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HomeMy WebLinkAboutCaruso, Mark Qualifying Packet 2024 08 26NAME: CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL MUNICIPAL ELECTION AFFI DAVI T O FACCEPTANCE CITY COMMISSION: DISTRICT ONE/ DISTRICTTHREE DISTRICT FIVE Circle which applies to candidacy Ka .Y XL �- dt-h� s Date &Time Review Started 2ro / Zo 2 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 IS YOUR RESPONSIBILITYTO READAND 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 this section are due to the City Clerk/Designee no later than 12:00 p.m. on the last day of Qualifying which is Friday, August 30, 2024, 1* 2 5 Accepted: "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") "Notice of Testing Tabulating Equipment" "Notice of Political Campaign Advertisements/Signs" "Schedule of Campaign Finance Reporting Periods/Due Dates" "Notice of Access to Campaign Finance Forms" "Candidate Petition" *Candidate Oath [DS-DE302P] "Notice to Federal Government Employees (If applicable) "Form 1" - Statement of Financial Interest 2023 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" i State of Florida Election Information Contacts Accepted: AUG 2 6 2024 Advertising Revised 06/10/2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK NNTkR S CITY OF WINTER SPRINGS, FLORIDA A o� p 2020 GENERAL MUNICIPAL ELECTION FORM 0 J _ y 1959 y% AFFIDAVIT OF ACCEPTANCE THIS COMPLETED wttCITY COMMISSION: DISTRICT ONE/ DISTRICT THRE DISTRICT FIVE FORM MUST BE PROVIDED TO THE Circle which applies to candidacy CITY CLERK DURING QUALIFYING NAM E: �,,. �` S o Page 2 of 2 CAMPAIGN FINANCE/ELECTRONIC FILING INFORMATION "Contributions Returned" [DS-DE-2] Accepted: 5 _. CITY OF WINTER SPRINGS INFORMATION City of Winter Springs 2022 District Map Accepted: MISCELLANEOUS INFORMATION � "Foreign nationals" - from the Federal Election Commission lle Legal References for Qualifying Documents Accepted: NOTE: The Candidate SHOULD NOT close out 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 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 the Election Qualifying packet materials that have been provided to s as they apply to the 2024 Election. � Signature State ofFlorida Countyof S�M/w/tl�.f+ Sworn to (or affirmed) and subscribed before me by means of ( / physical presence or ( ) online notarization) his by 2Co 1 % day of & , n, 3 �}— %' C6--r l� cc 4 V to Personally known' Personally known: (Print name of person making statement) Revised O6/10/2024 Dare ?' ,2024 me; OR Provided identification: �_ Notary Public State of Florida l Christian D Gowan My Commission HH 433379 llll Expires 911512027 of Winter Springs' City Commission: CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL M U N ICI PAL ELECTION AFFIDAVITOFQUALIVII- VOTERSTATUSAND CITYAND DISTRICT RESIDENCY CITYCOMMISSION: DISTRICT ONE/ DISTRICT THR DISTRICT FIVE Circle which applies to candidacy I, I/V C< V' LC ( Ca V&j t J do hereby state that I seek election to the City Name of Candidate (Print or Type) District One/ District Thre District Five Circle which applies to c t acy FORM I THIS COMPLETED FORM MUST BE PROVIDEDTOTHE CITY CLERK DURING QUALIFYING for a four (4) year term in the election to be held in the City of Winter Springs, Florida on Tuesday, November 5, 2024. I further swear or affirm: (1.) I am a qualified voter in the City of Winter Springs (2.) My legal place of residence is: C' ) Length of time of residency in the City of Winter Springs is: City State Zip l� V e a rS _ r (4.) Length of time of residency in Winter Springs District: �� is i?/l CJ h (5.) 1 am attaching two (2) documents, one to be a Florida Driver's License, as verification of my residency in the City of Wint Springs. The second document is: Signature Date //O� %�^% yr ore L+ "c e n S e Typeofldentificationpraduced FOR OFFICE USE ONLY opy of Florida Driver's License provided for Item (5) AO G,JA lees Other documentation provided for Item (5) Notary Pubilc State of Florida Christian D Gowan IIII My Commission HH 433379 Expires 9/15/2027 , 2024 OR Produced Identification "� AUG 2 6 2024 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK Revised O6/10/2024 C� NJ t ■ Florida DRIVER , -7tJ?a12-1 � ,eewm, cL REPdACFD •6 rtf to ww SO°ieiybMjj UPS --_ _-� ��I L- _ CtYI��'7 Charges Breakdown Water Base Water Usage Water Tax Sewer Base Sewer Usage Stormwater Base Solid Waste Base City of Winter Springs Utility Billing Monday -Friday 8-5 1126 E State Road 434 Phone: 407-327-5996 Fax: 407-3274753 cityhallinfo@winterspringsfl.org www,winterspringsfl.org Emergency: 407-327-2669 rrent IUlonth $7.88 $9,50 $1,74 $16,13 $32.70 $5,50 $22,81 TOTAL CURRENT CHARGES $96.26 rNVIIN11111111 k 11111 is r6tTITaITA P41 allas 111114ya Is "News You Can Use" v Water Conservation Is Important! Please help save water by referring to the reverse side of this bill for Irrigation Restrictions. SummaVL of Payments and Charges DUE Account Number 17829=002 Service Address Past Due Charges $0.00 Penalties $0,00 Adjustments $0.00 Payments-$96.67 Current Charges $96,26 08/20/2024 TOTAL DUE $96.26 MONTHLY WATER USAGE (in gallons) 24080 16053 0027 0 o�,s ot4` oya oya o,�p oyd oyodya Meter Reading Information From To Days Meter Previous Current Usage 06/11/2024 07/11/2024 30 74242449 1785790 1790980 5190 ions (Use Account Number 17829-002) See back for more! Self -Pay by QR Code Scan the code above Self -Pay by Website eservices.winterspringsfl,org Online Bank Pay See your bank's website Call Center 407-327-5996 Please detach and return the bottom portion with your payment. (Make Checks Payable to City of Winter Springs) ------- ----------- F126949F CITY OF WINTER SPRINGS UTILITY BILLING 1126 E STATE ROAD 434 WINTER SPRINGS FL 32708-2715 "•"'"'*"'AUTO"5-DIGIT 32708 Ilnllillllu,.nlI I IilIlIlllillIlllllnI InInlii„i,lll.11�llll MARK CARUSO 6 1054 of Payments and Charges DUE Account Number 17829-002 Service Address 1054 Due Charges $0000 Current Charges $96,26 08/20/2024 TOTAL DUE $96.26 CITY OF WINTER SPRINGS UTILITY BILLING 1126 E STATE ROAD 434 WINTER SPRINGS FL 32708-2715 Ilnl„L.illll,unnlsil,lln,Ilrlli,ili,llil'il�lliliillll,i, 000000000000],7829002000000096265 Mark Caruso Political Campaign PAYTOTHE ORDEROF Memo yow % C Fifth Third Bank OOJ 63-993/631 Date y 'L X O- a 'DOLLARS P AV ------------- �: Mark1054 Chokecheary Dnbeaign PAY TO THE ORDER OF- /0ti , /�ri� �✓� �= PAYMENT DATE 08/28/2024 COLLECTION STATION UB Mid Ofc 2 (FI-CH-UB-5-W7) RECEIVED FROM MARK CARUSO DESCRIPTION QUALIFYING FEE Payments: pity of Winter Springs 1126 E. State Road 434 Winter Springs, FL 32708 Type Detail Amount heck Total Cash Total Check Total Charge Total Wire Total Other Total Remitted Change Total Received Customer Copy Total Amount: BATCH NO. 2024-00005007 RECEIPT NO. 2024-00121861 CASHIER Vonette Rucker ENTRY DATE 08j27/2024 04:38:20 PM Printed by: Vonetta Rucker Page 1 of 1 08J27J2024 04:38:21 PM PAYMENT DATE 08128/2024 COLLECTION STATION UB Mid Ofc 2 (FI-CH-UB-5 W7) RECEIVED FROM MARK CARUSO DESCRIPTION ELECTION AGREEMENT Payments: City of Winter Springs 1126 E. State Road 434 Winter Springs, FL 32708 Type Detail Amount heck Total Cash Total Check Total Charge Total Wire Total Other Total Remitted Change Total Received Customer Copy Total Amount: BATCH NO. 2024-00005008 RECEIPT NO. 2024-00121862 CASHIER Vonette Rucker ENTRY DATE 08/27/2024 04:41:44 PM Printed by: Vonetta Rucker Page 1 of 1 08j27j2024 04:41:44 PM CITY OF WINTER SPRINGS, FLORIDA 2024 G EN ERAL MUNICIPAL ELECTION APPLICATION FOR OFFICE AND ELECTION ASSESSMENT CITY COMMISSION: DISTRICT ONE/ DISTRICT THREE DISTRI T FIV Circle which applies to candidacy FORM 2 THISCOMPLETED FORM MUST BE PROVIDEDTOTHE CITYCLERKDURING QUALIFYING I, VV� C`'r I--C�V'"o S �7 do hereby state that I am a registered and qualified Elector of the Name of Candidate (Print or Type) City of W inter Springs; and I am applying for the Office of City Commission: District one/ District Thr / DistrieS for a four (4) year term, in the Election to be held Circle which applies tocan e in the City of Winter Springs, Florida on Tuesday, November 5, 2024. 1 further agree to paythe following Qualifying Fee AND applicable Election Assessment QUALIFYING FEE: $150.00 AND THE BELOW ELECTION ASSESSMENT ELECTION ASSESSMENT - COMMISSIONER: $120.00 Each Commissioner receives: $1,000.00 per month $1000.00 x 12 months = $12,000.00 annually The 1% Assessment a mou nts to: $120.00 NOTE: "Any person seeking to qualifyfor nomination or election to a municipal office who is unable to 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 Date FOR OFFICE USE ONLY APPLICATION FEE: Campaign Account Check in the amount of $150.00 attached (Check should be made payable to the City of Winter Springs) Check # 603 A/ND���7 1%ASSESSMENT -Commissioner: Campaign Account Check in the amount of $120.00 attached OR Mayor: Campaign Account Check in the amount of $144.00 attached (Check should be made payable to the City of Winter Springs) Check # Q () y OR, IFAPPLICABLE Completed Notice of Undue Burden" Attached Revised O6/10/2024 CITY OF WINTER SPRINGS, FLORIDA 2024GENERALMUN ICI PAL ELECTION NOTICF. OF TESTING OF TABULATING EQUIPMENT CITYCOMMISSION: DISTRICT ONE/ DISTRICT THRE /LDIST CT FIV Circle which applies to candidacy NOTICE FORM 3 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Please accept this notice that the tabulating equipment to be utilized in the City of W inter 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: TH E 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 AUG 2 6 2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Revised 06/10/2024 �irE s CIIYOFWINTER SPRINGS, FLORIDA NoD X 2024GENERAL MUNICIPAL ELECTION 11,Ca��sd APPLICATIONFOROFFICE HCO \ AND ELECTIONASSESSMENT \� WETN CITYCOMMISSION: DISTRICT ONE/ DISTRICT THREE/ ISTR CT FIVE Circle which applies to candidacy FORM 4 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING Please find thefollowing documents/information/references related to Political CampaignAdvertisementsgns 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"-(Whichincludesinformationfrom "Chapter12: Political Advertising" and "Chapter13:Other Disclaimers") [Included in Qualifying Packet] ACKNOWLEDGMENT do hereby acknowledge on this date of of Candidate (Print or Type) �-d:-4&-4),K024with 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 FOR OFFICE USE ONLY Attachment: Copy of Florida Statutes 106.1435 Date AUG 2 6 2014 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Revised O6/10/2024 CITY OF WINTER SPRINGS, FLORIDA 2024 GENERAL MUN ICIPAL ELECTION APPLICATION FOROFFICE AND ELECTION ASSESSMENT CITYCOMMISSION: DISTRICT ONE/ DISTRICT THREE/ DISTRIC FIVE Circle which applies to candidacy SCHEDULE DURING/AFTER QUALIFYING, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE: FORM 5 THISCOMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING 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 orbefore February3, 2025 -shall contain information regarding all previously unreported contributions and expenditures from November 1, 2024 - February 3, 202S ACKNOWLEDGMENT I, �R.,�r-� L CP/�,SJ do hereby acknowledge that on this date of Name ot Candidate Print or Type U` — Z Z. (% 2024 with my signature below that I received a written "Schedule of Campaigry�inance Ring Periods/Due Dates" (as noted above on this form). cr signature Date AUG 2 6 2024 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK Revised 06/]0/2024 r 4 CITYOFWINTERSPRINGS,FLORIDA 2024GENERALMUNICIPAL ELECTION tica� i;s ; NOTICE OFACCESS TO \tea WEj�, CAMPAIGN FINANCE FORMS CITY COMMISSION: DISTRICT ONE/ DISTRICT THREE/ IST 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." Name of Candidate not or Ty ` ,Co 1 Z`� ACKNOWLEDGMENT do hereby acknowledge that on this date of 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 Date AUG 2 6 2024 C17Y OF \n�NTER SPRINGS OFFIQF OF THE CITY CLERK Revised 06/l0/2024 CANDIDATE PETITION �� � A '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 all requested information on this form is not completed, the form will not be valid as a Candidate Petition I, Saeo�a'k Baker 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 1A r k dg (y o 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 Nu (MIA/DID" A � City Signature of Voter n.0 Rule 15-2:04s, F.A.0 F County roup, f / `V ' i`0 6'iorl ` ✓� CANDIDATE PETITION S[a[e Date Signed (MM/DD/Yl^!Y', [To be completed by Voter] 'All information on this form becomes a public record upon receipt by the Supervisor of 'It is a crime to Knowingly sign more than one petition for o candidate. (Section 104.185 Florida StotutesJ ' If all requested information on this form is not completed, the form will not be valid as a Candidate Petition Form. balk 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 /v( �i✓ /�GV U j0 placed on the General Election Ballot as a [check/complete box, as applicable] Code /DY 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 (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/DDA^M) City Signature of Voter gGle 75-2.045, F.A.0 SzJ�r�tv(c county State ZIp Code Date Signed (MM/DD/YYVY [To be completed by Voter] AUG 2 6 2024 Revised O6/10/2024 CITY OF \MNTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION FORM `All information ant form becomes o public record upon receipt by the Supervisor of Elections *It Is a crime to knowinglysign more than one petition for a candidate. [Section 704.78S Florida Statutes] 'ifall requested informationonthis form isnot completed, the form will not be valid as a Candidate Petition THIS COMPLETED .0�a ;"� A 1 n r FORM MUST BE I, E=%kINNJI -km� 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 r G /Ru ra 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 Date of Birth OR (M M/DD" City 7 15-2.045, F.A.C. Registration Number ress County S6L oLE Seat Number, if CANDIDATE PETITION State Zip Code L/� , 1 1:2 S Date Signed (MM/DD/WYY [To be completed by Voter] 'All information on this form becomes a public record upon receipt by the Supervisor ofElections 'Itls a crime to knowinglysign more than one petition for o candidate. (Section 704.185 Florida StotutesJ Ifoll requested information on this form is not completed, the form will not be volid as o Candidate Petition Form. (Please print name as It appears on your voter Information card) the undersigned, a registered FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING voter in said state and county, petition to have the name of 1 1 1�1 Y"140,QUALIFYING placed on the General Election Ballot as a [check/complete box, as applicable] Nonpartisan N/q No party affiliation FT71 Not Applicable Party Candidate for the Office of City of Winter Springs -City Commission District Five art the'tltle of Office and Include District, Circuit, Group. Seat Number, If )ate of Birth OR Voter Registration Number Address MM/DD/YYYY) �dct ;ity County � 1 � State Zlp Code 15-2.045, F.A.C. Date Signed (MM/DD/YWY) [To be complated by Voter] �sIaU�� AUG 2 6 2024 Revised O6/10/2024 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION •All information on this form becomes o 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} '!fall requested information on this form is not completed, the form will not be valid as a Candidate Petition ji ff SS e ! 1 / I ( the undersigned, a registered (Please print name as It appears on your vo er 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 Ctr�i QC< rL1S0 FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING 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) of Birth OR Voter Registration Number f Z `-f c> J1 c a4�L L � City County State .Zip Code 70 Signature of Voter Date Signed (MM/DD/YYYY) [To be completed by Voter] c� Its I CANDIDATE PETITION FORM 'All information on this form becomes a public record upon receipt by the Supervisor of Elections Olt is a crime to knowingly sign 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, THIS COMPLETED t FORM MUST BE it P b e.l< C N ` (J � the undersigned, a registered PROVIDED TO THE (Please print name as It appears on your voter lnfckmation card) CITY CLERK DURING voter in said state and county, petition to have the name of CL (\`� ccfi� CA� Q 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 Voter Registration Number (MM/DD/YYW) I I o4Sl ��1 City rN Signature of Voter 15-2.045, F.A.C. and Include District, circuit, Group, Seat County Istate I Code 5o�e 3a70� Date Signed (MM/D D/WW) [To be compl ted by Vote ] O� 1 ail �aaa y Revised 06/10/2024 A�JG 2 6 2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK 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 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 1 6' V 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 l'rj v'U S-1 FORM / THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING IA j Nonpartisan N/A No party affliction 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 (MM/DD" City � i w, � r 4r � of Voter Rule 15-2.045, F.A.C. title of Office and include District, Circuit, Group, Seat Number, if Address County State t��) CANDIDATE PETITION Date Signed (MM/DD/YYW [To be completed by Voter] 'All i0formation on this form becomes a public record upon receipt by the Supervisor ofElections •It 1s a crime to knowinglysign more than one petition for a candidate. (Section 104.185 Florida StotutesJ 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 i[ appears on your voter information card) I /� voter in said state and county, petition to have the name of t/t�t. li 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 QUALI FYI NG 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 ((,, _ (MM/DDArYrW) Ct C Lo (� 1 _ County of Voter X1. Date Signed (MM/DD/WYYJ [To be completed by Voter] iCode Revised 06/10/2024 AUG 2 6 201G CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK ��... CANDIDATE PETITION 'All information on Lhis form becomes o public record upon receipt by the Supervisor of Elections • It is o 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 I� l�(1 c5rl �.t�l 15evt� 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 mavo Ik C 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 I —A 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 Date of Birth OR Voter (MWDD/Y" Sig n_atu� of Voter F.ac. on 135.�T�dewIInc�IS U Co�� 1 nO �e Stat Zia a, o Date Signed (MM/D D%YWY; [To be completed by Voteri i51a ��: 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 `1 t is a crime to knowinglysign more than one petition for o candidate. (Section 704.185 Florida Sta tutesJ If al/ 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) THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING voter in said state and county, petition to have the name of p,Y�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 Voter RE (M M/DD%WYY) [City City of Winter Springs -City Commission District Five art the title of Office and Include District, Circuit, Group, Seat Number, If a Number ( (Address �7LD I 1135 County State a� 15-2.045, F.A.C. AUG 2 6 2024 Date Signed (MM/DC [To be completed, by Revised 06/10/2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK ICAN PETITION FORM •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 all requested Information on this form is not completed, the form will not be volidas a Candidate Petition THIS COMPLETED Yl I ,/n I FORM MUST BE a�A 4 -1 .1Undersigned, a registered PROVIDED TO THE (Please print name as it appppears on your voter ,Inforrmatlon card) CITY CLERK DURING voter in said state and county, petition to have the name of ar O QUALIFYING placed on the General Election Ballot as a [check/complete box, as applicable] Nonpartisan N/A No party affiliation N/A 71 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 T�/�/� (MM/DD/YYYY) 150 iE itJ '� V- 4e\1%VNJ Cit y _ County State Zip Code 3 VK 3a�o�s Voter Date Signed (MM/DD/WW) [To be comp ted by Voter] Wlb Rule 15-2.045, F.A.C. ��� CANDIDATE PETITION FORM � *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 704.78S Florida Statutes] �lfoltregtr tedinformationontiy'sfefna not completed, the form will not be valid as a Candidate Petition Form, THIS COMPLETED FORM MUST BE I, (J Gl the undersigned, a registered PROVIDED TO THE (Please print name as it appears on your vofe Informatloncard) it 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 Five Date of Birth OR Voter Registration Number of Voter 15-2.045, Group, Seat Number, Tress AUG 2 6 2024 State Zip Code Date Signed (MM/DD/YY) [To be complete by Voter] W Revised O6/10/2024 , CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION 'All information on this form becomes a public record upon receipt by the Supervisor ofElections ' It is a crime to knowingly sign 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 the undersigned, a registered (Please print name a� 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 a 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 of Office a Date of Birth OR Voter Registration Number (M M/D DA" oy/03/i7y �iIr nr 'SQr A nature of Voter Rule 15-2.045, F.A.C. Group, Seat Nu Address l I�� rv�wov� �� � Count State . Zlp Code ,. �. � - CANDIDATE PETITION Date Signed (MM/DD/YWY) [To be completed by Voterj 'All information on this form becomes a public record upon receipt by the Supervisor ofElections 'It is crime to knowinglysign more than one petition fora candidate. [Section 104.785Florida 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 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 the undersigned, a registered Ca 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 (MM/DD/YYYY) o� / o a� Signature of Voter 4 400ZJ Y6 ry 15-2.045, F.A.C. e District, Circuit, Group, Seat Number, Address county State Zlp Code Date Signed (MM/DD/YYYY) [To be completed by Voter] Revised 06/10/2024 AI�G 2 6 202b 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 for a candidate. [Section 704.785 Florida Statutes] *If oil requestedinformotio thisfia is nc plete thef rm will not be valid as a Candidate Petition THIS COMPLETED 4 �� FORM MUST BE I, TH � the undersigned, a registered PROVIDED TO THE (Please print n r�re as it appears on your voter Information card) I CITY CLERK DURING voter in said state and county, petition to have the name of L Cc/4-Ir (A Lj Y QUALIFYING placed on the General Election Ballot as a [check/complete box, as ap licable] 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 (Please Insert the title of Office and Include District, Circuit, Group, Seat Number, if app Date of Birth OR Voter Registration Number Address (MM/DD/YYYY) 4vr City county \,,j \nttic zprjW -e m I, ija Rule of �.�%?,ij Sta C�rcj 0" Zip Code Date Signed (MM/DD/YYYI� [To be completed by Voter] ����� CANDIDATE PETITION "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 704,785 Florida Statutes] *If oil requested information on this form lsr4pt completed, the form will notbe valid as Candidate Petition Form. it the undersigned, a registered 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 asa [check/complete box, as app FORM 7 THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING 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 Date of Birth OR Voter Registration Number (MM/DDI o�j2�9 City of 15-2.045, of Office and Include District, Circuit, Group, Seat ui�i:l�.✓L�J St Zip Code Date Signed (MM/DD/YYYY [To be completed by Voter] Revised 06/10/2024 AUG 2 5 1024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION *Ali 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] `If all requested information on this form is not completed, the form will not be valid as a Candidate Petition I, � waa' `i L cam Ii1J S0%3 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 V1, ,4•jG t/LJ 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 (Please insert the title of Office and include District, Circuit, Group, Seat Number, if appllc Date of Birth OR Voter Registration Number Address (MM/DD%YYW) Code 3 Z /c)4d� Date Signed (MM/DD/YYYY) [To be completed by Voter] S- /y-Z •All information on this form becomes a public record upon receipt by the Supervisor of Elections *it lsa crime to knowinglysign more than onepetldon fora candidate. jSectfon 704.785Florida StotutesJ 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 I Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the Office of City of Winter Springs - City Commission District Five >ate of Birth OR Voter Registration Number MM/DD/ � tr Signature of Voter Rule 15-2.045, and include District, Circuit, Group, � county State ZIp Code Date Signed (MM/DDAYM) [To be co Tpleted by Voter) Revised 06/10/2024 AUG 2 6 2014 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK 9� 314 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) ' I f oll requested Information on this form is not completed, the form will not be valid as a candidate Petition s the undersigned, a registered (Please print name5s it appears on your voter Information card) voter in said state and county, petition to have the name of M cork L ry 50 placed on the General Election Ballot as a [check/complete box, as applicable] o FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING ANonpartisan N/q 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 (M M/DD/YYYY) U county Spl�i f� S611? / oca/ nature of Voter Rule 15-2.045, F.AC. Zip Code 3z Zarb Date Signed (MM/D D/YWYj (To be completed by Voter] �5 CANDIDATE PETITION 'All information on this form becomes a public record upon receipt by the Supervisor of Elections 'It is crime to knowinglysign more than one petition for a candidate. (Section 704.785 Florida Statutes) • If oil requested information on this form Is not completed, the form will not be valid as a Candidate Petition Form. I, / , r1 3 lo io I eye /icoaimjo the undersigned, a registered (Please print name al it appears on your voter Information card) � voter in said state and county, petition to have the name of �/1Q LwS � 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 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 t County State Zip Code � in rC✓ .� P,��n9� SG�i�a)c � �a d � iture of Voter Date Signed (MM/DD/YWY) [To be comple d by V er] 1S-2.045, FAC. Revised 06/10/2024 AIM 2 6 2024 CITY OF VNNTER SPRINGS OFFICE OF THE CITY CLERK 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 704.78S Florida Statutes] if all requested Information on this form is not completed, the form will not be valid as a Candidate Petition I ZOLULM3the undersigned, a registered (PI se print name as it appears on your voter Information card) voter in said state and county, petition to have the name of�`L \ iQjld placed on the General Election Ballot as a [check/complete box, as appli able] FORM / THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING 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 ,• (MM/DDD/YYY1�(' / n fyiw ltI /r�\ nl I,v1G$ 11 a ,weer 15-2.045, F.A.C. County State �S Sevritin� rL :�� CANDIDATE PETITION Zip Code 06 Date Signed (MM/DD/Yl'W; [To he completed by Voter] '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 704.785 Florida Statutes) ' If all requested information on this form Is not completed, the form will not be valid as a Candidate Petition Form. I, Cis o Je `/ Conway the undersigned, a registered (Please print name as it appears on your voter Information card) p/� i voter in said state and county, petition to have the name of r^ v S � 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 Applicable 'Party Candidate for the Office of City of Winter Springs - City Commission District Five Date of Birth OR Voter Registration Number (MM/DD/YYYY) v5/2`[/1g �`1 of Office and Include District, Circuit, Group, Seat l c�� z w ; �► countyC i Signature of Voter /� Rule 1S-2.045, F.AC. _� `> r y ,ira AUG 2 6 2014 i State Zip Cade 32��8 Date Signed (MM/DD/YWV) [To be completed by Voter] Revised 06/10/2024 CITY OF WINTER SPRINGS OFFICE_ OF THE CITY CLERK }� CANDIDATE PETITION •All information on this form becomes o public record upon receipt bythe Supervisor ofElections It is a crime to knowinglysign more than one petition for a candidate. [Section 704.785 Florida Statutes] `If jHtl equested 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 S� FORM / THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING 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) )ate of Birth h R Voter Registration Number Addresl ( Il ` n a� tj 6 u (0 r2 V 1 j MM/DD J Iv /04(/11,3 w 11Jj Sin 3 z 7� :ity County a Sate Zip Code Q lature f Voter Date Signed (MM/D D/YYYY) � (l'o be compl ted by Voter] (Rule 15-2.045, F.A.C. :� �'� 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 isa crime to knowinglysign more than one petition fora candidate. [Section 704,785Florida Statutes] If all requested information on this for 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 Ca, w so 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 Insert the -title of Office a Date of Birth OR Voter Registration (M M/D D/YYYY) `7 � a t, 114 -, ri of voter county Address roup, AUG 2 6 2024 e Signed (MM/DD/YY) be cam leted b Voter) W Revised 06/10/2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK CANDIDATE PETITION •All information on this form becomes o 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 a Candidate Petition undersigned, a registered 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 ap FORM THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING l A Nonpartisan N/A No party affiliation N/A Not Applicable Party Candidate for the office of City of Winter Springs - City Commission District Five and Include Date of Birth oR Voter (MM/DD/" County I n Signature of, Voter 15-2.045, Number, if applicable] State Date Signed (MM/DD/WYV; [To be completed by Voter] 4 CANDIDATE PETITION FORM � *All information on this form becomes a public record upon receipt bythe Supervisor of Elections wit Is crime to knowinglysign more than one petition fora candidate. [Section 704,785Florida Statutes] 'If all requested information on this form Is not completed the form will not be valid as a Candidate Petition Form. THIS COMPLETED I FORM MUST BE I, �� �•1 the undersigned, a registered PROVIDED TO THE M L `(Please p 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 �� yL s 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) Date of Birth OR Voter Registration Number Address (MM/DDIYIYY)'� lI / 5 Ln vour bp� City County I State IZIp Code nature of Vo r Date Signed (MM/DD/YWY) [To be completed by Voter] le 1S-2.0 . F./.C. N' �: t!m t \,•/ �+'_� �.Llil AUG 2 6 2024 Revised 06/10/2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLEftK CANDIDATE PETITION •All information on this form becomes o 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 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 / THIS COMPLETED FORM MUST BE PROVIDED TO THE CITY CLERK DURING QUALIFYING ANonpartisan 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 Date of Birth OR Voter Registration Num (MM/DD/YYYY) City county Signature of Voter s� le 15-2.045, F.A.C. ILO CANDIDATE PETITION State �'6. Date Signed (MM/DD/YYYY; (To be completed by Voter] 'All information on this farm becomes a public record upon receipt by the Supervisor ofElections 'It is crime to knowinglysign more than one petition fora candidate. (Section 704.785Florida StotutesJ ' If all regOVsted information on this form Is notcompleted, 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 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 (Please Insert the title of Office and Include District, Circuit, Group, Seat Number, if applicable) OR Voter Registration Number I (Address e 15-2.045, F.A.C, Sta� Date Signed (MM/DC [To be ca I ted by c Code Revised 06/10/2024 AUG 2 6 2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK :12l3"1� Al!� �Hl �O 3�Id�0 SJNIildS 21�1NIM d0 Ally h101 9 �. 9fid bZOZ/OI/90 Pastnag o'V'j 'S40'Z-SL alnti (MAA/p❑/W W) Ja;on }o a;n1eu61S aPoo diZ 1S d .J .� 141J ®� &T .-1 r✓� ;Unop i i J ssajppy aaquanN uojjejlsj6aa aa1oA 6C) LW18 Jo a;ea (algeo!!dde J! yagwnN;eaS'dno1p';Ino-0p']oli;sip apn!oul pue aol o a JLO J pP ay; Uasul aseald) avid 401JISIG U0iss1L.uwo3 43 - s6ulads AaquiM Jo }iD 40 aowo Gg1101 alepipueD filled ajgeoliddy ION y/i e N uoj1ej Ild fined ON b/N uesj}!eduoN Nlldllt/na 1'lJ' Lal9ea!laae se 'xoq alaidwoorioayo] e se 1opeg u0113ai3 1eaauag aqj uo paoeld J�,S � �.f vJ �o aweu aye aney o� uoi�i�ad '�C�unoo pue a�e�s pies ui ,la}on �NRina N2i31� h11� 3Hl Ol 43Q1/�Otid (Pleo uol;eWJo;ul;a;on fnoA uo s;eadde;l se oWeu;ulld aseald) paaa�si6aa e'paudislapun aye �j s:_ S, r,1 3e lsnw waod y (MAIdW00 SIHI'wiojuggl3adaIoplpupDosopllonaqlouLLLmWJoJa41 pa;aldwoolousLwJOJS/gluouopoWioJulpalsenbaillop. (saLnJoJg oplJoLjS9LP+r0L uggoaS] •ejoplpuoa ojoj uoµlJadauo voyJ avow u6is ij6uln�ouN o� awrn ps1 71 . suopoal34o aoslniednS a47 4q jd/aoaj uodn piooaj ollgnd o se woaaq wio/ sl4; uo uggowjojul llV, N OI 1113 d HVC] I a NbD ��NTER � `rA o�* Z CITY OF WINTER SPRINGS, FLORIDA Incorporated 1126 EAST STATE ROAD 434 • 1959 0 WINTER SPRINGS, FLORIDA32708-2799 coo WE'Vit A% TELEPHONE: (407) 327-6560 FACSIMILE: (407) 327-4753 WEBSITE: www,winterspringsfl.org August 28, 2024 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: • Mark Caruso 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: __ /i.ra?�.i•, (���-�^ Given to Seminole County Supervisor of Elections Office Representative on this date: Petitions provided: and time:. $.'bo 2a CANDIDATE OATH NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) AUG 2 6 1014 Check box only if you are seeking to qualify as a write-in candidate: CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Write-in candidate OFFICE USE ONLY Candidate Oath Name to appear on ballot: L "L OL r /C. C '�L , `s -0 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.) G'UlafYO ✓I/l-S f swear or affirm that I am a candidate for the nonpartisan office of 'o-Aot es 'r fl6h C fv� (Office) (District #) I am a qualified elector of Koot h -d L County, Florida (Circuit N (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, 1 Do NO, 1 Do Not l� If you do, you must also specify the amount owed and each entity that levied the same on the reverse side. Signature of Candidate Telephone Number Email Address n of Legal Residence f City State ZIP Code STATE OF FLORIDA COUNTY OF Sim/NOG F_ 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,® this 2G tk day of A Lxq tKa 20 2y Notary Public State of Florida Christian D Gowan ❑ ® Itll My Commission HH �3337s Personal) Known OR Produced Identification Expires 611612027 y Type of Identification Produced: It DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C. Phonetic Spellingo 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): wl l� r le� (,t coos o 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 Entity Affidavit of Nickname (Only required if using nickname for the ballot.) My legal name is VVXa �' �C- IN I am over the age of eighteen (18) and the contents of this affidavit are true and correct. My nickname is r'J �� 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 S5,C o plVaLe 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 X this Z! day of k 4 wS 20 2`/. of Florida, Notary Public :DGowan Personally Known ❑ OR Produced Identification Chommis My CopmmisH 433379Type Itll of Identification Produced: / �4) yr �tEx fires 027 DS-DE 302NP (Effm 10/2023) Rule 1S=2.0001, F.A.C. AUG 2 '7 2024 2023 Form 1 - Statement of Financial Interests General Information Name: Address: County: Organization N/A Mr Mark Anthony Caruso CANDIDATE FOR Position City, Town or Village (Commission or Council), Governing Board - Form 1 (Effective 6/10/2024) Disclosure Period Suborganization Agency Name Seminole County Supervisor or Elections CITY OF WINTER SPRINGS CITY CLERK Title Position sought or held Commissioner District 5 THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2023. Primary Sources of Income PRIMARY SOURCE OF INCOME (Over $2,500) (Major sources of income to the reporting person) (If you have nothing to report, write "none" or "n/a") Name of Source of Income Source's Address Description of the Source's Principal Business Activity Lawn Enforcement of Seminole 1054 Chokecherry Dr Landscaping Company Printed from the Florida EFDMS System Page 1 of 4 AUG 2 rl 2024 2023 Form 1 - Statement of Financial Interests CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Secondary Sources of Income SECONDARY SOURCES OF INCOME (Major customers, clients, and other sources of income to businesses owned by the reporting person) (If you have nothing to report, write "none" or "n/a") Name of Business EntityName of Major Sources of Address of Source Principal Business Business' Income Activity of Source N/A N/A N/A N/A Real Property REAL PROPERTY (Land, buildings owned by the reporting person) (If you have nothing to report, write "none" or "n/a") Location/Description N/A Printed from the Florida EFDMS System Page 2 of 4 2023 Form 1 - Statement of Financial Interests Intangible Personal Property INTANGIBLE PERSONAL PROPERTY (Stocks, bonds, certificates of deposit, etc. over $10,000) (If you have nothing to report, write "none" or "n/a") AUG 27 2024 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Type of Intangible Business Entity to Which the Property Relates Tesla Stock Disney Stock Paypal Stock SOFT Technoligies Stock Altamira Technoligies Stock BIOSIG Technoligies Stock IQSTEL Stock DEAR CASHMERE Stock KONTROL Technoligies Stock American Battery Materials Stock ALYI Stock Sports Quest Stock ICOA INC Stock Liabilities LIABILITIES (Major debts valued over $10,000): (If you have nothing to report, write "none" or "n/a") Name of Creditor N/A Addr ess of Creditor Printed from the Florida EFDMS System Page 3 of 4 2023 Form 1 - Statement of Financial Interests Interests in Specified Businesses INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions in certain types of businesses) If you have nothing to report, write "none" or "n/a") Business Entity # 1 N/A Signature of Filer Mark Anthony Caruso Digitally signed: 08/26/2024 AUG 2 '7 2024 CITY OF WINTER SPRINGS )FFICE OF THE CITY CLERK Printed from the Florida EFDMS System Page 4 of 4