HomeMy WebLinkAboutMorrisey, Brandon Qualifying Packet- 2022 08 29 \NTER CITY OF WINTER SPRINGS, FLORIDA FORM A
a ? s� 2022 GENERAL MUNICIPAL ELECTION
> z
u ins•rva.•an u� THIS COMPLETED
• 1959 AFFIDAVITOFACCEPTANCE FORM MUST BE
~00a WEs PROVIDED TO THE
CITY CLERK DURING
CITY COMMISSION: AYO DISTRICT TWO/ DISTRICT FOUR QUALIFYING
Circle which applies to candidacy
NAM E: Date&Time I 1
&IJ Q0A MQ(��S& Review Started 81Z��ZZ Pagel oft
The following information is provided toyou 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 documentand 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 91
"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 V-"Statement of Financial Interests 2021"
Accepted: /V1
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 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
�a�NTtlTs CITY OF WINTER SPRINGS,FLORIDA
o 2020 GENERAL MUNICIPAL ELECTION FORM A
z
u,ti t 9• AFFIDAVITOFACCEPTANCE THIS COMPLETED
FORM MUST BE
PROVIDED TO THE
CITYCOMMISSION AY DISTRICT TWO/DISTRICT FOUR CITY CLERKDURtNG
QUALIFYING
Circle which applies to candidacy
NAME: l orl Nl or C;se Page 2 of:2::::]
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:
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: � ZR � n
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
I, �(4A J-06 M o Cr.S have on this date received the forms and information
Name of Candidate(Printor 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 understan hat it is my responsibility to comply with all Laws as they apply to the 20/22 Election.
ignature Date
City zip code
StateofFlorida C
Countyof J F'-,M M1G le.
Sworn to(or affirmed)andsubscribed before me by means of( phyysical presence or( )online notarization)
this ` dayof 4L(-L(- f T Z 2 Z
by �IFCVIJCj 2 (9rr Personally known: OR Provided identification: /
(Printnameofperson makingstatei ent)
/ 1—b r
Type ofidentificationproduced Signature ofllotaryPublic-StateofFlorida RECEIVER)
bVvr v
Chris an D SowState of Flonde AUG 2 9 2022
Christian d Gowan
^ g My COMMisdon GG 913234
Ex ns MIN2023 Cpryi QF VANTript,60A...
�prL?E SIF IrNME aar>r�r
Revised 08/29/2022
y
o���NTEgso CITY OF WINTER SPRINGS, FLORIDA
p� 2022 GENERAL MUNICIPAL ELECTION FORM
x
959 y AFF(DAVITOFQUALIF/ED VOTERSTATUSAND
5� CITYANDDISTRICTRESIDENCY THISCOMPLETED
c�O`"E�PJ FORM MUST BE
PROVIDEDTOTHE
CITY COMMISSIO /DISTRICT TWO/DISTRICT FOUR CITY
CLERKDUPING
Circlewhichappliestocandidacy QUALIFYING
I. Q-evi /�aolt (��o rr'S�N do hereby state that I seek election to the City
Name of Candidate(Print or Type)
of Winter Springs' City CommissioMayor District 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:
(1.) 1 am a qualified voter in the City of Winter Springs
(2.) My legal place of residence is: LA11�A+tr_5f(;n�S ��32�8
StreetAddress City aQ State ` zipcode
(3.) Length of time of residency in the City of Winter Springs is:
(4.) Length of time of residency in Winter Springs District: is
S
(S.) I am attaching two(2)documents,one to be a Florida Driver's License,as verification of my residency in the
ty of inter Springs. eco -document is: ���I"�-i -(�; 1I / DGG
e53/2q / 22,
Si aW Date
5 �� 327�,�
StreetAddress City G State Zip Code
StateofFlorida <
Countyof SEAM 1'f7U1e
Sworn to(or affirmed)and subscribed before me by means of( physical presence or( )onlline notarization)
this Z a dayof lo4 Lam)Lts 2022
byG,'L 10 rrl Yo u� Personally known: OR Produced Identification
(Printnameofpersonmakingstateme
Type ofldentificationproduced SignatureofNotaryPublic-StateofFlorlda
ZEE:]
State of Florid;
Gowan
ion GG 913234 AUG 2 9 2022
/2023
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 f provided for Item(5)
Revised 08/29/2022
1
���Nr�RSA CITY OF WINTER SPRINGS, FLORIDA FORM 2
o —tom, 2022 GENERAL MUNICIPAL ELECTION
� z
~ * THISCOMPLETED
U .1, 959 ;' APPLICATIONFOROFFICE FORM MUST BE
o wElp°y� AND EL ECTIONASSESSMENT PROVI DED TO TH E
CITY CLERK DURING
CITY COMMISSIO AY DISTRICT TWO/DISTRICT FOUR QUALIFYING
Circle which applies to candidacy
I, i3r aAam Mo rr i Se y do hereby state that I am a registered and qualified Elector ofthe
Name of Candidate(Print or Type)
�t, yof\)intte�rSprings;�udIamaKTues
fortheOfficeof
CityCommission: / Di==�***Pe / ls�^ ;omafor a four(4)year term,in the Election to be held
Circle which applies to candidacy -Z
in the City of Winter Springs,Florida ony,November 8,2022.
]further agree to pay the following Qualifying Fee AND applicable Election Assessment
QUALIFYING FEE: $150.00 AND THE BELOW ELECTION ASSESSMENT
ELECTION ASSESSMENT - COMMISSIONER: $120.00
Each Commissioner receives:$1,000.00 per month
$1000.00x`12 months=$12,000.00 annually
The 1%Assessment amounts to:$120.00
ELECTION ASSESSMENT-MAYOR:$144.00
The Mayor receives:$1,200.00 per month
$1200.00x12 months=$14,400.00 annually
The 1%Assessment amounts to:$144.00
NOTE: "Any person seeking to qualify for nomination or election to a municipal office who is unable to pay the
election assessment without imposing an undue burden on personal resources or on resources otherwise available to him
or her shall,upon written certification of such inability given under oath to the qualifying officer,be exempt
from paying the election assessment." [99.093(2) Florida Statutes]
Pursuant to F.S.99.093(2),candidates who are unable to paythe election assessment without imposing an undue burden on
their personal resources or resources otherwise available to them shall upon written certification ofsuch inability given
under oath to the city clerk be exempted from paying the election assessment. Any candidate exempt from the election
assessment shall also be exempt from the city's qualifying fee.
,$/Z.q f 2 z
Si nature Date
FOR OFFICE USE ONLY
APPLICATION FEE:Campaign Account Check in the amount of$150.00 attached
(Check should be made payable to the City of Winter Springs) Check# C0t-t,r7,4
' C../1,k
AND
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 Springs) Check# CWS,
OR,IFAPPLICABLE �y
RECEI 7/ IED
Completed"Notice of Undue Burden"Attached
AUG 2 9 1022
Revised 08/09/2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
�tNT>:gS CITY OF WINTER SPRINGS,FLORIDA
o-z_ 2022GENERALMUNICI PAL ELECTION FORM 3
t
°—1-9109 NOTICEOF
t TESTING OF TABULATING EQUIPMENT THIS COMPLETED
ry��o weta`'6 FORM MUST BE
PROVIDED TO THE
CITYCOMMISSIO . AYO /DISTRICT 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's2022
General Municipal Election will betested on:
DATE:Friday,October 14,2022
TI M E:10:00 a.m.
The aforementioned test will be held at:
THE OFFICE OF THE SUPERVISOR OF ELECTIONS FOR SEMINOLE COUNTY
1500 East Airport Boulevard,Sanford,Florida,32773
(407)585-VOTE[8683]
City of Winter Springs
Municipal Elections Official/Designee
Revised 08/09/2022
RECEIVED
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
�N��rER CITY OF WINTER SPRINGS,FLORIDA FORM 4
s 2022 G EN ERAL MUNICIPAL ELECTION
u mo.po,aa `� APPLICATIONFOROFFICE THIS COMPLETED
AND ELE'CTIONASSESSMENT FORM MUST BE
WE.tNVy/l PROVIDED TO THE
CITY CLERK DURING
CITYCOMMISSION' YO STRICT TWO/ DISTRICT FOUR QUALIFYING
Circle which applies to candidacy
Please find the following documents/information/references relatedto Political Campaign Advertisements/Signs
in this Notice:
Copies related to Political campaign Advertisement/Signs attached:
(1) Copy of Florida Statutes 106.1435
1 nformation/References related to Political Campaign 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 "Chapter13:Other Disclaimers") [Included in Qualifying Packet]
ACKNOWLEDGMENT
�CSt_—� do hereby acknowledge on this date of
Name of Candidate(Print or Type)
V V Sa' 2, 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."
S/Zq /22
ature Date
FOR OFFICE USE ONLY
Attachment:Copy of Florida Statutes 106.1435
Revised 08/29/2022
RECEIVF—V
AUG 2 9 2022
CITY OF VNINTER SPRINGS
OFFICE OF THE CITY CLERK
I
��pITERs CITY OF WINTER SPRINGS,FLORIDA
o`` p 2022 GENERAL MUNICIPAL ELECTION FORM S
F t z
V "1959 APPLICATIONFOROFFICE
•HCoD WE2Jy4 ANDELECTIONASSESSMENT THISCOMPLETED
0.
FORM MUST BE
PROVIDEDTOTHE
CITY COMMISSION AYO DISTRICTTWO/DISTRICTFOUR CITYCLERKDURING
Circle which applies to candidacy QUALIFYING
SCHEDULE
DURING/AFTER QUALIFYING*,THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE:
Report Due Date.October I7,2022
-shall contain information regarding all previously unreported contributions and expenditures from September 1,2022-
September 30,2022
Report Due Date:October 74,2022
-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 Date:Nowmber4,2022
-shall contain information regarding all previously unreported contributions and expenditures from October 22,2022-
November 3,2022.
A Final Reportshall be filed 90 claysafterthe General Election-on orbefore February6,2022
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, c A/1 d on or(i_s/ do hereby acknowledge that on this date of
ame or Nnamate rant or Type
A V QS4• 2`!j 2022 with my signature below that I received a written
"Schedule of Campaign Finance Reporting Periods/Due Dates" (as noted above on this form).
<489/ZI/ZZ
Signature Date
Revised 08/09/2022
DECEIVE®
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
IATERS CITY OF WINTER SPRINGS,FLORIDA
2022 G EN ERAL M U N ICI PAL ELECTION FORM 6
Z
—d NOTICE OFA CCESS TO
1959
CAMPAIGNFINANCEFORMS THIS COMPLETED
caoWE`av FORM MUST BE
PROVIDED TO THE
CITY COM MISSIO AYO /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.myflorida.com/elections/forms-publications/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, i3(d�/>,�p� /hO��;S�� do hereby acknowledge that on this date of
ame or(Tan3i ate(Print or y e
V SUS¢ 7-11", 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."
1��; Z, Zz
Signature Date
Revised 08/09/2022
RECEIVED
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
r ' CANDIDATE PETITION FORM
'All information on this form becomes a public record upon recelpt by the Supervisor of Elections
'it
7s a crime to knowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes]
"/failrequested Information on this form is not completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
j� � FORM MUST BE
I, ,y c1 412+ R12SSCL- f las.,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 ��AaFr7 xt ,'(O+t�fs�r 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/Y"
City County State Zip Code
ell 144P 61E�
Signature of V r -`"`�--.WDate Signed(MM/DD/YYYV)
--��•- (To be completed by Voter)
__.. :_�J
Rule 1S-2.04S.FAC.
CANDIDATE PETITION FORM
'All information on this form becomes a publicrecord upon recelpt bythe Supervisor of Elections
'It is a crime to knowinglysign more than one petition fora candidate.[Section 704.785Florlda Statutes]
'lfalirequested Information onthis form Isnot completed the mwillnotbevalidasaCandidate Petition Form. THIS COMPLETED
FORM MUST BE
1ASthe 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 ofp� r'(�� 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"
bIS b C -Z)C, 2
Ci Cou State Zip Code
t� `Y11 L
Signature of ter Date Signed(MM/DDAIYW)
r (To be completed by Voter)
aa�
ule 1S-.045,PAC. -
AUG 2 9 7022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
� - CANDIDATE PETITION FORM f
C_
'All Information on this form becomes a public record upon recelpt by the Supervisor of Elections
'it
Is crime to know/nglysign more than one petition fora candidate.(Section 104.785 Florida Statutes)
'/fall req sted Information on this form Isnot completed,the form will not be vai/d asa Candidate Petition Form. THIS COMPLETED
T FORM MUST BE
I, RA Nk AM£S 110 G the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your oter Information card) CITY CLERK DURING
voter in said state and county,petition to have the name of A'Ddd �f2�SE 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/DD/Y" C1G 2 ��"�+ 0 �D ,
/ i �+( Il
Ci
�w'1 County state Zip Code
I NTE ��R NGS SEntt tiroc.E—: �� �o g
ISIgnaturepf Voter Date Signed(MM/DD/YYYY)
[To be completedbyV ter)
Rule 1S-2.045,F.P.C.
CANDIDATE PETITION FORM 7
•Alllnformation on thls form becomes a public record upon recelpt bythesupervisorofE/ections
*It Is a crime to know1ng4,s1gn more than one petition fora candidate.[Section 704.785 Florida Statutes]
Itall requestedInformation on this form Is not completed,the form willnot bevylldasaCandidate Petition Form. THIS COMPLETED
FORM MUST BE
I,
V(Please
` () cif 1' Oif r—r5 EYthe undersigned, a registered PROVIDED TO THE
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 ,r 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-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/DDH"
`�ty Cou ty 17tp Code a
Signature of Vot D "
Dat ned(MM/D
D o ed to � ]/-)
Rule lS-2.045 f
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CHER-
I C-GNO'.
CANDIDATE PETITION FORM
.All information on this form becomes a public record upon recelpt bythe Supervisor of Elections
.It
is a crime to knowinglysign more than one petition fora candidate.]Section W4785 Florida Statutes]
'lfallrequested lnformalo thlsformisnotcompleted,theformwillnotbevalidasaCandidatePetitionForm. 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 ofQUALIFYING
placed on the General Election Ballot as a[check/complete box,as applicable]
Nonpartisan No party affiliation FF771 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" / D ♦J_ �r/"i��/tZ ��,
City County State Zip Code
w/,�/� ��w S.vi►Ttn.�Lc � 3 27 os?
signature of V ter;{��J� Date Signed(MM/DD/YYYY)
(To be completed by Voter]
•«�� 8 2/ Zd L 2_
Rule1 -2.045,F.A.C.
CANDIDATE PETITION FORM 7
'Alllnformatlon on this form becomes a public record upon recelpt bythe5upervisor ofE/actions
*It isa crime to knowing4,s/gn more than one petitlon fora candidate.[Section 704.765Florlda Statutes]
'lfailrequestedInformationonthisformisnotcompleted,theformwillnotbevalldasaCandidatePetitionForm. THIS COMPLETED
e FORM MUST BE
I• 01 C 1'� 1 I� �t n �l h V the undersigned, a registered PROVIDED TO THE
(Please print name as It appears on your voter information card) 1� CITY CLERK DURING
voter in said state and county,petition to have the name of /Arldt n 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/WW) � ' ( U�' c de-e C.�C//
City County State d Zip Code
t
Signature of Voter Date Signed(M DD/YYW)
[To be co plate by Voter]
�2� ze.22
Rule 1S-2.045,F.A.C. D
AUG 2 9 2022
CITY OF WINTER SPRINCS
OFFICE OF THE CITY CLERK
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon recelpt by the Supervisor of Elections
.It
Is a crime to knowinglyslgn more than one petition fora candidate.[Section 704.785Florida Statutes]
•(fall requested information on this form Isnot completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
' p I 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 (3f�Gf� (� e 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 insertthe title of Office and include District,Circuit,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY)
City I Counte I- p Code
t'j L state
Z1v
c
Signature of Voter �t Date Signed(MM/DD/VYYY)
qV
` ITo be completely Voter]
v
l .2 0)
Rule 1S-2.045,F.A.C.
CANDIDATE PETITION FORM 7
'Alllnformation on thlsform becomes public recordupon recelpt bythe Supervisor ofElections
'it
Ise crime to knowinglysign more than one petition fora candidate,15ection 704.785Florlda Statutes]
•lfallreq1uesrteldln{f�ormarlono�nthisfo�rmIIssnotcomplet�eld,the form
pw�illnotbevalidasaCandidate Petition Form. THIS COMPLETED
FORM
ST BE
I, VGL11�I \JC Vwy� 0171 CIF g g PROVIDED U TO THE
Q the undersigned, a registered
(Please print Amme as it appears on your voter information card) A CITY CLERK DURING
voter in said state and county,petition to have the name of `R�DVv W)MM'El 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/WY1')
(t, LP A(4 SFGLOaIA oR
City County State Zip Code
W{�1�t�R SP>RtN�S SEMINDLE FL 3 �O
Signature of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
OL g 1 i- 22
Rule 15-2.045,F.AC.
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE.CITY CLERK
z k CANDIDATE PETITION FORM
'All information on this form becomes a public record upon receipt by the supervisor ofElection
'it
Is crime to knowinglysign more than one petition fora candidate.(Section W4785 Florida Statutes]
•lfallrequ'ested Information on this form Isnot completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I, �' {Sem �. �Q�� the undersigned, a registered PROVIDED TO THE
(Please print name as it appears on your Vaer 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/DDAINW)
O�lr � Iq(na gSCa Se un�� T�n
City Count State Zip Code
Signature of Voter Date Signed(MM/DD/YYYY)
[ro be completed by Voter)
Rule 1S-2.045,F.A.C.
E CANDIDATE PETITION r7
FORM
'All information on this form becomes a public record upon recelpt bythe Supervisor of Elections
'It is crime to knowingyslgn more than one petition fora candidate.[Section 704.785 Florida Statutes]
•ifal/r uested information on this form Is not complared the(orm w1linotbe valldas a Candidate Petition Form. THIS COMPLETED
+- ---> FORM MUST BE
I, A 0 ` the undersigned, a registered PROVIDED TO THE
se
Pleaprint n me as it appears on your voter informs ion card) CITY CLERK DURING
voter in said state and county,petition to have the name of Srar4loy-) 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/WYY) C\oq 6L -SP g 1A Q i r; Y C
City County State Zip Code
Ay-y- ey. ' h II'UrM9
Signature of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
aA�:�
0 I
Rule 15-
AUG 2 9 2022
CITY OF WINTER SPRING_=S
OFFICE OF THE CIT" G.`
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon recelpt by the Supervisor ofElectlons
it is a crime to knowinglysign more than one petition fora candidate.[Section 704.705 Florida Statutes]
•IfallrequestedInformation onthis form Isnot completed,the form will not bevalidasaCandidatePet/tlonForm. THIS COMPLETED
FORM MUST BE
I. �(� �„nt 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 A 0 C ( � �e 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/YdW)
0 - q r
City County State Zip Code
114z) LC L 3 D-7 (0
Signature of ter Date Signed(MM/DD"
I
[To be completed by Voter]
Rule 152.045,F.AC.
CANDIDATE PETITION FORM 7
'All Information on this form becomes a public record upon receipt bythe Supervisor ofElectlons
'it is crime to knowingQrsign more than one petition fora candidate.[Section 704.785 Florida Statutes]
`lfallrequestedinformationonthis form Isnot completed,the form wlllnotbetalldasaCandidate Petition Form. THIS COMPLETED
Q�� ` FORM MUST BE
j o M g 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 Q,4A-?-)V?-0P caz l.� QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
u 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
o r Address
(MM/DDWIt S`/)
` L u 14
p,e-
City County State Zip Code
W Nu tpf 3� K
Signatureof Voter Date Signed(MM/DD/YYYY)
[To be completed y Voter]
�� i a0ao?
Rule 1S-2.045,FAC
R F- ra 1311
AUG 2 9 2022
CITY OF WINTFR 1r P,1+GS
OFFICE OF T!-! =R,
T CANDIDATE PETITION FORM f
'All information on this form becomes a public record upon recelpt by the Supervisor of Elections
'lt Is a crime to knowinglysign more than one petition fora candidate.(Section 104.185 Florida Statutes)
ffaflrequested information on this form Is not completed,the form will not be valldas a Candidate Petition Form. THIS COMPLETED
q� FORM
I. V V(�
V 5 I the undersigned, a registered PROV D DU O THE
(Please print ame as it appears on your voter Information card) CITY CLERK DURING
voter in said state and county,petition to have the name of -brow dw Oyyl' QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No party affiliation N/A Not Applicable Part
Y
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 Addre'ssn�j
(MM/DDA" O Z �1Y �l
City CountyState Zip Code
IM S SP�vv+VL� 3Zlr-40\
Signature of Voter�J Date Signed(MM/DD/YY"
[To be completed by Voter]
Rule 1S-2.045,RAC.
CANDIDATE PETITION FORM 7
'All information on this form becomes a public record upon receipt bythe Supervisor of Elections
'It isa crime to knowingtyslgn more than one petition fora candidate./Sectlon 104.785Florlda5tatutesj
'lfallrequestedlnformatlononthisformisnotcompleted,theformwillnotbevalidasaCandidate Petition Form. THIS COMPLETED
I, AoY y fr�0C-1, /t FORM MUST BE
f"- // 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 9 ran CL\ 0'10 rrl5. 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"
Seflnai"n
City Count State Zip Code
Z0,
Signature of Voter Date Signed(MM/DD/YM)
� [To be completed by Voter)f/ �-ZC)ZZ
Rule 1S-2.045,FAC.
- r r a
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERW
CANDIDATE PETITION FORM
'All information on this form becomes a public record upon receipt by the Supervisor ofElectlons
'It is a crime to knowinglysign more than one petition fora candidate.[Section 104.7BSFlorida Statutes]
•/fail requested information on this form isnot c pleted,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
J
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/DD/YYYY) 9%
CityCounty State Zip Code
Signature of Voter Date Signed completed
by Vot:70
(To 6e completed by Vot )
Rule ls-2.045,FAC.
CANDIDATE PETITION 7i-- FORM
*Alllnformation on this form becomes public record upon receipt by the Supervisor ofElectlons
It is a crime to knowingyslgn more than one petition fora candidate.(Section 704.785 Florida Statutes]
1(a requested In form a t1on on th is form is n ot comple ted,th e form will no t be valid as a CandIde te Pa t1tion Form, THIS COMPLETED
FORM MUST BE
C Cf the undersigned, a registered PROVIDED 70 THE
(Please print Ame as it appears on your voter information card) a CITY CLERK DURING
voter in said state and county,petition to have the name of ��rg1.d G!tiD��i j'e QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No party affiliation F/A�771 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 7 r 1
(MM/DD"�
City ` County t State Zip Code
W '11Lfey- � " s d 2-701
Signature of Vote Date Signed(MM/DD")VtterI
[To be completed by V
oglq
Rule 15-2.045,RAC. VEMI
AUG 2 9 2022
CITY OF VANTF.P
OFFICE OF' :.F4�
C=
CANDIDATE PETITION FORM
.Alt 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 704.785Florida Statutes]
•lfallrequestedinformation onthis form
Isnot completed,the form will not bevalidasaCandidate Petition Form. THIS COMPLETED
I' -�1 �M ASO Y Irl 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 QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
�� Nonpartisan N/A No party affiliation N/A Not Applicable Part
Y
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) C merry �1r .
obi eye �-�o� rens V-� �z�01;6
City CountyState de Zip Co
o��e SpY� r�S Sem', ,no► �, �L 3 0?
Signat p of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
•q I ZLo22
Rule 1S-2.045,F.AC.
t�Qt�'
CANDIDATE PETITION FORM 7
'Ali Information on this form becomes a public record upon recelpt bythe Supervisor of Elections
'It lsa crime to knowingysign more than one petition fora candidate.(Section 704.785FIorida Statutes)
'lfallrequestedinformatlono thisf mIsnotcompleted,the form willnotbevalidasaCandidate Petition Form. THIS COMPLETED
the undersigned, a FORM MUST BE
registered g g PROVIDED 70 THE
(Please print name as it appears on your voter Information card) r �n CITY CLERK DURING
voter in said state and county,petition to have the name of I`01� \``Q<<�S� QUALIFYING
'`A
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/1YW) O
City C' Count5S.\� St�t� ZiP o^
v-Atr
Signature of Voter Date Signed(MM/DD/YYYY)
[To be cdmpleted by Voter]
Rule 1S-2.045,RAC.
AUG 2 9 2022
CITY OF WINTER'�^!?IN!GS
OFFICF nP 1"F "
(C' CANDIDATE PETITION
FORM 7
'A/1 information on this form becomes a public record upon receipt by the Supervisor ofElections
.It
Is crime to knowinglysign more than one petition fora candidate.[Section 704185 Florida Statutes]
•frail requested information on this form Isnot completed,the form will not be valid asa candidate Petition Form. THIS COMPLETED
Q `! FORM MUST BE
0 l� �,`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 S (f QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
Nonpartisan N/A No party affiliation N/A Not Applicable Part
Y
Candidate for the Office of
City of Winter Springs- Mayor
(Please insert the title of Office and include District,Circult,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address/ ,
(MM/DD" - \ lL e Q o-\L C.
City County State Zip Code
��-v
signature of voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
2
Ru
't CANDIDATE PETITION FORM 7
'All information on this form becomes a public record upon recelpt bythe Supervisor ofElections
'It isa crime to knowinglyslgn more than one petition fora candidate.[Section 704.785Flor/da Statutes]
'Ifallrequ tedinformation on this form is not completed,the form willnot be valld as a Candidate Petition Form. THIS COMPLETED
FORM MUST BE
the undersigned, a registered PROVIDED TO THE
(Please print name lis It appears on your vot information card) CITY CLERK DURING
voter in said state and county,petition to have the name of0(&14 Or✓[ se QUALIFYING
1-140
placed on the General Election Ballot as a [check/complete box,as app cable]
Nonpartisan N/A No party affiliation N/A Not Applicable Part
Y
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 Numbers /t C
(MM/DD(MM/DD" Addres9 cr
2 7 9 1- (,� r s f-C 3 2 700
City % County Stale Zip Code
4dt- Ire 3 Z 7 P
Signature of Voter Date Signed(MM/DD/YYW)
[To be completed by oter]
L
RulelS-2.0 F.A.C.
AUG 2 9 2022
CITY OF WINTER SPRING:
OFFICE OF THE CITY CLERr
'CANDIDATE PETITION
FORM
'A rmation on this form becomes a public record upon receipt by the Supervisor ofElections
It 75 a cn o knowinglyslgn more than one petition for a candidate.(Section 704.785 Florida Statutes)
'/fall requested info tion on this form isnot completed,the form will not be valid asa Candidate Petition Form. THIS COM PL
T ] FORM MU BE
I, LWIL JO S C-INICI A the undersigned, a registered pROViD TO THE
(Please print name as it app s on your voter information card)
CITY ERK DURING
voter in said state and county,petition to ve the name of gght4DOW MOCILI SE QUALIFYING
placed on the General Election Ballot as a[che complete box,as applicable]
I Nonpartisan N/A No pa ffiliation N/A ��N pplicable Part
Y
Candidate for the ffice of
City of Winter Springs- yor
(Please insert the title of Office and include District,C(rcui ou eat Number,if applicable)
Date of Birth OR Voter Registration Number ress
(MM/DD/YYYY)
ual ID viV q 4. Svow DR
City County State Zip Code
Wtni'[rCC. SPR�i►Jl. S�MiNdl-G Fl.
Signature of Voter Date Signed(MM/DD
fro be completed by Voter)
Z2
15-2.045,FAC.
CANDIDATE PETITION FORM 7
'All information on this form becomes a public record upon recelpt bythesupervisor ofElections
*It 1sa crime to knowing6,sign more than one petition fora candidate.(Section 704.785Florida Statutes?
'/fall requestedInformatlon on this form Is not completed,the form wilinot be valid as a 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 ofp r r 1 e QUALIFYING
placed on the General Election Ballot as a [check/complete box,as applicable]
FI 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 Addtr�esrs- �^
(MM/ODD/WW)) _1 (4Z J e-q V O;G d'-1 ,J
City County State Zip Code
eM�,nole r, l- 3 Z�08
signature of voter Date Signed(MM/DDA1yW)
[To be completed by Voter)
1* 1-11 Zc�Z2
Rule 1S-2.045,F.A.C.
AUG 2 9 2022
CITY OF WINTER SPR:'•Jc
OFFICE OF THE Ch" ;=R,
CANDIDATE PETITION FORM 7
.All information on this form becomes a public record upon receipt by the Supervisor ofE/ectlons
•it is a crime to knowinglysign more than one petition fora candidate.[Section 704.785Florida statutes]
ffall requested Information on this form Is not completed,the form will not be validasa Candidate Petition Form. THIS COMPLETED
FORM MUST BE
I,Mq��hc w �,'cthe 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 in)'s Py 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,Circult,Group,Seat Number,if applicable)
Date of Birth OR Voter Registration Number Address
(MM/DD/YYYY)
03//3/ /99b IG 8S ell 0Ke CIV ff U.
City County State Zip Code
w i 4er s;Alhg nol e FL 317vF
Signature of Voter Date Signed(MM/DDNYYY)
[To be completed by Voter]
0612-1 /2,p
Rule 1S-2.045,RAC
C'153-oj
CAN D I DATE P ET I T I O N FORM 7
'Aillnformation on thJs form becomes public record upon receipt by thesupervlsor ofE/ectlons
*It is a crime to knowinglysign more than one petition fora candidate.(Sectlon 704.7BSFlorlda Statutes]
'lfailrequestedlnformationonthisformisnotcompieted,theformwillnotbevalldasaCandidatePetitionForm. THIS COMPLETED
1� FORM MUST BE
I, &00',Lam/ //,PM J, 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 �/� U JB 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)
o
v —l y—� 6 Fr /6 � e-4 lee c�P rye ear.
City t County State Zip Code
w1 ti '< County
T'--^ �� �27�F1
Signature of Voter Date Signed(MM/DDMNY)
(To be completed by Voter]
Rule 1S-2.045,FAC.
RECEIVED
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
= CANDIDATE PETITION FORM
C
'All information on this form becomes public record upon receipt by the5upervisorofElections
.It Is crime to knowinglysign more than one petition fora candidate.(Section 104785 Florida Statutes]
•!fall requested information on this form Isnot completed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED
,H /� I FORM MUST BE
/"C 1"YM ` �s.� , Q 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 ofr�� Qct^ ¢� 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/DD/YY1'Y)
5 �3 9 �1 ► a t�rJ Chi . `L�e'r jJ�.
city County State Zip Code
Signature of Voter Date Signed(MM/DD/YYYY)
[To be completed by Voter]
Rule 1S-2.045,FAC. '
z CANDIDATE PETITION FORM
.Ali Information on this form becomesa public record upon receipt bythe5upervisorofE/ections
'It Ise crime to knowingyslgn more than one petition fora candidate.[Section 104.I65FIorida Statutes]
'Ifaflrequestedlnformatlononthlsforrnisnotcompleted the form wilinotbe validasa 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/DD"
City County State Zip Code
Signature of Voter Date Signed(MM/DDIYYYY)
Fo be completed by Voter]
Rule 1S-2.045,FAC.
E C E I V E V -.. D
AUG 2 9 2022 AUG 2 9 2022
CITY OF WINTER SPRINGS :=iTY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK )rrICE OF THE CITY CLERK
CANDIDATE OATH
NONPARTISAN OFFICE
RtEiCE1VED
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a AUG 2 9 2022
write-in candidate:
CITY OF WINTER SPRINGS
❑ Write-in candidate OFFICE OF THE CITY CLERK
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
c "OA M o cc;,SPS
(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 M Ct:E Q r – W 1 A*-u S 2`1 q �,
(Office) (District#)
; I am a qualified elector of �S&–.4.1/10)-e- County, Florida;
(Circuit#) (Group or Seat#)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I
have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office
I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes;
and I will support the Constitution of the United States and the Constitution of the State of Florida.
Candidate's Florida Voter Registration Number(located on your voter information card): 2 y 20 -7 0,0,�T
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.]
Ce r U,k -- -Sea,
Z&0 el Vote. b(,6vVqn Morn' &%00
Signature of Candi Telephone Number Email Address
�l b� >&j ,uo:cj pr W,nf-c.l
Address City State ZIP Code
STATE OF FLORIDA
/ Signature of Notary Public
COUNTY OF ��'M//l4' le Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me by means of
REgi
ate of Florida
online notarization ❑ OR physical presenc wanthis Z � da Of u S 2� GG 913234
y � 23
Personally Known ❑ OR Produced Identificatio>- >
Type of Identification Produced:
DS-DE 302NP (Rev.0812021) Rule 1S-2.0001, F.A.C.
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:
XQrr)SG w', 1�i,� aC&A J0,1 RECEIVED
MAILING ADDRESS:
AUG 2 9 2022
CITY OF WINTER SPRINGS
OFFICE_OF THE CITY CLERK
CITY: L,1ZIP: COUNTY
',,ra-cf Sir 14SS 32-70-9 S, i nal
NAME OF AGENCY:
NAME OF OFFICE OR POSITION HELD OR SOUGHT
Maur
CHECK ONLY IF a CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2021.
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES
FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES
(see instructions for further details). CHECK THE ONE YOU ARE USING (must check one):
COMPARATIVE (PERCENTAGE)THRESHOLDS OR 16 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
.ST-Ao, -t A-G,v p-t 110 7Z U6 14" yl S F4 33.53Li f1 I fAva u a;,xq $ew r,"
Airt-
/Ve t o/1 t1 S
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
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'Wa") I lines on this form.Attach additional
Z-9(.) 4(—
sheets,if necessary.
�, Dr 1 ( ` -e o- FILING INSTRUCTIONS for when
U
wl✓t7 and where to file this form are
5,.� o f-/J /�/ r y located at the bottom of page 2.
0 of Or v! 1'� � " rte J r� 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 PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
N/A N/A
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
N N1A
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'Wa")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY 1 a�
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.
❑ 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:
G 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 IF) 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 CEForm1@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.