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HomeMy WebLinkAboutQualifying Forms 4N- i ‘iot 4,)14 EbAtiV21:— , . titiggir CITY OF CAPE CANAVERAL, FLORIDA QUALIFYING PACKET FOR PERSONS WHO ANNOUNCED CANDIDACY PRIOR TO QUALIFYING PERIOD I, o gc,„4- previously announced my candidacy for Mayor and do hereby acknowledge receipt of additional materials as follows: • Form DS-DE 25 (rev. 05/11), Candidate Oath — Non-Partisan Office and Affidavit of Nickname • City Oath of Candidate • CE Form 1, (Jan 1, 2015) Statement of Financial Interests and Instructions • Election Laws of the State of Florida as of August 2015 • Candidate and Campaign Treasurer Handbook as of June 2015 • Form DS-DE 87 (rev. 6/15), Waiver of Report • 2015 General Election Canvassing Board Dates • Certification of Elections Results For Municipal Elections I understand to have my name appear on the November 3, 2015 Municipal Election Ballot, I must complete qualifying paperwork and pay qualifying fees during the qualifying period which begins o August 7, 2015 at noon and ends August 21, 2015 at noon. -ea i 5- 7-ic Signature Date sew i v ON' Y D AUG 0 7 2015 I: is pM. , Enter Date&Time Received and Initials of Clerk's Office Staff Member CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) 76- Bx6 G (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT*-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of n ✓ (office) (district#) ; I am a qualified elector of ��'�� County, Florida; (circuit#) (group or seat#) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Flor;;,.. (3zl ) — 783-S2(/ @S.Cd"." Signature of a didate Telephone Number Email Address Al AV 6;6414617-el‘c-e .3;5 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): `©o/ 82.0* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): . EOL 1-100 STATE OF FLORIDA COUNTY OF , retard Sworn to (or affirmed) and subscribed before me this 7 day of /+U7c4S-11" , 20/,S- . Personally Known: 1 or Sig ture of Notary P I c Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public :`vtc ANGELA M.APPERSON Type of Identification Produced: :<: N% ;._- MY COMMISSION#I FF 095122 EXPIRES:April 13,2018 p c d Bonded Thru Notary Public Underwriters I 401111101.11... DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO BALLOT Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames. Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes (-)to separate syllables. You should also add any notes such as rhyming examples, silent letters, etc. Samples: PRONUNCIATION KEY Stressed Vowel Sounds NAME ON BALLOT PRONOUNCED AS EE (FEET)feet (FIT)fit Mishaud mee-SHO('d'is silent) E (BED)bed A (KAT)cat(KAD)cad Jahn HAHN(rhyme:fawn) AH (FAH-thur)father Beauprez boo-PRAI(rhyme:hooray) (PAHR)par AH (HAHT)hot(TAH- Maniscalco man-uh-SKAL-ko dee)toddy UH (FUHJ)fudge Tangipahoa TAN-ji-pah-HO-uh (FLUHD)flood UH Monte Mahn-TAI (CHUHRCH)church _ AW (FAWN)fawn Tanya TAWN-yuh(not TAN) U (FUL)full 00 (FOOD)food OU (FOUND)found O (FO)foe El (FE IT)fight Al (FAIT)fate OI (FOIL)foil Y00 (FYOOR-ee-uhs) furious Unstressed Vowel Sounds uh (SO-fuh)sofa(FING- guhr)finger Certain Vowel Sounds with R AHR (PAHR)par ER (PER)pair IR (PIR)peer OR (POR)pour OOR (POOR)poor UHR (PUHR)purr Consonant Sounds B (BED)bed TS (ITS)its(PITS-feeld)Pittsfield D (DET)debt TH (THEI) Thigh F (FED)fed TH (THEI) Thy G (GET)get ZH (A-zhuhr)azure(VI-zhuhn)vision H (HED)head Z (GOODZ)goods(HUH-buhz-tuhn) Hubbardston HW (HWICH) which J (JUNG)jug K (KAD)cad L CLAIM)lame M (MAT)mat N (NET)net NG (SING-uhr)singer P (PET)pet R (RED)red S (SET)set T (TEN)ten ✓ (VET) vet Y (YET)yet W (WICH) witch CH (CHUCRCH)church SH (SHEEP)sheep NOTE: This page should not be submitted to the filing officer. Page 2,DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. Su ervIsor of Elections BREVARD COUNTY AFFIDAVIT OF NICKNAME STATE OF COUNTY OFV/z` i .P BEFORE ME,the undersigned,personally appeared: (written legal name of candidate) 1. My legal name is: DST ,e5-. I am over the age of(18)and the contents ooff this affidavit are true and correct 2. I am a candidate for the office of: �//` v 6'r�• t�'�� �'a���B l 3. My nickname is: 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.I plan to designate this nickname on my candidate oath as the same name I wish to have printed on the ballot when I submit the candidate oath form during the qualifying period for the above office. 4. Attached are documents that show that my nickname is one by which I am generally known or one that I have used as part of my legal name. (List the title of any document or affidavits from other persons reflecting that the candidate is generally know by the nickname or that it has been used as part of the candidate's legal name.) 1((j9 �2 ,// i oge' G Eg-4C er,o d /?j4//4 B. 9 �obll / /c411111111 Printed Name of Affiant Signature of Affiant Sworn tome this day of Au, (,Ls f 20 (�. •;;;;;•, ANGELA M.APPERSON MY COMMISSION#FF 095122 A- Notary blit :.; •r ((�� �I .• ��.: EXPIRES:April 13 2018 A/, /1 �5� ''f o;i1-d' Bonded Th u NotaryPubl c Underwr ters Printed Name XVII , NN�`" Personally known to me Produced Identification ❑ Candidate1rev5/2015 a Supervisor of Elections II.REW RD C0004, NOVEMBER 4, 2014 GENERAL ELECTION BALLOT IMPORTANT INFORMATION REGARDING YOUR POLLING LOCATION Please take a moment to note your precinct number and polling location as reflected on your"Official Voter Information Card".This information is also listed on your 16 Sample Ballot and under the"FIND YOUR PRECINCT'tab on the www.VoteBrevard corn website. For more information,please contact the Elections Office at(321)633-2124. .. - AN REPRESENTATIVE IN CONGRESS CANAVERAL PORT AUTHORITY CAPE CANAVERAL CITY COUNCIL DISTRICT 8 DISTRICT 3 (Vote for no more than 2) (Vote for One) (Vote for One) PRECINTS:204 and 226 ALL PRECINCTS PRECINCTS:128,133,207,209,210,211,214,219,224, 0 R.E."Bob"Hoog C Bill Posey REP 228,231,232,233,234,238,417,418,425,428,433,435, 0 Betty Walsh C Gabriel Rothblatt DEM and 436 0 Don Willis C 0 Wayne Justice REP COCOA BEACH PRECINCTS: wore-in O 208,215.221,and 222 GOVERNOR AND UEUTENANT GOVERNOR wme n COCOA BEACH COMMISSIONER (Vote for One) SEAT 4 ALL PRECINCTS DISTRICT COURT OF APPEAL (Vote for One) O Rick Scott REP ALL PRECINCTS C Dee Dee Sheffield Shall Judge Wendy W.Berger of the Fifth District C Skip Williams Carlos Lopez-Cantera Court of Appeal be retained in office? O Charlie Crist DEM 0 YES COCOA BEACH COMMISSIONER Annette Taddeo O NO SEAT 5 O Adrian Wyllie LPF (Vote for One) Yf DISTRICT COURT OF APPEAL C Anne Herzog Greg Roe ALL PRECINCTS O Mike Miller O Farid Khavari NPA Shall Judge Kerry I.Evander of the Fifth District 0 Mary Nail Lateresa A.Jones Court of Appeal be retained in office? MELBOURNE PRECINCTS: C YES 300,306,310,317,321.323,400,402.403,408,414,422, O Glenn Burkett NPA 0 NO 434,500,502,507,509.514,515.518.528.and 529 Jose Augusto Matos DISTRICT COURT OF APPEAL MELBOURNE CITY COUNCIL O ALL PRECINCTS DISTRICT 2 wme-m Shall Judge Charles Alan Lawson of the Fifth (Vote for One) ATTORNEY GENERAL District Court of Appeal be retained in office? 0 Betty Moore (Vote for One) 0 YES 0 Robert Wicker ALL PRECINCTS 0 NO MELBOURNE CITY COUNCIL O Pam Bondi REP DISTRICT 3 O George Sheldon DEM DISTRICT COURT OF APPEAL (Vote for One) 9 ALL PRECINCTS O Bill Wohlsifer LPF Shall Judge Richard B.Orfinger of the Fifth C Hazel Buggs CHIEF FINANCIAL OFFICER District Court of Appeal be retained in office? 0 Yvonne Minus (Vote for One) 0 YES O Dan Porsi ALL PRECINCTS 0 NO MELBOURNE CITY COUNCIL 0 Jeff Atwater REP DISTRICT COURT OF APPEAL DISTRICT 4 (Vote for One) O William"Will"Rankin DEM ALL PRECINCTS C Debbie Thomas COMMISSIONER OF AGRICULTURE Shall Judge William David Palmer of the Fifth O Terry L.Wooldridge,Jr. (Vote for One) District Court of Appeal be retained in office? ALL PRECINCTS 0 YES MELBOURNE CITY COUNCIL DISTRICT 6 C Adam Putnam REP NO (Vote for One) C Thaddeus Thad Hamilton DEM DISTRICT COURT OF APPEAL C Teresa Lopez ALL PRECINCTS c James P.Teele wnce Shall Judge Thomas D.Sawaya of the Fifth PALM BAY PRECINCTS: District Court of Appeal be retained in office? 303,308,313,314,315,316.320.322,510.513,516,517, STATE REPRESENTATIVE 51 O YES 519,520,521,526.and 527 (Vote for DISTRICT 5e1 0 NO PALM BAY CITY COUNCIL PRECINCTS:102,113,178,119,120,121,122,123,124, DISTRICT COURT OF APPEAL SEAT 4 ALL PRECINCTS (Vote for One) 125,126,127,128,129,130,131,132,133,134,135,137, Shall Judge F.Rand Wallis of the Fifth District C Tres Holton 138,200,201,202,203,204,205,206,207,208,209,210, Court of Appeal be retained in office? 0 Bill Rettinger 211,212,213,214,215,216,217,219,220,221,222,224, O YES PALM BAY CITY COUNCIL 225,226,227,228,230,231,232,233,234,235,216,237, 0 NO SEAT 5 • 238,412,417,d25,433,435,and 436 (Vote for One) C Steve Crisafulli REP CIRCUIT JUDGE,18TH CIRCUIT C Jeff Bailey C Joe Murray DEM GROUP 13 C Ken Greene (Vote for One) STATE REPRESENTATIVE ALL PRECINCTS TITUSVILLE PRECINCTS: DISTRICT 53 101,105,107,108,109,110,111.112,114,115.117.and O George T.Paulk 134 (Vote for One) 0 Christina Sanchez TITUSVILLE CITY COUNCIL PRECINTS:301,302,303,304,306,307,308,309,310, CIRCUIT JUDGE,18TH CIRCUIT SEAT 1 311,312,313,314,315,316,317,318,319,320,321,322, (Vote for One) 510,512,513,516,517,519,520,521,522,525,526,and GROUP 19 C Matthew Barringer 527 (Vote for One) C Kathleen Burson O John Tobia REP ALL PRECINCTS C Santa Isabel Wright DEM O Mitch Krause TITUSVILLE CITY COUNCIL C Susan Stacy SEAT 5 O David A.Kearns NPA (Vote for One) C WRITE-IN CANDIDATE WITHDREW CIRCUIT JUDGE,18Th CIRCUIT O Stan Johnston wnce-in GROUP 23 O Rita Pritchett BOARD OF COUNTY COMMISSIONERS (Vote for One) DISTRICT 2 ALL PRECINCTS BAREFOOT BAY TRUSTEE (Vote for One) O Nancy Maloney (Vote for no more than 3) PRECINCTS:200,201,202,203,204,205,206,207,208, O John Moser PRECINCT 304 209,210,211,212,213,214,215,216,217,218,219,220, SCHOOL BOARD O Richard Bleau 221,222,223,224,225,226,227,228,229,230,231,232, DISTRICT 2 O Frank Cavaliers 233,234,235,236,237,and 238 (Vote for One) 0 Steven Diana O Jim Barfield REP PRECINTS:201,202,203,204,205,206,207,208,209, 0 Joseph B.Klosky O JJ McCurry LPF 210,212,213,214,215,216,217,218,219,220,221,222, 0 Brian Lavier O Jack Smink NPA 223,224,225,226,220,229,231,232,233,234,235,236, BAYTREE SUPERVISOR BOARD OF COUNTY COMMISSIONERS 417,and 433 GROUP 4 DISTRICT 4 0 John Craig (Vote for One) O Keith Yarbrough PRECINCT 430 (Vote for One) SCHOOL BOARD O Maria G.Hemandez PRECINCTS:400,401,402,403,404,405,406,407,408, DISTRICT 5 O Jen Tecson 409,410,411,412,413,414,415,416,417,418,419,420, (Vote for One) 421,422,423,424,425,426,427,428,429,430,431,432, PRECINTS:307,709,310,313,316,321,322,323,500, VIERA EAST SUPERVISOR 433,434,435,436,and d37 GROUP 1 501,570,612,513,516,517,519,520,521,522,523,524, (Vote for One) C Curt Smith REP 525,526,527,and 530 PRECINCTS 425,428,431,and 436 C Mike McCarty DEM C Denise Coyle C David Bedwell C George Lebovitz LPF O Andy Ziegler 0 Larry Mangum VOTE BOTH SIDES OF BALLOT }opCE Aka • yJ i.,......- .1 9 Atti- a �t witit t CITY OF CAPE CANAVERAL OATH OF CANDIDATE I °leer e> do solemnly y swear or affirm that I am qualified under the City of Cape Canaveral Charter and Ordinances to hold the Office of Mayor, to which I desire to be elected and I will support the City of Cape Canaveral Charter and Ordinances. 7 ,i/ 0-- Signature of Candidate State of Florida County of Brevard City of Cape Canaveral -En Sworn to (or affirmed) and subscribed before me this I day of August, 2015 by Robe,-� . gal_ , who is personally known or produced Identification. Gil fri, ��� cjlAElJ1Signature of Notary Public "°�"pP"ai`Underwriters Print,type or stamp Commissioned Name of Notary Public 4 FORM 1 STATEMENT OF 2014 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME bG 2z1 ci•r e. MAILING ADDRE S : CAP a t.) veRo--(J K/ egg.,4/4 Th © C O V CITY: /C,age aboAvE ZIP: COUNTY (� �2�'� AUG 0 7 2015 NAME OF AGE CY : P &tire NAME OF OFFICE OR POSITION HELD OR SOUGHT: fa plo You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF ilcCANDIDATE 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(rpxst check one): DECEMBER 31. 2014 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: ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR 0 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 /4,o6 Z—�' C 2/4/.--Te•'&rz.sa i AV /= 'T2 cwG ,,T'• TZ PART B-- SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY^^OF SOURCE 4.71, PART C--REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when and where to file this form are $( Z �t�Gdrtr,l .1 UC)- 66p ? located at the bottom of page 2. INSTRUCTIONS on who must file ' O A)E-5 Dr Optha , P( , this form and how to fill it out !! ! d� begin on page 3. \1477/a DE P,4/i 5 . CE FORM 1-Effective:January 1.2015 (Continued on reverse side) F/-GE I Adopted by reference in Rule 34-8.202(1),F.A.C. PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit.etc. -See instructions] (If you have nothing to report,write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Srlci - SV,�az�-std t3o� K PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR -3c37( 771104 EWI*c A r --A7E-4.U/U5 rF.o. ?-c / 8'c./ BiR/1/.•/-4101, AC t PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,write"none"or"n/a") BUSINESS ENTITY# 1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY /� PRINCIPAL BUSINESS ACTIVITY /,UJ POSITION HELD WITH 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 j SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or Signature: attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief. the disclosure herein is true and correct. Date Signed: g .�� //�� CPA/Attorney Signature: l Date Signed: 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 dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet(pages 1 and 2)for filing. 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 "n/a" in that Supervisor of Elections of the county in which they prior to confirmation, 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: papers. State officers or specified state employees A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer Thereafter, local officers/employees, state of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are of his or her original Form 1 when qualifying. A address: 325 John Knox Road, Building E, Suite required to file by July 1st following each calendar candidate who files a Form 1 with a qualifying 200,Tallahassee, FL 32303. year in which they hold their positions. officer is not required to file with the Commission Finally,at the end of office or employment,each or Supervisor of Elections. Candidates file this form together with their local officer/employee,state officer,and specified qualifying papers. state employee is required to file a final disclosure To determine what category your position falls form(Form 1 F)within 60 days of leaving office or under, see the "Who Must File" Instructions on employment.However,filing a CE Form 1F(Final page 3. Statement of Financial Interests)does not relieve the filer of filing a CE Form 1 if he or she was in Facsimiles will not be accepted. their position on December 31,2014. CE FORM 1-Effective January 1,2015. PAGE 2 Adopted by reference in Rule 34-8.202(1),F.A.C.