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HomeMy WebLinkAboutPhillips, Jesse - Application for the Office of the Mayor - 2021 04 01 P-ECEIVED APR 012011 CITY OF WINTER SPRINGS, FLORIDA CITY OF WINTER SPRINGS OF THE CITY CLERK QUALIFYING APPLICATION FOR APPOINTMENT TO MAYOR SEAT THE ORIGINAL QUALIFYING APPLICATION AND ALL OTHER DOCUMENTS MUST COMPLETED WITH ORIGINAL SIGNATURESAND MUST BE FILED IN THE CITYCLERKS OFFICEBYNOOIN ON THURSDAKAPRIL 7,2 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 1. Name: 3 e 55 e �� 2. Home Address: I'�?t1` eO n � � JO/19✓a-, ��:41e•l � ,22/.,35 3. Occupation: /T `C42 -- 4. Telephone (cell): � 0-7 'y 9 Z-�!rtS elephone (other): s S. Email: IMet2 -'-4`a56- P s:.Clef 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) (N)_ lb. Are you duly registered to vote in the City of Winter Springs? M7 (N) 2a. Do you live within the City limits of Winter Springs: I (Y)_ (N). 2b. What district do you reside in? (1)._ (2)_ (3)�L (4)._ (5)- 2c. How long (years and/or months) have you resided in the district selected in 2b? 2d. How long (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 conshall be considered a conviction for purposes of this question. (Y)_ (N)tes RECEIVED APR 012021 CITY OF"INTER SPRINGS 4a. Do you presently serve on any other City of Wint SpriRT�`1564ra CI&CLERK committee? (Y)— (N)y 4b. Please list each: 5. Do you haye any private or personal interests which might conflict with serving the City's inter sts, if you were to be appointed to serve on this board or committee? (Y)— (N) Y 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 standard background check being performed on you by the City of Winter Springs? (Y) -J (N) 6a. Are you related to a City ofinter Springs Commission member by blood, adoption, or marriage? (Y)— (N)—�/ 6b. If yes to 6a, please provide relation: 7. 1 have read the attached information detailing the duties powers of the Mayor and the Rules and Procedures of the City Commission. (Y) . _ (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 why you 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 DUTY TO COMPLY WITH SUCH LAWS. Signature. 1D Date: 3 / 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 BE FILED IN THE CITYCLEWS OFFICE BY NOON ON THURSDAY, APRIL 1, 2027 FAILURE TO TIMELY FILE AN APPLIC4TIONMAYRESULTIN YOURAPPLIC4TION NOT BEING CONSIDERED BY THE CITYCOMMISSION. Jesse Phillips Qualifications for Winter Springs Mayor Jab Description:The job description of the Winter Springs Mayor includes,but is not limited to, representing the city in intergovernmental relationships and presiding with over the commission meetings. Jesse Phillips has the experience and skillset to perform these and other duties. COMMunity LeaderAiI2&Involvernent• With extensive public speaking experience and a track record of building and maintaining positive interactions and relationships with many county and state elected officials,Jesse Phillips is well respected and has the ability to represent Winter Springs in intergovernmental relationships. Jesse has been commended,endorsed and supported for the quality of his leadership for various positions in the past by many community leaders who are both current and past county constitutional officers, commissioners from surrounding municipalities,Seminole County commissioners,local State Representatives and appointed members of various governing agencies and boards.While he has not sought public support for this appointment,these examples are provided to show Jesse will have no learning curve in the development of productive relationships with local governmental agencies,since many of these relationships already exist and have been nurtured over the years. Jesse worked as a resident to lobby Seminole County government and the city of Winter Springs to pass a resolution to address traffic issues,which was unanimously passed.He co-founded the Winter Springs Community Association and Our Winter Springs network which daily reach thousands of residents in an ongoing effort to bring the community together behind our shared ideals to find solutions to our ongoing problems.He also helped launch the Business Alliance Council as a community partner with the Seminole County Chamber of Commerce to support the city's struggling small businesses.In all,Jesse has worked as a relentless community advocate to build relationships with leaders of various community and governmental organizations. Quasi-judicial Experience: Jesse has extensive experience,both ecclesiastical and political,in the quasi- judicial realm,both in the development and authoring of constitutions,charters,by laws and rules of procedure,and in serving as a member and as Chairman on panels dedicated to implementing the same. He participated with his national ecclesiastical network to develop its governing documents and serves on its regional judicial review committee which oversees cases involving the resolution of conflicts, grievances and ensuring the proper adherence to complex rules and regulations.Jesse has also chaired several committees for his political party which requires navigating difficult and often emotional decisions through a very strict rules process.He has been recognized as someone who is fair and impartial in his conduct as chair even to those with whom he disagrees and believes even if people disagree with the outcome of a decision,steps should be taken to ensure the process of making the decision is clear, transparent and fair. Jesse feels it would be an honor to serve as Mayor of Winter Springs if that is indeed the desire and decision of the commission. APR 011011 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Jesse Phillips Resume P.F-CEPVF-D 1124 Duncan Drive 0 Winter Springs,FL 32708 0 Phone:(407)49`2-4915 0 E-Mail:me@jessephillips.net APR 0 12021 CITY OF VVINTER SPRINGS OFFICE OF THE CITY CLERK Summary • Energetic and experienced Information Technology Director specializing in the health information system vertical.Provided oversight of a million-dollar+technology asset and application portfolio,including acquisition, support and life cycle planning for a 200+employee base. • Proven ability to develop strong working relationships with colleagues,business associates and key stakeholders, with the vision and motivation necessary to constantly improve technological offering and enhance business processes. • Experienced campaign manager,communications director,grassroots organizer and Republican Party leader. Core Competencies Solid Work Ethic Strategic Planning Technical Troubleshooting Process Improvement Vendor Management Process Automation System Interoperability(HU) Clinical Application Support Customer Support Experience ProVislon Technology Solutions,Managing Partner January 2015 -Present 0 Provide Managed IT and consulting services to small business throughout Central Florida,including anti-virus, data backup and recovery,new hardware and software installation,website hosting,preventative server maintenance and other helpdesk services. State Committeeman of Seminole County Republican Party January 2017 -Present 0 Elected by county-wide ballot to serve as a top-ranking Republican Party official for Seminole County,as a voting member of the State Executive Cornmittce for the Republican Party of Florida.Appointed co-Chwir of the Digital Engagement Committee,facilitating the use of technology and data engagement for local county organizations and was elected Chairman of the 134 seat State Cominitteeman and Committeewoman Caucus in 2019. Sammy Gibson for Seminole County Clerk of Circuit Court,Manager January 2016-August 2016 0 Oversaw day to day campaign operations,including budgeting,recruiting and organizing volunteers,coordination of canvassing,management of social media presence,writing press releases,data analytics and voter targeting,mail piece design and production,absentee chasing and overall ground operation. Seminole County Republican Executive Cornmittee,Secretary December 2014-December 2016 0 Elected as Secretary of the Seminole County Republican Executive Committee by unanimous vote of acclamation. Republican Party of Florida, Consultant October 2014-November 2014 • Design and implement a plan of action and political campaign in consultation with the Bob Cortes campaign. Oversaw all aspects of the campaign including day to day operations,the hiring and management of staff,recruiting of campaign volunteers,the coordination and implementation of the fundraising events,ongoing coordination with R-WE C E I V E D APR 012021 ■ CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK the candidate,management of social media and website,organizing voter outreach events and overall campaign ground game which successfully elected Bob Cortes to the Florida House of Representatives. Bob Cortes for State Representative Campaign, Manager July 2014- September 2014 • Oversaw all aspects of the campaign including day to day operations,the hiring and management of staff,recruiting of campaign volunteers,coordination and implementation of fundraising event,,,ongoing, coordination with the candidate,management of social media and website,organizing voter outreach events and overall campaign ground game of a successful Republican primary campaign that won by 14%points. Orlando Orthopaedic Center,Director of Information Technology November 2012 -June 2014 • Oversee the streamlined operation of the IT department and to ensure it aligns with OOC's business objectives. ,jectives. Develop and manage application portfolios for cacti department and to attain all IT service level agreements for the 200+employee user community.Plan,coordinate,direct,and design all operational activities of the IT department,as well as provide direction and support for IT solutions that enhance mission-critical business operations.Working closely with decision makers in other departments to identify,recorm-nmd,develop, implement,and support cost-effective technology solutions. Oversee IT helpdesk team of four employees plus an outside managed service provider. • Managed the overhaul and re-installation or major version upgrade of all of the practices core computer systems, including:PACS (conversion from Stryker to Medstrat,$35k budget across 6 offices);phone system(conversion from Nortel to Allworx w/5-year cost savings of$9440;fixing(conversion from ActiFax to GF1 w/5-year cost savings of$40k);practice management(GE Centricity Group Management.);and several other non-critical applications, including dictation systems and internal help desk ticketing platform.Implemented several HL7 interfaces to facilitate the confidential transfer of patient information between internal systems and outside partner organizations. Worked%vith vendors,suppliers and consultants to develop the organizations first comprehensive technology budget and asset life-cycle plan for($800k annually). ProVisionlT TM,Systems Administrator January 2011 -November 2012 • Orlando Orthopedic Center System Administrator.principal System Administrator for Orlando Orthopedic Center,a large orthopedic practice with five branch offices throughout Orlando on a single network with X-ray and MRI devices.Provided network and application support for X-ray modalities and PACS software,practice management software,dictation system,finance processes and HU interfaces to ensure interoperability between systems.Also provided support for desktops,tablets and other peripherals. Daily responsibilities*include assisting doctors,clinical and administrative staff and software vendors to support and trouble shoot clinical applications,including Workflow(practice management),Stryker(PACS),Medstrat Echoes (PACS),GE Centricity Group Cast(Billing and Appointments),GE ConncctR(HU Interface),dictation and transcription applications,Canon and Fuji CR and DR X-ray modalities and a number of other workstation software platforms,performing software patches and server upgrades as needed. 2 FI-11 Z C E I V E D APR 0110421 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Provided technical support for doctors,clinical and administrative staff by ensuring functionality of Windom workstations and peripherals including tablets,mobile devices,printers,scanners,WAPs and other network devices,performing software patches and error troubleshooting during clinic as needed. ProVisionlT`rm,Applications Specialist June 2007 -January 2011 • System Integration:Integrated the client management system and client monitoring agents within the ProVisionITI'm infrastructure, *including the service desk and ticketing system,billing department and sales team. Certified as a support technician for Laserfiche,a comprehensive document-imaging platform that automates corporate internal processes and workflow. • Web Development:Managed ProVisionITrm web development projects,including WordPress"'Im powered sites, custom designed PHP/MYSQI,powered sites and custom graphic design and a custom written content management system and website for a regional business association. • Database System Development Developed Analyst Work Tracking System(AWTS)for the H&j Intensity Drug 7),afflckzngAgrnc policing. V(HIDTA),a government agency that serves local law enforcement agencies in drug po c The AWTS system developed is a fully-functional case management system used by HIDTA analysts and managers to input reported case data,track drug seizures,query search suspects for identity matches,and manage a submission and approval process for case closure.Developed using PHP,MySQL and AJAX. Metro Life:Church, Pastor July 2007 - October 2011 • Youth Ministry:Organized and administrated a parent-based youth ministry,including oversight of Parental Committee,Student Leadership Council and training and deployment of student mentors. • International Mission Trip Program:Organized and led an international outreach of 175+individuals from 10 churches in the southeast United States being deployed to perform compassionate outreach to three countries (Bolivia,Haiti and Dominican Republic)and several Florida cities,including coordinated budgeting and fundraising efforts exceeding$150,000. • High School Athletic Director.administrated the church's high school athletic department and church leagues, including multiple high school and middle basketball teams,high school soccer team and intramural church basketball and volleyball leagues,including schedule coordination with competing schools and fee collection from athletes. • Speaking,Writing&Counseling.regular public speaking responsibilities for church events and meetings,opinion and perspective writing,issue-based research,family and teenage crisis counseling and mentoring Technical Certification * Lueffiche 8 Administi-ator.Completed the Laserfiche Certified Professional program requirements and is recognized as a Laserfiche 8 Administrator. * Microsoft Certified Technology Specialist:Microsoft Certified Technology Specialist(MCTS)and certified in the .NET Framework 4,Web Applications. * BL7 Certified Control Spedalist'W2.6 Certified Control Specialist for HL7,the global authority on standards for interoperability of health information technology. 3 APR 012021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Education Computer Science,BS,UCF 2005 Graduated with a Bachelor's of Science in Computer Science from the University of Central Florida Other Skills Programming:Java,C/C++,PHP,MySQL,Visual Basic,.NBT Framework Contact information Phone: (407)492-4915 Email: r E R I F I k 0 e� Microsoft CfRTMED NET Ramework 4.Web App ieations rkhttojagy N specialit RECEIVED APR 01 2021 j,TCITY OF WINTER SPRINGS,FLORIDA CITY OF WNTFR SPRINGS t .. g 2021 MAYOR APPOINTMENT oFFICF of THS: CITY CLE-FW � � o THIS COMPLETED " 19 AFFIDAVIT©F QUALIFIED VOTER STA TUSAND FORM MUST BE CITYAND DISTRICT RESIDENCY PROVIDED Td THE CITY CLERK NO OFFICE OF THE MAYOR LATER THAN NOON ON THURSDAY, ''� / r APRIL 1,2021 1, Te 955 I e c�t c,� �J do hereby state that I seek appointment to the City Name of Candidate('I int or Tvpe.) of Winter Springs' Mayor of the City of Winter Springs 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.) I am a qualified voter in the City of Winter Springs (2.) My legal place of residence is: Street Address Clty St d zip Code (3.) Length of time of residency in the City of Winter Springs is: pars (4.) 1 am attaching two(2)documents,one to be a Florida Driver's License,asverification of my residency in the City of Winter Springs.The second document is: W Ct -Q v4. 111.4, ,6 i r� Signature Cute I t 2.� D�� Dr�U.{ ll�•�kr d �S [- �?t�� StreetAddre s Crty State Zip code State of Florida County of Sx 7i Sworn to(or a>firmed)and subscribed before me by means of( physical presence or_onlline notarization) this 3 tdayof e 2021 by SSC L l<< �$ Personally known: jf OR ro uc I en (print name of person making statement) 's � RG MYC'' aR: EX M.Fe&uary 1.2023 Type ofidentification produced It!f N FOR OFFICE USE ONLY Copy of Florida Driver's License provided for Item(5) Other documentation provided for Item(5) Revised 03/23(2021 rlorlda ��NSE ,,. ' • , PHILLIPS i JESSE MERRt f T c 1 r.24 DUNCAN DRIVE WINTER 3'= 4 W0811983 SPRINGS,5�3M48 APR 012021 6xa 04x4811029 ,5xas 6'45^ r?aes-NbNE s.E„p NC1NE CITY OF WINTER SPRINGS XSr GIVEFf OFFICE OF THE CITY CLERK �,4l3112021 R� ?i93719x7!„ -_— 0��or a nwRor rtFesxe p 'o 1« -- �+�11ifi6+v'YsaB ey h#t+a n CITY OF WINTER SPRINGS Summary of Payments and Charges DUE 0 UTILITY BILLING ACCOUNT NUMBER 19369-002 MON-FRI 8-5 1125 E STATE ROAD 434 SERVICE ADDRESS 1124 DUNCAN DR PHONE:407-327-5996 PAST DUE CHARGES $0.00 incorporated FAX:407-327-4763 PENALTIES $0.1010 1959 EMERGENCY:407-327.2009 ADJUSTMENTS $0.00 U1-ILITYBILLS(cDWINTERSPRINGSFL.DRG PAYMENTS -$134.06 WWW,WINTERSPRINGSFL-ORGIUB CURRENT CHARGES $95.99 02/16/2021 TOTALDV Water Bass $6.18 MONTHLY WATER USAGE Water Usage $11.87 (in gallons) Water Tax $1.81 15000 Sewer Base $12.14 Sewer Usage $39 17 10000 Irrigation Usage $1.11 Irrigation Tax $0.11 5000 Stormwater Base $5.50 1 L Solid Waste Bass $18.10 JAN 9 FEB iOMAR 12APR 13 MAY III JUN III JUL 113 AUG 12 SEP 114 OCT 12 NOVII DEC 10 JAN Ii Scan this code to make [R lllltsievt�ea�dirtgl Information a payment with your From To Days Motor# Previous Current use" smartphone today! 12/10/20 1/11/21 32 77317951 1344720 1352980 8260 12110/20 1111121 32 82184636 3593400 3593930 530 Can Use" STAY IN THE CONVENIENCE OF YOUR Self-Pay by QR Code Scan the code above VEHICLE AND MAKE YOUR UTILITY BILL Self-Pay by Website eservices.winterspringsfl.org PAYMENTS THROUGH THE QUICKPAY Online Bank Pay See your bank's website AUTOMATED PAYMENT KIOSK LOCATED IN THE EAST LOT AT CITY HALL. Self-Pay by Phone 407-327-5991 Call Center 407-127-5996 Please detach and return the bottom portion with your payment(Make Checks Payable to City of Winter Springs) ges Surntnaryo Payrn Char ACCOUNT NUMBER 19369-002 CITY OF WINTER SPRINGS SERVICE ADDRESS 1124 DUNCAN DR 1128 E STATE ROAD 434 ( PAST DUE CHARGES $0.00 WINTER SPRINGS,FL 32703-2715 1959 SCURRENT CHARGES $95.99 02/16/2021 Return Service Requested TOTAL DUE $95-99 # 000000759 I=0001 1111111111 11111111111,111111-11-1 -+ 11111 1 E C E I V�__Lli� 7591 AV 0.386 CITY OF WINTER SPRINGS UTILITY BILLING JESSE PHILLIPS 1126 E STATE ROAD 434 1124 DUNCAN DR APR 0 1201. WINTER SPRINGS, FL 32708-2715 WINTER SPRINGS FL 32708-4308 CITY OF-WNTER SPRINGS OFFICE OF THE CiTY 000CL.ERK 00000000019369002300000095994 NOMINATION PETITION *All information on this form becomes a public record upon receipt by the Supervisor of Elections THIS COMPLETED *ltis a crime to knowing/y sign more than one petition for a candidate.[section 704385Florida statutesj w1failrequestedinformation on this form is not completed,the form will not be vaildaszi Candidate petition Form. FORM MUST BE , IPROVIDED TO THE '57TC--verN f7ex--,(— the undersigned, a registered CITY Cl...EPK NO (Please print name as it appears on your voter information card) LAI EP THAN NOON voter of the City of Winter Springs,nominate q-cssff A, 11,P SON .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 (MMID DNYYY) Ll 66/ 1-1 1�� CiLy lcountv Zip Code -7 Signature of Vot Date Signed(MM/DD/YYYY) o be completed b V t J?! e IS-2.045,F.A.C. NOM I NATION PETITION "Allintormarhonon this form becomes a public record upon receipt by the Supervisor ofElections I's creme t k wmglysj�grt more than one petition fora candidate.[Section 704.185FIorida Statutes] THIS COMPLETED lffa//C'11�el i"Ifftion on this farrn is not completed,theform will not be vaild as a Canoidate Petition Form. FORM MUST BE I. I PROVIDED TO THE ,S&k'e� the undersigned, a registered CITY CLERK NO (Please print name as it appears onyour voter information car I-.— voter of the City of Winter Springs,nominate oto'�Se Ile LI\I'EP T' ;AN NOON ON THURSDAY, to complete the unexpired term of'Office of Mayor of Winter Springs recently vacated loy former Mayor APRIL],2021 Lacey. Date of Birth OR Voter Regi.stration Number Address (MM/DDA-YW) PRI city � tool �County �t%�-- t.te Zip Code 1 1 3)-7 OCP tr S S'qna of te, Date Signed(MM/DD/YYYY) 9na' of ot (To be completed by Voter] �'110 1 2.ZOC. 2- R S C E I V E D 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 by the Supervisor of Elections THIS COMPLETED *it is a crime to knowingly sign more than one petition fora candidate.[Section 704.785 Florida Statutes) *1fallrequestedinformation on this form is not completed,theforni will not be vailda5 a Candidate Petition Form. FORM MUST BE ' PROVIDED TO THE J e 5's 0- F1,JI tje 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 j as-sc.e- ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former kyor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/DD" City [ounty tate Zip Code 1�1 w LAO :3 IR j5 ri— I I Signature of Voter ate Signed(IvIM(DDtPM) (To be completby Voter] 0,3 / 36ed Rule e545,FAC. 11 NOMINATION PETITION 'All information on this form becomes a Public record upon receipt b - ctlons by off-e Supervisor e 5 MTHIS COMPLETED *It is a crime to knowinglysign more than one petition for a candidate.[Section 704.785 Florida Statutes] Ifall ested*n/or 1 /7" f leted.theform willnotbe validasa Candidate Petition Form. FORM MUST BE I, z - / mationont is opisnotcornp PROVIDED TO THE 4--6eks'L '� 1 1 the undersigned, a registered CITY CLERK NO (Please print name as it appears on your votelinro-rmation card) LATER THAN NOON voter of the City of Winter Springs,nominate Pk I N P 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 IMM/DD/Y" c q-r) vr- - city [ounty tate Zip Code I nicc I ok S Signature of Voter Date Signed(MM/DD(Y^tYY) [To be completed by voter] Rule IS-2.045,FAC. R&EECEIVED APR 0 12021 CITY OF VVINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION 'All information on this form becomes a public record upon receipt bythe Supervisor ofElections THIS COMPLETED *Itisa crime toknowinglysign more than one petition fora candidate-[Section 704.785 Florida Statutes] .Ifallrequesteformation on thIsf, /.snotcomp/eted,the form willnotbe vaildasa Candidate Petition Form, FORM MUST BE I'-- PROVIDED TO THE - ) - � C, the undersigned, a registered CITY CLERK NO (Please print name as it appears on voter information card) J r LATER THAN NOON voter of the City of Winter Springs,nominatees-5 e ON THURSDAY, 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 (MM/DD" —,5- - city roSn, �State Zip Code t Signature of Voter Date Signed(MM(DD/YYYY) [To be completed by voter] Pule 1S-2.045,F.A.C. NOM I NATION PETITION *All information on this form becomes a public record upon receipt bythe Supervisor of lections THIS COMPLETED *It is a crime to knowingly sign more than one petition for a candidate.[Section 70 4.785 Florida Statutes) '!fall requested information on this form isnot completed,the form will not be vaildasa Candidate Petition Form. FORM MUST BE the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it-4ears on your voter information card) LATER THAN NOON voter of the City of Winter Springs,nominate e- ON THURSDAY, 1)P�55 T ,— ;( o� to complete the unexpirecIterm of Office of Mayor of Winter Springs rec�el,/f 1) byformer Mayor APR]L 1,2021 Lacey. Date of Birth OR Voter Registration Number Address (mm/DDA,yw)03 (Ae City [ounty tate Zip Code Signature of Voter Date signed(MM/DDAYW) [To be completed by voterl j4" f 6,3 3a CDO(D- Rule IIS-2.046,FAC. R!E C LEE I VE D APR 0 12021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION .Allintormation on this form becomes a public record upon receipt by the SupervisorofElections THIS COMPLETED *lt is a crime to knowinglysign more than one petition for a candidate.[Section 704.785FIorida Statutes] *Ifallreques d information an thi's fi-rm Isno comp FORM MUST BE PROVIDED TO THE the undersigned, a registered A�vc,),47' CITY CLERK NO (Please print name as it appears on your r information card) LATER THAN NOON voter of the City of Winter Springs,nomina lie-51-se- ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former May Lac APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MMIDDA'Y" D 0 )" AV, OdK5-7 - Iq - Iq f50 K11 City [ate ZipCode t 7. 91 Signat 9er Date Signed(MM/DDAIYW) (To be completed by Voter] i— Vule is-2. S,F.A.C. NOMINATION PETITION 'Allinformation on thisform becomesapublic record upon receiptby the Supervisor ofElections THIS COMPLETED *It is a crime to knowinglysign more than one petition for a candidate.[Section 704.785FIcrida Statutes] Iffall requested information on this form is not completed,the form will not be vaild as a Candidate Petition Form. FORM MUST BE I. Gi- CP Lre " the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it appears on your voter I nfoPtion card) LATER THAN NOON Oessc, I voter of the City of Winter Springs,nominate ON THURSDAY, T- -Z) 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 Pegistration Number Address (MM1DDiYY`M Rrvork--L-ew.let e, Dr 0 1 /Qs I I qy 8� City ��ounty, �ta ZipCode :5prinj< 700 Signature of Voter Date Signed(MM(DQAvw) [To be coMpleted W Voter] 0/,-L 0 Z, Pule IS-2.045,FAC. R INE C E IV E D APR 0 12021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION *All information on this form becomes a public record upon receipt by the Supervisor of Elections THIS COMPLETED */t is a crime to knowinglysign more than one petition for a candidate,j5ection 704.785 Florida Statutes] *lfall request r or' ation on this form is not completed,the form will not be vaild as a Candidate Petition Form. FORM MUST BE PROVIDED TO THE �''( yr��t..� the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON t voter of the City of Winter Springs,nominate ''fie -Se— f�/ ON THURSDAY, o complete the unexpired term of Office of Mayor of Winter SpVVrin``g''s recently vacated by/f r mer Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MMIDD/YYW) 0�l17/ l'Fdl city [ou nty tate Zip Code Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by Voter] 071t70/2 a1 Rule 1S-2.045,FA.C. NOM I NATION PETITION *All information on this form becomes a public record upon receipt by the Supervisor of Elections THIS COMPLETED it is a crime to knowingly sign more.than one petition for a candidate.[.Section 704.785 Florida Statutes) *ifallrequested in ormat//lon on this form is not completed,the form will not be vaiid as Candidate Petition Form. FORM MUST BE 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 rJ r Itt I , 5 ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs rece tlyvacated by former Mayor APRIL 1,2021 Lacey. Date of Birth OR Voter Registration Number Address 11,31V-a Cit [ountytate Zip Code Signature of voter Date Signed(MM/DD/YWY) [To be completed by Voter] v3 � .��la�a► Rule 1S-2.045,F.A.C. 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 by the supervisor of Elections THIS Ci 4PLETED *it is a crime to knowingly sign more than one petition for a candidate,[section 704785Florida Statutes] FORM MUST BE *tfall requested information on this form isnot completed,the form will notbe vaild as a Candidate Petition Form. THE 1, Lf2 4G the undersigned, a registered PROVIDED CITY CLERKK NO (Please print name as it appears on y ur voter information card/]�, LATER THAN NOON voter of the City of Winter Springs,nominate � �Gm 11 1��1�� ON 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 Addr�esss (MMIDo[mw) 1 0 c1 City [.unty tate Zip Code Signature of Voter Date Signed(M MlDDA^NY) [To be completed by Voter 0 -3) Z ,ro�/. Rule lS-2.015,FAC. NOMI NATION PETITION 'Aflinformation on this form becomes a public record upon receipt by the Supervisor ofEYections THIS COMPLETED *1tis a crime to knowingtysign more than one petition for a candidate.[.Section 704.785 Florida Statutesl *!fall requestedinformationon this form is not completed,the form vvill notbe vaildas a Candidate Petition Form. FORM MUST BE 14_ Az4 the undersigned, a registered PROVIDED THE CITY CLERK NO (Please print name as it appears tn your voter information card) `A LATER THAN NOON voter of the City of Winter Springs,nominate -j! j& Nlt'vs 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 Voot (}ter Regiistration Number Address IMM[OD //1I+�i D ! ! -7 6�00 J City ounty ✓ tate Zip Code Signature of Voter Date Signed(MMfDDNYYY) �f [To be completed by Voter] ,4��r- Rule IS-2-04S,FAC. RECEIVED APR 4.112021 CITY OF Vv1NTER SPRINGS OFFICE OF THE Ci7Y CLERK A NOMINATION PETITION *All information on this,'orm becotres a pub/ic record upon receipt t�v the Supervisor offlections THIS COMPLETED ,it is a crime to knowinglysign more than one petition fbra candidate.]-Section 704.785 Florida Statute,-sj 'ifa4J!equ sted information or.this form 45 not compteted,the form willnotbe vailoasa Canchdate Petition Form. FORM MUST BE PROVIDED TO THE 1, Nicholos C. 13;vorlek the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information card) voter of the City of Winter Springs,nominate 3`�, e filkiHips LATER THAN NOONON THURSDAY, 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 jAclare s (MM/DD/YYYY) 0110110114 Moll Nork W-1, J C� Cityty Zip Code Wlfbf <�A.AIA5:5 St Mll@,.)a(4t� ( �Z-7�8 loun I tate Signature of voter Date Signed(Mri/oo/YYYY) ,To be completed by Voter] 1 4 CO(- Wer� Rule 15-2.045,F.A.C. NOMINATION PETITION 'A//intormarion on tht5 form 6pcomes a publi:-recorzy Upon receipt by the Supervisor or Eiections it 4g�,,cr;tne tc�knowir.,q.v6iyn n)o'e tnu,)onc oclibon for a 704 1,1?j�:IoricYa Stolotcsj THIS COMPLETED FORM MUST BF ,/ undersigned, a registered PROVIDED TO THE I, A-Al n .,e vv c me,wd d CITY CLERK NO (Please name as it appears on your voter informatic.0n�ard) LATER THAN NOON voter of the City of Winter Springs,nominate 1—esse A, I Y-s ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor APRIL 1,2021 Lacey. I Date of Birth OR Voter Registration Number Adores (MM/1-)DNYYY) b4.,)j I AID U /S2�Z (96 A/ Cit ouy [tate Zip Code W#A4-tr- 5Pp^r,_S Signature o oter Date Signed(MM/DD/YYYY) rTo be completed by Voter] ;6�� z 0 2 /3d 1Vv Rule IS-2.045,F.AC. R C Ll-z i v e7 n APR 0 1202" CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION &j *All information on this form becomes a public record upon receipt by the Supervisor ofFlections THIS COMPLETED 'It is a crime to knowinglvsygn more than one petition for a candidate.[Section 704,185 Florida Starur&sj ffallrequested Information on this form is not completed,the form will not be vaildas a Candidate Petition.Form. FORM MUST BE PROVIDED TO THE the undersigned, a registered CITY CLERK NO (Please print name as it on your voter inrormation card) jppears, LATER*THAN NOON voter of the City of Winter Springs,nominate 1—less- C Pi" Mill ON THURSDAY, 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 (MM/DDPMY) oa-1k(o I [CrI( City [ounty [tate �Zip Code Int�,n'�-tf ��tt,�✓tSS ,n�lhl a I 1--c_. ( 3 14 Signature er Date signed(v1IvI/DD/YYYY) [To be compl-ted by votary 0/ F.A.C. NOM I NATION PETITION 'Allfrifolmazion on thisform becomes a publicrecord upon receipt by the Supervisor ofFlections *Jt)s a came to knowingly sign more than one petition for a candidate[Section 70-��785 Florida Statutes] THIS COMPLETED "!fall requested information of?this form is not completed the form will not be vaildas a candidate Petition Form, FORM MUST BE S- 1, M. yti-+{ e PROVIDED TO THE CITY CLERvoylot the undersigned, a registered K NO (Please print name as it appears on your voter information cardLATER THAN NOON voter of the City of Winter Springs,nominate ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recentlyvacated by former Mayor APRIL 1,2021 Lacey, Date of Birth OR voter Registration Number Adores (MM/DD,l`"YY)Ul C 6 0 ail WjAj c�5/ jql City oust#4--(pA y-5e ,, [rate, Zip Code 1:'-c- 0 Signature of Voter Date Signed(MM/DC/YYYY) [To be completed by voter] "1%,-)/ w/ lrc 1S-2.045,F.A.C. P-i=-c:F-PVED APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOM I NATION PETITION *Allinforination on this form becornes a public record upon receipt by the Supervisor o(Elections THIS COMPLETED It is a crime to knowinglysign more than one petition for a candidate.[Section 704.785 Florida Statutesl *rfallrequestedi. forma .on on thisform&nCot completed,the form will not be vaild as a Candidate Petition Form. FORM MUST BE �S2 �j . e PROVIDED TO THE T; I (AA1 _ UCr 6(tj the undersigned, a registered CITY CLERK NO (Please print Arne as it appears on your voter t;nfornat,.on card) LATER THAN NOON voter of the City of Winter Springs,nominate �j cge Pk,//'e ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by ormer Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Addre S (MMI DNY' �j om C' 3 1 q City ounty[ clstate Zip Code 5f.441 0%feit- 32--2 08" Signa re of oter Date signed(MM/DD/VYYY) [To be co,qeted by'olterj Pule 1S-2.045,F.A.C. NOMINATION PETITION All information on rh4g form tecome-5a oublic record upon recript by rMe Suppr0sor ofFie c,ions 'It 45�)crime to knowing,"y 5icpri more than�on e petition for o cand"do lc�J'S.Ctk'o 704 ISS i:"Ofidu Sru eu t-S! THIS COMPLETED '!fall requestedirtianone`7xsformisnotcamgletaU,theforrn :r7lnatbevairdasaCandidatePetrtianFarm. FORM MUST BE PROVIDED TO THE the undersigned, a registered CITY CLERK NO (Please print name as it appears on your voter information card) LAI-ER THAN NOON voter of the City of Winter Springs,nominate Z-,g t' �A, I/,r-'.5 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/DDNYYY) /&0S w eeld Dock t City r ounty tate Zi Code UJI Signature ter Date signed(MM/DD"Y)pl [To be comp) by Voter] -q��z�Le�- 7z��/a n.l.IS-2.91S,F.AC P 'ECEIVED APR 0 12021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION �Aflipformation on thistbIrn beromes a pablicrecoldupon recelpt by theSupetvlsot offlecrions THIS COMPLETED ,t Is a crime to knowingly sign more than one petition for a candidate.[Section 704.185 Florida Statutes] 'ffallrequested' f, tion en this form is not completed,the firm will not be vaildasa Candidate Petition Form. FORM MUST BE k cltlls 4 �iii the undersigned, a registered PROVIDED TO THE k� I egzll (Please print name as it appears on your voter informationj1) CITY CLERK NO o�-- LATER THAN NOON voter of the City of Winter Springs,nominate I/If ON THURSDAY, Jes-9,P 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 (MM/DD/Y 193S 1---1ki4eJNve- City t [t.te Zip Code Signature of Voter Date Signed(Mlv/DiDpf`W) (To be completed by Voter) Rule IS-2.045,F.A.C. NOMINATION PETITION *Allinformation on ths form becornesa public--record upon receipt by the Supervisor of Flections 'it is a crime to knowing6�srqn more than onepetition fora candidate.[Spr6on 104,18-5Floride THIS COMPLETED 'Ifall reguested information on lh;s forms notcomploled,Me ro"M.4WInor Det'aildasj r-andidate Petition Form. FORM MUST BE 7 PROVIDED 1-0 THE Ni6rV6, Q4e,6,&IW the undersigned, a registered CITY CLERK NO (Please print n1me as it appears on your vokk-r infer ca LATER THAN NOON voter of the City of Winter Springs,nominate h;ll, 1—&<M 10-S 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 Adores (MM/DD, ) 2 egJOS tA )AIllfe DoveAje - 'D -11 - 0 71 5.3 [ounty [late z c d City 000 SCM!No 11 4) W1.44<r SlOttili Signature of Voter Date Signed(MM/DDA"yW) [To be completed by Voter] 0 3 -3 o-A,44 P.re IS-2,045,F.A.C. RECEIVED APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOMINATION PETITION All information 017 this form becomes a public record upon receipt by the Supervisor ofElectlons THIS COMPLETED It Is a crime to knowingly sign more than one petition for a candidate.(Section 704.785Florida Statutest '/fall requested information on this form is not completed the form will not be vaildesa Candidate Petition Form FORM MUST BE 1, — — the undersigned, a registered PROVIDED TO THE AtjLA�,—N EFS— CITY CLERK NO IPlease print name as it appears on your voter information carp)-i 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 vacated by former Mayor Lacey. APRIL 1,2021 Date of Birth OR Voter Registration Number Address (MM/DDNYYY) () I If 0 it [eunty [rate Zip Code ,0 Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by voter] � ✓' Z—_;() — Pule IS-2.045,F.A.C. NOMINATION PETITION All information on this form becomes a public record upon receipt by the Supervisor ofElections It is a crime to knovwng�Y.5ign more than one petition fora candidate.ISection 704.785 Florida Statutes] THIS COMPLETED *1failrequested information on this form is not completed,the form will not be vaild as Candidate Petition Form. FORM MUST BE —1-1%, ii 5,cL A. �%\f 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 C— ON THURSDAY, to complete the unexpired term of Office of Mayor of Winter Springs recently vacated by former Mayor APRIL 1 202', Lacey. Date of Birth OR Voter Registration Number Address (JVM/DDNYYY) It ),-301A wi,V�L II (91 City [ountyI [ Zip Cod2-. � Signature of Voter Date Signed(MM/DD/YYYY) [7o be cornipleled by Voter] 3- �)o IRule 1S-2.045,FA,C APR 01 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NOM I NATION PETITION 'All Information or?th45 form beconies a public tecord upon recelt'n k)ythe StjoervisororElectioos 'THIS COMPLETED It is a crime to knowinglysi'gn more than one petition to.,a cai;didare.l5ection 704785-Florida Statute-51 "!fall re sted Information on this form is not completed the form will not be vaildas a Candidate petition Form. FORM MUST BE PROVIDED TO THE the undersigned, a registered CITY CLERK NO I(Please print name as it app ei`+on your voter information card) LATER THAN NOON voter of the City of Winter Springs%ominate 4—e-s-S t 0iiiv, I I ON THURSDAY, 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 (MM/DD/YYYY) *J City 1--oun,yZip Code ir IlAJ 1b tate 6 Signature of Voter Date signed(MM/DCh`vYV) ��,J�� To be completed by voter) NOM I NATION PETITION .AllInformaricin on rl-,Isk�rrn become,,;aPublx-rec',wdupon recrilotby ihe.supprvisorofElectioos THIS COMPLETED it .5a crime toknowingJy-,igamore than one petition fora canry'date.(Se:-tion *Ifa1l requested information on rnis form is not compietarJ,the form i4finot bo vaildasa Candidate Petition J`-06mr FORM MUST HE 1, the undersigned, a registered PROVIDED TO THE CITY CLERK NO (Please print name as it appears on your voter information card) LATER THAN NOON jevoter of the City of Winter Springs,nominate —�r— fk. I)IPS 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 (MM/DD/YYYY) I City ounty tate Zip Code Signature of Voter Date Signed(MlV/DD/YYYY) [To be completed by Voter] 1PuIQ IS-2.045,F.A.C. RECEIVED APR 012021 CITY OF VVINTER SPRINGS OFFICE OF THE CITY CLERK r, NOMINATION PETITION - *All information on this form becomes a public record upon receipt by the Supervisor ofElections THIS COMPLETED *!t isa crime to knowinglysign more than one petition fora candidate.[Section 704.785Florida Statutes] FORM MUST BE `!fall requ ted infor atian on this for is not co pleted,the form will not be vaild as a Candidate Petition Form. PROVIDED TO THE I, _ the undersigned, a registered CITY CLERK NO (Please print name as R appears on your v ter information card) /j//,T LATER THAN NOON voter of the City of Winter Springs,nominate �'z_ /I�( 1t 3 ON THURSDAY, 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 (MM/DD/WW) 07i ) q lq3l� 1s / City, [ountytate' Zip Code Signature of Voter Date Signed(MM/DDA^tW) [To be completed by Voter) (2 3 Rule 1S-2.04S,FA.C. k: NOMINATION PETITION 'Aflinformation on thisform becomes apublic record upon receipt by the Supervisor offlections THIS COMPLETED -It isa crime to knowinglysign more than one petition for a candidate.[Section 704.785Florida Statutes] `lfallrequestedinformationonthisformisnotcompleted,theformwiilnotbevaildasaCandidatePetitionForm. FORM MUST BE ] PROVIDED the undersigned, a registered CITY CLERK THE 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, 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 (MM/DD" City [ounty I tate I Zip Code Signature of Voter Date Signed(MM/DD/YYW) [7o be completed by Voter] Rule 15-2045,F.A.C. APR 01 zo2] CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CITY OF WINTER SPRINGS 2021 MAYOR APPOINTMENT APR 01, zov OATH OF CAN D I DATE CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK OFFICE OF THE MAYOR `Allpersons who now or hereafter are employed by or who now or hereafter are on the payroll of the state,or any of its departments and agencie4 subdivisions,counties cities,school boards and districts of the free public schools state counties institutions candidates system ateorcound orin itution of higher learning,and all can Vd for public office,are required to take an oath before any person duly authorized to take acknowledgements of instruments for public record in the state..."[876.05[1)Florida Statutes) 'Any person seeking to qualify for public office who fails or refuses to file the oath required by this act shall be held to have failed to qualifyas a candidate for public office,and the name of such person shall not be printed on the ballot as a qualified candidate."[871507FIorida Statutes] J e 9-s a 1 1444 a citizen of the State of Florida and of the United States of America, and a candidate for public office, do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. Signature of Appointee jj zt Dver raft .,e— Street Address VIIAVA�' ME City State Zip Code RM.CEIVED APR 012021 STATE OF FLORIDA CITY OF W NTF_R SPRINGS COUNTY OF PFICE.OF THE CITY CLERK Sworn to (or affirmed) and subscribed before me by means of{_physical presence or—onlline notarization} this day of :F >w,- _ , 2021 by Personally known _OR Produced Identification Type of Id ntification produced EXPIRES:February 1,2023 y4F P4+.+ P1IkUfKWW*= Signature otary Public - State of Florida ������������c�� ���Y��F��INTER SPRINGS �~~�~�~�~ � ~�~� � 2021 MAYOR APPOINTMENT APR `0 1^ ~0�'�1 CITY oF°^wrERSPRINGS OATH OF CANDIDATE OFFICE oFTHE CITY CLERK OFFICE OF THE MAYOR "Each candidate,whether a party candidate,a candidate with no party affiliation,or a write-in candidate,in order toqualify for nomination orelection toany office other than ajudicia| 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 toquoUfv-" [99.D2l (l)(a) Florida Statutes] STATE DFFLORIDA COUNTYDF 0 4t~ ' "8efore nnm,an officer authorized to administer oaths, personally appeared . ^ (Please Print Name/s You Wish It)bAppea/In cily9e«nnds For ThIs Appointment) to me well known,who,being sworn,says that he or she is a candidate for the office of Mayor;that he or 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 be nominated or elected;that he or she has taken the oath required by ss.876.05-876.10, 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 ofthe office heo/she seeks;and that heorshe has resigned from any office from which he or she is required to resign pursuant to s.99.012, Florida Statutes." ignature of Appointee ^ 00vk«-ma*~- vw��^U-f� Street Address " *�^ ����~����� ^� . ~� ��� ~�~~ � city State Zip Code OL Sworn toand subscribed before rnethis dayof 2021,at Seminole County, Florida. (Signature and Title ofOfficer Administering Oath)