter Date Signed(lAI41DDNYYV) [To be completed by Voter) 03 J3112-02-1 Rule 15-2.04%FAC. c E i V E D APR 012021 CITY OF VIANTER SPRINGS OFFICE OF THE CITY CLERK - I NOMINATION PETITION 'A!/information on this form becomes a public record upon receipt by the 5upofwsor of Elecifinc THIS COMPLETED it s a crime e to knowingly sign more than one petition for a candida re/Section 104 IP5 Florida 5ra ttjrro>l T-OP'A MUST BE t d f, ation on this form is not completed,the form twl/not be vaId as i?(or"(Plate Pelpf'o,r"'m PED e5e P�VID the undersigned, a registered CLERK THE RK NO (Please print name as it appears on your ester information card) �ATER 7HAN NOON voter of the City of Winter Springs,nominate W i It I'Arm As o rf(s6q-4 ON THURSDAY, to complete the unexpired term of office of mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address 01 (MMADDAYM o�lz 3/ t y��� %3 City. runty tate Zip Code Sem"no 4r, 3 Z?CK Signature of Voter Date Signed(MM/0D/yyYy) fro be completed by Voter] 03/31/ Z0z1 Rule IS-2.04 5,FAC. /7 NOMINATION PETITION `(;_- .All informa rion on thfs-form becomes a public record upon receipt by the Supervaor of Elections THIS COMPLETED .1t is a crime to knowlngty sign more than Drie petition for a candidate.ISection 104.IBSFIbrida Statutes] •ffall requested information on this form is not co—pleted.the form 9,411not be i,aildasa Candidate Petition Form FORM MUST BE Y-tl Cyy S the undersigned, a registered PROVIDED TO THE �— CITY CLERK NO (Please print nat s it appears on your voter information card) LATER THAN NOON voter of the City of Winter prings,nominate wiWApt A- Ygorrrsv- ON THURSDAY, to complete the unexpired term of office of Mayor of Winter Springs recently vacated by former Mat APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MM/DDryyyy) city runty litate 2ip Code W 751 signature of Y Date Signed(MM/D0/YYYVj fro be completed by voter] 2. 21 Rule IS-2.045,FAC, V U R n CK 1V E I D NOMINATION PETITION •Aninformauon on this form becomes a public record upon receiPt bvtne 5urN-f1w50r arEtections THIS COMPLETED '!t is crime to knownglysign more than one petition for a candidate/Sechrn,lilt IRS Florkla 5rarure4/ 'Ifanrequestedinformation onthis form isnot completed,the form mill not bevaldasaC"and�dd.telretitoo^Far.n -ORM MUST RE �- FROVIDED TO THE f I, t �" Gc-, D" G the undersigned, a registered �I?Y CLERK h0 (Please print name as it appears on your voter information card) ;A1 ER THAN NOON voter of the City of Winter Springs,nominate Ul 1,C ftM A-> M Q ON THURSDAY o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address (MMiODAly" t t, Fr7 t5 a ("C City ounty tate Zip Code t.c7ttt, S J f 5�—w�c �e I FC sign Date Signed(MM(DO,/YYYY) ITo be completed by Voter) f Liz Rule 1S•2.04S,FAC. r NOMINATION PETITION •Ali information an this form becomes a public record upon receipt by the Supervisor of Elections THIS COMPLETED 'it is a crime to knomnglysign more than one petition for a candidate Isection 104.185Florida Statutes) Iran requested information on this form is not completed the form will not be vaild as a Candidate Petition Form- FORM MUST BE 1, 1 Gt„ C('t"Cq„ R)C'f-6 the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it appears on your voter information card) +r� LATER THAN NOON voter of the City of Winter Springs,nominate W f k L f"4 �"pp t v I'Joi in j�q ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recentlyvacated byformer Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MMID� 5 cityFFF �Q� j� �A(� alnty �...���a1( f1 TI�- Zi code C- L 1n.,r�v�G_. ��"`� ` r �1JYr/V 14th1���i L i �. Sig a of Voter Date signed(m"DIYYYyi tro be comp ed by Voterl Rule 1 .045,FAG 4 vim�R }L pia APR 01 mi CITY OF WINTER SPRINGS OFFICE OF THE CIT`,'CLFRK C- NOMINATION PETITION 'Ailtriformarion on this form becomes a Public record upon receipt t{v(AP 5urerv'50r Of Elections THISS COMPLETED .111 is a crime r knehan one petition for a candidate JSC-Cfinn 104 W5 I 1011rM 51.1tUf�';j "�sr n o r irisnot completed.the form K0 not be valdasa IM ro-n T�ORMUST BE ng WPOVIDED TO THE ')�f6,0— the undersigned, a registered CIT�CLERK NO (Aease print name as it appears on your voter information card) iATZ:R THAN NOON voter of the City of Winter Springs,nominate P'. I (I/ LAJ J0,M Ck)THURSDAY, i I( N A , M 6 V to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address City [ounty Pat, I [zip C-de Signature of Voter Signed(MMIDONYYY) be comple by, r I Rule 1 2 FAC A NOMINATION PETITION .Allinformation on thtsrorm becomes apublic record upon receipt birthe Supervisor ofElections THIS COMPLETED -tr is crime to knovwnqysiqn more than aineperition fora candidate.fSection 104.795F/arida Statutes] 'Ifa#requested informarton on ths fmrri is not completed,the form vvillnot be vaildas a Candidate Petition Form FORM MUST BE 1. b /,b 0 11- (5 C:E)1nJ the undersigned, a registered PROVIDED TO THE /1 1�w AL y CITY CLERK NO (Please print name as it appears on your voter Information card) LATER THAN NOON voter of the City of Winter Springs,nominate W'�� �� �4m A- ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MM/DD(MM/DDtYYYy) 0 0(5 city untye rte1p Cod I rz':2-� Signature of voter Rate Signed(MM/DD/YYYY) (To be completrd byjV0ter) R E: I V APR 0 12021 CITY OF WINTER SPRiN11 OFFICE OF THE CITY, =r?r- NOMINATION PETITION 'All information on this form becomes a public record upon receipt by the 5UP,-rvrsnr At£lections THIS C. LETE D 'tt isa crime to knowinglysign more than one petition for a candidate/Sertion 104 tgS Ronda 51awrp,q 'Jfail requested information on this form is not completed the form w,il not be vadd as a Cand>dale Petition roan FORM MUST BE 1 PP.9,/IDED TO THE the undersigned, a registered VI;,{CLERK NO (Please print name as it appears on your voter information card) />.T6R THAN NOON voter of the City of Winter Springs,nominate � �tM ((���t ON THURSDAY o complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor Lacey. APPIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/L7DNYY1� J city r r;y tate Zip Code Signature of voter late Signed{MM/ODNYYV) [To be completed by Voter) _V Rule 11S-2.045.FAC. NOMINATION PETITION .A#information on this form becomes a public record upon recefpt by the Supervisor ofElections 'HES COMPLETED is a crime to knomnglysign more than one petition for a candidate.[Section 104.785 Florida Statutes] ifa#requested in 12irma von on th is form is n at completed the lb rm"I not be vaild as a Candida re Petition Form FORM MUST BE ), the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it appears on year voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated byformer Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (MM/DDiYYYY) city [ounty Mate ( 2iP Code Signature of Voter Rate Signed(MM/)l)JYYYY) )To be completed by Voter) RQIe IS-2.o4s,FAC. RIECEIVED APR 012021 CITY OF WNTER SPRINGS OFcICE OF THE CITY CLERK NOMINATION PETITION _ *All information on this form becomes a public record upon receipt by the Supervisor ofElections THIS COMPLETED It is a crime to knowinglysign more than one petition for a candidate.[Section 104.785 Florida Statutesl /��j FORM MUST BE *Ifallrequestedi ormationonth/ farmi tcompleted,the form will not bevaildasaCandida tePetition FFrrrr l GVO � 0 the undersigrlsd;a registered PROVIDED K THE CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate ON THURSDAY, o complete the unexpired term of Office of Mayor of Winter Springs recently v feed by former Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/DD/YYYY) City [ounty I tate ( Zip Code Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by Voter] ;yule 1S-2.045,F.A.C. ct�5-��1'75Y NOM I NATION PETITION *A//informationonthisformbecomesapubiicrecorduponreceiptbytheSupervisorofElections THIS COMPLETED *!t is a crime to knowinglysign more than one petition for a candidate,[Section 104.785 F/arida Statutes] *lfallrequestedinfibl yiononthisformisnotcornpleted,theformwil/notbevaildasaCandidalePetitiemForm FORM MUST BE 1�J� l�}� �0 the undersigned, a registered PROVIDED THE CITU CLERK NO (please print name as it appears on your voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate f � �� � � � (Aeg � ,,�,� ON THURSDAY, to complete the unexpired term of Office of Mayor of In er nrs re ently y o rj�d`ay r APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Addressr(`��i (MM�Dr—) v � cog city �� [ounty tate, Zi Cod^e—� Signature of Voter Date Signed(MM/DDANW) [To beTTI ed by Voter] >*�� 1 Rul - .045,F.A.C. APR 012021 OF WINTER SP CLERK ;E OF- THE CITY LE CITY OF WINTER SPRINGS APR 012021 2021 MAYOR APPOINTMENT CITY OF VVINTER SPRINGS OATH OF CAN DI DATE OFFICE OF THE CITY CLERK OFFICE OF THE MAYOR "All persons who now orhereafter are employed by or who now or hereafter are on the payroll of the state,or any of Its departments and agencies subdwsion4 counties cities school boards and districts of the free public school system of the state or counties or institutions of higher learning,and all candidates for public office,are required to take an oath before any person dulyauthorlzed to take acknowledgements of instruments for public record in the state..."[8760517)Florida Statutes] `Anypersonseelang to qualIfyforpubfic offlce who falls or refuses to Me the oath requIredbythis act shall be held to have failed to qualff .y as a candidate forpublIc offlce,and the name ofsuch person shall not be printed on the ballot as a qualified candidate."[876 07 Florda Statutes] I,0 M, f(t W�OM-� , a citizen of the State of Florida and of the k - A - ' United States of America, and a candidate for public office, do hereby solemnly swear or affirm that I wi upport the Constitution of th United States and of the State of Florida Signature of Appointee Street Address City tate Zip Code RECEIVED STATE OF FLORIDA APR 012011 COUNTY OF 5e rr%;Yi o)l e CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Sworn to (or affirmed) and subscribed before me by means of{A-physical presence or—oniline notari tion}this ZSt day of 2021 by - �-���r�r-- �' l.0;l/y"�;n /�1�:r�S�� f��r `�'/G/z�:4;+ �Yt���' Personally known —OR Produced Identification Type of Identification produced flo,-1 VA Signature of Notary Public - State of Florida NoWrY Public State 0f Ficinda Christian D Gowan My commission GG 913234 Expires 09/15/2023 Notary Pubric State of Florida Christian 0 Gowan MY Commission GG 913234 er Expires 09/16/2023 CITY OF WINTER SPRINGS 2021 MAYOR APPOINTMENT APR 01 701 SPRINGS �XA]��� ��U� C������IK�AT�� CITY OF op~.s~"' ' "Each candidate,whether a party candidate,a candidate with no party affiliation,or a write-in candidate in order to qualify for nomination or election to any office other than a judicial office as defined in chapter 105,shall take and subscribe to an oath or affirmation in writing. A printed copy of the oath or affirmation shall be furnished to the candidate by the officer before whom such candidate seeks toqua|ify.''' [99.O2l (1)(a) Florida Statutes] STATE OFFLORIDA COUNTY OF I Ig "Before officer h i d to adminXer |k/appeared (Please Print lVameAs You Wish It ToAppear In City Pecords For This Appointment) to me well known,who,being sworn,says that he or she is a candidate for the office ofMayor;that heor she is a qualified elector of the City of Winter Springs,Seminole County, Florida;that he or she is qualified under the Constitution and the laws of Florida to hold the office to which he or she desires to benominated orelected;that heorshe has taken the oath required byss.876.O6-875]D, Florida Statutes;that he or she has qualified for no other public office in the state,the term of which office or any part thereof runs concurrent with that mfthe office heorshe seeks;and that h*orshe has resigned from any office from which heurshe isrequired toresign pursuant tos.99.Ol2. Florida Statutes." signature of pointee Street Address iM1�5� city State Zip Code Sworn toand subscribed before rnathis ~L dayof iv, .2O2l.at Seminole County, Florida. ~ (Signature and Title ofOfficer Administering Oath)