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HomeMy WebLinkAboutCade Resnick - Seat Four - Qualifying DocumentsDS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C. M35(3 Ai r t'F E� APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. I OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): nitial Filing of Farm Re -filing to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code) 4z -z � / 4. Telephone 5. E -mail address (�) 69'7 -�`rs 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if ssr Z �. applicable: ❑ My intent is to run as a Write -In candidate. 8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a Write -In ❑ No Party Affiliation ❑ Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. N,, ame of Treasurer or Deputy Treasurer r�b'�4i�C�_ 11. Mailing Address 12. Telephone 13. City 14. County 15. State 16, Zip Cade 17. E -mail address re C c Ccr�� 18. I have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address "5 z- Al d /mil / 9 z 21. City 22. County 23. State 24. Zip Code br-e. r:� -Y7 C9C•� / �t -'- .•�-rr [-. C% /C ��G %C�ra 7 � �s�! UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE, 25. Date 26. Signature of Candidate _.._. 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1, 5 hC� �,o do hereby accept the appointment (Please Print or Type Name) designated above as: Er Campaign Treasurer ❑ Deputy Treasurer. Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C. STATEMENT OF �s1�J11!7:i (Section 106.023, F.S.) (Please print or type) candidate for the office of have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X_��_� Signature of Candidate Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (05111) CIE r Teri c CITY OF WINTER SPRINGS, FL( IDA 2014 GENERAL MUNICIPAL ELECTION � � E ; M_' R 11E D z u n�rn9i9 1- AFFIDAVIT OFACCEPTANCE Yv l �4 }age 1 of3 MAYOR -CITY COMMISSION SEAT TWO /SE�FOUI C'irc €c Which Appiics "Co C:and cfacy i c "e' NOTE: The information provided to you in this packet, and the documents listed on this sheet, are provided to you to assist you in your campaign for Elective Office, however, the documents in this packet of materials are not intended to be a complete digest of the Elections Laws. IT IS YOUR RESPONSIBILITY TO READ AND UNDERSTAND THE ELECTION CODE AND COMPLY WITH ALL APPLICABLE REQUIREMENTS. The Applicant accepting this document and the attachments, and the Municipal Elections Official /City Clerk /Designee providing these documents, should each initial by each item (in each block) as reviewed: Date /Time Review Began Date /Time Review Concluded Paper Version Qualifying Documents: (The documents in this section are due to the City Clerk/Designee no later than 12:00 Noon on the last day of Qualifying - Friday, August 29, 2014) S /., ijti A "Appointment Of Campaign Treasurer And Designation Of Campaign Depository For Candidates" [DS -DE 9] F/1- f lq Jp "Statement Of Candidate" [DS -DE 84] WT—e I - "Affidavit Of Acceptance" (Must be completedAigned in front of the City Clerk/Designee). i 1 f6 2 - "Affidavit Of City Residency And Qualified Voter Status" (Must be completed /signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). �f 3 - "Affidavit Of Residency - District" (If Applicable) (Must be completed /signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). ,, g I-4 TO 4 - "Application For Office" (With Check drawn from Campaign Account or "Notice. of Undue Burden ") ,y f� S - "Election Assessment" (With Check drawn from Campaign Account or "Notice of Undue Burden. ") 6 - "Oath Of Candidate" (Must he completed/signed in front of the City Clerk /Designee DURING THE QUALIFYING PERIOD). tf F111 301 7- "Loyalty Oath" (Must be completed /signed in fi-ont qf the City Clerk /Designee DURING THE QUALIFYING PERIOD). v//P' $f 11 s 8 - "Notice Of Testing Of Tabulating Equipment" �y Rif 9 - "Notice Of Political Campaign Advertisements /Signage" 10 - "Schedule Of Campaign Finance Reporting Periods/Due Dates" e �y i>1 0 11 - "Notice Of Access To Campaign Finance Forms" �y y Et 12 - Petition g �p� Fa 50 "Notice to Federal Government Employees" (VApplicable) �y 01 56 "Form 1" -"Statement Of Financial Interests 2013" Revised 8/12/2014 �'�`•�T� A CITY OF WINTER SPRINGS, FL[ IDA c - _ 2014 GENERAL MUNICIPAL ELECTION a`' 1- AFFIDA VIT OF ACCEPTANCE Page 2 or 3 i��rno:a�.a .S4 r qtL�. e, r I h �Gbb 1�1 'OaE State of Florida - Information: 441 GLo � ty sb (A Compilation of) "The Election Laws of the State of Florida" - August 2013 9/0 q "Candidate and Campaign Treasurer Handbook" - November 2013 (Which includes Chapter 12 "Political Advertising" and Chapter 13 "Other Disclaimers ") 6 y 4 t4 "2014 Public Campaign Financing Handbook" g y "� ik SPi "Electioneering Communications Organization Handbook" (April 2014) rq 5t� "State of Florida Election Information/Contacts" State of Florida - Division of Elections Campaign Finance Information: �• Q IG "Contributions Returned" [DS -DE 2] [Florida Statutes 106.07 (4)(c)] ilA Sn Receipts Envelope Electronic Filing Information: ? ij 4 Letter from the Winter Springs City Clerk to "Candidates for Elected Office" (Re: Electronic Filing of Campaign Finance Reports) S&t j �`� "Online Treasurer Reporting System" [Guidelines for Campaign Finance Electronic Filing of Reports] from the Seminole County Supervisor of Elections Miscellaneous Information: Q (q ) "GUIDE to the SUNSHINE AMENDMENT and CODE of ETHICS for Public Officers and Employees" (2014) i "Foreign Nationals" - July 2003 "Statement of Ethical Campaign Practices" (from the Seminole County Supervisor of Elections) g I Ij 2014 "Voter Guide & Florida Voter Registration Application" (from the Seminole County Supervisor of Elections) Revised 8!1212014 o 11 I�comornr d � 1459 Mc�b WcIRVy "'CITY OF WINTER SPRINGS, FL( �DA 2014 GENERAL MUNICIPAL ELECTION RE V4' C E7 I �.S F I - AFFIDA VIT OF ACCEPTANCE Page 3 of 3 A (I r\f i i.l'4t =i 'C�.- �,"I V Ji: o� City Information: r4 Sb "Charter" of the City Of Winter Springs q'4q "Chapter 2 - Administration" from the City of Winter Springs Code of Ordinances ip 3 ij 5a City of Winter Springs Ordinance Number 2008 -16 (also noted in Chapter 2 of the City of Winter Springs' Code of Ordinances) Q it sty 5Q City of Winter Springs Ordinance Number 2009 -14 (also noted in Chapter 2 of the City of Winter Springs' Code of Ordinances) iT f 2014 General Municipal Election "Information" g ,y cjt 50 City of Winter Springs [November] 2013 District Map The following signature area is to be signed upon receiving the 2014 Election Qualifying packet, including the above referenced documents: 1, Z!5�' C-� 9 eSEr11 C- � have on this date received the forms and information, noted on these Name o. Canclidate (Pl(Nase i rlt:f Or'BTU) three (3) pages, in addition to any other Election materials that 1 may have previously received from the Office of the City Clerk for Winter Springs; and agree that I will read all of the Election packet materials that have been provided to me; and I also agree that it is my responsibility to comply with all Laws as they apply to the 2014 Election, Signature oi'Candidate Street Address / `city state Zin Cedc e�shl -/ -Z oz- , or 4r Date STATE OF FLORIDA �� €alp COUNT�'OF �PiYniAO�G _ Sworn to (or afftrtned) and subscribed, under penalties of pcduty, before me this t�� A UG, < � rrz.f i � �€ ;4 day of � 201._.1 by V- '�-- CAt�t T AE -�(L- t J: , -- {Print Name of Verson Making ,.�.a��t`- Statement)' �Trrvri r' -fa;; Notary Public - State of Florida Signatul Notary Public �LCAI1�i ) (SEAL) - - -- (Print Nante of Notary Public)` Produced OR Pe+sovtally x• a¢xP �n Notary Public State M F:Wda Idenrifcatio :t Known Sean Beaudet Arty Commission EE 206726 Type of Jde+atificatiat Produced Expires 0611012016 Revised 8/12/2014 k-44 ENTt�RS CITY OF WINTER SPRINGS, FLORIDA � ! 2014 GENERAL MUNICIPAL ELECTION r, JG AU - 2 - AFFIDA VIT OF CITY RESIDENCY AND u ` "` °ptgs QUALIFIED VOTER STATUS Cf, y 0 OFFICE b w TP MAYOR - CITY COMMISSION SEAT TWO /SEAT FOUR Circle Whch Applies io Caixtidacy "Eligibility. Only qualified voters of the city shall be eligible to hold the office of mayor or commissioner." "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall have resided in the city one (1) year prior to the time of qualifying. Each candidate seeking the office of city commissioner shall be a resident of a designated commission district established by ordinance and shall have resided in the designated commission district six (6) months prior to the time of qualifying." "All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk..." [4.01.(6) Charter, City of winter Springsl I. do hereby state that I seek election to the City of Winter Nai3te �tf Cmdidate (Please t'rifit or type} Springs`, Mayor - Cite Commission Seat Two i' :. eat - a four (4) year term, in the Election to be held Circle Which Ahhlics l o (,andidan in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. I, further swear or affirm: (1) 1 ani a qualified Voter of the City of Winter Springs 12.) My legal place of residence is: le 7Z.i; %v:, ��G ,• ( ,n -./,S i Slrect Addres� I Cif, - ..Stan '_ii) Code (.3) Lenath of time of residency in the City of Winter Springs is: (4) T am aitachina two (2) documents. one to be a Florida Driver's License, as verification of my residency in the City of Winter Spriggs. The second document is: - - l�'ZC> j ✓u. �ta CGrr d7e r Sl%& Address TCi[y sta� Lip Codc Date STATE OF FLORIDA COUNTY OF Sworn to (or affirmed) and subscribed, under penalties of perjury, before me this day of • 201/ by (Print Name of Person Making Statement) `,o` My ion E pf6912d Sp57574 Produced Identification Type of ldenlificafron Produced Notary Public - State of Florida {Print Name of Notary Public) OR Personally Known ✓� rt FOR OFFICE USE ONLY Copy Of Florida Driver's License P�ovided For Item. (4). Other Documentation Provided For Item (4). Revised 8/12/2014 - LL![ t� r�Rs CITY OF WINTER SPRINGS, FLORIDA 4; 7 4 ° 2014 GENERAL MUNICIPAL ELECTION 3 - AFFIDA VIT OF RESIDENCY - DISTRICT OF^FFFiCE OF T}-tE: C:i7"Y CLERK U 1— 1,6 CITY COMMISSION SEAT TWO 1 EAT FOUR C: ircic WIii li Appiic.v To Candidacy "Eligibility. Only qualified voters of the city shall be eligible to hold the office of mayor or commissioner." "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall have resided in the city one (l) year prior to the time of qualifying. Each candidate seeking the office of city commissioner shall be a resident of a designated commission district established by ordinance and shall have resided in the designated commission district six (6) months prior to the time of qualifying." "All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk..." [4.01. (b) Charter, City of Winter Springs] do hereby state that I seek election to the City of Winter Name of Can&dale (VlenSe Print or lype) Springs City Canxlltis5iol> peat Two Seat Ffillt' a four (4) year term, in the Election to be held Cirv1� Vdl;iclr tp, lies 'in C'altdicacy in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. I, further swear or affirm: (1) My legal place of residence is: 7� r-4 4pl- .� � � �� i Lc r d� /r r' .- � 5 Slreet rldeires5 Cis• Stateio Cuce (_2) Length of time of residency in the City of Winter Springs is: �,� �r. 14- (3) Length of time of residency in Winter Springs District is: (4) I am attaching two (2) documents, one to be a Florida Driver's License, as verification of my residence in. the City of W inter- Springs. The second document is:. A - fir" tii�*ttanire Street Address City / St�te Zip Code STATF. OF FLORIDA � e Date COUNTY OFD C Sworn to for afiinned) and subscribed, under penalties of perjury, before me this day of 20 I- , by l l (Print Name of Person Making Statement) Z't pea Notary public State of Florida fy y � i.orerrzo- Luace� My Commission EE087574 r'k ytd� Expires 0510912015 Identifieotion Type ofldentifcolion Produced Notary Public - State of Florida Name of Notary Public) OR Personally Known 4r k k 9c � k k 4r k eir k k * k ic k ** k k 3c k �r k ic k 9c k it k* k :F k 9e k k 9r it * k k* k� k k k 9r �F k k k k* 4r FOR OFFICE USE ONLY Copy Of Florida Driver's License Provided For Item (4). 0 l Other Documentation Provided For Item (4). Revised 7131/2014 <`1:T�SA CITY OF WINTER SPRINGS, FLORIDA a a 2414 GENERAL MUNICIPAL ELECTION OFF 1 ¢ ; 4 - APPLICA TION FOR OFFICE u v, e lncar, 1 3959 M��Y��u MAYOR - CITY COMMISSION SEAT T L'1'0/( SEAT FOUR Circle 1Vhtch Applies To Cllididacy All candidates for offices in municipal elections shall be registered and qualified electors of the city at the time of their qualifying as a candidate with the city clerk and shall file qualifying papers in accordance with state statutes and pay the qualifying fee and election assessment provided for in section 2-88. Such application shall be tiled and the qualifying fee paid daring regular business hours any time after 12:00 noon on the first filing date, which shall be seventy -one (71) calendar days prior to the municipal election, but not later than 12:00 noon on the sixty- seventh (67) calendar day prior to the municipal election. 14.01.(6) Charter, City of Winter Springs] [2 -87. Code of Ordinances, City of Winter Springs] "All candidates for city commission and mayor, qualifying as provided in this Code, shall pay a qualifying fee of one hundred fifty dollars ($150.00). The qualifying fee and the election assessment shall be paid to the city clerk and be paid by the clerk into the general fund of the city." [2 -88. (a) Code of Ordinances, City of Winter Springs] "Pursuant to F.S. 99.093 (2), candidates who are unable to pay the election assessment without imposing an undue burden on their personal resources or resources otherwise available to them shall upon written certification of such inability given under oath to The city clerk he exempted from paying the election assessment. Any candidate exempt from the election assessment shall also be exempt from the city's qualifying fee." 12-88. (b) Code of Ordinances, City of Winter Springs) I rur. ,�:�,- do hereby state that I am a registered and qualified Elector of the Name of Candidate (!'lease Print or typo - City of Winter Springs; and am applying for the Office of Mayor - City Commission Seat Two / .'eat Fotir Circle l %hioli Apphus I Candidacy -- a four (4) year term, in the Election to be held in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. 1 further agree to pay the following Qualifying Fee.. QUALIFYING FEE: $150.00 Signature of Candidate 3 ! Daly Document Signed :k 9r 3r N� * * *oY k�c* �9c9: �Y9e�ka'e k� k� kaY *oh k'.raY k3r * *9e�eeF��k��FoF x:EaFA'eF9e>tc�k *fie 9r�4e� FOR OFFICE USE ONLY Campaign Account Check in the amount of S 150.00 attached (Check should be made payable to the [� "City of Winter Springs ") or, if applicable LlCompleted "Notice of Undue Burden" Attached Revised 8/11/2014 CITY OF WINTER SPRINGS, FLORIDA p - - . r 2014 GENERAL MUNICIPAL ELECTION of c'or 5 - ELECHONASSESSMENT MAYOR - CITY COMMISSION SEAT TWO 1 SEAT FOLD Fart]! WliidiApplies 7i,) C233didaci "Each person seeking to qualify for nomination or election to a municipal office shall pay, at the time of qualifying for office, an election assessment. The election assessment shall be an amount equal to 1 percent of the annual salary of the office sought." [99.093 (1) Florida Statutes] "Any person seeking to qualify for nomination or election to a municipal office who is unable to pay the election assessment without imposing an undue burden on personal resources or on resources otherwise available to him or her shall, upon written certification of such inability given under oath to the qualifying officer, be exempt from paying the election assessment." 199.093 (2) Florida Statutes] I, e- S /—�, „ 5 7 :.,. k do hereby state that I am a registered and qualified Elector of the N2131c o� Candidatc (Picas Prim ur'1'vpe}'- City of Winter Springs; and am applying for the Office of Mayor - City Commission Seat Two I Seat I otn Oick: Which Applies To CandidacN - a four (4) year term, in the Election to be held in the City of Winter Springs, Florida, on Tuesday, November 4, 2414. I further agree to pay the following applicable Elections Assessment: ELECTION ASSESSMENT - MAYOR: $144.00 The Mayor Receives: $1,200.00 per month $1,200.00 x 12 months = $14,400.00 annually The 1% Assessment amounts to: $144.00 OR ELECTION ASSESSMENT - COMMISSIONER: $120.00 Each Commissioner Receives: $1,000.00 per month $1,000.00 x 12 months = $12,000.00 annually The I% Assessment amounts to: $120.00 Signature of Cmididat:. / Date Dacummi 5i2ned 9e sk 9e >�+F eE& 9c k k�'c �k *$c 9c keF k9r� k�F k�c� *9r�ar Je �F k4c �'c K * * * *�:?ac 3r d: *�>ti 9r de k * *a'r 9c ek 9c FOR OFFICE USE ONLY 1-1 For Office of Mayor - Campaign Account Check in the amount of $144.00 attached (Check should be made payable to the "City of Winter Springs ") or For Office of Commissioner - Campaign Account Check in the amount of $120.00 attached (Check should be made payable to the "City of Winter Springs ") or, 1 applicable Completed "Notice of Undue Burden" Attached Revised 7/31/2014 010's, CITY OF WINTER SPRINGS, FLORIDA L.-I 2014 GENERAL MUNICIPAL ELECTION CITY OF 6 - OATH OF CANDIDATE of l c W �Fr ` �' MAYOR - CITY COMMISSION SEAT TWO / EAT FOUR Circle Which Applies '1b ICandidary "Each candidate, whether a party candidate, a candidate with no party affiliation, or a write -in candidate, in order to qualify for nomination or election to any office other than a judicial office as defined in chapter 105 or a federal office, shall take and subscribe to an oath or affirmation in writing. A copy of the oath or affirmation shall be made available to the candidate by the officer before whom such candidate seeks to qualify and shall be substantially in the following form:" 199.021 (1) (a) 1. Florida Statutes] STATE OF FLORIDA COUNTY OF "Before me, an officer authorized to administer oaths, personally appeared to me well known, who, being sworn, says that he or she is a candidate for the office of Ni layor - City Commission Seat `Iwo I Seat ro€ r- that he or she is a qualified elector of Circle 1� 17ich Ap }lies 'fn Candidacy County, Florida; that he or she is qualified under the Constitution and the laws of Florida to hold the office to which he or she desires to be nominated or elected; that he or she has qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with that of the office he or she seeks; that he or she has resigned from any office from which he or she is required to resign pursuant to s. 99.012, Florida Statutes; and that he or she will support the Constitution of the United States and the Constitution of the State of Florida." / Sig,tu,enfCsndidace. Street Address •..----- . � iii,= � SLVtu r lip £_acre Swon1 to and subscribed before me this day of '!^,t 201 r at Seminole County, Florida. 1 itle of Officer Admimstenng Oath) Revised 8/12/2014 W - W-- :--- , ,44� k, L9 1, • u -. .` `STE p CITY OF WINTER SPRINGS, FLORIDA � A CITY O r r�'4ti_ = R 0 2014 GENERAL MUNICIPAL ELECTION OFFICE OF 4-i w C {�7a� er"%iYA's:a C=LF PK r- * `, 7 - LOYALTY OATH zsss "gab WE-C's� MAYOR -CITY COMMISSION SEAT TWO /SEAT FOUR Circle Which Applies 'To CandidacN "All persons who now or hereafter are employed by or who now or hereafter are on the payroll of the state, or any of its departments and agencies, subdivisions, counties, cities, school boards and districts of the free public school system of the state or counties, or institutions of higher learning, except candidates for federal office, are required to take an oath before any person duly authorized to take ackatowledgements of instruments for public record in the state in the following form:" 1876.05 (1) Florida Statutes ] "1,� G-s;�� • �. �c a citizen of the State of Florida and of the United States Na:�ic {P €ease I'si.�i or 7ype3 of America, and being employed by or an officer of Lr/, .. gnd a recipient of public funds as such employee or officer, do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida." Signs n:rc STATE OF FLORIDA (7OUNT)' OF S�reCt A(iCirCSS C;it} State ' Zip Cedc Sworn to (or affirmed) and subscribed, under penalties of perjury, before me this c day of, 20t4-"' R (Print Name df Person Making statement) Notary Public - State of Florida =off °a¢� Notary u a tats of Flo tla c Andrea I c o(4l�uacES NIy Commission EEos7574 (Print Name of Notary Public) or ti Expires 05109/2015 Produced ' ' ""' OR Pci-sonally Idenlificaiion Known Type ofldenlificalion Produced Revised 7/31/2014 S Oa WE YFyv t s -, 'p4 CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION OFFICE: OF THE cl ry 1--LERK 8 - NOTICE OF TESTING OF TABULATING EQUIPMENT MAYOR - CITY COMMISSION SEAT TWO /(SEAT FOUR Circle Which Applies To Candiflacp "On any day not more than 10 days prior to the commencement of early voting as provided in s. 101.657, the supervisor of elections shall have the automatic tabulating equipment publicly tested to ascertain that the equipment will correctly count the votes cast for all offices and on all measures. If the ballots to be used at the polling place on election day are not available at the time of the testing, the supervisor may conduct an additional test not more than 10 days before election day. Public notice of the time and place of the test shall be given at least 48 hours prior thereto by publication on the supervisor of elections' website and once in one or more newspapers of general circulation in the county or, if there is no newspaper of general circulation in the county, by posting the notice in at least four conspicuous places in the county. The supervisor or the municipal elections official may, at the time of qualifying, give written notice of the time and location of the public preelection test to each candidate qualifying with that office and obtain a signed receipt that the notice has been given." [101.5612 (2) Florida statutes] NOTICE Please accept this Notice that the tabulating equipment to be utilized in the City of Winter Springs, Florida's 2014 General Municipal Election will be tested on: The aforementioned test will be held at: THE OFFICE OF THE SUPERVISOR OF ELECTIONS FOR SEMINOLE COUNTY 1500 EAST AIRPORT BOULEVARD, SANFORD, FLORIDA (407) 585 -VOTE [8683] City of Winter Springs Municipal Elections Off cial /Designee RECEIPT e- je, -74 y /< do hereby acknowledge that on this Name of Caiidic}afe (Please Print or Iyx} date of 'r, Sr / 7 5 201 , I received written Notice (as noted above /on this form in the e highlighted block of the date, tune, and location related to the "Testing of Tabulating Equipment ". si! }na`aue o1 Candidate Date Document signer • •......_.___� Revised 7/31/2014 4 Sa 4 � ry9 [459, ��Ob weT�ug CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 9 - NOTICE OF POLITICAL CAMPAIGN ADVERTISEMENTS /SIGNS A �..',. t`. a 0A MAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies 1'o Candid;ic "The officer before whom a candidate qualifies for office shall notify the candidate, in writing, of the provisions in this section. 1106.1435 (4) Florida Statutes] NOTICE Please find the following documents /information /references related to Political Campaign Advertisements/ Signs in this Notice: Copies related to Political Campaign Advertisements /Signs attached: (1) Copy of Florida Statutes 106.1435 (2) Copy of City of Winter Springs Signage information (Chapter 16 from our Code of Ordinances) Information/References related to Political Campaign Advertisements /Signs: (3) "The Election Laws" - August 2013 [Chapters 97, 98, 99, 100, 101, 102, 103, 104, 105 and 106] (i.e. "Florida Election Code ") [Included in Qualifying packet] (4) "Candidate & Campaign Treasurer Handbook" - November 2013 (Which includes "Chapter 12: Political Advertising" and "Chapter 13: Other Disclaimers ") [Included in Qualifying Packet] ACKNOWLEDGEMENT I, c' c -,"L _T s c do hereby acknowledge that on this date Uaitie of Caiid idate (Please Pr:Etl or'lppe) of fs% } 201_4_, 1 received a copy of Florida Statutes 106.1435 and a copy of Chapter 16 from our Code of Ordinances, 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 below, I acknowledge that I will comply with all Laws related to Disclaimers as explained /noted in "The Election Laws" and the "Candidate & Campaign Treasurer Handbook ". signanue of CEUididai 1� 41 Date Dociamentsiyted FOR OFFICE USE ONLY Attachment: Copy of Florida Statutes 106.1435 Attachment. Chapter 16 from our Code of Ordinances Revised 7/31/2014 CITY OF WINTER SPRINGS, FLORIDA .F & `; °} 2014 GENERAL MUNICIPAL ELECTION CITY ur ' 10- SCHEDULE OF CAMPAIGN FINANCE c`-F1cf:. 1959 REPORTING PERIODSIDUE DATES 5� GOO wa sa`> MAYOR - CITY COMMISSION SEAT TWO /SEAT FOUR Circle Which App ies "i'o Catid (lacy "The filing officer shall pro0de each candidate with a schedule designating the beginning and end of reporting periods as well as the corresponding designated due dates." [106.07 (1) (e) Florida Statutes J "Any candidate or political committee failing to file a report on the designated due date is subject to a fine..." 1106.07 (8) (a) Florida Statutes ] SCHEDULE DURING /AFTER QUALIFYING *, THE FOLLOWING CAMPAIGN FINANCE REPORTS ARE DUE: Report Due Date: September 10, 2014 - shall contain information regarding all previously unreported contributions and expenditures from August 1, 2014 - August 31, 2014 Report Due Date: October 10, 2014 - shall contain information regarding all previously unreported contributions and expenditures from September 1, 2014 - September 30, 2014 Report Due Date: October 24, 2014 - shall contain information regarding all previously unreported contributions and expenditures from October 1, 2014 - October 17, 2014 Report Due Date: October 31, 2014 - shall contain information regarding all previously unreported contributions and expenditures from October 18, 2014 - October 30, 2014 A Final Report shall be filed 90 days after the General Election - on or before February 2, 2015. - shall contain information regarding all previously unreported contributions and expenditures from October 31, 2014 - February 2, 2015 *For Unopposed Candidates Report Due Date: November 28, 2014 - shall contain information regarding all previously unreported contributions and expenditures from September 1, 2014 - November 28, 2014 ACKNOWLEDGEMENT I, t ,517,, do hereby acknowledge that on this Name of Candidate (.Please I'mil or Tgpe1 date of d 201 1 received a written "Schedule Of Campaign Finance Reporting Periods/Due Dates" (as noted above /on this form). .pate 1)0�tinlcin signed Signature of Candidate Revised 8/12/2014 CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 11- NOTICE OF A CCESS TO CAMPAIGN FINANCE FORMS ineoriora[eC agse MAYOR - CITY COMMISSION SEAT TWO SEAT FOUR Circle tivliich Arplics TO Caiutitlaey NOTICE Please note that Campaign Finance fortes are available at the following State of Florida Website address: http: / /e€ection. dos ,state.fl.us /forms /index.shtm€ #can ._ _ 00 a through the Seminole County Supervisor of Elections Office when using their "Online Treasurer Reporting System "/may be requested from the City of Winter Springs' Municipal Elections Official /City Clerk/Designee. ACKNOWLEDGEMENT ?''c z � do hereby acknowledge that on this date Name of Candidate ❑'Eease Prim or fyj,6. of 5` 201 , with my signature below, I acknowledge that I understand that I am to comply with the provisions in Ordinance 2014 -11; and in addition, I acknowledge that I have received this Notice that Campaign Finance forms can be accessed at the above noted State of Florida Website; and I also understand that State of Florida Campaign Finance forms are accessible through the Seminole County Supervisor of Elections Office when using their "Online Treasurer Reporting System" and understand that State of Florida Campaign Finance forms can also be requested from the City Clerk/Designeefor the City of Winter Springs. Signature Df Candidate % e, Date Document Sigced �r 9r �F k iF 9c k 3c sF k it � �r 9c 9r * 9r �F k 9r do eF �H eY 4r �'e 9r �'e k 3r �r 9e �Y �F zF �F * eF �k � 9t 4e 9e 4t * is is � it 9c k 9r sF dt eY �Y ,a FOR OFFICE 113E ONLY 5 Attachment: Ordinance 2014 -11 Revised 8/11/2014 u 9 u, h,corPOrntcd wVr'L,•ab wE-fRVi CI'i i( OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 12 — PETITION CITY fj;= VV1ea;_ r tF'.!;t �F+r;!fti�r CS OF FICE Of THE CITY CLERK MAYOR - CITY COMMISSION SEAT TWO / S=FOUR t'irc!e Which Applies i o C:uididac% "Each candidate seeking the office of city commissioner or mayor or any other elective office of the city shall file a petition signed by fifteen (15) registered voters of the city with the city clerk." t2 -87. Code of Ordinances, City of Winter Springs) I,r ts���, do hereby state that I seek nomination to the City of Wintcr Nance 0 1'Caadidate ( Please 111-1 In m Tsae) Springs', Mayor - City Commission Seat Two r' Seat Tout=`- a four (4) year term, in the Election to be held t: irelc Sera Which Al +])lies To Candidacy in the City of Winter Springs, Florida, on Tuesday, November 4, 201.4. I, further state that- 1 1 ) %j 4y legal place of residence is: i l � �c.�. - C T !e. rte .— -::� '• S. �. x ' Street Address (14" Sale Zia Codc 12 j I.,c lagth c7i'ti�1 e of residence in tlac: City of Winter Spnngs: • S <� 5 'A ;3) Citl, 01'Winter Springs Registered. Vote:: Yes �� No /Slnaa!urcai'C;�t }dilate ,_, - - - - -- ff /l[r:t:^,1 fKldris� IIy S ate Zit, C'ocl We, the undersigned qualified Electors, residing in the City of Winter Springs, Florida, nominate: s ;T for the City of Winter Springs' ., NaIne nQ:andidare (Please Print nrTypt)....,. - Mayor - City Commission Seat 'l'w o i �e�tt Enid Circle! Scar Whlel; Applies];) k-- ,odidar, f Please Print or Type Name) Signature Street Address CAN, slam (Please Print orT}-pe Narue) Signature Revised 8/11/2014 Dat Pehc� t Est Signed County. Zip Code Voter Registration Number OR Bate 01' 13011 Dale Pefilion Signed County (ICl Street Address City State Zip Code Voter Registration Number OR pate Of Birth CI ;t i OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 12 - PETITION `) t„co —15d 1 ti Gar) w -'Ox NAME OF1 C.ANDIDA E: i E Xef7l e -IL Namr ctl'C.- andidace (Please i'mil nr'I ype) (3) i� Gr�� pis'' Z,- {Please Print or Type Name) sTgnatttrc u • 4/'4 / 14, Street Address City Stale (4) D SY1'rt_� (Please Print or Type Natne) Sign, Lire 41(Q [:b&ocAl a Street Address City asc (s) (Please Print or Type Name) Signaturc Hat �-W t, n- Street Address cq State (6) (Please Print or Type Num SignVur Li Street Address City State iP €ease Print or Type N se) Sgt atur 44 �q djC7��L, 11��' Street Address City 11 Slate ( Ptease Print or Type Narne) -,y R / Street Address (9) ok Y) '(C)�? & r (Please Print or Type NatneI 31 '1-4 V c,n � Street Address Revised 8/11)2014 CITY 0= OFFICE OF- THE CI-y CLL =tiK Page 2 of S da . w ; --,s- ""/, 1)4c Petj on Sig ed County Zip Code Voter Registration N tuber 6R Date Of Binh D c Peti on Sighed County T?©� Zip Code Voter Registratiot Number dR Date Of Birth 42J 14 1 "&, ( e� D e Petilon Si ned Connry �..r.t Zip Code Voter Rcgistrati u N nbcr DR Date Of Birth Date Petition Signed County Zip Code Voter Registration Number OR Date Of Bir h 14 ` & /r); 0 <jie Dat Petition fined County 3 "1 7a 1) v S (2f t -7S Zip Codc Voter Registration Nuirker OR Date Of Birth ,w t Signature { Date Petit(un S gncd C'oun Mo city State Zip C�dc Voter Regisiration Nunibef OR Sate Of Birtlt rte..... Si( e e Yet €tin Signe County �/lIA-7j 11,4f -& -3,?-7/)'�- City State Zip Code Voter Registration Number OR Sate Of Birth .ls °t<tT'trh' 4 sA S c� L) i�isa 0 yC'dt] WL-'rRJS Ch Y OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 12 - PETITION N,MNIF OF CANDIDATE- T�s�� Nam ol'Carcdi,iaw {Please Prun m'ivuei ( Please Print or Type Name) Signature z43! 4larboc UJu �& Ct Street Address City SCaie (Please Print or Type Name) ��-- Street Address (Please Print Or l'ype Name) Stmct Address f (1 3) CP 5-c�— t fOti (15) (Please Print or Type Name) S[met Address Signature City State Ci-fY ul'= — NJ''ii r;k S "t:;NWtA OFFICE OF THE. CITY CLEFIK Page 3 of 5 Sep-m an v 1� Data Petition Signed County Zip Code Voter Registration Number OR Data Of Uirtb 3a76 151? Pz Date Petition Signed Connty � a n - -)� s I s-r3 Zip Code Voter Registr lion wetter OR Date Of Birth Signature ate Petition Signed County City It Stile Zip Code Voter Registra on Nu lxr OR Date Of Birth Signature Date Petition Signed County r FE ? �t�� �z City State ,,/ Zip Code Voter Registration Number OR Date Oftl3inh (Please Print or Type Name) ignature Dathelilitfit Signed County. JF Street A dress City t% State Zip Cade Voter Registration Amber OR Date Of f3irth {Please Print or Type Name) County erect Address C'it,• Late Zip Code Voter Registration Number OR Date Or Birth. (16)10 S 1� (Please Prim or Type Name) C'1!e,kf Street Address Revised 8/11/2014 /60W ; Signature City Slate r j Le'. - Da e Petition Signed County 32? or 11: 1.- rgy V - Zip Code Voter Registration Number OR Date Of Birth `�,t�>~ sA C1 Y OF WINTER SPRINGS, FLORIDA .s o -- 2014 GENERAL MUNICIPAL ELECTION x 12 - PETITION CITY ..,� OFFICE O 'Tt- Q C: "fY'GLEJ"Aa w 1nSOrpor4r d 1959 A. NANIF ID) CANDI1.3ATE: 3 h•r —� Page 4 of 5 Name of Candidate (Plcaec Pr {m of Type) (17) Ta mp-[,a Z5 zo y wa (Please Print or Type Name) Signature Dale Petition Signed County _ kv' b \ j s ovt A t v� S fV FL 32 0 8 W S 1 Strc t :address City State Zip Code Voter Regis tr ion quinber OR Date Of Birth (18) /7 j�j- r .v (Please tin= or Type >4airte) Signature Da€e Pelit n Signed Cot ty Street Address City State Zip Code Voter Regisi ation Nut er OR Date of Birth i t s (Please Print or Type Name) ignatute Daic Petition Signed County St'*JAddmss City 7 tate yip Code Voter Registration umber OR Data Of Birth (20) (21) (22) (23) (Please Prim or Type Same) Street Address (Please Print or'lype Name) Street ,Address (Please Print or Type Narne) Signature Da €e Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth City Signature Date Petition Signed Count} State Zip Code Voter Registration Number OR Date Of Birth Signature Date Petition Signed County Street Address Cit}• State Zip Code Voter Registration Number OR Date Of Birth (Please Print or'fvpc Name) Revised 8/1 U2014 Signature Date PCtiticm Signed County Street Address City State Zip Lode Voter Registration Number OR Date Of Birth FORM 1 STATEMENT OF 2013 Please print or type your name, FINANCIAL INTERESTS address, agency name, and F0ftVn6E1U§ff ONLY' I LAST NAME — FIRST NAME — MIDDLE NAME : 01 It AUG2 6 2' MAILING ADDRESS : SPRINGS OFFICE DF. Hf- Ct rY CLERK , 3 C_ CITY: ZIP: COUNTY: zz !:A I C-41 NAME 01F A e' NAME OFFICE OR POSITION HELD OR SOUGHT: You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CA) CHECK ONLY IF ❑ CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE BOTH PARTS OF THIS SECTION MUST BE COMPLETED DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must c eck one): DECEMBER 31, 2013 OR Q SPECIFY TAX YEAR IF OTHER THAN THE CALENDARYEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES; WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING, ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS. PART A --PRIMARY SOURCES OF INCOME [Major sources of income to the reporting.person> See instructions] (if you have nothing to report, write "none" or "n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME' ADDRESS PRINCIPAL BUSINESS ACTIVITY e zg- ze- S Cam` —TEA e- SS, W PART IS — SECONDARY SOURCES OF INCOME ,[Major Customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (if you have nothing to report, write "none" or "nia") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or 'Wa") FILING INSTRUCTIONS for when and where to file this form are. located at the bottom of page 2. INSTRUCTIONS on who must file this form arLd how to fill It out begin on page 3. CE FORM I - EffecNe: January 1, 2014. (Continued on reverse side) PAGE I Adopted by reference in Rule 34-8-202(1), FAC, PART D —t - TANGIBLE PERSONAL PRC TY (Stocks, bonds, certificates of deposit, etc. - SE Aructions] (if you have nothing to report, write "none" or "nla ") BUSINESS ENTITY TO WHICH THE TYPE OF INTANGIBLE /� A blve- QFFtCE OF THE. C €"f"l' C: L. RK PART E -- LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "nia ") NAME OF CREDITOR ADDRESS OF CREDITOR Ale /y,,=7 PART F -- INTERESTS .IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or "nla ") BUSINESS I =NTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WIIIJ ENTITY I OWN MORE THAN A 5 %.INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Q SIGNATURE re uired : DATE SIGNED (required):_ If a certified public accountant licensed under Chapter 473, or attorney in good standing with th6 Florida Bar, prepared this farm for you, he or she must complete the following statement: 1, , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. Signature Date FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, including If you were mailed the form by the Commission Initially, each local officer /employee, state officer, signing and It, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within _dating sheet (pages 1 and 2) for fling. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers /employees file with the who must be confirmed by the Senate must file section, you must write "none" or "nia" in that Supervisor of Elections of the county in which they prior to conf€rmabon, even if that is less than section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment. reside in Florida, file with the Supervisor of the Candidates for publicly- elected local office must NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY: State officers or specified state employees papers. Generally, a person who has filed Form 1 for a file with the Commission on Ethics, P.O. Drawer Thereafter, local officers /employees, state calendar or fiscal year is not required to file a 15709, Tallahassee, FL 32317 -5709; physical officers, and specified state employees are required second Form 1 for the same year. However, a address: 325 ,john Knox Road, Building E, Suite r required to file by July 1st following each calendar candidate who previously filed Form 1 because 200, Tallahassee, FL 32303. year in which they hold their positions. of another public position must at least file a copy C of his or her original Form 1 when qualifying. Candidates file this form together with their Finally, at the end of office or employment, each qualifying papers. local officer /employee, state officer, and specified To determine what category your position falls state employee is required to file a final disclosure under, see the "Who Must File" Instructions on form (Form 1F) within 60 days of leaving office or page 3. employment. However, filing a CE Form IF (Final Statement of Financial Interests) does not relieve Facsimiles will not be aCCjltBd. the filer of filing a CE Form 1 if he or she was in their position on December 31, 2013. CE FORM 1 - Effective: January 1, 2014, Adopted by reference in Rule 34- 8202 (1), F.A.C.