HomeMy WebLinkAboutMcCann, Kevin Qualifyin Packet - 2022 08 30 NTER CITY OF WINTER SPRINGS, FLORIDA FORM A
F sA 2022 GENERAL MUNICIPAL ELECTION
� z
u ` THIS COMPLETED
1959 AFFIDAVITOFACCEPTANCE
FORM MUST BE
Wt1a'y� PROVIDED TO THE
CITY CLERK DURING
CITY COMMISSION: AYOR DISTRICT TWO/ DISTRICT FOUR QUALIFYING
Circle which applies to candidacy
NAME: /� ) L/� a , Date&Time
Review StartedJc9 --4j f�f1 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 RESPONSIBILITY TO READ AND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALL APPLICABLE
REQUIREMENTS
The applicant accepting this document and the attachmentsshould initial after each section as it is reviewed
QUALIFYING DOCUMENTS
The documents in thissection are due to the CityClerk/Designee no later than 12.•00 p.m.on the last dayofQualifying which is
Friday,September 2,2022.
"Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates" [DS-DE 9]
"Statement of Candidate" [DS-DE 84]
1* *"Affidavit of Qualified Voter Status and City Residency"
2 "Application for Office and Election Assessment" (WITH a check drawn from campaign account for the Application Fee
AND the applicable 1%Assessment OR"Notice of Undue Burden")
3 "Notice of Testing Tabulating Equipment"
4 "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
*Candidate Oath CLERK/DESIGNEE DURING_
"Notice to Federal Government Employees (If applicable) QUALIFYING
"Form 1"-"Statement of Financial Interests 2021"
Accepted:
STATE OF FLORIDA INFORMATION
]"The Florida Election Code,Chapter 97-106, Florida Statutes(includes Chapter 106 which addresses Political Advertising
and Disclaimers,etc.
Candidate and Campaign Treasurer Handbook" (04/27/22) (Which includes"Chapter 12: Political Advertising"and
"Chapter 13:Other Disclaimers"
"Electioneering Communications Organization Handbook"
State of Florida Election Information Contacts
Accepted:
Revised 08/29/2022
RECEIVED
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
��NTkrrs CITY OF WINTER SPRINGS,FLORIDA
v 2020 GENERAL MUNICIPAL ELECTION FORM A
Z
U'Y.'W,959• �' AFFIDAVITOFA CCEPTANCE THIS COMPLETED
FORM MUST BE
PROVIDED TO THE
CITY COMM ISSIO MjO DISTRICT TWO/DISTRICT FOUR CITU CLERK DURING
.
QUALIFYING
Circle which applies to candidacy
NAME: 11fE//l-C, R , �qcc,;g�v Page 2of2
CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION
"Contributions Returned" [DS-DE-2]
Envelope of Checks/Receipts
Accepted: (-=
CITY OF WINTER SPRINGS INFORMATION
City of Winter Springs 2022 District Map
Accepted: 6/v
MISCELLANEOUS INFORMATION
"Statement of Ethical Campaign Practices" (From the Seminole County Supervisor of
Elections
"Foreign nationals" - from the Federal Election Commission
Legal References for Qualifying Documents
Accepted:
l -
NOTE: The Candidate SHOULD NOT closeout 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 2022 Election Qualifying Packet,including the above referenced
documents
k ,� C(_//�jjJ have on this date received the forms and information
Name ofCandidate(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 2022 Election.
Signature D to
StreetAddress City Zip Code
State ofFlorida
Countyof fe/I✓`""" ;I&
Sworn to(oraffirmed)andsubscribed before me by means of( )physical presence or( )online notarization)
this 3 O t-K Zdayof A-Co ` V- o Z
n
by x,Q Vr 114 C Cf Y]I) Personally known: OR Provided identification:
,C (P�ntname ofperson makingstaatement)
/ L ?D";1v"rFJ 4\Ce"?Te 'k,
Type ofldentification produced Signature ofNotaryPublic-State ofFlorida
RECIEM`
Notary Public State of Florida
c � Christian D Gowan AUG 3 0 2012
r My Commission GG 913234
pr n Expires 09/1512023
CITY OF WINTER Sh!
OFFICE OF THE C
Revised 08/2912022
�3ytNTE/�SA CITY OF WINTER SPRINGS, FLORIDA
o —
2022GENERAL MUNICIPAL ELECTION FORM
o ��. �.•..a "
59 AFFIDAVITOFQUALIFIED VOTERSTATUSAND
19
5� . CITYANDDISTRICTRESIDENCY THISCOMPLETED
cob WEtPo FORM MUST BE
-� PROVIDED TO THE
CITYCOMMISSIONC�] ISTRICT TWO/DISTRICT FOUR CITY CLERK DURING
Circle which applies to candidacy QUALIFYING
I, I E I/wl /�. t`'G'A..y r/ do hereby state that I seek election to the City
Name of Candidate(Print or Type)
of Winter Springs' City Commission: ayor istrict Two / District Four for a four(4)year term
Circle which applies to candidacy
in the election to be held in the City of Winter Springs,Florida on Tuesday,November 8,2022.1 further swear or affirm:
(l.) 1 am a qualified voter in the City of Winter Springs
(2.) My legal place of residence is: //o q �E{�� T L°/Q(��f= C�/�`��/z$J�2i�Cs� FL ,V 706
StreetAddress City State Zip Co e
(3.) Length of time of residency in the City of Winter Springs is: G T �5
(4.) Length of time of residency in Winter Springs District: is
18 y ,�
(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: VST r2 )Z, 6IS7-A*7�/49d C4/2-Z
Signature Date
0-/204Z- &Jc_� r" iL 5 i'�ZI.�G:6 r G. 3,_-7 7a g
StreetAddress Cit State Zip Code
State ofFlorida /
Countyof .S-�mi hale
Sworn to(or afflrmed)and subscribed before me by means of physical presence or f J onlline notarization]
this �N dayof 2022
by 1 p v y n lur Zit j7 Personally known: OR Produced Identification
(Printnameofpersonma/kingstatement)
Type ofldentification produced SignatureofNotarypublic-StateofFlorida
�Vt Notary f utak State of Fbrtda
Christian D Gowan
y; My Cemmiwlon GG 913231 AUG 3 0 2022
Expires 0911512023
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
FOR OFFICE USE ONLY
Copy of Florida Driver's License provided for Item(5)
Other documentation pro v ed for Item(5)
Revised 08/29/2022
CITY OF WINTER SPRINGS, FLORIDA FORM 2
2022 GENERAL MUNICIPAL ELECTION
~ ' THISCOMPLETED
c�
t1 �..n1959 APPLICATIONFOROFFICE FORM MUST BE
•ry�o�`�EYa,y� • AND ELECTIONASSESSMENT PROVIDED TO THE
CITYCLERK DURING
CITY COM MISS IO MAYOR DISTRICT TWO/DISTRICT FOUR QUALIFYING
Circle which applies to candidacy
A. do hereby state that I am a registered and qualified Elector of the
Name of Candidate(Print or Type)
City of Winter Springs;and l am applying for the Office of
City Commission• a or istrict Two/District Four for a four(4)year term,in the Election to be held
Circle which applies to candidacy
in the City of Winter Springs,Florida on Tuesday, November 8,2022.
1 further agree to pay the following Qualifying Fee AN D 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 a mounts to:$120.00
ELECTION ASSESSMENT—MAYOR:$144.00
The Mayor receives:$1,200.00 per month
$1200.00 x 12 months=$14,400.00 annually
The 1%Assessment amounts to:$144.00
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 IDate
FOR OFFICE USE ONLY
E4ZbAPPLICATION FEE:Campaign Account Check in the amount of$150.00 attached
(Check should be made payable to the City of Winter Springs) Check#
AN
1%ASSESSMENT-Commissioner:Campaign Account Check in the amount of$120.00 attached
OR
Mayor:Campaign Account Check in the amount of$144.00 attached /�
(Check should be made payable to the City of Winter SIRki—E C IE, Y E lyeck# / 67
OR,IFAPPLICABLE ��riri''t�
Completed"Notice of Undue Burden"Attached AUG 3 0 2022
CITY OF WINTER SPRINGS
Revised 08/29/2022 OFFICE OF THE CITY CLERK
�Lr1TER CITY OF WINTER SPRINGS,FLORIDA
o`' SOp 2022 GENERAL MUNICIPAL ELECTION FORM 3
�- 1 z
L- . Q
M«q/959 y NOTICEOF
• TESTING OF TABULATING EQUIPMENT THIS COMPLETED
~�oow"t FORM MUST BE
�— PROVIDED TO THE
CITY COMMISSI :MAYOR/ ISTRICT TWO/DISTRICT FOUR CITY CLERK DURING
Circle which applies to candidacy QUALIFYING
NOTICE
Please acceptthis notice that the tabulating equipmentto be utilized in the Cityof Winter Springs,Florida's 2022
General Municipal Election will betested on:
DATE:Friday,October 14,2022
TIME:10:00 a.m.
The aforementioned testwill be held at:
THE OFFICE OFTHE SUPERVISOR OF ELECTIONS FOP SEMINOLE COUNTY
1500 East Airport Boulevard,Sanford,Florida,32773
(407)585-VOTE[8683]
City of Winter Springs
Municipal Elections Official/Designee
Revised 08/09/2022
RECEIVED
AUG 3 01011
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
�y�NTEr� CITY OF WINTER SPRINGS, FLORIDA FORM 4
o— - sA 2022 GENERAL MUNICIPAL ELECTION
z
G)
APPLICATIONFOROFFICE THIS COMPLETED
1959 FORM MUST BE
AND EL ECTIONASSESSMENT
C06 WEl -PROVIDED TO THE
CITY COMMISSIO . M YO DISTRICT TWO/ DISTRICT FOUR CITY CLERK DURING
QUALIFYING
Circle which applies to candidacy
Please find the fol lowing documents/information/references related to Political Cam paignAdvertisements/Sig ns
in this Notice:
Copies related to Political campaign Advertisement/Signs attached:
(1) Copy of Florida Statutes 106.1435
Information/Referencesrelatedto PoliticalCampaign Advertisements/Sig ns:
(2) "The Florida Election Code,Chapters 97-106,Florida Statutes"(included in Qualifying Packet)
(3) "Candidate and Campaign Treasurer Handbook"-(Which included information from "Chapter12:
Political Advertising"and "Chapterl3:Other Disclaimers") [Included in Qualifying Packet]
ACKNOWLEDGMENT
do hereby acknowledge on this date of
Name of Candidate (Print or Type)
2022 with my signature below that I received a copy of
Florida Statutes 106.1435 and with my signature affixed below, I understand that it is MY responsibility as a Candidate for
Elected Office to comply with all laws, especially 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."
69
Signature Date
FOR OFFICE USE ONLY
Attachment:Copy of Florida Statutes 106.1435
Revised 08/29/2022
RECEIVED
AUG 3 01012
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
NNNTeR CITY OF WINTER SPRINGS,FLORIDA
o — _ x, 2022 GENERAL MUNICIPAL ELECTION FORM S
+l -
APPLICATIONFOROFFICE
v tesv ya•
eoo,vE jR„ AND EL ECTIONASSESSMENT THISCOMPLETED
FORM MUST BE
PROVIDEDTOTHE
CITY COMMISSIO : MAYO DISTRICT TWO/DISTRICT FOUR CITYCLERKDURING
Circle which applies to candidacy QUALIFYING
SCHEDULE
DURING/AFTER QUALIFYING*,THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
Report Due Date:October 11,2022
-shall contain information regarding all previously unreported contributions and expenditures from September 1,2022-
September 30,2022
Report Due Date.-October 14,2022
-shall contain information regarding all previously unreported contributions and expenditures from October 1,2022-
October 7,2022
ReportDue Date:October28,2022
-shall contain information regarding all previously unreported contributions and expenditures from October 8,2022-
October 21,2022
Report Due Da te:Nowmber4,2022
-shall contain information regarding all previously unreported contributions and expenditures from October 22,2022-
November 3,2022.
A Final Report shall be filed 90 days after the General Election-on or before February 6,2022
shall contain information regarding all previously unreported contributions and expenditures from November 4,2022
February 6,2022
*For Unopposed Candidates
Report Due Date:December 1,2022
-shall contain information regarding all previously unreported contributions and expenditures from September 1,
2022- December 1,2022
ACKNOWLEDGMENT
I, �f� do hereby acknowledge that on this date of
Name o Can i ate Print or fype)
2022 with my signature below that I received a written
"Schedule of Campaign Finance Reporting Periods/Due Dates" (as noted above on this form).
Signature Date
Revised 08/09/2022
=� ,�-cEiVED
AUG 3 0 1012
,�i-TY OF VNNTER SPRINGS
,cICE OF THE CITY CLERK
��NTEr� CITY OF WINTER SPRINGS,FLORIDA
s 2022 GEN ERALMUNICI PAL ELECTION FORM 6
�( A
a z
"
J.-M.—d NOTICE OFA CCESSTO
9 959
• y^ • CAMPAIGNFINANCEFORMS THIS COMPLETED
FORM MUST BE
PROVIDED TO THE
CITY COMMISSIO DISTRICT TWO/DISTRICT FOUR CITY CLERK DURING
circle which applies to candidacy QUALIFYING
NOTICE
Please note that Campaign Finance forms are available at the following State of Florida Website address:
https://dos.m)dlorida.com/elections/`forms-r)ublications/forms
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
I, �� )/f c� 2 ,�Yl CC'��/� do hereby acknowledge that on this date of
Name of Candidate(Print or ype
,/06 6 T 2022 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."
Signature Date
Revised 08/09/2022
ECEiVED
AUG 3 01022
:'ITY OF WINTER SPRINGS
PRICE OF THE CITY CLERK
AUG 3 0 2022
CITY OF WINTERISPRINGS
CLERK
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
'It is a crime to knowingysign more than one petition fora candidate.[Section 704.185 Florida Statutes]
'(failrequestedinformation onthisformisnotcompleted,theformwillnotbevalidasaCandidate PetitionForm. THIS COMPLETED
FORM MUST BE
I, 0� �/ , Q /� + �n the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of J5V 1 AO-CN 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- Mayor
(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")0 0( I C C d ow w "'DC-1
C
city County State Zip Code
3179
Signature of Voter Date Signed(MM/DDA^NY)
[To be completed by Voter]
� l2°I /2o22
Rule 1S-2.045,FAC.
CAN D I DATE P ETITI O N FORM /
'All information on this form becomesa public record upon receipt by the Supervisor ofElections
*It Is a crime to knowingysign more than one petition for a candidate./Section 704.785 Florida Statutes]
*1fallrequested Information on this form is notcompleted,theform will not be valid as a Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, the undersigned, a registered PROVIDED TO THE
(Please print name as It appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of 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-Mayor
(Please insert the title of Office and include District,Circuit.Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDN"
city county State Zip Ccde
Signature of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
Rule 1S-2.045,F.A.C.
- )
CANDIDATE PETITION FORM
`All information on this form becomes a public record upon receipt by the Supervisor ofElections
.It is a crime to knowinglvs7gn more than one petition fora candidate.[Section 704785 Florida Statutes]
*ffa#requested Information on this form is not completed,the form will not be valid as a Candidate Petition Form. THIS COMPLETED
J FORM MUST BE
the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of N �41 QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicablej
Nonpartisan N/A No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(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)
�iZ
&ea r2r% A-j
city County .� State Zip Code� O�
Signature of Voter Date Signed(MM/DD/WYY)
[To be completed by Voter]
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
It is crime to knowingly sign more than one petition fora candidate.(Section 704.785 Florida Statutes]
'/fall requested/nformation on this form is not completed,the form will not be valid as a Candida te Petition Form. THIS COMPLETED
FORM MUST BE
I, , Ven 14 ) p2�Q✓S(� the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of � etl 61 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- Mayor
(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 3�� �IK j I,! ��Qe
QV z
Cityl Cou ;y State Zip Code
L;-)x w'J't �' f Q t o f-� F t —
SignaVoter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
zvzv
Rule 1 5,F.A.C,
RECEIVED
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
CANDIDATE PETITION FORM 7
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
'!t isa crime to know/nglys7gn more than'one petition fora candidate.[Section 704.185 Florida Statutes]
•lfa/lre uestedinformat.non this form i. t mpleted,theformwill not bevalid asaCandidate Petition Form. THIS COMPLETED
` FORM MUST BE
I, '�"S the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of �j e C QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan [[/q No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(M M/DD/YYYY)
CJS a a- �LA q4
city Co ty ` State Zip Code
Signature o Voter Date Signed(MM/DD/YYYY)
[To be comp ted by V )
Rule lS-2.045,FAC. i
r�
CANDIDATE PETITION FORM 7
'All information on this form becomes public record upon receipt by the Supervisor ofElections
*It is crime to knowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes]
ffa//requested information on this form is not completed the form will not be valid as a Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, � &P�r the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of IkEU l A3, _ 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- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDA"
city 1 , County State Zip Code
i A/TJC— S'P?—tAjc 3, M j 0 L- z]
Signature of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter)
C
(2-7 ZZ
Rule 1S-2.045,F.A.C.
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
,..`l CAN D I DATE P ETITI O N FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
'it is crime to knowingly sign more than one petition for a candidate.[Section 704.785 Florida Statutes]
]fall requested information on this form is not completed,the form will not be valid as Candidate Petition Form. THIS COMPLETED
ST BE
Crthe undersigned, a registered PROVIDED UTO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of �J L' �/4AJA) 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- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDM W) L4 Lj
' �� V�DvC�Vt' r✓��Y
City County State Zip Code
Signature of V r Date Signed(MM/DDNY1'Y)
(To bey.completed
by Voter]
Rule 1S-2.045,F .C.
~ ' CAN D I DATE P ETITI O N FORM /
'All information on this form becomes a public record upon receipt by the Supervisor ofElections
It isa crime to knowingysign more than one petition for a candidate.[Section 704.785 Florida Statutes]
'Ifallrequ stedinformationonthisformisnotcompleted,theformwillnotbevalidasaCandidatePetitionForm. THIS COMPLETED
,�/� /J FORM MUST BE
�
I, y 11 (LFi /&--r( ck —, the undersigned, a registered PROVIDED TO THE
ease print name as it appears on your voter information card) CITY CLERK DURING
y�
voter in said state and county,petition to have the name of ZoV /�lC(fnoa�\j 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- Mayor
(Please insert the title of Office and Include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number AdJdrre�ees/ss^^�� y/�J/ //�
(MM/DD I G Q o(Q Sen e c� lJ( Vj
i
o' s « �
City County state Zip Code
&)),nte� S r.` S ern note =.L 3a7D
Signature of voter Date Signed(MM/DD/YYYY)
[To be completed by Voter)
G,) a
Rule1 - .04S,F.A.C.
T
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
CAN D I DATE P ETITI O N FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
It is crime to knowing/ysign more than one petition for a candidate.[Section 704.185 Florida Statutes]
'ffagrequestedinformatidn on this form is not completed,the form will not be validas a Candidate Petition Form. THIS COMPLETED
/ Lou
FORM MUST BE
I, l {!(� S�f�R Wu f S ��`�k the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) ,p CITY CLERK DURING
voter in said state and county,petition to have the name of C QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
F Nonpartisan
No No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(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
o z l 3 /9 ll o � fiea__� anl C��;r c/�
City County State ] Zip Code
W r ���.` 5�rr� '� 5�i✓l t JA_0 .� �L 13,2 70
0 Fill �Z�)0Signa re of voter Date Signed(MM/DD/YWY)� (To be comple[ d by Voter
Rule 1S-2.045,FAC.
c CAN DI DATE PETITION FORM /
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
It is a crime to knowinglysign more than one petition for a candidate.[Section 704.785 Florida Statutes]
•lfallrequestedinformationonthisformisnotcompleted,theformwillnotbevalidasaCandidatePetitionForm.' THIS COMPLETED
FORM MUST BE
I, zz) the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of �C V J I-,j QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No partyaffliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(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/YWY)
0 21 1ci
City C County S[ Zip Code
I
Signature of Voter Date Signed(MM/DDNY1'V)
[To be completed by Vot r)
Rule 1S-2. 45,FALL
.A.C. 0
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
CAN DI DATE PETITION FORM 7
.All information on this form becomes a public record upon receipt by the Supervisor of Elections
'It is a crime to knowinglvsign more than one petition for a candidate.(Section 104185 Florida Starutesf
'/tallrequestedinformation onthis form isnot completed,the form will not bevalidasaCandidate PetitionForm. THIS COMPLETED
FORM MUST BE
I, e t Com. t-'��... v�-� the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) r CITY CLERK DURING
voter in said state and county,petition to have the name of KevJ o yAd`I'h A QUALIFYING
placed on the General Election Ballot as a[check/complete box,as applicable]
rNonpartisan N/A No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District.Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DDIYYVY) ` C�cQa✓tit U;.tQ C -',
City County State Zip Code
Signature cf Voter Date Signed(MM/DD.HY"j
[To be completed bi Voterj
Rule 1S-2.045,FAC.
CANDIDATE PETITION FORM 7
'Ali information on this form becomesa public record upon receipt by the Supervisor of Elections
R is crime to knowing6,sign more than one petition fora candidate./Section 704.785Florida Statutes/
•1fallrequestedinformationonthisformisnotcompleted.theformwillnotbevalidasaCandidatePetitionForm. THIS COMPLETED
L1 / 0 FORM MUST BE
r\� 0
1 0Qr ` ' the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of V 11 VG4 n rj 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
IF VCandidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address G
v'( og j S-%
CityCounty State Zip Code
�av�v_5�(-1.^�j) �r.µa,� FL- 1 '3
Signature of Voter Date Signed(MM/DD/YYW)
ITo be completed by Voter)
Rule 1S-2.045,RRC.
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
` CANDIDATE PETITION FORM 7
.Allinformation on this form becomes a public record upon receipt by the Supervisor of Elections
it
Is crime to knowinglysign more than one petition fora candidate.[Section 704185 Florida Statutes]
•/fall requested information on this form is not completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, L �� the undersigned, a registered PROVIDED TO THE
Pease print name as it appears on your v er information card) ` r CITY CLERK DURING
voter in said state and county,petition to have the name of �V LCa0l/n) QUALIFYING
placed on the General Election Ballot as a [check/complete box,as ap icable]
Nonpartisan N/A No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number
Ad/dress p
(MM/DD/YYY() w
(/7— io")5—[ �8 Ild v
city CountyState Zip Code
�Ati �« t�-►11�vrJ 1 �L �a-76�
Signature of Vote Date Signed(MM/DD/Y(YY)
[To be completed by Voter]
Rule 1S-2.045,FAC.
CAN DI DATE PETITION FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
'It isa crime to knowingysign more than one petition fora candidate./Section 704.785Florida Statutes]
•/fall requested inlormationonthisform isnot complet.d,t eform w!/Inotbeva/idasaCandidate Petition Form. THIS COMPLETED
I, V Si'yt l the undersigned, a registered pROV DEDMUST
TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of 14:�- '14 d QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N A No party affiliation Not Applicable Party .
Candidate for the Office of
City of Winter Springs- Mayor
(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"
0 :3 l 17 176 Q -7 e-i C6q le hi'z
Cit'f County / State Zip Code
W Al S 2r]� S� V4 ('/V0
Signature of V r, Date Signed(MM/DD/YYYY)
/ [To be completed by Voter]
Rule 1S-2.045,F.A.C.
Ele,E ,
AUG 3 0 1011
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
' CANDIDATE PETITION FORM
`All information on this form becomes a public record upon receipt by the supervisor of Elections
'It is crime to knowinglysign more than one petition fora candidate.[Section 704.785 Florida statutes]
•lfallrequ tedinh
ormation on this form is not completed,the form will not be valid as a Candidate Petition Form. THIS COMPLETED
f FORM MUST BE
the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) ``-�� CITY CLERK DURING
voter in said state and county,petition to have the name of /he V I )V l cov, 1v QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No party affiliation F/A771 Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(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/Yl'Yl')
City County state Zip Code
Signature Vote Date Signed(MM/DD/YYYY)
(To be completed by Voter]
o?�`4N 7-vZ-2
Rule 1S-2.045,F.A.C.
( CANDIDATE PETITION FORM
*All information on this form becomes a public record upon receipt by the Supervisor of Elections
'lt isa crime to knowinglysign more than one petition fora candidate.[Section 704.785Florida Statutes]
'lfall requested information onthisformisnotcompleted,theformwilinotbevalidasaCandidate Petition Form. THIS COMPLETED
FORM MUST BE
I, �r"r E—�) y— �� the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter Information card) CITY CLERK DURING
voter in said state and county,petition to have the name of i14\)11 r' I c_ w V\ 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- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(M M/D D/"
City County S State F
p Code
Signature of V t Date Signed(MM/DD/YYYY)
[To be completed by Voter]
Rule 1S-2.045,F.A.C.
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
` . CANDIDATE PETITION FORM 7.
.All information on this form becomes a public record upon receipt by the Supervisor of Elections
.It
is crime to kno wing&,sign more than one petition fora candidate./Section 704785 Florida Statutes]
ff all req uested in forma tion on th is form is n ot comple ted,the form will no t be va lid as a Ca ndida te Petition Form. THIS COMPLETED
FORM MUST BE
I. the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of �F V1 e,/ 114G �� 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- Mayor
(Please insert the title of Office and Include District,Circuit,Group,Seat Number,If applicable)
Date of Birth OR Voter Registtrrat{ioon Number Add1ress �(, fJ
(MM/DD" -1 J( t1 ��1JTA 610-4)C
City ( County State Zip Code
Signature of Voter Date Signed(MM/DD"
[To be completed by Voter]
�oaa,
Rule 1S-2.045,F.A.C.
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon recelpt bythe Supervisor of Elections
•it isa crime to knowinglysign more than one petition fora candidate.[Section 704.785Florida Statutes]
'Ifaflrequestedinformarlon on thisform isnotcompleted,the form willnotbe vafidasa Candidate Petition Form. THIS COMPLETED
v`r K} `i rte_, t^ FORM MUST BE
V G [--w�1[\ the undersigned, a registered PROVIDED TO THE
(Please print 4ame as it ears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of 1-1gaAz 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- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable) .
Date of Birth OR Voter Registration NumberAd7dress
(�
(MM/DD v 1`�,
it County state Zip Code
�S
Si n ture of V e Date Signed(MM/DD/YVYY)
[Tobegnpletedb Vo er]
Ruley.-2.045,F.A.C. t r r1e
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
? CANDIDATE PETITION FORM
'All information on this form becomes a public record upon receipt by the Supervisor of Elections
'it is a crime to knowingysign more than one petition for a candidate.[Section 104785 Florida Statutes]
•
ffaflrequested information o thi form is not completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, �n the undersigned, a registered PROVIDED TO THE
(Please print nam as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of l v �� G',gyr�/. 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- Mayor
(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 /� )""`V"• v-Y County ^ 7� State � Zip- � 10,�) .
Signature of Voter 11y�
` Date Signed(MM/DDA^(YY)
^ [ro be completed y Voter]
Rule 1S-2.045,F.A.C.
:.
CANDIDATE PETITION FORM
'A/l information on this form becomes a public record upon receipt by the Supervisor of Elections
'It is crime to knowingysign more than one petition fora candidate.[Section 704.1B5Florida Statutes]
ffa#requested information on this form is not completed,the form willnotbe validas a Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, T� AJ A2 E—f SA-LVA (_ the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of WZ O1� G QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No party affiliation N/A71
Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
City County State Zip Code
Signature of VoteV Date Signed(MM/DD/YYYY)
[To be completed by Voter]
Rule 1S-2.045,F.
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
CANDIDATE PETITION FORM 7
.All Information on this form becomes a public record upon recelpt by the Supervlsor ofElections
.It Is a crime to knowinglyslgn more than one petition fora candidate./Section 704.785FIorlda Statutes)
'/fall requested Information on this form Is not completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
the undersigned, a registered PROVIDED TO THE
(Please print name as It appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of `.� vj� 1q G �iL/ QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/q No parcy affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs-City Commission District Four
(Please insertthe title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DD"
X75�c'5- /,P 7 ��o $�rre� ®� G_5 !v /4'Z)
city 1 County State Zip Code
signature of Voter Date Signed(MM/DDIYYYY)
tTo be completed by Voter)
Rule 1S-2.045,FAC.
CANDIDATE PETITION
FORM 7
*All Information on this form becomes a public record upon recelpt by the Supervisor of flections
*It Is crime to krfowingyslgn more than one petition fora candidate.[Section 704,785 Florida Statutes]
Ifall requested Informa tion on this form Is not completed,the form will not be valid as a Canoida te Petition Form. THIS COMPLETED
I, (�0 },—�^s' ✓J
FORM MUST BE
g g the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CIN CLERK DURING
voter in said state and county,petition to have the name of k1�� L 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 Four
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if appllcable)
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY)
City County
� State Zip Code C
Signature of Vo Date Signed(MM/DD/Y(YY)
. [To be completed by Voter)
Rule 1S-2.045,FAC. �^^
AUG 3 0 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
�cr=BVF
I
AUG 3 0 2022
FFICE OF THE CITY CLERK
CANDIDATE PETITION FORM 7
'All information on this form becomes a public record upon recelpt by the Supervisor of Elections
It is crime to knowinglysign more than one petition fora candidate.[Section 70 4.785 Florida Statutes]
ffaffrequested information on this form Is not completed,the form will not be valid as a Candidate Petition Form. THIS COMPLETED
ia FORM MUST BE
I, ti.11�HA) Ah L�P'me, the undersigned, a registered PROVIDED TO THE
(Please print name as It appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of k-QV] c Cawl,[/1 QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan (]/A No party affiliation N/A V Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Addres��
(MM/DD" 1 Xlc '+7--=tS tL /2iE�D
3 �
City County Istate I Zip Code
Signature of Voter Date Signed(MM/DDM'YY)
[To he completed by Voter]
.91 70 Lz
Rule 1S-2.045,F.
CANDIDATE PETITION FORM 7
'All information on this form becomesa public record upon receipt by the Supervisor of Elections
'lt isa crime to knowinglysign more than one petition fora candidate.[Section 704.785F1orlda Statutes]
'(fall requested information on thisform isnotcompleted,the form willnotbe validasa Candidate Petition Form. THIS COMPLETED
1, r l� FORM MUST BE
I, Hd�C, A4L J 4 —A l the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CITY CLERK DURING
voter in said state and county,petition to have the name of 0EVI N MC CA41,i QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
ANonpartisan N/A No party affiliation N/A I Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circuit,Group,Seat Number,If applicable)
Date of Birth OR Voter Registration Number Add/e
(M M/DD/YYY1� ((y
oq p 1jg5-/
City County strtey Zip Code
W��IT.t,/ � rno fe
Signature of Voter Date Signed(MM/DD/YYW)
[To be comp) ed by oter]
a a-a—
Rule 1S-2.045,F.A.C.
AUG 3 0 2011
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
II-ECEIVED
AUG 3 0 2022
CITY OF WINTER SPRINGS
ERK
l;. CANDIDATE PETITION FORM
`Al/information on this form becomes a public record upon receipt by the Supervisor of Elections
It is a crime to knowinglysign more than one petition fora candidate.jsection 104.785F16rida Statutes]
*ffa#requested information on thisform Isnotcompleted the form willnotbe validasa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, CJ the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your voter information card) CIN CLERK DURING
voter in said state and county,petition to have the name of (L(vi i C(A h h QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/q No party affiliation N/A Not Applicable Party
Candidate for the Office of
City of Winter Springs- Mayor
(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/YYW)
City County State Zip Code
W/ !2'-70
Signature of Voter Date Signed(MM/DD/YWY)
[To be completed by Voter]
/1� g;-/Z`9 12,Z
RulelS-2. S,F.A.
CANDIDATE PETITION FORM 7
*A/l information on this form becomes a public record upon receipt bythe Supervisor of Elections
It lsa crime to knowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes]
*Ifafl requested information on this form is not completed,the form wilinot be valiclas a Candidate Petition Form. THIS COMPLETED
I, �,D '' __ll FORM MUST BE
O14ElQ'r UlJ�/_fCLC� the undersigned, a registered PROVIDED TO THE
(Please print name as It appears on your voter Information card) CITY CLERK DURING
voter in said state and county,petition to have the name of i 04 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- Mayor
(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" /
33o HAYS s �D
City County State Zip Code
W I/YT&1Z 544 NGS S=w►I N C)LF L 3 X70 8
Signature of Voter Date Signed(MM/DD/YYYY)
(To be completed by Voter]
Rule 15-2.045,FAC.
AUG 3 0 2011
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
CANDIDATE OATH RECEIVED
NONPARTISAN OFFICE
AUG 3 0 2022
(Do not use this form if a Judicial or School Board Candidate)
CITY OF WINTER SPRINGS
Check box only If you are seeking to qualify as a OFFICE OF THE CITY CLERK
write-in candidate:
❑ Write-in candidate
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 1)14yo,4 — GcJ [-L-27-0-IL -5
(Office) (District#)
I am a qualified elector of County, Florida;
(Circuit#) (Group or Seat#)
1 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): !0-3 e9_3 g Qf
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.]
"7,-5' 1-f614"gCGy9N9v,cc
Signature of Candidate Telephone Number Email Address
Address City State ZIP Code
STATE OF FLORIDA
� / Signature of Notary Public
COUNTY OF JE'M i r)o /f' Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me by means of
online notarization ❑ OR physical presence 91
�
L � � Notary Public State of Florida
this3() hf day of ,20 2 Z Christian D Gowan
My Commission GG 913234
or Expires 09/15/2023
Personally Known ❑ OR Produced Identification
Type of Identification Produced:IL Dn L,'Y-ff Zj�,e I f,,p
DS-DE 302NP(Rev.08/2021) Rule 1S-2.0001, F.A.C.
v
FORM 1 STATEMENT OF 2021
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME--FIRST NAME--MIDDLE NAME :
A ` C411,141 H251110ca, RECEIVED
MAILING ADDRESS
AUG 3 0 2011
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
r�r Cr'3 CITY: ZIP: COUNTY: r'1'
cG-)
�`F C7rri
NAME OF AGENCY: N7C i
W G�
NAME OF OFFICE OR POSITION HELD OR SOUGHT: ( Ir
�a
CHECK ONLY IF ❑ CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE �� c
**** THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2021.
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
ZY'or y s F1)-4 t/9 1,0gJ a631 5. F111 clLE A119 .5 P 1-Ll 4 1 7-
F J9
FL 1-41C- 0214VV0 v/-
wivrgk., 5Pf,t,,E/66 F
PART B-- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
NZA
PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] You are not limited to the space on the
(If you have nothing to report,write"none"or"n/a") lines on this form.Attach additional
sheets,if necessary.
FILING INSTRUCTIONS for when
and where to file this form are
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 1,2022 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1),F.A.C.
PART D—INTANGIBLE PERSONAL PROPL ([Stocks, bonds,certificates of deposit, etc. -See, uctions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
/11CA FAMI4� -rk 0,5r F IL. y Vlj J 7' ti M
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"nia")
NAME OF CREDITOR ADDRESS OF CREDITOR
U gy_,41� 110'7519 Bep4fLMO4_/Y, S y^ .V 7.9Rgr
V L A16,41' 59, P 0, ' U .5' 7 d 4,0.5 .Ul C 749ob-
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 ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
PART G—TRAINING For elected municipal officers,appointed school superintendents,and commissioners of a community redevelopment
agency created under Part III, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S.
ZO I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or attorney
Signature: 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 112.3145, Florida Statutes, and the
instructions to the form. Upon my reasonable knowledge and belief,the
disclosure herein is true and correct.
Date Signed:
CPA/Attorney Signature:
J Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment:
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing address or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter, file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1 F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does not relieve the filer of filing a CE Form 1
other format), send it to CEForml@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31,2021.
for your records. Do not file by both mail and email. Choose only one
filing method. Form 6s will not be accepted via email.
CE FORM 1-Effective:January 1,2022. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.