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HomeMy WebLinkAboutElliott, Robert Qualifying Packet 2024 08 29NAME: CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL MUNICIPAL ELECTION AFFI DAVIT OFACCEPTANCE CITY COMMISSION: DISTRICT ONE/ DISTRICT THRE / DISTRICT FIVE Circle which applies to candidacy Date &Time Review Started ?:C�1 ZoZ FORM A THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Page 1 of 2 The following information is provided to you to assist in your campaign for Public Office; however, please note the documents in this packet of materials are not intended to be a complete digest of Florida's Election Laws, IT ISYOUR RESPONSIBILITY TO READ AND UNDERSTANDTHE ELECTION CODEAND COMPLY WITH ALL APPLICABLE REQUIREMENTS The applicant accepting this document and the attachments should 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, August 30, 2024. "Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates" [DS-DE 9] "Statement of Candidate" [DS-DE 84] * "Affidavit of Qualified Voter Status and City Residency" "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") i� "Notice of Testing Tabulating Equipment" �+ "Notice of Political Campaign Advertisements/Signs" "Schedule of Campaign Finance Reporting Periods/Due Dates" 6 "Notice of Access to Campaign Finance Forms" "Candidate Petition" * Candidate Oath [DS-DE 302P] "Notice to Federal Government Employees (If applicable) "Form V - Statement of Financial Interest 2023 Acce QUALIFYING DOCUMENTS WITH AN *ASTERISK MUST BE COMPLETED IN FRONT OF THE CITY CLERK/DESIGNEE DURING QUALIFYING STATE OF FLORIDA INFORMATION "The Florida Election Code, Chapter 97 -106, Florida Statutes (includes Chapter 106 which addresses Political and Disclaimers, etc. ®"Candidate and Campaign Treasurer Handbook" (2024) (Which includes "Chapter 12: Political Advertising" and "Chapter 13: Other Disclaimers" "Electioneering Communications Organization Handbook" State of Florida Election Information Contacts Accepted: A[IG 2 9 2024 Advertising CITY OF WINTER SPRINGS Revised 06/10/2024 OFFICE OF THE CITY CLERK ,\NTe�RS CITY OF WINTER SPRINGS, FLORIDA A p�—•—._ 2020 GENERAL MUNICIPAL ELECTION FORM F �z V y 19S9 w AFFIDAVIT OFACCEPTANCE THIS COMPLETED CITY COMMISSION: DISTRICT ONE/ DISTRICT THR / DISTRICT FIVE FORM MUST BE PROVIDED TO THE Circle which applies to candidacy CITY CLERK DUPING QUALIFYING NAME: Oti'J�t,/1� i� � LLIoTQ� Page2of2 CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION "Contributions Returned" [DS-DE-2] Accepted: , CITY OF WINTER SPRINGS INFORMATION City of Winter Springs 2022 District Map Accepted: MISCELLANEOUS INFORMATION "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 2024 Election Qualifying Packet, including the above referenced documents ' `01434-iL-t M . � L-L-) o 'f-T- have on this date received the forms and information Nome of Candidate (Print or Type) noted on these two (2) pages and agree that I will read all the Election Qualifying packet materials that have been provided to me; and understand that it is my responsibility to comply with all Laws as they apply to the 2024 Election. g%1aoa� Signature Date 995 tAAk�ch�trru, FL 3aWPM) o8 State of Florida Countyof S E /11 � No L E Sworn to (or affirmed) andsubscribed before me by means as physical presence or ( ) online notarization) this Zal �l day of 12024 by btrt L//l'af'P Personally known: OR Provided identification: (Print name ofperson making statement) FL !�Y'trr� L) Type of Identification produced Signature of Notary Public -State of Florida Revised O6/10/2024 Notary Public State of Florida � Christian D Gowan i� 111®My Commission HH 433379 Expires 9/15/2027 110IJG 2 9 ?0?4 CITY OF WINTER SPRINGS -I -HE CITY CLEia: CITY OF WINTER SPRINGS, FLORIDA 2024GENERAL MUNICIPAL ELECTION AFFI DAVIT OF Q UALI FI ED VOTER STATUSAND CITYAND DISTRICT RESIDENCY CITYCOMMISSION: DISTRICT ONE/ DISTRICTTHREE* DISTRICT FIVE Circle which applies to candidacy I, ����►z? M • Z� 1 T�i do hereby state that I seek election to the City Name of Candidate (Print or Type) FORM 1 THIS COMPLETED FORM MUST BE PROVIDEDTOTHE CITY CLERK DURING QUALIFYING of Winter Springs' City Commission: District One/ District Thre District Five 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 5, 2024. 1 further swear or affirm: I am a qualified voter in the City of Winter Springs My legal place of residence is: Length of time of residency in the City of Winter Springs is: Length of time of residency in Winter Springs District: 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: u -T^ I / , I jr�) r` / Signature C1,3kj'kKV,1) A C- , W )r,4-r�(- SPA State of Florida Countyof SrMitV0(,6 Sworn to (or affirmed) and subscribed before me by means of [f() physical presence or( ) online notarization This by Rohe►-� /� 1/ / 71Personally known: (Print name ofperson making statement) ft- )f,'�-�ers Lr�enrr Type ofldentifica[ion produced ,2024 Notary Public State of Florida Chrletlan p Qowan Commission HH 433379 Expires 9/16/2027 FOR OFFICE USE ONLY I /fZ� I Copy of Florida Driver's License provided for Item (5) / Other documentation provided for Item (S) V -La�I J T Date State OR Produced Identification Zip Code AUG 2 9 2024 Revised O6/10/2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK T CITY OF WINTER SPRINGS UTILITY BILLING MON-FRI M 1126 E STATE ROAD 434 PHONE: 407-327-5996 FAX:407-327-4753 UTILITYBILLS@WINTERSPRINGSFL.ORG W W W.WINTERSPRINGSFL.ORG/UB Charges Breakdown (Current Month) WATER BASE $788 WATER USAGE $5.62 WATER TAX $1.35 SEWER BASE $16.13' SEWER USAGE $19.34 STORMWATER BASE $5.50 SOLID WASTE BASE $2281' Scan this code to make a payment with your smartphone or tablet today! "News You Can Use" Ensure you stay informed - Sign up via the Winter Springs Everbridge Portal at https://www.winterspringsfl .org/alertwintersprings to receive emergency notification alerts. n Summary of Payments and Charges DUE ACCOUNT NUMBER 17651-001 SERVICE ADDRESS 925 CHOKECHERRY CT PAST DUE CHARGES $0.00 IMMEDIATELY PENALTIES $0.00 ADJUSTMENTS $0.00 PAYMENTS ($72.48) CURRENT CHARGES $78.63 9/17/2024 Meter Reading Information From To Days Meter # Previous Current Usage 7/11/2024 8/9/2024 29 37739969 253,960 257,030 31070 Payment Options (Use Account Number 17651-001) See back for more! Self -Pay by C1R Code Scan the code above Self -Pay by Website eservices.winterspringsfLorg Online Bank Pay See your bank's website Call Center 407-327-5996 N Please detach and return the bottom portion with your payment (Make Checks Payable to City of Winter Springs) .., 434 PHONE:0 FAX* 407w3274753 ROBERT ELLIOTT & SARAH ELLIOTT 925 CHOKECHERRY CT WINTER SPRINGS, FL 32708 d Ch Summary of Payments anarges DUE ACCOUNT NUMBER:. 17651-001 SERVICE ADDRESS 925 CHOKECHERRY CT PAST DUE CHARGES$0,00 IMMEDIATELY CURRENT CHARGES $78.63 9/17/2024 CITY OF WINTER SPRINGS UTILITY BILLING 1126 E STATE ROAD 434 WINTER SPRINGS, FL 32708-2715 CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL MUNICIPAL ELECTION APPLICATION FOR OFFICE AND ELECTION ASSESSMENT CITYCOMMISSION: DISTRICT ONE/ DISTRICT THREODISTRICTFIVE) Circle which applies to candidacy --- Name of Candidate (Print or Type) FORM Z THISCOMPLETED FORM MUST BE PROVIDEDTOTHE CITYCLERKDURING QUALIFYING do hereby state that I am a registered and qualified Elector of the City of Winter Springs; and I am applying for the Office of City Commission: District One/ District Three �istrict rive for a four (4) year term, in the Election to be held Circle which applies to candidacy in the City of Winter Springs, Florida on Tuesday, November 5, 2024. 1 further agree to pay the following Qualifying Fee AN D applicable Election Assessment QUALIFYING FEE: $150.00 AND THE BELOW ELECTION ASSESSMENT ELECTION ASSESSMENT - COMMISSIONER: $120.00 Each Commissioner receives: $1,000.00 per month $1000.00 x12 months = $12,000.00 annually The 1% Assessment amounts to: $120.00 NOTE: "Any person seeking to qualifyfor nomination orelection to a municipal officewho is unableto pay the election assessmentwithout 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), candidateswho are unableto paythe election assessmentwithoutimposing anundue 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. Signature 81a� la Date FOR OFFICE USE ONLY APPLICATION FEE: Campaign Account Check in the amount of $1S0.00 attached (Check should be made payable to the City of Winter Springs) Check # 0 9� A1%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) OR, IF APPLICABLE Completed "Notice of Undue Burden" Attached AUG 3 0 2024 Revised 06/10/2024 SPRINGS � CITY OF F THECITY CLERK �pFICE OF THE Pay to the Order of 3�loco L4 Date $ DI oo9s 63-993/631 S.ea.iry Fc�ta..c taps an 6cck, ' f FIFTH THIRD BANK t�-� - `�' �:0631099353272989n■ t 63-993/831 Date Its. It 'Orclero� (—�1��• if1 �Q 'l lu MT / SO •� /� ! F..la..c 111Y' Ili �•+.r{ / O O �� Dollars �1 � �W$ I... FIFTH_ THIRD BA21K AOP For CO63 109935I: 7443 27 298911' PAY ENT DATE 08/30/2024 COLLECTION STATION UB Mid Ofc 2 (FI-CH-UB-5-W7) RECEIVED FROM ROB ELLIOTT DESCRIPTION QUALIFYING FEE I;ity of Winter springs 1126 E. State Road 434 4Ninter Springs, FL 32708 uer7enc rayr Payments. I Type Detail Amounk Check !, Total Cash Total Check Total Charge Total Wire Total Other Total Remitted Change Total Received Customer Copy $150.00 #0.00 #0.00 $0.00�!, � WOO Sl5iTw Total Amount: BATCH N O. 2024-00005000 RECEIPT NO. 2024-00122595 CASHIER Vonetta Rucker ENTRY DATE 08f30/202410:53:13 AM Printed by: Vonetta Rucker Page 1 of 1 08j30J2024 10.53.14 AM PAYMENT DATE 08/30/2024 COLLECTION STATION UB Mid Ofc 2 (FI-CH-UB-5-W7) RECEIVED FROM ROB ELLIOTT DESCRIPTION ELECTION ASSESSMENT ity of Winter Springs 1126 E. State Road 434 1Ninter Springs, FL 32708 Payments= Type Detail a?4mount Check Total Cash Total Check Total Charge Total Wire Total Other Total Remitted Change Total Received Customer Copy $120.00 $0.00 $0.00 $0.00 — M $0.00 Total Amount= BATCH NO. 2024-00005066 RECEIPT NO. 2024-00122607 CASHIER Vonetta Rucker ENTRY DATE 08 30/202411:09:29 Alva Printed by_ Vonetta Rucker Page 1 of 1 08{30j2024 11:11=58 AM CITY OF W INTER SPRINGS, FLORIDA 2024 GEN ERAL MUNICIPAL ELECTION NOTICEOF TESTING OF TABULATING EQUIPMENT CITY COMMISSION: DISTRICT ONE/ DISTRICT THREE DISTRICT FIVE_ Circle which applies to candidacy NOTICE FORM 75 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Please accept this notice that the tabulati ng equ i pment to be utilized in the City of W i nter Springs, Florida's 2024 General Municipal Electionwill betestedon: DATE: Friday, October 11, 2024 TI M E: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) S85-VOTE [86831 City of Winter Springs Mun(cipal Elect(ons Offtclal/Designee AUG 2 9 7014 CITY OF WINTER SPRINGS OFFICE OF TF1E rITY CLERK Revised 06/10/2024 CITY OF W INTER SPRI NGS, FLORI DA 2 D24 G EN ERAL MUNICIPAL ELECTION APPLICATION FOR OFFICE AND ELECTIONASSESSMENT CITYCOMMISSION: DISTRICT ONE/ DISTRICT THRE q DISTRICT FIVE Circle which applies to candidacy FORM 4 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Pleasefind thefollowing documents/information/references related to Pocal Campaign Advertisements/Signs in this Notice: Copies related to Political campaign Advertisement/Signs attached: (1) Copy of Florida Statutes 106,1435: Information/References relatedto 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 includes information from "Chapter12: Political Advertising" and "Chapter13:Other Disclaimers") [Included in Qualifying Packet] ACKNOWLEDGMENT I, R�>sit, Q_7� rvl .t:� Lk / rr do hereby acknowledge on this date of Name of Candidate (Print or Type) !&.("l, )T- �%41. 2024with 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. AISO 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 tachment: Copy of Florida Statutes 106.1435 AUG 2 9 1024 CITY OFV:INTE' ^�(,_3� OFFICE OF THE CITY CLERK Revised O6/]0/2024 CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL MUNICIPAL ELECTION APPLICATION FOR OFFICE AND ELECTIONASSESSMENT CITY COMMISSION: DISTRICT ONE/ DISTRICT THREI ISTRICT FIVE Circle which applies to candidacy SCHEDULE DURING/AFTER QUALIFYING, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE: FORM S THISCOMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALI FYI N G Report Due Date: October 10, 2024 - shall contain information regarding all previously unreported contributions and expenditures from July1, 2024- September 30, 2024 Report Due Date: October 11, 2024 - shall contain information regarding all previously unreported contributions and expenditures from October 1, 2024 - October 4, 2024 Report Due Date: October25, 2024 - shall contain information regarding all previously unreported contributions and expenditures from October 5, 2024 - October 18, 2024 Report Due Date: No�mberl, 2024 - shall contain information regarding all previously unreported contributions and expenditures from October 19, 2024 - October 31, 2024. A Final Reportshall be filed 90 days after the General Election - on or before February3, 2025 -shall contain information regarding all previously unreported contributions and expenditures from November 1, 2024 - February 3, 2025 ACKNOWLEDGMENT I, %t p f3 �.rz.r M, � �-+-�/ o t v- do hereby acknowledge that on this date of Name of Candidate (Print or Type QLit, o 9 T t�" d k 2024 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 AUG 2 9 2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Revised 06/10/2024 CI I y OF WINTER SPRINGS, FLORIDA 2024GENERALMUNICI PAL ELECTION NOTICE OFACCESS TO 1959 /~C04 WETHVy.( CAMPAIGN FINANCE FORMS CITYCOMMISSION: DISTRICT0NE/ DISTRICTTHRE QRLST.RICT FIVE Circle which applies to candidacy NOTICE FORM 6 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Please note that Campaign Finance forms are available at the following State of Florida Website address: https://dos.myflorida.com/elections/forms-publications/forms/ through the Seminole County Supervisor of Elections Office when using their "Online Treasure Reporting System." ACKNOWLEDGMENT I, � o�� I�- �V1 � 1...,`-1 �v-Q- do hereby acknowledge that on this date of n Name of Candidate(Print or ype /4 u �U y 7— 2024 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 AUG 2 9 1014 -� OF WINTER SPRINGS THE CITY CLERK Date Revised O6/10/2024 CITY CANDIDATE PETITION OFFICOE F i l IE .. 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 for a candidate. [Section 704,185 Florida statutes] ' If all requested information on this form Is not completed, the form will not be valid as Candidate Petition THIS COMPLETED ( FORM MUST BE I, [,S the undersigned, a registered PROVIDED TO THE (Please pr(nt 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 �O 1 1 (3+1,.}_ QUALIFYING placed on the General Election Ballot as a [check/complete box, as applicable] I"J Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five (Please insert the title of office and include District, Circuit, Group. Seat' Number, if applicable) Date of Birth OR Voter ►aLv3 I ra ��-- County state Zip Code Semi no I0" L 3a be completed by Voter] Rule ls-2.045, FA.C. Fes` CAN D I DATE P ETITI O N *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 for a candidate, (Section 104.785 Florida Statutes] If all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form. the undersigned, a registered FORM '7 THIS COMPLETED FORM MUST BE PROVIDED TO THE (Please pr(nt name as it appears on your voter information card) CITY CLERK DURING voter in said state and county, petition to have the name of L 4;: 1' J , 3.4 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 Five Date of Birth OR (MM/DD/YYYI� Voter Rule 15-2.04s, FAC. Number County Seat Num sta� fro be completed by Voter] 3a�o Revised 06/10/2024 4!IG 2 9 2074 CITY OF \MNTER SP OFFICE OF THE CITY C LERK �7 f,` CAN DI DATE PETITI O N FORM 'All information on this form becomes a public record upon receipt bythe Supervisor of Elections ' It is a crime to knowinglysign more than one petition for a candidate. [Section 704.785 Florida Statutes] '[fall requested information on this formlsnot completed, the form will not be valid as a Candidate Petition THIS COMPLETED ((` FORM MUST BE I, ! l �Clifi'1 y�Tr$�l�l the undersigned, a registered PROVIDED TO THE (Please print name as it appears on y r voter information card) A CITY CLERK DURING voter in said state and county, petition to have the name of , 1 I aft QUALIFYING placed on the General Election Ballot as a [check/complete box, as applicable] L� Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five (MM/DDM'Y1� 03/3© nature of Voter le 15-2.045, FAC. 1 po 1 Gho County Semi no I�Q' CAN D I DATE P ETITI O N D%fV coo� Sty � r Date Signed (MM/DD/YYYY, [ro be completed by Voter) A S-'04 L ' 'All information on this form becomes a public record upon receipt by the Supervisor of Elections • I t is a crime to knowingly sign more than one petition for a candidate. (Section 104.185 Florida Statutes) 'If all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form. (Please print name as It appe�rs on your voter information card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as the undersigned, a registered ��lems6 5:.11 i aI' 3a FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the office of City of Winter Springs - City Commission District Five Voter Registration Number Old County Stat Zip Code Date Signed (MM/DD/YYYY; [To be completed by Voter] Rl��l ac 15.2.045, FAC. Revised 06/10/2024 y F,477 CAN D I DATE P ETITI O N CITY OF 1MNTER SP IPJGS FORM 'All information on this form becomes a public record upon receipt bythe5upervisor ofElections ' It Is a crime to knowinglysign more than one petition for a candidate. (Section 104.185 Florida Statutes) ' If all requested information on this form is not completed, the form will not be valid as a Candidate Petition (Please print name as it appears on your voter Information card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as the undersigned, a registered E11IOTT THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five (Please insert the title of Office and Include District, Circuit, Group, Seat Number, If applicable) (MM/DD/YYY1� C,G \(2)0 \ vexo I I �V� �Ch��eer�err-u County State S ern l YA a I �Q, IL, re of Voter FAC. '~' CANDIDATE PETITION Date Signed (MM/DD/WW; [ro be completed by Voter] 'All information on this form becomes a public record upon receipt by the Supervisor of Elections •/t is o crime to knowinglysign more than one petition for a candidate. (Section 104.785 Florida Statutes) 'If all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form. the undersigned, a registered (Please print name as it appears on your voter information card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five Date of Birth OR Voter Registration (MM/DD/WYI� Signature of Voter Rule 15-2045, FAgI and Include District, Circuit, Group, �2�1 Cho�echer�l County State SA ; do �Q Zip Code 3a'�o [To be completed by Voter] �11517� Revised 06/10/2024 f= n: CANDIDATE PETITION OFFICE OTI� ER So?' '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 104.185 Florida Statutes] If oil requested information on this form is not completed, ;he form will not be valid as Candidate Petition 1, f ��i�- 7"f-T;Gt/r r�/S 6GV the undersigned, a registered (Please print name as it appears on your voter information card) voter in said state and county, petition to have the name of 10b E , 1 0+t placed on the General Election Ballot as a [check/complete box, as applicable] FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five Date of Birth OR Voter Registration Number � Address ?r r 5pr10 of Voter FAC. Group, Seat County SP'MI no I�Q' '�� CAN D I DATE P ETITI O N State Zip Code Date Signed (MM/DD/yYW) (To be completed by Voter] "'All information on this form becomes a public record upon receipt by the Supervisor of Elections •1[ isa crime to knowinglysign more than one petition fora candidate. [Section 704.185E/orida Statutes] If all requested information on this form is not completed, the form will notbe valid as a Candidate Petition Form. I, en ran C pr] the undersigned, a registered (Please print name as it appears on your voter information card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING �'J�j c C� 1') ��"'I' QUALIFYING Nonpartisan N A No party affiliation N/A Not Applicable ,Party Candidate for the Office of City of Winter Springs - City Commission District Five the title of Office and include District, Circuit, Group, Date of Birth OR Voter Registration Numl (MM/DD/YYY1� county S•e �l �o I�. (Rule 15-2.045, FAC. Sta� Zip 3 Date Signed (MM/DD/YYVY) ITo be cam leted by Voter] Revised 06/10/2024 CANDIDATE PETITION CITY OF VNNTEF RN oFFlre OF r FORM / J '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 for a candidate. [Section 704,185 Florida Statutes] If all requested information on this forT is not corppleted, the form will not be valid as a Candidate Petition THIS COMPLETED 4 FORM MUST BE I, p/J�p Y T/�the undersigned, a registered PROVIDED TO THE (Please print name as it appe rs on your ote informatio ar ` {_ CITY CLERK DURING name voter in said state and county, petition to have the of �Q I I � I 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 Five (Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable) Date of Birth OR Voter Registration Number Address ( M M/D DA^M) County State Zip Code ature of V Date Signed (MM/DD/YYYY) [To be complet by Voter] Rule 15-2.045, F.A.C. `�( CAN D I DATE P ETITI O N FORM rI 'All information on this form becomes a public record upon receipt by the Supervisor of Elections '![ is a crime to knowingly sign more than one petition for a candidate. [Section 104.185 Florida Statutes] If all requested information on this form Is not completed, the form will not be valid as a Candidate Petition Form. 1, Z y n ..� ,ffi�L° _ �jo. rsigned, a registered (Please p nt name as It appears on your voter information card) V voter in said state and county, petition to have the name of l I ITT placed on the General Election Ballot as a [check/complete box, as applicable] THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs -City Commission District Five (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/" 9L57 yyZ' County S-Q nn 1 ✓1 O I Q. of Voter le 15-2rb�, F.A.C. Stale t- L Date Signed (MM/DD/YYYI'', [To be completed b y Voter] Code 3a�o Revised 06/10/2024 :-= CAN D I DATE P ETITI O N OFF COE OF WINTER Li�S. 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 104,785 Florida Statutes] *Ifaltrequested information on thisform ignotcompleted, the form will notbe validascr Candidate Petition THIS COMPLETED r�,�1•t R / /�� f— 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 �� I] I 1 I O+I}� 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 Five (Please insert the title of Office and include District, Circuit, Group, Seat Number, If applicable) to of Birth OR Voter Registration Number Address M/DD/YYYI'j o 3 j11 / l q '3 County State Zip Code Signature of Voter Date Signed (MM/DD%1'YYY) ` � [To be completed by V terj Rule 1S-2,045, FAC, ����� CANDIDATE PETITION ''All information on this form becomes a public record upon receipt bythe Supervisor ofElections It is a crime to knowinglysign more than one petition for a candidate. (Section 704.185 Florida Statutes] ' If all requested information on this form is not completed, the form will not be valid as a Candidate petition Form, I, 1Zrp,4 �IA0"� the undersigned, a registered FORM 7 THIS COMPLETED FORM MUST BE 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 5:�4 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 Date of Birth OR \ (MM/DD/YYYY)� City of Winter Springs -City Commission District Five art the title of Office and Include District, Circuit, Group, Seat Number, if Num City County Sta[ Zip Code ) /� f, i Yl� S ��2 � 1 ✓L O � Q. � � � � � Q Slg nature of Voter Rule IS-24S, FAC, Dale Signed M/DD/V/YY) [To be compl [e d by ter) Revised 06/10/2024 M -VE D ''' CANDIDATE PETITION CITYOF\MNTER OFFICE OF TF'F r: 'All information on this form becomes a public record upon receipt bythe Supervisor of Elections It is a crime to knowinglysign more than one petition for a candidate. [Section 104,785 Florida Statutes] If all requested information on this form is not completed, the form will not be valid as a Candidate Petition a� f (Please print name as it appears on your voter in rmation card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as the undersigned, a registered �IIIOTT N s FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five Group, Seat to of Birth OR Voter Registration Nun M/DD" 1 _ c'� County Ld of Voter I = Vd 15-2.0451 FAC. I. CAN D I DATE P ETITI O N State �L Zip Code 3a740'S be completed by Voter] 'All information on this form becomes a public record upon receipt bythe Supervisor ofElections *it is a crime to knowingly sign more than one petition for a candidate. (Section 104.185 Florida Statutes] If ail requested information on this not completed, the form will not be valid as a Candidate Petition Form. (Please print name as )t appears on your voter inforr/iation card) voter in said state and county, petition to have the name of placed on the General Election Ballot asa [check/complete box, as of Voter FAC. the undersigned, a registered h :.11 i a.4 FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N A No party affiliation N/A Not Applicable r Party Candidate for the Office of City of Winter Springs - City Commission District Five (Please insert the title of Office and include District, Circuit, Group, Seat Number, if applicable) Number County Stat Zip Code Date Signed (MM/DD/YYYY) [To be corn eted by Vot r] Revised 06/10/2024 !!� '�- I-fi is r CITY OFV� CANDIDATE PETITION NTER r'+--•�� S F2WGS OFFICE OF T� FORM rI uJ '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 for a candidate. [Section 104,785 Florida Statutes] If all requested information on this form is not completed, the form will not be valid as a Candidate Petition THIS COMPLETED "—' FORM MUST BE I, Q,� �� the undersigned, a registered PROVIDED TO THE e pP e^`� ) CITY CLERK DURING (Please print name as It a ears on you ter information card voter in said state and county, petition to have the name of Fw 6 , 1 1 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 Five of Birth OR Voter Registration � nor Voter Rule 75-2045, FAC. coSteml no I � [ELI r CANDIDATE PETITION Date Signed (MM/DD/WW', (To be completed by Voter] ' 'All information on this form becomes of public record upon receipt by the Supervisor of Elections `I[ isa crime to knowinglysign more than one petition for a candidate. (Section 104.185Florida Statutes) If all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form. the undersigned, a registered (Please print n$me as i[ appears on your voter Information card) voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as �a FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Applicable ,Party Candidate for the Office of City of Winter Springs - City Commission District Five Date of Birth OR Voter Registration Number I� County nature of Voter Rule 15-2.045, FAC. k w >� Code �Zp3a'�o Date Signed (MM/DD/YYYY) (To be completed by Voter] 7A Revised 06/10/2024 'It1. A1�G s z�' CANDIDATE PETITION ' FORM 7 t` M CITY OF \MNT=R .. ...- 'All information on this form becomes a public record upon receipt by the Supervisor ofElecWssICE OF t''- ' It is a crime to knowinglysign more than one petition for a 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 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 % I a+t QUALIFYING placed on the General Election Ballot as a [check/complete box, as applicable] Nonpartisan N/A No party affiliation N/A Not Appllcable Party Candidate for the Office of City of Winter Springs - City Commission District Five (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/"ll 1� S e�n�C Gi �Q�C�VJS r County State Zip Code nature of Voter 1 ' Date Signed (MM/DD/YYW) [To be completed by Voter] all0000, 9) Rule 15-2.045, FAC. t` CANDIDATE PETITION *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 all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form, I, A M O t r, L a,1 j a rh I ► 7 the undersigned, a registered � (Please print name as it appears on your voter information card) t voter in said state and county, petition to have the name of placed on the General Election Ballot as a [check/complete box, as applicable] FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Nonpartisan N/A No party affiliation N/A Not Appllcable 'Party Candidate for the Office of City of Winter Springs - City Commission District Five (Please insert the title of Office and include District, Circuit, Group, Seat Number, if ap Date of Birth OR Voter Registration Number Address }� (MM/DD/YYYY) 6�40 County nature (Rule 1S•2.045, FAC. S[at Zlp Cade Date Signed (MM/DD/YWY [To be completed by Voter] Revised 06/10/2024 CANDIDATE OATH NONPARTISAN OFFICE PF7 4 M 2 V a F) (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in 41.16 2 9 Z024 candidate: G)T" OF kaTWTIEFg SR III� s Write-in candidate OFFICE USE ONLY Candidate Oath Name to appear on ballot: Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.) Check box if name includes nickname. (For use of a nickname, you must complete the Nickname Affidavit on reverse side.) swear or affirm that I am a candidate for the nonpartisan office of W t ����' S r , ne (Officcce) (District #) y I am a qualified elector of2 m I (1'� I County, Florida (Circuit #) (Group or Seat #) I am a qualified elector 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. Statement of Outstanding Fines, Fees, or Penalties I owe outstanding fines, fees, or penalties, that cumulatively exceed $250, for ethics or campaign finance violations (s. 99.021(1)(d), F.S.). YES, I Do NO, I Do Not If you do, you must also specify the amount owed and each entity that levied the same on the reverse side. X (q07) 844A. 44G3 (2lli�N0w,t,�.us Signature of Candidate Telephone Number Email Address L f4k-kL\qrrC:}-_ la► ���� S �,r s Fz 3a�g Address of Legal Residence City State ZIP Code STATE OF FLORIDA COUNTY OF 5CM1&01, Signature of Notary Public 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,® - �qj� Notary Public State of Florida this � day of 20 2,if. AL Christian D Gowan IIII My Commission HH 433379 Personally Known ElOR Produced Identification Expires 9/t512027 Type of Identification Produced: ),f%V*eo Y Lt cPAfe DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C. onetic pe Ingo ame Phonetic spelling for the audio ballot (not required for qualifying purposes): Print the 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 3 of this form): Statement of Outstanding Fines, Fees or Penalties Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a write-in candidate, shall, at the time of subscribing to the oath or affirmation, state in writing whether he or she owes any outstanding fines, fees, or penalties that cumulatively exceed $250 for any violations of s. 8, Art. II of the State Constitution, the Code of Ethics for Public Officers and Employees under part III of chapter 112, any local ethics ordinance governing standards of conduct and disclosure requirements, or chapter 106. Amount Entit Affidavit of Nickname (Only required if using nickname for the ballot.) My legal name is �C t3�c 2T M . FLU oTj . I am over the age of eighteen (18) and the contents of this affidavit are true and correct. My nickname is � � 73 � t- �- t'O 1"'1- I am generally known by this nickname or have used it as part of my legal name. I have not created the nickname to mislead voters. My nickname does not imply I am some other person, constitute a political slogan or otherwise associate me with a cause or issue, or that is obscene or profane. Signature of Candidate: `' � STATE OF FLORIDA COUNTY OF �EMiNoLE Signa ure of Notary Public 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 Notary PubNc.State of Florida this Zq thday of - /�-uauS� , 20 2�i Christian D Gowan My Commission HH 433379 till Personally Known ❑ OR Produced Identification,] Expires 9/t5/2o27 Type of Identification Produced:_ f'L !?n`re-mot L,����Se DS-DE 302NP (Eff. 10/2023) AUG 2 9 1014 Rule 1S-2.0001, F.A.C. v �,NGS Ors=ICE OF I i .. � � .�'—'— •�. Ashley Lukis Chair Michelle Anchors Vice Chair Paul D. Bain Tina Descovich Freddie Figgers Luis M. Fuste Laird A. Lile Wengay M. Newton, Sr. State of Florida COMMISSION ON ETHICS P.O. Drawer 15709 Tallahassee, Florida 32317-5709 325 Sohn Knox Road Building E, Suite 200 Tallahassee, Florida 32303 "A Public Office is a Public Trust" VERIFICATION AND RECEIPT OF SUBMISSION TO THE ELECTRONIC FINANCIAL DISCLOSURE FILING SYSTEM Kerrie J. Stillman Executive Director Steven �. Zuilkowski Deputy Executive Director/ General Counsel (850) 488-7864 Phone (850) 488-3077 (FAX) www.ethics.state.H.us This Verification and Receipt of Submission acknowledges that the Commissions on Ethics received a submission through its electronic financial disclosure filing system. Filer Name: Mr Robert Miles Elliott Filer PID #: 287292 Date Filed: 4/29/2024 Disclosure Received: 2023 Full and Public Disclosure of Financial Interests Filing ID: 938542 Receipt Print Date: 8/29/2024 The foregoing is a true and accurate depiction of information contained in the electronic financial disclosure filing system held by the Florida Conunission on Ethics. This Verification and Receipt of Submission complies with Sections l 12.3144(4) and 112.3145(2)(c), Florida Statutes, aud, in accordance with those statutes, it may be presented to any qualifying officer by au incumbent in an elective office or any candidate holding another position subject to an annual filing requirement. This Verification and Receipt of Submission is not a certification that the form submitted is complete or that the information entered in the form by the filer is true or correct. This Verification and Receipt of Submission is system generated, is created automatically, aud its issuance does not indicate that the submission by the filer has been reviewed by Commission staff. To see the filer's disclosure, visit https://disclosure.floridaethics.gov/PublicSearch/Filings. For questions regarding this Verification and Receipt of Submission, please contact the Florida Conunission on Ethics at (850) 488-7864. j i_ A�JG 2 9 1014 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK 1/1 'ti�5� °p we-ca August 30, 2024 CITY OF WINTER SPRINGS, FLORIDA 1126 EAST STATE ROAD 434 WINTER SPRINGS, FLOPIDA32708-2799 TELEPHONE: (407) 327-6560 FACSIMILE: (407) 327-4753 WEBSITE: www.winterspringsfl.org The Honorable Chris Anderson Supervisor of Elections for Seminole County 1500 East Airport Boulevard Sanford, Florida 32773 Dear Mr. Anderson: Please find attached original Petition forms for the following individual who is interested in Qualifying for the City of Winter Springs, Florida 2024 General Municipal Election: • Rob Elliott "Fifteen (15) registered voters of the city" on the Petition are required for the City of Winter Springs, Florida 2024 General Municipal Election. Please contact me as soon as possible with the results from verifying the signatures on this Petition. Sincerely, Christian Gowan, MPA City Clerk ******************************************************************************************************** Hand carried by City of Winter Springs, Florida Representative: __��j��"__G6'`' ""'=_____ Given to Seminole County Supervisor of Elections Office Representative on this date: and time: ---1e Petitions provided: ___ �_7 � U � JS / � ND� ;SON SEMINOLE COUNTY SUPERVISOR OF ELECTIONS 1500 EAST AIRPORT BLVD, SANFORD, FL 32773 hIA�NGFFIGEPHGHE:407-585-VOTE (0003) I GENERAL FAX: 407-708-7705 The following candidate petitions: ROB ELLIOTT- WINTER SPRINGS COMMISSIONER DIST 5 Candidate Name Number of Petitions Office That have not been counted or verified were delivered to the Seminole County Supervisor of Elections office by: Candidate/Designee Printed Name Staff Signature VO1fESEMINOLE.ORG � �+©@VoteSeminole `�'s��,�.�`';;•,_.. Date Date ENSURING YOUR CHOICE COUNTS