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HomeMy WebLinkAboutQualifying Forms 61 74)4> 44,tAAA •1- '. ' - CITY OF CAPE CANAVERAL, FLORIDA QUALIFYING PACKET FOR PERSONS WHO ANNOUNCED CANDIDACY PRIOR TO QUALIFYING PERIOD I, rYt,2 x k'-;.-�V of 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 '4- 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 on August 7, 2015 at noon and ends August 21, 2015 at noon. c:,--Z 4._____ ., /,67//5 Signature Date OFFICE USE ONLY !-RIECIEOVE--- AUG 1 8 2015 J 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) I, Buzz Petsos (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 Mayor, City of Cape Canaveral (office) (district#) ; I am a qualified elector of Brevard 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 Florida. / (321 )799-1876 / buzzpetsos©earthlink.net Signature of Candidate Telephone Number Email Address 618 Madison Ave Cape Canaveral FL 32920 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): /4!0 39'0-/ 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): STATE OF FLORIDA COUNTY OF UCQ,(/arcl -th lS Sworn to (or affirmed) and subscribed before me this t? day of `-`7�t,�G�S� , 20 Personally Known: f or /►� Sign ure of Notary P is Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public • Type of Identification Produced: ANGELAM.APPERSON j° ` �., ,v MY COMMISSION#FF 095122 r4" • EXPIRES:April 13,2018 • ..B9n<1ed_ThSyN4�9CPk�.Underwriters i .e w� DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. II.'sal.—Yc-T"-------"--Fq pleat Su sor of Elections NIEVARD COUNTY AFFIDAVIT OF NICKNAME STATE OF Florida COUNTY OF Brevard BEFORE ME,the undersigned,personally appeared: (written legal name of candidate) 1. My legal name is: Arthur Lee Petsos I am over the age of(18)and the contents of this affidavit are true and correct 2. I am a candidate for the office of: Mayor 3. My nickname is: Buzz 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 known by the nickname or that it has been used as part of the candidate's legal name.) A. Previous election filings B. 1.7 'iz1. PE7-5 0 5 Printed Name of Affiant Signature of Affiant Sworn to me this I►v 'h day of August 20 15 . --77--"-----. We.-4,4,-k :•';0 ' ri' ANGELA M.APPERSON t ..: " ;.: MY COMMISSION it FF 095122 t 1........7"-....11 EXPIRES: 13,2018 Notaryublic • . April , �?„Rf 0Bonded Thru Notary Pubic Underwriters i S .'-. �-. r}-r. el ti � M 5 �� Printed Name Personally known to me Produced Identification ❑ Candidatelrev5/2015 **Official** CERTIFICATE OF COUNTY CANVASSING BOARD STATE OF FLORIDA Brevard County We, the undersigned, Kelly McKibben, County Court Judge, Lori Scott, Supervisor of Elections, and Robin Fisher, Member of the Board of County Commissioners, constituting the Board of County Canvassers in and for said County, do hereby certify that we met on the 12th day of November, A.D., 2010, and proceeded publicly to canvass the votes given for the CITY OF CAPE CANAVERAL GENERAL ELECTION held on the 2nd day of November, A.D., 2010 as shown by the returns on file in the office of the Supervisor of Elections. We do hereby certify from said returns as follows: For City Council, (Vote for No More Than Two) the whole number of votes cast was 5276of which number Richard Fischer received 817votes John Johanson received 664votes Jim Morgan received 1052votes Leo Nicholas received 653votes Buzz Petsos received 1443votes David Schirtzinger received 647 votes For Cape Canaveral Charter Amendment 1, New City Charter the whole number of votes cast was 3054 of which number YES, FOR CHARTER AMENDMENT received 1875 votes NO, AGAINST CHARTER AMENDMENT received 1179 votes 1 of 2 **Official** For Cape Canaveral Charter Amendment 2, Mayor & Councilmember Term Limits the whole number of votes cast was 3208 of which number YES, FOR CHARTER AMENDMENT received 2230 votes NO, AGAINST CHARTER AMENDMENT received 978 votes CO ' COURT JUDGE SUPE; 1 ISOR OF ELECTIONS Aq ME BER, : ARD OF COUNTY COMMISSIONERS 2 of 2 AqXE -4 Nd sic► 1 11111.y...Logomn 41\ CITY OF CAPE CANAVERAL OATH OF CANDIDATE I, Buzz Petsos , do solemnly 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. j v Signature of Candidate State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me this 1 nth day of August, 2015 by Buzz Petsos , who is personally known or produced Identification. "• ANGELA M.APPERSON i*i • MY COMMISSION#FF 095122 EXPIRES•April 13,2018 Rf,t4 Bonded Thw Notary Pudic Underwriters Signature of Notary Public Print,type or stamp Commissioned Name of Notary Public FORM 1 STATEMENT OF 2014 Please print or type your name,mailing FINANCIAL INTERESTS I FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME-- FIRST NAME--MIDDLE NAME : Petsos Buzz 96411 MAILING ADDRESS : 618 Madison Ave pC CITY: ZIP : COUNTY Cpe Canaveral, FL 32920 AUG 1 8 2015 NAME OF AGENCY: are C anavPralriiCIEDVEfi ,^ NAME OF OFFICE OR POSITION HELD OR SOUGHT: 74F-- C'• _ , - • - . . , Al V C?I� You are not limite. to the space on the lines on this form.Attach additional sheets,if necessary. 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 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 ❑ 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 Accofr1 PaAcos :zlo zS Ksc, 32 '/s j,,yl000 P easmj 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 /00/96 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 A10tic 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 1,2015 (Continued on reverse side) PAGE 1 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 5-rOG� 30,6 Grr R� K /1- -cou.tZ J -TR,./K or Arne A 643 PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR /Vro,ig r 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 'JD A/1 ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY 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 ❑ 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: , 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: CPA/Attorney Signature: /`` di 6- 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). 30 days from the date of their appointment. ( ) permanently reside. (If you do not permanently 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 Thereafter, local officers/employees, state file with the Commission on Ethics, P.O. Drawer 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.