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Charles Lacey - Mayor - Qualifying Documents
" X= r--1= I r41%V M JUL 3 1 2014 APPOINTMENT OF CAMPAIGN TREASURER CITY OF WINTER SPRINGS AND DESIGNATION OF CAMPAIGN OFFICE OF THE CITY CL-ERK DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYP ) NOTE: This form must be on file witt the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Q Initial Filing of Form 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 st,�r,,/eet, city, state, zip C.,ORIC-S T 1 L�I 1 -41 code) 733 �qv- C(2a �lFClto (JItit r ::! In 4. Telephone 15. E-mail address (`o ) SBA-171�{ CAL.ws®b, G-reom V� 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if /�,, AV- 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. Name of Treasurer or DeputyTreasurer -3. VI �6 kae ( ss 11. Mailing Address /�++ Uf to r eek �'t t 12. Telephone 13. City 14. County n0 e 15. State 16. Zip Code 370�' 17. E-mail address /%'6,o PA VAA, Caws 18. 1 have designated the following bank as my Primary Depository Secondary Depository 19. Name of Bank 20. Address 21. City lij/hAr w g 22. County 5ev,--4V_o(e 23. State Bonk 24. Zip Code 3 z`1v 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 d LtL`( 3 11 Z o l f X 27. Treasurer's of Appointment (fill in the blanks and check the ppropriate block) (Acceptance I, JAj do herebythe accept p appointment (Please Print or Type Name) designated above as: ® Campaign Treasurer Deputy Treasurer. ZO1 X --_ Date Signature of Campaign Treasurer or Deputy Treasurer Us -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. "., RECEIVED APPOINTMENT OF CAMPAIGN TREASURER JUL 3 1 2014 AND DESIGNATION OF CAMPAIGN CITY of ;v;,. ; L..R n 4;,,NGS DEPOSITORY FOR CANDIDATES OFFICE OF THC CITY CLERK (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. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: Fk] Treasurer/Deputy Depository 0 Office Ej Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip L 1e5 M L code) Cc-ee(C 6kc(t_ h)f4 r *1-951 FL 32`7D 4. Telephone 5. E-mail bddress ( qz)-� ) S 4 - -7%I 1 6L. ljs 9) 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if �qq, A11611 W I 4C S -{ applicable: My intent is to Write � run as a -In candidate. 8. If a candidate for a partisan office, the k block and fill in name of party as applicable: My intent is to run as a Ej U Write -In [j No Party Affiliation F] Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer 11. Mailing Address `7 33 P.,e.,�r CVt4, G°kc� 12. Telephone (�fo7) 2-7 . 13. City. 14. County 15. State 16. Zip Code 17. E-mail address W 14C 5r kv S�.„, �;c,, l� /-" _ 3 27 0 V e4 L, wS e v c! 6 r - c(i vk 18. 1 have designated the following bank as my ® Primary Depository Secondary Depository 19. Name of Bank 7,— _/b 20. Address �S l S�e �3l 21. City 22. County 23. State 24. Zip Code 4)1'*I' IIx 5 sc,,,.kb� 11z 3 17 c)g-' 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 'l J311�1� 26. Signature f Candidate X°o 27. , Treasurer's Acceptance of Appointment (fill in the blanks and check th ppropriate block) z I, d "��-�is 14 • Z A,�ry , do hereby accept the appointment (Please Print or Type Nam4) designated above as: Campaign Treasurer Deputy Treasurer. X e�tzle lu'afe Signat&rI6 of Campa gn Tre urer or Deputy Treasurer DS-DE 9 (Rev. 10/10) V Rule 1S-2.0001, F.A.C. RECEIVED OFFICE USE ONLY STATEMENT OF CITY OFFICEO�T IECITr "JERK CANDIDATE (Section 106.023, F.S.) (Please print or type) i, 6&(t-1,es Le-e candidate for the office of have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X 4 bignatu rrcandidate Ll j 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). T10 TT' OA /At/1 i TER O� S r ''ITY OF WINTER SPRINGS, FLQ A z014 GENERAL MUNICIPAL ELECTION , ' 1- AFFIDA VIT OF A CCEPTANCE Pagel of 3 •'~COD yyETRJ� . MAYOR CITY COMMISSION SEAT TWO /SEAT FOUR Circle Which Applies To Candidacy 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 material VMC 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 REQUIREMENTAUG 2 5 2014 The Applicant accepting this document and the attachments, and the Municipal Elections Official1Cit.)tjQ�wk1 5* NHS providing these documents, should each initial by each item (in each block) as reviewed: OFFICE OF THE Cory (-,LERK Date/Time Review Began Paper Version �4 Date/Time Review Concluded 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) J x¢ "Appointment Of Campaign Treasurer And Designation Of Campaign Depository For Candidates" [DS-DE 9] "Statement Of Candidate" [DS-DE 84] 1 - "Affidavit Of Acceptance" (Must be completed/signed in front of the City Clerk/Designee). 2 - "Affidavit Of City Residency And Qualified Voter Status" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 3 - "Affidavit Of Residency - District" (If Applicable) (Must be completed/signed in front of the City ClerklDesignee DURING THE QUALIFYING PERIOD). 4 - "Application For Office" (With Check drawn from Campaign Account or "Notice of Undue Burden") 5 - "Election Assessment" (With Check drawn from Campaign Account or "Notice of Undue Burden") 6 - "Oath Of Candidate" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 7- "Loyalty Oath" (Must be completed/signed in front of the City Clerk/Designee DURING THE QUALIFYING PERIOD). 8 - "Notice Of Testing Of Tabulating Equipment" 9 - "Notice Of Political Campaign Advertisements/Signage" 10 - "Schedule Of Campaign Finance Reporting Periods/Due Dates" 11 - "Notice Of Access To Campaign Finance Forms" 12 - Petition "Notice to Federal Government Employees" (If Applicable) "Form V - "Statement Of Financial Interests 2013" Revised 8/12/2014 �.�JtNTERSA ':ITY OF WINTER SPRINGS, FLA ° **2014 GENERAL MUNICIPAL ELE ION 1-AFFIDAVIT OF ACCEPTANCE R E C E ��,�.'; iLt, Page 2 of 3 • mM� 1959 • `�" /7�y/ AUG //� [ry I/� 1 ~GAD WE'�aJ ✓ AUG i .J 2014 `\ CITY OF VVI"i fc:fK PyS�htfr�f3 OFFICE OF Th4E GITY CLERK eo �State of Florida - Information: (A Compilation of) "The Election Laws of the State of Florida" - August 2013 "Candidate and Campaign Treasurer Handbook" - November 2013 (Which includes Chapter 12 "Political Advertising" and Chapter 13 "Other Disclaimers") "2014 Public Campaign Financing Handbook" "Electioneering Communications Organization Handbook" (April 2014) "State of Florida Election Information/Contacts" State of Florida - Division of Elections Campaign Finance Information: "Contributions Returned" [DS-DE 21 [Florida Statutes 106.07 (4)(c)] Receipts Envelope Electronic Filing Information: Letter from the Winter Springs City Clerk to "Candidates for Elected Office" (Re: Electronic Filing of Campaign Finance Reports) "Online Treasurer Reporting System" [Guidelines for Campaign Finance Electronic Filing of Reports] from the Seminole County Supervisor of Elections Miscellaneous Information: "GUIDE to the SUNSHINE AMENDMENT and CODE of ETHICS for Public Officers and Employees" (2014) "Foreign Nationals" - July 2003 "Statement of Ethical Campaign Practices" (from the Seminole County Supervisor of Elections) 2014 "Voter Guide & Florida Voter Registration Application" (from the Seminole County Supervisor of Elections) Revised 8/12/2014 �%NreR -ITY OF WINTER SPRINGS, FLC `DA �` 2.014 GENERAL MUNICIPAL ELEC PION 1-A FFIDA VIT OF ACCEPTANCE �1N �CSwK Page 3of3 /` • �� 4V 191959 AUG 2 5 2014 OFFICE OF THE CITY CLERK sp City Information: "Charter" of the City Of Winter Springs "Chapter 2 - Administration" from the City of Winter Springs Code of Ordinances City of Winter Springs Ordinance Number 2008-16 (also noted in Chapter 2 of the City of Winter Springs' Code of Ordinances) City of Winter Springs Ordinance Number 2009-14 (also noted in Chapter 2 of the City of Winter Springs' Code of Ordinances) 2014 General Municipal Election "Information" 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: I, & have on this date received the forms and information, noted on these Name of Candidate (Ple se Print or Type) three (3) pages, in addition to any other Election materials that I 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. city State zip Code 2,4 1 STATE OF FLORIDA COUNTYOF Sw�{om tto. (or affirrm`e"d)�and �subscribed, under penalties of perjury, before me this ,. " day of �+ u"t Ar , 2014--, by &,PC"-G0 t P (Print Name A Person Making Statement) p� Notary Public S Public Andrea Loy�pzp- uaces ,tom My commiss 7574 op j�tT' F-)Vres 05/09/2015 Identification Type of Identification Produced OR Notary Public - State of Florida (Print Name of Notary Public) Personally Known Revised 8/12/2014 �y�NTERS CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 o� 2014 GENERAL MUNICIPAL ELECTION > z 1= 2 -AFFIDAVIT OF CITY RESIDENCY AND CITY OF wiN �z:-..:> to OFFICE OF THE CITY CLERK 1959 QUALIFIED VOTER STATUS iti yK coa we-T MAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies 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 (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..." 14.01.(b) Charter, City of Winter Springs] do hereby state that I seek election to the City of Winter Name of Candidate (Please P nt or Type) Springs', Qjay2jr - City Commission Seat Two / Seat Four - a four (4) year term, in the Election to be held Circle Which Applies To Candidacy in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. I, further swear or affirm: (1) I am a qualified Voter of the City of Winter Springs (2) My legal place of residence is: / LAO Street Address r /City 1 /Statd Zio Code (3) Length of time of residency in the City of Winter Springs is: (4) I am attaching two (2) documents, one to be a Florida Driver's Licen , as in the City of Winter Springs. The second document is: �At, k of my residency t J 41s' < -T Street Zip Code STATE OF FLORIDA COUNTYOF ��l-e- Date �Sworn to (or affirmed) and subscribed, under penalties offperjury, before me this 201�, by N\,Z44A qq (Print Name of Person Making tatement) ?o YP, f�7otarvR051ii b�'c State 8f Florid; AndrM� ji fjenzo_Luaces My Commission EE067574 a 0i- Expires 05/09/2015 Produced F Identification Type of Identification Produced Notary Public - State of Florida (Print Name of Notary Public) OR Personally Known Ll / FOR OFFICE USE ONLY Copy Of Florida Driver's License �Provided ^�For Item (4). Other Documentation V�=��y-o has l� Provided For Item (4). Revised 8/12/2014 J1�NTERS CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 o� 2014 GENERAL MUNICIPAL ELECTION czi 3 -AFFIDAVIT OFRESIDENCY-DISTRICT FFI E 'Jv'TH ry'CLE S f- ,r of=f=10E OF "fHt; Ci'G'�r C:6�RK U meo y X9 t/1 1959 '~0-0 yyESaJy� CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies 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 (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. (b) Charter, City of Winter Springsl I, do hereby state that I seek election to the City of Winter Name of Candidate (Please Print or Type) Springs City Commission Seat Two / Seat Four - a four (4) year term, in the Election to be held Circle Which Applies To Candidacy in the City of Winter Springs, Florida, on Tuesday (1) My legal place of residence is, St (2) Length of time of residency in the Ci of W (3) Length of time of residency in Winter Sp 'nl (4) I am attaching two (2; residency in the City i STATE OF FLORIDA COUNTY OF , Nov)iker 4, 2014. I, further swear or affirm: ,en Address City State Zio Code int r S ri s is ;s Di nct is: I Driver License, as verification of my current is: Signature Street Address City State Zip Code Date Sworn to (or affirmed) and subscribed, under penalties of perjury, before me this day of 201 , by (Print Name of Person Making Statement) Notary Public - State of Florida Signature of Notary Public (SEAL) (Print Name of Notary Public) Produced OR Personally Identification Known Type of Identification Produced 9e ie 9e dr ie it �t �r ie �Y 9e * �e �t * �r * eY 9e 9c * 9e 9e 9e 9e 9e �t et 9r 9e 9e 9e � �t 9r 9e 9e de * 9e �e 9e 9e � �e �e 9e 9e 9r 9e 9c �e 9e * 9e 9e FOR OFFICE USE ONLY Copy Of Florida Driver's License Provided For Item (4). Other Documentation Provided For Item (4). Revised 7/31/2014 ,Ti�NTERs CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 O p� 2014 GENERAL MUNICIPAL ELECTION CITY OF "IN'I LR GI -RINGS u y 4 -APPLICATION FOR OFFICE OFFICE OF THE CITY CLERK � • t459 00 WF:I 'yam MAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy 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 filed and the qualifying fee paid during 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.(b) Charter, City of Winter Springs] 12-87. 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." j2-88. (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 be exempted from paying the election assessment. Any candidate exempt from the election assessment shall also be exempt from the city's qualifying fee." ]2-88. (b) Code of Ordinances, City of Winter Springs] I, Gh��Ce y do hereby state that I am a registered and qualified Elector of the Name of Candidate (Please Print or Type) City of Winter Springs; and am applying for the Office of Mayor City Commission Seat Two / Seat Four Circle Which Applies To Candidacy - a four (4) year term, in the Election to be held in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. I further agree to pay the following Qualifying Fee: QUALIFYING FEE: $150.00 Date FOR OFFICE USE ONLY Signed 9 Campaign Account Check in the amount of $150.00 attached (Check should be made payable to the "City of Winter Springs") or, if applicable HCompleted "Notice of Undue Burden" Attached Revised 8/11/2014 ,p�NTERS 6TY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 o� 2014 GENERAL MUNICIPAL ELECTION F} * Z CITY OF '.'.itdT ER o 5 - ELECTIONASSESSMENT OFFICE OF T� I.E CITY CLEF �.. d � 1959 iyGOo WE�aJyt MAYOR -CITY COMMISSION SEAT TWO /SEAT FOUR Circle Which Applies To Candidacy "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." 199.093 (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, 1� 111 _- s Le!! , y do hereby state that I am a registered and qualified Elector of the Name of Candidate (Please Prin or Type) City of Winter Springs; and am applying for the Office of ayor - City Commission Seat Two / Seat Foul Circle Which Applies To 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 applicable Election 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 1% Assessment amounts to: $120.00 N Signed 9e ie * 9e 9e 9e 4e 9e 9e �t 9e 9c �t * 9e �t 9e 9r * 9e �r * 9e 9e 9e 9e �t 9t 9t 9e et 9t 9e 9r * 9r 9t * 4t 9t 9t * * 9t * 9t * 9t 9r � �e �t 9t �t �e FOR OFFICE USE ONLY For Office of Mayor - Campaign Account Check in the amount of $144.00 attached (Check tD should be made payable to the "City of Winter Springs") or For Office of Commissioner - Campaign Account Check in the amount of $120.00 attached (Check should be made payable to the "City of Winter Springs") or, I applicable 1-1 Completed "Notice of Undue Burden" Attached Revised 7/31/2014 4,��NTERSA CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 ° 2014 GENERAL MUNICIPAL ELECTION )- Z CITY OF yJ4h: i £: h' Sl'i^2ING$ 6 - OATH OF CANDIDATE OFFICE OF THE CITY CLERK u 0 1959 '~600 WF'V MAYO - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "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 I—Aee--V your name as you wish ft to appear on the ballot; to me well known, who, being sworn, says that he or she is a candidate for the office of ayor - City Commission Seat Two / Seat Four; that he or she is a qualified elector of Z13a1.. Circle Which Applies To 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 al Sworn to and subscribed before me this y� �'� day of �✓ , 201,4—, at Seminole County, Florida. and Title of Officer Administering Oath) Revised 8/12/2014 R ., AUG 2 5 2014 s U 07 h�eoepor.r a 1959 • '��ao wE ta�� CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION 7 - LOYALTY OATH CITY OF 00IN" Z" . OFFICE OF THE CI;,, MAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "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 acknowledgements of instruments for public record in the state in the following form:" 1876.05 (1) Florida Statutes] ZS Lefift4 , a citizen of the State of Florida and of the United States Name (Please Print or T e) of America, and being employed by or an officer of Oi dgf- S Yt mud 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." Signature StrVAddress City State Zip Code STATE OF FLORIDA COUNTY OF Sworn to (or affirmed) and subscribed, under penalties of perjury, (before me this day of 20 y^l-- , by n (Print Name of Person Making Statement) o<rr Po,W IV0t4Rfiybk State of Florida Andrea Lorenzo-Luaces o` My Commission EE087574 "1.7,0' Expires 05/09/2015 Identification Type of Identification Produced Notary Public - State of Florida (Print Name of Notary Public) OR Personally Known Revised 7/31/2014 F�`NTERSo CITY OF WINTER SPRINGS, FLORIDA AUG2 5 2014 2014 GENERAL MUNICIPAL ELECTION > x 8 -NOTICE OF TESTING OF TABULATING EQUIPMENT crry ol- yti l' 'ten 1959 OFFICE OF THE Clr OO M,ET�VgMAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "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." 1101.5612 (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: DATE: FRIDAY, OCTOBER 10, 2014 TIME: 10:00 A.M. The aforementioned test will be held at: THE OFFICE OF THE SUPERVISOR OF ELECTIONS FOR SEMINOLE COUNTY 1500 EAST AIRPORT BOULEVARD, SANFORD, FLORIDA (407) 585-VOTE [86831 City of Winter Springs Municipal Elections Official/Designee RECEIPT I, PS do hereby acknowledge that on this A Name of Candidate (Ple a Print or Type) /` date of o 2-S— , 201_y�_ , I received written Notice (as noted above/on this form in the highlighted block of the date, time, and location related to the "Testing of Tabulating Equipment". Signature oteaii V_L41-/y Date Document Signed Revised 7/31/2014 11x W" k. F��NTeRso CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 o —_? 2014 GENERAL MUNICIPAL ELECTION CITY OF Wirv7::.:'�ri?itr'GS F • 9 -NOTICE OF POLITICAL CAMPAIGN OFFICE OF THE CITY CLORK 9 ADVERTISEMENTS/SIGNS 00 W6'raJy� IAAYO - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "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, Q-"&S do hereby acknowledge that on this date Name of Candidate iflease Print or Type) of f y, S , 201 , I 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". Signature of Candida Date Document Signed ******************************************************** FOR OFFICE USE ONLY Attachment: Copy of Florida Statutes 106.1435 Attachment: Chapter 16 from our Code of Ordinances Revised 7/31/2014 11 t"ir. ,. G t.F: F�`NTER`rA CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION AUG 2 5 2014 Z 10 - SCHED ULE OF CAMPAIGN FINANCE 0 U y CITY OF YVIM'tAK M S1 REPORTING PERIODS/DUE DATES oFFlce OF THE elrY act tiOp wE-C MAYOR CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "The filing officer shall provide each candidate with a schedule designating the beginning and end of reporting periods as well as the corresponding designated due dates." 1106.07 (1) (e) Florida Statutes I "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 do hereby acknowledge that on this Name of Candidate (Pleas Print or Type) date of is . 9S_ , 2014 ,1 received a written "Schedule Of Campaign Finance Reporting Periods/Due Dates" (as noted above/on this form). Date Document Signed Zz ye Si re of Ca to Revised 8/12/2014 RE-C:Eqi.,FED J,�NTE�gSA CITY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 2014 GENERAL MUNICIPAL ELECTION � CITY OF 'JJI,N-EF2 :.Y}1tNC,5 u to11- NOTICE OFACCESS TO CAMPAIGN FINANCE FORMS OFFlCE of THE CITY CLERK 1959 Z-00 W6<RJMAYOR - CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy NOTICE Please note that Campaign Finance forms are available at the following State of Florida Website address: http://election.dos.state.fl.us/forms/index.shtmI#can AND/OR 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 do hereby acknowledge that on this date Name of Candidate Please Print or Type) of S' , 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 Candi t s° 25/1x Date Document Signed 9e9e�nY*�e*$e**eF�r*9e*9r�'c9ede4r*9eie**�'iitat*�k*9e�'c*9e9c**�e*9e�'e�Y9ea'e*9r�Yet*etoY*9e�tie FOR OFFICE USE ONLY Attachment: Ordinance 2014-11 Revised 8/11/2014 EC1—:1Vr=0 4 %NTE�So CifY OF WINTER SPRINGS, FLORIDA AUG 2 5 2014 ° 2014 GENERAL MUNICIPAL ELECTION I� ,t CITY OF vvi,,,-rF : ;'FZIPJG3S U (p . 12 - PETITION OFFICE OF THE CITY CLERK hrco.po.,r.a 1959 WEY�`°yam MAYOR CITY COMMISSION SEAT TWO / SEAT FOUR Circle Which Applies To Candidacy "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." 12-87. Code of Ordinances, City of Winter Springs] do hereby state that I seek nomination to the City of Winter Name of Candidate (Please Print or Typcf Springs', ayor - City Commission Seat Two / Seat Four a four (4) year term, in the Election to be held Circle Seat Which Applies To Candidacy in the City of Winter Springs, Florida, on Tuesday, November 4, 2014. I, further state that: (1) My legal place of residence is: )'fAOfc� L.O A, — Street A#ess (2) Length of time of residence in the City of Winter Springs (3) City of Winter Springs Registered Voter: Citv Yes � No rL .3 0 State Zin Code Y1�11y. Date Signature of Ca ate Street Address Civ a State Zip Code �Y �e 9e 9e * * 9e 9e 4r 9e * 9r 4e 9t it �Y �k 9e et de ie 9e * 9e 9e de 9e 9t �c 9t 9e �t 9e 9r �e nY et 9e ie 9t 9c �Y ie 9t eF 9t is 9e 9r 9e * 9e 4r 9e 9e 9t We, the undersigned qualified Electors, residing in the City of Winter Springs, Florida, nominate: �✓+� for the City of Winter Springs' Name of Candidate (PI se Print or Type) ayor - City Commission Seat Two / Seat Four: Circle Seat Which Applies To Candidacy �_. (1) _SaploCra i-CLcet (Please Print or Type Name) Signature 5_1r�Gfn Cf Street Address j , State lq l L (2) ('�L.IN ref. .�/`I�L: ir2t�✓ (Plea a Print or Type Name) Type Name) Signature Street ddress City State Revised 8/11/2014 '9185Z I SCtn In o l Date Fretition Signed County Zip Code Voter Registration Number OR Date Of Birth ate PetitVn Signed gn County Zip Code Voter Registration Number OR Date Of Birth • RIECErIVED •N�NT�R s Ct I'Y OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION AUG [ 5 2ol4 * 12 - PETITION CITY OF VVltlji"ER SPRINGS `' -;5od 'n OFFICE OF THE CITY CLERK i 5 60D WE,r�J NAME OF CANDIDATE: i�POLI�-S-, A Page 2 of 5 Name of Candidate (Please Print or Type) T i (3) 4r� (Please Print or Type Name Signature Dat etition i d County Street Address City State Zip Code Voter Registrati Nu er OR Date Of Birth (4)"� �-y O SC/1 ✓� (Please Print or Tyd Name) N3 �JY S C,r Street Addres ) \ (5) �2—yctj (Please Print or Type Name) 1 ov �(— Street Address (Please Print or Type Name) nn Street Address (7)D�Aok I& (Please Print or Type Name) l 115 iZ10) 2. (--7%�, �z . Street Address (8) (Please Print or Type Name) 1102- kck/ F Tfrnll Street Address (9) F. a �4- (- I,a ,-1-- (Please Print or Type Name) q2--2� C b4 )Lo-(- C4- Street Address Signature 0, S , P City State Signature City State Signature F L City State ();A�r A), �C. City State Signature City State Dat Petitio Sign d County -3-270,g I'OAA f Zip Code Voter Registration Number OR Date Of Birth Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth S Z �e00 Date Petition Si ed County Zip Code Voter Registration Number OR Date Of Birth Date Petition Signed County 3,971E 1/- /9 - Sg Zip Code Voter Registration Number OR Date Of Birth .2-y ( k MI�o Date Petition Signed County 3a-7uY Zip Code 3 A /174s Voter Registration Number OR Date Of Birth Date Petition Signed County 3n08 Y/a �j / 5 Zip Code Voter Registration Number OR Date Of Birth Revised 8/11/2014 OZ< INTERS'0 CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION * 12 - PETITION 1959 y4 tiG00 WET AGOG 2 5 2Q14 CITY GF �tilrv'i't�R 5PF71NGS OFFICE O THE Ci7Y CLERK NAME OF CANDIDATE: e Page 3 of 5 Name of Candi to (Ple ) (10)3 !rl i • a� s (Please Print or Type Name) Signature Dale P tition gned County Q(- Street Address City State Zip Code Voter Registrati n Numb OR Date O Birth (Please Print or Type Name)Signature le'��,�-Y— �E (P �l Date Petition Signed Coun --- / Street ress City State z oT 6 6 V Zip Code Voter Registration Number OR Date Of Birth (12) rc�. j e (Please Print or Type Name) Signatu 1039n Street Address cit y State (116) Kd-hlenj /P 5/4j, (Please Print or Type Name) ,5-3I Me -lee /Leo Street Address (Please Print or Type Name) Street Address (Please Print or ype Name) ,�,(� i i'Lt✓i' Street Address Revised 8/11/2014 City y State Date fetition Signed County Zip Code Voter Registry ion Number OR Date Of Birth Date Petition Signed Co ity 3zR AV / � J Zip Code Voter Ret4stration Number OR Date Of Birth Die 9P_etitiioon igned County Zip Code Voter Registraf i Number O ate Of Birth �� ./ Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth le Date etition Signed ounty Zip Code Voter Re stratio Number OR Date Of Birth IV14 INTeq, CITY OF WINTER SPRINGS, FLORIDA AUG L 5 2014 2014 GENERAL MUNICIPAL ELECTION * 12-PETITION CITY oI= .v;I;::_:;: ;;-Rjrj ;S U q OFFICE OF Teiej CI rr ;4 ERK • Incorpo1959 ~Q00 WE-f NAME OF CANDIDATE:---�i_E L� �- Page 4 of 5 1 Name of Candidate (Please Print or Type) nM (Please Print or Type Name) 0 Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (18) (Please Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (19) (Please Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (20) (21) (22) (23) (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address Revised 8/11/2014 Signature Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth Signature Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth Signature Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth Signature Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth R C-rwE (25) ��NTeRs CITY OF WINTER SPRINGS, FLORIDA 0`` �� 2014 GENERAL MUNICIPAL ELECTION z 12 - PETITION V tnrn:porled 1959 i y G00 WE'rRJ NAME OF CANDIDATE: a&1�4cs 14, Gr Name of Candidate (Please Print or Type) AUG 2 6 2014 CITY OF vV1iV j'eR SPRiNGa OFFICE OF THE CITY CLERK Page 5 of 5 (24) LEor coG.ON60 S�J�lNOtx� (Please Print or Type Name) Signature DaleDa[e tied County (,03� l�lA t DQ I,JinT�45 b I077I � Street Address City State Zip Code Voter Registration Number OR Date Of Birth e Print • Name Street Address 6;k" S* ature �r City State Date t eitio Signed County � Zip Code Voter Registration Number OR Date Of Birth ��P ease Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (27)A44 (Please Print or Typ Name) S117Address (28) (29) (30) (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address Revised 8/11/2014 Signature Date Petition Signed County kAowS FL 3,9W 7- 7- & City State Zip Code Voter Registration umber OR Date Of Birth Signature City State Signature Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth Date Petition Signed County City State Zip Code Signature City State Voter Registration Number OR Date Of Birth Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth R C-rwE (25) ��NTeRs CITY OF WINTER SPRINGS, FLORIDA 0`` �� 2014 GENERAL MUNICIPAL ELECTION z 12 - PETITION V tnrn:porled 1959 i y G00 WE'rRJ NAME OF CANDIDATE: a&1�4cs 14, Gr Name of Candidate (Please Print or Type) AUG 2 6 2014 CITY OF vV1iV j'eR SPRiNGa OFFICE OF THE CITY CLERK Page 5 of 5 (24) LEor coG.ON60 S�J�lNOtx� (Please Print or Type Name) Signature DaleDa[e tied County (,03� l�lA t DQ I,JinT�45 b I077I � Street Address City State Zip Code Voter Registration Number OR Date Of Birth e Print • Name Street Address 6;k" S* ature �r City State Date t eitio Signed County � Zip Code Voter Registration Number OR Date Of Birth ��P ease Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (27)A44 (Please Print or Typ Name) S117Address (28) (29) (30) (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address (Please Print or Type Name) Street Address Revised 8/11/2014 Signature Date Petition Signed County kAowS FL 3,9W 7- 7- & City State Zip Code Voter Registration umber OR Date Of Birth Signature City State Signature Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth Date Petition Signed County City State Zip Code Signature City State Voter Registration Number OR Date Of Birth Date Petition Signed County Zip Code Voter Registration Number OR Date Of Birth FORM I STATEMENT OF 2013 Please print or type your name, mailing FINANCIAL INTERESTS address, agency name, and position below: FOR OFFICE USE ONLY: LAST NAME — FIRST NAME — MIDDLE NAME: 1,AC,64 MAAtCe, AJ RECEGV" a MAILING ADDRESS: �33 — &c- AUG 2 5 2014 CITY OF WINTER SPRiN<36 CITYZIP: COUNTY OFFICE OF THE CITY .CLERK ' : W"`Isr NAME OF AGENCY: NAME OF OFFICE OR POSITION HELD OR SOUGHT You are not ilmited to the space on the lines on this form. Attach additional sheets, If necessary. CHECK ONLY IF LJ CANDIDATE OR LJ 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 check one): Z DECEMBER 31, 2013 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING: IV 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 "nla") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY JVou,✓ PART B — SECONDARY SOURCES OF INCOME (Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (If you have nothing to report, write "none" or'Wa") 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 and how to fill it out begin on page 3_ CE FORM 1 - Effective: January 1, 2014. (Continued on reverse side) PAGE 1 Adopted by reference in Rule 34-8.202(1), F A,C. PART D — INTANGIBLE PERSONAL PROP IC '[Stocks, bonds, certificates of deposit, etc. - See `actions] (if you have nothing to report, wr "none" or "n/a") I TYPE OF INTANGIBLE BUSINESS ENTITY'ro WHICH THE PROPERTY RELATES HE AUG 2 5 CITY OF VVINTER PART E — LIABILITIES [Major debts - See instructions] (if you have nothing to report, write "none" or "n4a") PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (if you have nothing to report, write "none" or "n/a*') BUSINESS ENTITY # I BUSINESS ENTITY# 2 NAME OF BUSINESS ENTITY Nw� Ar%MDrZQQ n17 Q1 ICIIlr--ZQ r-KITITV 00. I OWN MORE THAN A 5% INTEREST IN IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Ll SIGNATURE (reguiredh DATE SIGNED (requirqdh If a certified public accountant licensed under Chapter 473, or attorney in good standing he or she must complete the following statement: prepared this form for you, 1, , prepared the CE Form I 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. S WHAT TO FILE: After completing all parts of this form, including signing and dating it, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, you must write "none" or 'Wa" in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form I for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. FILING 1Ns,nzuC'PIONS: WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for Your annual disclosure filing, return the form to that location. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside, (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709: physical address; 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates fit,, this form together with their qualifying papers, To determine what category your position falls under, see the "Who Must File" Instructions on page 3. Facsimiles will not be accepted. Date MIMMILSPOIN211104 Initially, each local officer/employee, state officer, and specified state employee must rile within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates for publicly -elected local office must file at the same time they file their qualifying papers. Thereafter, local officers/employees, state officers, and specified state employees are required to file by July 1st following each calendar year in which they hold their positions. Finally, at the end of office or employment. each local officerlemployee, state officer, and specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. However, filing a CE Form IF (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if he or she was in their position on December 31, 2013. tr rklKm I - UlToclive—iPlivary 1. ail,4. PAGE 2 Adopted by reforoce in Rule 34-8202(1), V A,C DECEIVED AUG 2 9 7nu CITY OF WINTER SPRINGS, FLORIDA 2014 GENERAL MUNICIPAL ELECTION OFFICECITY OFOFF THE CITY CLECL C3$ 'Q . HCERK z 12 - PETITION u (47 1959 '~r'0O WETaJy.( f NAME OF CANDIDATE: C.r it G�C� Page 5 of 5 P` Name of Candidate (PI Print o ype (24) c�j' 6/J 4 f �-7 "54* K s (© t`t i (Please Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (25) #kV /T 'p i.1r�k l./ r r P /fY1 f /1) 15 /P lease Print or Type Name) Signature Date Petition Signed County Street Address City State Zip Code Voter Registration Number OR Date Of Birth (26) (Please Print or Type Name) Street Address City IWI (Please Print or Type Name) Street Address (28) (Please Print or Type Name) (29) Signature Date Petition Signed County State Zip Code Voter Registration Number OR Date Of Birth Signature Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth Street Address City (Please Print or Type Name) Street Address (30) (Please Print or Type Name) Signature Signature Date Petition Signed State Zip Code Voter Registration Number OR Date Of Birth County Date Petition Signed County City State Zip Code Voter Registration Number OR Date Of Birth Street Address City Signature Date Petition Signed County State Zip Code Voter Registration Number OR Date Of Birth Revised 8/11/2014