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HomeMy WebLinkAboutResnick, Cade Qualifying Packet - 2022 08 29 �`NTeR CITY OF WINTER SPRINGS, FLORIDA FORM A off` s� 2022 GENERAL MUNICIPAL ELECTION � z u * v THIS COMPLETED 1nco'P 195 1959 AFFIDA VITOFACCEPTANCE FORM MUST BE 5010)WETRJy� PROVIDED TO THE CITY CLERK DURING CITY COMMISSION: MAYOR/ DISTRICT TWO/ DISTRICT FOUR QUALIFYING Circle which applies to candidacy NAME: Date&Time Review Started O 2-1"^ ZZ Pagel of 2 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 ISYOUR RESPONSIBILITYTO READ AND UNDERSTANDTHE ELECTION CODEAND COMPLY WITH ALLAPPLICABLE REQUIREMENTS The applicant accepting this document and the attachmentsshould initial aftereach section as it is reviewed QUALIFYING DOCUMENTS The documents in this section are due to the City Clerk/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 V-"Statement of Financial Interests 2021" Accepted: ��� STATE OF FLORIDA INFORMATION I"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 cc .ECGIVE® AUG 2 9 '1022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK ��NTeRs CITY OF WINTER SPRINGS,FLORIDA o� 2020 GENERAL MUNICIPAL ELECTION FORM A U y {959 AFFIDAVITOFA CCEPTANCE THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY COMMISSION:MAYOR/DISTRICT TWO/DISTRICT FOUR CITY CLERK DURINGQUALIFYING Circle which applies to candidacy NAME: G« �- t S/Jl 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: 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 4' have on this date received the forms and information Name of Candidate(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' is my responsibility to comply with all Laws as they apply to the 2022 Election. 1 � Signature Date C. S StreetAddress r City Zip Cod State ofFlodda Countyof eryl I ri0 Sworn to(oralfiirmed)anddsubscribed before me by means of Vi physical presence or( J online notarization) this ` q" n day of (4 '-wr 4- Z 0 2'L— by 2 S I 'f L Personally known: OR Provided identification: A— - ` (Printnameofpersonmakingsstatement) `c -e- Type ofldentification produced iyPublic-State of Florida Public oFlorida AIJG 2 9 2022 Christian D Gowan yg' ,per My Commission GG 913234 "r OF rd Expires 09/15/2023 CITY OF VVI NTER SPRINGS OFFICE OF THE CITY CLERK Revised 08/29/2022 ��ytNTE/p y.A CITY OF WINTER SPRINGS, FLORIDA 2022 GENERAL MUNICIPAL ELECTION FORM x " s9 " AFFIDAVITOFQUALIFIED VO TER S TA TUSA ND 5� . CITYANDDISTRICTRESIDENCY THISCOMPLETED cam°"E`PJ FORM MUST BE PROVIDED TO THE CITY COMMISSION:MAYOR/DISTRICT TW DISTRICT FOUR CITY CLERK DURING Circle which applies to candidacy QUALIFYING Gam''« �Gsif?<(i�'�- do hereby state that I seek election to the City Name of Candidate(Print or Type) of Winter Springs' City Commission: Mayor /District Two /(pistrict 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: S Z0 SLIle ey ®11,-S �5 rGQ wr��ti S�-�rryS' /-G 3Z7 StreetAddress City 'StateipC� ode (3.) Length of time of residency in the City of Winter Springs is: 7 yrS /U (4.) Length of time of residency in Winter Springs District: w r'. is A/ .-s /0 (S.) I 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: signature Date -5 zo 5;; StreetAddress Ci State Zip Code StateofFlorida i Countyof ✓�i✓r f j1'O/e Sworn to(or affirmed)and subscribed before me by means of(k)physical presence or( ]onlline notarization] this c�L� dayof 2022 144 by � P /lx n I OL Personally known: OR Produced Identification (Printnameofperson makingstatement) 7ypeofldentification produced SignatuseofNotaryPublic-StateofFlorida N Cw: �Vr Notary Public State of Florida Christian D Gowan AUG 2 9 1022 My Commission GG 913234 '►r Expires 09/15/2023 CITY OF WINTER SPRINGS OFFICE OF THF CITY CLERK FOR OFFICE USE ONLY py of Florida Driver's License provided for Item(5) Other documentation provided for Item(5) Revised 08/29/2022 ) �y�HrER CITY OF WINTER SPRINGS, FLORIDA FORM 2 s 2022GENEPAL MUNICIPAL ELECTION ~ * THISCOMPLETED U m�rv1959 APPL ICA TION FOROFFICE FORM MUST BE •ry000weTt`Oy� AND ELECTIONASSESSMENT PROVIDEDTOTHE CITYCLERKDURING CITYCOMMISSION: MAYOR/DISTRICT TWO DISTRICT FOUR QUALIFYING Circle which applies to candidacy do hereby state that I am a registered and qualified Elector of the Name of Candidate(Print or Type) 114",,;-City ofWinter.. �Sprin al d�l-a appl in for the Office of City Commission: E�istrt�t6lil� rtnrt TrPP L iStTTCTIVL''� for a four(4)yearterm,in the Election to be held Circle which applies to candidacy in the City of Winter Springs,Florida on Tuesday,November 8,2022. I further agree to paythefollowing 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 $1000.00 x12 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 $1200.00 x 12 months=$14,400.00 annually The 1%Assessment amounts to:$144.00 NOTE: "Any person seeking to qualifyfor nomination or election to a municipal office who is unable to paythe 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] Pursuantto F.S.99.093(2),candidateswho 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 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 exemptfrom the city's qualifying fee. e9A?/zo ZZ Signature Date FOR OFFICE USE ONLY PPLICATION FEE:Campaign Account Check in the amount of$150.00 attached N� (Check should be made payable to the City of Winter Springs) Check# /y =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 /yy (Check should be made payable to the City of Winter Springs) Check# OR,IFAPPLICABLE RECEIVED Completed"Notice of Undue Burden"Attached AUG 2 9 2022 Revised 08/09/2022 CITY OF WINTER SPRINGS OFFICE OF THE rlTvr,LERh � 1 ��NTERS CITY OF WINTER SPRINGS,FLORIDA 'O.p 2022 GENERAL MUNICIPALELECTION FORM 3 � x 0 `' mroro1959 y NOTICEOF h 6�• TESTING OF TABULATING EQUIPMENT THIS COMPLETED coow��av FORM MUST BE PROVIDED TO THE CITY COMMISSION:MAYOR/DISTRICT TWO DISTRICT FOUR CITY CLERK DURING Circle which applies to candidacy QUALIFYING NOTICE Please accept this noticethat the tabulating equipmentto be utilized in the City of Winter Springs,Florida's 2022 General Municipal Election will betested on: DATE:Friday,October 14,2022 TIME:10:00 a.m. The aforementioned test will be held at: THE OFFICE OFTHE 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 91011 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK �y�NTEl� CITY OF WINTERSPRINGS, FLORIDA FORM 4 s 2022 GENERAL MUNICIPAL ELECTION Z3 APPLICATIONFOROFFICE THIS COMPLETED 1959 AND ELECTIONASSESSMENT FORM MUST BE Goo WE'T0 PROVIDED TO THE CITY CLERK DURING CITY COMMISSION: MAYOR/DISTRICT TWO DISTRICT FOUR QUALIFYING Circle which applies to candidacy Pleasefind the following documents/information/references related to Political Campaign Advertisements/Signs in this Notice: Copies related to Political campaign Advertisement/Signs attached: (1) Copy of Florida Statutes 106.1435 Information/References related to Political Campaign Advertisements/Signs: (2) "The Florida Election Code,Chapters 97-106,Florida Statutes"(included in Qualifying Packet) (3) "Candidate and Campaign Treasurer Handbook"-(Which included information from "Chapterl2: Political Advertising"and "Chapter13:Other Disclaimers") [Included in Qualifying Packet] ACKNOWLEDGMENT do hereby acknowledge on this date of Name of Candidate (Print or Type) r` ;9u 51 zy 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." Signature Date FOR OFFICE USE ONLY Attachment:Copy of Florida Statutes 106.1435 Revised 08/29/2022 R E C G' V E D [�a AUG 2 9 1021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK \f �XNTC CITY OF WINTER SPRINGS,FLORIDA o — p 2022 GENERAL MUNICIPAL ELECTION FORM rJ L � o " isse APPLICATIONFOROFFICE 1co vyt ANDELECTIONASSESSMENT THISCOMPLETED FORM MUST BE PROVIDED TO THE CITYCOMMISSION:MAYOR/DISTRICT TW CITYCLERKDURING Circlewhich applles to O DISTRICT FOUR candidacy QUALIFYING SCHEDULE DURING/AFTER QUALIFYING*,THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE: ReportDueDate.•Octoberl7,2022 -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- November3,2022. A Final Reportshall be filed90 daysafterthe 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 1, �� /��5�<G!-�' do hereby acknowledge that on this date of Name of Candidate(Print orType) 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 -'.' ,EiVE� AUG 2 9 2022 CITY OF WINTER SPRINGS OF-ICFOF T HE CITY CLERK �xNTER CITY OF WINTER SPRINGS,FLORIDA S 2022GENERALMUNICIPAL ELECTION FORM ~ * o 1959 NOTICE OFA CCESSTO • CAMPAICNFIN4NCEFORMS THIS COMPLETED cabWE�n� FORM MUST BE PROVIDED TO THE CITY COMMISSION: MAYOR/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.mvflorida.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 do hereby acknowledge that on this date of Name ot Candidate rent or ype G�ycis ZY'zL' 2�2� 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 RECEIVEV AUG 2 91021 CITY OF WINTER SPRING OFFICE OF THE CITY Cl-i { CANDIDATE 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] If alljegi ested information on this f isnot competed,the form will not be valid asa Candidate Petition Form. THIS COMPLETED �� FORM MUST BE I, a the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter information ard) CITY CLERK DURING voter in said state and county,petition to have the name of16� � QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] Nonpartisan N/A No party affiliationN/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 applicable) Date of Birth OR Voter Registration Number Address 1� (� (nom/� I1r11Y/� II11IV,�/1 /,JAG City Co r�ty r State Zip Code S,Y16ture of Voter Date Signed(MM/DD" [To be completed by Voter] JVJ �b 2 Rule 1 -2.045,F.A.C. t CANDIDATE PETITION FORM / 'A/I information on this form becomes a public record upon receipt by the Supervisor of Elections *It/sa crime to knowinglysign more than one petition fora candidate.[Section 704.785FIorida Statutes] `IfallrequestedInformationonthisformisnotcompleted,theformwillnotbevalldasaCandidatePetitionForm. THIS COMPLETED I, +2 E �� 4/ N � S. FORM MUST BE 7/t 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-City Commission District Four (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 / Stale Zip Code Signature of Voter f" Date Signed(MM/DD/YYYY) f� [To be completed by Voter] V 9 I z 3 / Rule IS-2.045,F.A.C. AUG 2 9 2022 CITY OF WINTER.SPRINGS OFFICE OF THE CITY CLERK S" CANDIDATE 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 fora candidate.[Section 104.785 Florida Statutes] 'If all requested i ormation on this form is not completed,the form will not be valid as a Candidate Petitlon Form. THIS COMPLETED FORM MUST BE I - r the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter infdmation card) CITY CLERK DURING voter in said state and county,petition to have the name of fC G QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] I�I Nonpartisan N/q No party 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 (M M/DD" 12 city County State Zip Code signature of voter Date signed(MM/DD/YYYY) [To be completed by Voter) Rule 1S-2.045,FAC. CANDIDATE PETITION FORM 'All information on this form becomesa public record upon receipt bythe Supervisor ofElections 'It isa crime to kriowingysign more than one petition fora candidate.]Section 704.785 Florida Statutes] 'Ifallrequestedinformationonthisformisnotcompleted,theformwilinotbevalidasaCandidatePetitionForm. 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-City Commission District Four (Please Insert the title cf 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/DD/YYYY) [To be completed by Voter) Rule 1S-2.045,F.A.C. ve 'r AUG 2 9 2021 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION FORM C_ 'All information on this form becomes a public record upon receipt by the Supervisor of Elections .It Is crime to knowinglyslgn more than one petition fora candidate./Section 704.785 Florida Statutes) Wal/requestedInformation onthis form Isnot completed,the form will not be validas a Candidate Petition Form. THIS COMPLETED FORM BE ST I, , cl�'1 y) M . —L �) �"�. the undersigned, a registered PROV DEDUTO THE (Please print name as it appears on your voter infazAation 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-City Commission District Four (Please Insert the title of Office and Include District,Circuit,Group,Seat Number,If applicable) Date of Birth OR Vo[r Registratio Number Address (MM/DD/Y" 1ti1 o< l� 30 R,- )6v 'Pr) l 'Wu,Kk 6 -hy Stat Zip Code yo, 0." Signature a Date Signed(MM D" (r [To be cog;plete by Voter] R -2.045,F.A.C. CANDIDATE PETITION FORM 7 'All information on this form becomes public record upon recelpt bythe5upervisorofElections '1t 1sa crime to kriowingysign more than one petition fora candidate.(Section 104.785F1orlda Statutes) 'lfa//requestedlnformatlononthlsformisnotcompleted,theformwlllnorbevalldasaCandidatePetitionForm, THIS COMPLETED FORM MUST BE I, V�F&C24 1, cn'1 ! 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-City Commission District Four (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) if Z 5 9 y7 2- City County Stale Zlp Code Signature of Voter Date Signed(MM/DD/YYVY) --•-- [To be completed by Voter] Rule 1S-2.045,FAC. .�..v w 03� AUG 2 9 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 crime to knowingysign more than one petition fora candidate.(section 704.785 Florida Statutes] • ffallrequestedlLpforrpation on Upfffm Isnotccompl�eted,the form will not be valid as Candidate Petition Form. THIS COMPLETED FORM M BE ST I, /7// 1/!r'i ' \J the undersigned, a registered PROV D DUTO 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 - QUALIFYING placed on the General Election Ballot as a[check/complete box,as applicable] �7-7 J 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DDNYV 'V L✓ � �� 1 �� � I CityCo a/��n�p ApI Zi ode Signature ofvoter Date Signed(MM/DD/YYYY) [To be comp] ted by Voter) Rule CANDIDATE PETITION FORM *All information on this form becomes a public record upon receipt bythe Supervisor ofElections *It Is crime to kriowingysign more than one petition fora candidate.[Section 704.785 Florida Statutes] 'lfallrequested ln r tlononthisfor rs tcF I ted,the form wllinotbevalldasaCandidate Petition Form. THIS COMPLETED pp FORM MUST BE 1A V � tm'33L-� the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter information card) nn � 11 CITY CLERK DURING voter in said state and county,petition to have the name of Crt°fy lei IN1 CA�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-City Commission District Four (Please Insert the title of Office and include District,Circuit,Group,Seat Number,if applicable) Date of Birth OR Voter Registration Number Address ,7 (MM/DD/YWY) City S County StateZlp Code 3y��� Signature of Vote Date Signed(MM/DD/YYYY) [To be completed byoter) .\)VOC Zt/ Rule 15-2.045,F.4C. AUG 2 9 1022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION FORM 'All information on this form becomes a public record upon receipt bytheSupervisor of Elections .It Is a crime to knowinglysign more than one petition fora candidate.(Section 704.785 Florida Statutes) '/fall requested Information on this form Isnot completed,the form will not be valid as a Candidate Petition Form. THIS COMPLETED �t ( FORM MUST BE I, d�� rn • 1� 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-City Commission District Four (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) _ City C,ynty State 2(p Code r pec- 3a .- Signatur�f.�loter Date signed(MM/DD/YYYY) [To be completed by Voter] Rule15-2.045 C. CANDIDATE PETITION FORM7 'All information on this form becomes publlcrecord upon receipt bytheSupervisor ofElections 'It isa crime to kdowinglyslgn more than one petitlon fora candidate.(Section 704.785FIorida Statutes) 'IfallrstedInformationonthlsformisnotcompleted,theformwillnotbevalldasaCandidatePetitionForm. THIS COMPLETED r FORM MUST BE I, 17P4- �C yj 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 G� 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 applicable) Date of Birth OR Voter Registration Number Address (M©3 1 R 51 I Ob 1 c� City ` - Co y State Zip Code " qtr IV Signature of Voter Date Signed(MM/DD/YYYV) Fd (To be completed by Voter)4LI C - Rule 1S-2.045,FAC. AUG 2 9 2022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK z -- CANDIDATE PETITION FORM 7 .A#Information on this form becomes a public record upon receipt by the Supervisor offlections .It Is a crime to know1ng4,s1gn more than one petition fora candidate./Sectlon 704.785 Florida Statutes] 'Ifallrequeste�nformation onthlsfor;��ve—a mpleted,the form will not bevalldasaCandidate Petition Form. THIS COMPLETED FORM MUST BE I, ea� the undersign , a registered PROVIDED TO THE (Please print name as It appears on your voter informati n card) c CITY CLERK DURING voter in said state and county,petition to have the name C61dif eS�/GK, QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] Nonpartisan N/q No party affiliation N/A Not Applicable Part Y 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD" Or, ve- Cit �) I Count r StaZi 0 Signature of Voter _ Date Signed(MM/DDA YW) [To be completed by Voter] Ryle 15-2.045/, ! i CAN DI DATE PETITION FORM 7 *AH Information on this form becomes a public record upon receipt bythe Supervisor of Elections '1t Ise crime to kriowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes] '1fallrequestedinformationonthisformIsnotcompleted,theformwlilnotbevalidasaCandidatePetitionForm. THIS COMPLETED FORM MUST BE I, r v C ve the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter informatio card) CITY CLERK DURING voter in said state and county,petition to have the name of /a(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 applicable) Date of Birth OR Voter Registration Number Address Or 16, City costy State Zip Code nI Al 3,2 70S' Signature o oter Date Signed(MM/DD/VYYY) [ro be completed by voter) Rule 1S-2.04S,FAC. AUG 2 9 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 ofElectlons 'lt is a crime to knowinglys/gn more than one petition fora candidate.[Sectlon 704.785 Florida Statutes] *lfaflrequested information on this form Is not completed,the form will not be validas a Candidate Petition Form. THIS COMPLETED FORM MUST BE I, SOW Ln'A the undersigned, g•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-City Commission District Four (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" It '7 If 00 LP,t, e City County St Zip Code hjTA Signature footer Date signed(MM/DD/YYYY) [To be co pleted by Voter] S-2.045,rA.C. is CAN D I DATE PETITION FORM 7 •Ali Information on this form becomes a public record upon recelpt by the SupervlsorofElections ']t lsa crime to knowingysign more than one petitlon fora candidate.[Section 704.785Florlda Statutes] •Ifallrequestedlnformationonthisformisnotcompleted,theformwillnotbevalldasaCandldatepetitionForm. THIS COMPLETED �4 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] ANonpartisan N/A No party 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/DDH" City County State Zip Code Signa�&Vote Date Signed(MM/DD/YYYV) (To be completed by Voter) Rule 1S-2.045,F.A.C. s,• AUG 2 9 1071 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION7 FORM *AHInformation 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.[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 FORM MUST BE I, lea 1/k1 .'0 e Com/ 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 ,,si+ .4J r Coll- QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] Nonpartisan N/A No party affiliation FFA77] 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 applicable) Date of Birth OR Voter Registration Number Address /. (MM/DD" t IOCt P/Fo✓I Ctli�-PLE City County State Zip Code Signature of Voter Date Signed(MM/DD/YYYV) [r [To be compI ted by V ) '•� Rule 1S-2.045,F.A.C. CANDIDATE PETITION ..ji F RM Information on this form becomes a public record upon recelpt bythe Supervisor of Elections •/t/sac. e to kriowinglysign more than one petition fora candidate.(Section 704.785 Florida Statutes) '/fa//requestedl mationonthis for Ecom et ,th ��Izln tbevsaCandidatePetitlonForm. THIS COMPLETED )VOundersi ned registered FORM MUST BE g g PROVIDED TO THE (Please print name as It ears on your voter information card) CITY CLERK DURING voter in said state and county,petition ave the name of QUALIFYING placed on the General Election Ballot as a [c k/complete box,as applicabl Nonpartisan N/A No p affilla FTA-- Not Applicable Party Candidate for ffice of City of Winter Springs ity Com ' Sion District our (Please insert the title of Office and' clude District,Circuit,Gro eat Number,If applicable) Date of Birth OR Voter Registration Number Address (MM/DD" - City ;, Ga Co vt � /V Stag ZIPC4de �� Signature of Vo[ / Date Signed(MM/DD/YYW) [Tobe cleted by,pVqt ) Rule IS-2.045,F.A.C. E= AUG 2 9 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 ofElections .It is a crime to knowinglysign more than one petition fora candidate.(Section]04185 Florida Statutes] '!fall 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, 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 7 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DID/Y" City County State ZIp Code Signature of Voter Date Signed(MM/DD/AY() ..�^ [To be completed 6y Vot ] � a� aoaa Rule 1S-2.045,FAC. J CAN D I DATE P ETITI O N FORM f 'All information on this form becomes a public record upon receipt bythe Supervisor ofElections 'It isa crime to kriowingysign more than one petition fora candidate.(Section 704785 Florida Statutes) `1fallrequestedinformationonthisformisnotcompleted,theformwillnotbevalidasaCandidatePetitionForm. THIS COMPLETED FORM MUST BE C- t--2. 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 [checkicomplete 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 Distrlct,Clrcuit,Group,Seat Number,If applicable) Date of Birth OR Voter Registration Number Address (MM/DDNff 2)�v City County State Zip Code D� Signature of Voter Date Signed(MM/DD/YYYY) (To be completed by Voter) O6 Z Z— Rule 15-2.x45,F.AC. AUG 2 9 1022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION FORM C_ 'All information on this form becomes a public record upon receipt by the Supervisor ofEfections 'It is a crime to knowing6vs1gn more than one petition fora candidate.[Section 704.785 Florida Statutes] 'ffall requested information on this form is not completed,the form will not be valid as a Candidate Petition Form. THIS COMPLETED y, FORM MUST BE I, :-flSC�'{� yC f�N�r S the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter information card) CITY CLERK DURING r voter in said state and county,petition to have the name of CA t> P(FXtJ/C./1� QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] XNonpartisan F N/A7 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 applicable) Date of Birth OR Voter Re istration N tuber Address (MM/DD/YWI� r © s 7S �I Ali<--X �� R. r City County State Zip Code (J' Signature of Voter e 7 1 Date Signed(MMcompleted by Voterl) [To 6e completed by Voter) Rule 1S-2.045,F.A.C. 0.5 CAN DI DATE PETITION FORM / 'All information on this form becomes a public record upon receipt by the Supervisor ofElections 'ft isa crime to kriowingfysign more than one petition fora candidate.[Section 704.785Florida Statutes] •ffailrequestedinformationonthisforrmisnotccompleted,the form willnotbevefidasaCandidate Petition Form. THIS COMPLETED .1 e ss e p6l ;1/ �1 �Cl the undersigned, a registered FORM MUST BE PROVIDED TO THE (Please print name as it appears on your vot r information card) D CITY CLERK DURING voter in said state and county,petition to have the name of C OL 1 a S A 4G� 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD/yWt� f1 O �� q�3 Z, �( +moi Ac ah 0 f•J4. City Count Scate Zip Code G'L1 -31 TOP Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by Voter) 'L 1 Zo 22 Rule 1S-2.045,FAC. Jill AUG 2 9 2021 CITY OF WINTER SPRINP', OFFICE OF THE(:'TY CL FRI< CANDIDATE 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 fora candidate.[Section 704185 Florida Statutes] 'ffaffrequestSV Information on this form Is not completed,the form wUlnot bevalidasaCandidate Petition Form. THIS COMPLETED FORM MUST BE I, - s;e the undersigned, a registered PROVIDED TO THE (Please print name as It appears on your voter I ormation card) CITY CLERK DURING voter in said state and county,petition to have the name of CQ�L nQs`! 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 insertthe title of Office and Include District,Circuit,Group,Seat Number,if applicable) Date of Birth OR Voter Registration Number Address (M M/DD/YYYY) i JP td VLJ �)�ea-AK a city County State Zip Code i%4►i n o le, �L 3 X7D Signature of Voter Date Signed(MM/DD" [To be completerd by Votjr] �� b`'317qv/ ZG�Z Rule IS-2.045,F.A.C. 4 CANDIDATE PETITION FORM / 'All informatlon on this form becomes a public record upon recelpt by the Supervisor of Elections 'It isa crime to kdowinglysign more than one petition fora candidate.[Section 704.785FIorlda Statutes] `Ifallr uestedinformat nonthisformisnotcompleted,theformwillnotbevalldasaCandidatePetitionForm. THIS COMPLETED FORM MUST BE I, '-�/'/� lis// the undersigned, a registered PROVIDED TO THE (Please print ame as it appears on your voter information card) CITY CLERK DURING voter in said state and co nty,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-City Commission District Four (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� 4ow—, City , /� C [y �� State Zip Code ' Signature f Voter Date Signed(MM/DD/YYYy) [To be complet d by Vote Rule 1S-2.04, A.C. AUG 2 9 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 knowinglysign more than one petition fora candidate.[Section 704.785 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 ( yl A IQ V A Q 0 CA i ( A GQ 6 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 �4e4e Gs�� QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] X Nonpartisan 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD/YYYY) CityCounty State Zip Code r r s sem l` L 3 . 7 0 Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by Voter] ac, Rule 1S-2.045,FAC. CAN D I DATE P ETITI O N FORM 7 'All information on this form becomesa public record upon receipt by the Supervisor of Elections '/t isa crime to kdowinglysign more than one petition fora candidate.[Section 704.785FIorida Statutes) '(fallrequestedinformationonthisformisnotcompleted,theformwillnotbevalidasaCandidatePetitionForm. THIS COMPLETED FORM MUST BE I, (� J ( 5 A L t N G (_( e, (? 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 fflC 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD" / 1 Z (00/ O A I(- DLV D City County State Zip Code ftit w i Cn 5 n2 ]tua Ge f=L 32 7 Signature of Voter Date Signed(MM/DDAYM) [To be completed by Voter] 9,Z Za G z z Rule 1S-2.045,FAC. AUG 3 12022 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 knowinglysign more than one petition fora candidate.[Section 704.185 Florida Statutes] ffallrequested information on this form is not completed,the form will not be validas a Candidate Petition Form. THIS COMPLETED 2004 v` C(� g g FORM MUST BE I, the undersigned, are registered PROVIDED TO THE (Please print name as it appears on your ter Information card) _ t CITY CLERK DURING voter in said state and county,petition to have the name of C�2 �� /��5;-2( QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] XNonpartisan 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DDH" oc 1969 cc\ Snx Q City County State Code tA/; A I�� r�1�yf Seth d I1ZIp 3Z ) � Signature of V er Date Signed(MM/DDA^" [To be completed by Voter] 2z Rule1S-2. ,•FAC. CAN D I DATE P ETITI O N FORM 'All information on this form becomes a public record upon receipt bythe Supervisor ofElections 'It 1sa crime to kriowinglysign more than one petition fora candidate.(Section 704.785F1orlda Statutes] '/fallrequestedinformationonthisformisnotcompleted,theformwilinotbevalidasaCandidatePetitionForm. THIS COMPLETED I, VFORM MUST BE !c fs fin 6` ( the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your voter information card) � /f CITY CLERK DURING voter in said state and county,petition to have the name of LQ epleL �'` 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD/" city County State Zip Code oe— Signature ofVoter Date Signed(MM/DDAWM) (To be completed by Voter C/A /Z6ZU Rule 15-2.045,F.AC. "4idy AUG 3 12022 CITY OF WINTER SPRINGS OlFFIOE'OF TtjE OIITY CLERK `- CANDIDATE PETITION7.._� FORM .All information on this form becomes a public record upon receipt by the Supervisor of Elections 'It is a crime to knowingllvsign more than one petition fora candidate.[Section 704.785 Florida Statutes] Wall requested information on this form is not completed,the form will not be valid as 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 ---6(L lz--�1ore G� QUALIFYING placed on the General Election Ballot as a (check/complete box,as applicable] XNonpartisan 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 applicable) Date of Birthd R Voter Registration Number Add ressW 3 CO r (MM/DD y- Z.1; - W y /1 L C r Ft- City County Sta a Zip Code `1f,1� � Y SPrr}" SS �e-rr h � 3�212G Signature of Voter Date Signed(MM/DD/YY"7 / q (To be completed /b`y Voter] Rule 1S-2.045,FAG is CAN D I DATE P ETITI O N FORM 'All information on this form becomes a public record upon receipt bythe Supervisor of Elections 'It isa crime to kdowinglysign more than one petition fora candidate.[Section 704.785Florida Statutes] 'If0requestedinformation on this form is not completed,theform willnotbe valldasa Candidate Petition Form. THIS COMPLETED FORM MUST BE l %-/C9 1 u jn-{ the undersigned, a registered PROVIDED TO THE iPlease print namd as it appears on your voter information card) CITY CLERK DURING voter in said state and county,petition to have the name of C� / j'�Yc QUALIFYING placed on the General Election Ballot as a[check/complete box,as applicable] CI 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 applicable) Date of Birth OR Voter Registration Number Address c' city , County Sta ; oy K �' �(� ® Zip Code a��t270)6 . signatur of Vote Date Signed(MM/DD/YYYY) (To be comp) ted by Voter] Rule 15-2045,FAC. RECEIVED AUG 31 2022 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK CAN DI DATE PETITION7�) FORM 'Al/information on this form becomes a public record upon receipt by the Supervisor of Elections 'It is a crime to knowing6ls7gn more than one petition fora candidate.[Section 704.785 Florida Statutes] 'lfallrequested 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 a ears A your voter information card) ,s _ CITY CLERK DURING voter in said state and county,petition to have the name of5G?l QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] XNonpartisan 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 applicable) Date of Birth OR Voter Registration Number Address n,� (MM/DD/WY`(] ( �Z I? --ua4 A '�2?0 � Ciry ` ,, 1 Coun Zip Code fl/�/' V_vlI'�--('/, •t_ tY '' nn State r PL ->o Signature of Voter Date signed(MM/DDAYM [To be completed by Voter] Rule 1S-2.045,FAC. CAN D I DATE P ETiTi O N FORM f 'All information on this form bacomesa public record upon receipt by the Supervisor ofElections It is crime to kriowinglysign more than one petition fora candidate.(Section 704.785 Florida Statutes] ffallrequested information on this form is not completed,the form will not be valid as a Candida te Petition Form. THIS COMPLETED I J� I FORM MUST BE l ` a C7 0� dj C0: tS 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 tGs QUALIFYING placed on the General Election Ballot as a (check/complete box,as applicable] XNonpartisan 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD" ZY7 /17 wto. Lc74 City County ( St/a't^e Zip^CCode signature of Voter Date signed(MM/DD/YYYY) [To be completes, by Voter) �A�- ?-- /1y -.2)-- Rule 1S-2045,FAC. RECEIVED AUG 3 12022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION FORM •A#Information on this form becomes a public record upon receipt by the supervisor ofElections .It Is a crime to knowinglyslgn more than one petition fora candidate.[Section 704.785 Florida statutes] 'If all 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, the undersigned, a registered PROVIDED TO THE (Please print name as it appears<njour 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 N/q 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DDN" ((( � 0 O 1 l� city County State Zip Code LU S S �e ,�� �e J � Viz: � Signature of Vo[ Date Signed(MM/DD/YYYY) [To be completed by Voter] 2i?Er�lz Rule -2.045,F.A.C. CANDIDATE PETITION ••i,;.'�rFORM 7 'All Information on this form becomes a public record upon recelpt by the supervisor ofElections It Is crime to knowinglysign more than one petition fora candidate.(Section 704.785 Florida statutes] •lfalire u stedInformationonthisformIsnotcompleted,theformwillnotbevalidasaCandidatePetitlonForm. THIS COMPLETED FORM MUST BE I, the undersigned, a registered PROVIDED TO THE (Please pont name asit appears on your voter information card) � CITY CLERK DURING voter in said state and county,petition to have the name of G�.ri1� �'� �`< QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] �.J 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD I 0 q7-1 tl City Count State Zip Code Sp H, LleA Signature of ter Date Signed(MM/DD/YYYY) t [To be completed by Voter] �f3 Rule -2.045,FAC. AUG 3 12022 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK := CAN D I DATE P ETITI O N FORM 7 'All information on this form becomes a public record upon receipt by the Supervisor of Elections It Is a crime to knowingly sign more than one petition fora candidate[Section 704.785 Florida Statutes] '/fall requested information on this form is not complete,the form will not be valid as Candidate Petition Form. THIS COMPLETED J r FORM MUST BE '✓ t7 the undersigned, a registered PROVIDED TO THE (Please print name as it appea n your voter information card) CITY CLERK DURING voter in said state and county,petition to have the name of Cee ae- �C QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] XNonpartisan 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,Croup,Seat Number,if applicable) Date of Birth OR Voter Registration Number Address (WAIDDHyl City ` Y'1�_ Countyt VN t Statr� �. ZlpCode �Z n( U Signature of Voter Date Signed(MM/DDPf" [To be completed by Voter) {2 9 d` . Rule 1S-2.045,FAC. CAN DI DATE PETITION FORM 7 L 'All information on this form becomes a public record upon receipt bythe Supervisor of Elections 'It isa crime to kriowingysign more than one petition fora candidate.[Section 704.785FIonda Statutes] 'lfallrequestedinformationonthisformIsnotcompleted,theformwillnotbevalidasaCandidatePetitionForm. THIS COMPLETED FORM MUST BE I' the undersigned, a registered PROVIDED TO THE (Ple se print name as it ap arson your voter information card) CITY CLERK DURING voter in said state and county,petition to have the name of C� � � Sap G G� QUALIFYING placed on the General Election Ballot as a [checkicomplete box,as applicable] XNonpartisan 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD D 4' 0. e CI ti, County 56at� Zip Code ' Signature of Voter — Date Signed(MM/DD/YYVY) [t'o be-.. \ comple by Vot rJ Z) 2,Z . Rule 75-2045,FAC. ,N AUG 312021 (TY 01t WINTER SPRINGS � hitt OF THE CITY CLERKS 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 a crime to knowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes] 'TfalT.rle�uestedinformationonthis form isnotcompleted,theform will notbeva lid asaCandidatePetition Form. THIS COMPLETED Jt 0. � p� � �Nlg'—(- 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 �� ���s�t QUAUFYING placed on the General Election Ballot as a [check/complete box,as applicable] X� Nonpartisan N/q No party affiliation EK71 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 applicable) Date of Birth OR Voter Registration(Number Address (` r City County Se Zip Code Z 7 Signature of Voter Date Signed(MM/DD/YYYY) [To be completed by Voter) of 3 022 RUIe1S-2.045,FAC CAN D I DATE P ETITi O N FORM 47301-- 'A information on this form becomes public record upon receipt bythe Supervisor ofElections 'It is crime to kriowinglysign more than one petition fora candidate.[Section 704.785 Florida Statutes] -1f0requested information on this form is not completed,the form willnotbe validas 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 of �u�C QUALIFYING placed on the General Election Ballot as a[check/complete box,as applicable] �X 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DD I/ /? I v o 2.6 Myt Lem Lam, City county . Zip 3x2od,n Signature of VoterDate Signed(MM/DD/yYYY) [To be comple ed by Vo r] . 7'3 Rule 15-2045,FAC. AUG 3 12022 CIT(OF WINTER SP ING OFFICE OF THE CITY CLERK Y CAN DI DATE PETITION FORM 'All information on th/sform becomes a public record upon receipt by the Supervisor of Elections 'It is a crime to knowinglysign more than one petition fora candidate.[Section 704185 Florida Statutes] 'Ifallrequested information on this form is not completed,the form will not be valid asa candidate Petition Form. THIS COMPLETED 17 1 . ���� FORM MUST BE 0t Cf' the undersigned, a registered g 9 PROVIDED TO THE (Please print nam5ogs it appears on your voter information card) CITY CLERK DURING voter in said state and county,petition to have the name of �G �� �4 QUALIFYING placed on the General Election Ballot as a [check/complete box,as applicable] X 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 applicable) Date of Birth OR Voter Registration Number Address (MM/DDM'Y`() City County Fs—tate----1 Zip Code Signature of Voter Date Signed(MM/DD/1^" (To be completed by Voter) R ls-2.045,FACOor CANDIDATE PETITION FORM 'Allinform nthis form becomesapublicrecordupon receiptbytheSup ervisorofElection 'It lsa cri to kriow gysign more than one petition fora candidate.(Section 704.785FIorida Statutes) /fat/request infor io o r ompleted,the form wilinotbevalidasacandidate Petition Form, THIS COMPLETED C FORM MUST BE the undersigned, a registered PROVIDED TO THE ( lease prin name as i appears n your voter information card) / CITY CLERK DURING voter in said stat an ounty,p ition have the name of C' � rL2t LGC QUALIFYING placed on the General Election Ba as a[check/complete box,as appl)cable] XNonpartisan 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,Clrcult,Group,seat Number,if applicable) Date of Birth OR Voter Registration Number Address (MM/DDH" City44. Coun a ' ^ 1ZiP Code 1 '3 Al()g Signature of Voter Date Signed(MM/DDNYW) (To be completed byvoter) R / z z ule 15-2 �,F C. �c� AUG 31 2022 tNTY OF WINTER SPRINGS OF THE CITY CLERK CANDIDATE OM ri R FEE CF_:NVIE NONPARTISAN OFFICE AUG 2 9 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 El (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 G/�Y «�s�55i d�l•� , (Office) (District#) I am a qualified elector of k',� e.-/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): 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):[Notapplicable to write-in candidates.] y C 5— ��G /< Signature of Candidate Telephone Number Email Address 5'-� SLlrCriJ mcg/S �14�. /lii,/il�/ ski/elfin CG. Z71 Address City State ZIP Code STATE OF FLORIDA Signature of Notary Public COUNTY OF ��/►'��itf��� 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 Q �Or" Notary Public State of Florida Christian D Gowan this !��'day of 20 Z .. d My Commission GG 913234 Expires 09/15/2023 Personally Known ❑ Produced Identification 0 t � Type of Identification Produced: /)_�� Fr vtify1 G,e.2 rr DS-DE 302NP(Rev. 0812021) Rule 1S-2.0001, F.A.C. FORM 1 STATEMENT OF 2021 Please print or type your name,mailinglow: FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position be LAST NAME---7. T NAME--MIDDLE NAME: RECEOJ" MAILING ADDRESS: Sv 5 ��� ��•�s iGo .AUG 2 9 2022 i �� �(� `7 X ���'/�a/c CITY OF WINTER SPRINGS U- j"� rf' S ✓ U OFFICE OF THE.CITY CLERK CITY: ZIP: COUNTY: le,- NAME emsNAME OF AGENCY: NAME OF OFFICE OR POSITION HELD OR SOUGHT: CHECK ONLY IF E2 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 (mt check one): COMPARATIVE (PERCENTAGE)THRESHOLDS OR Ki 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 �/U-rola �/.��cu, St`�o✓ 54G�.��it� 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 M 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") 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 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 PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR 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. ❑ 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: 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 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.