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HomeMy WebLinkAboutQualifying Forms CITY Of CAPE CANAVERAL CITY OF CAPE CANAVERAL, FLORIDA CANDIDATE PACKET ACKNOWLEDGEMENT )32e vAR) 0, i91.�i9-Ce iLCtli u n/ would like to qualify as a candidate for either of the two City Council Member vacancies and do hereby acknowledge receipt of: 1. 2015 Election Information for Council vacancies 2. Form DS-DE 9 (rev. 10/10), Appointment of Campaign Treasurer and designation of Campaign Depository for Candidates 3. Form DS-DE 25 (rev. 05/11), Candidate Oath—Nonpartisan Office and Affidavit of Nickname 4. City Oath of Candidate 5. CE Form 1 (Jan 1, 2015), Statement of Financial Interests and Instructions 6. Form DS-DE 84 (rev. 05/11), Statement of Candidate 7. Election Laws of the State of Florida as of August 2015 8. Candidate and Campaign Treasurer Handbook as of June 2015 9. 2015 Campaign Treasurer's Report Due Dates and general information about filing reports 10. Do's and Don'ts for Campaign Treasurer's Reports 11. Form DS-DE 12 (rev. 11/13), Campaign Treasurer's Report Summary 12. Form DS-DE 13 (rev. 11/13), Campaign Treasurer's Report—Itemized Contributions 13. Form DS-DE 13A (rev. 11/13), Campaign Treasurer's Report—Fund Transfers 14. Form DS-DE 14 (rev. 11/13), Campaign Treasurer's Report—Itemized Expenditures 15. Form DS-DE 14A (rev. 11/13), Campaign Treasurer's Report—Itemized Distributions 16. Form DS-DE 87 (rev. 06/15), Waiver of Report 17. Public Service Request Form 18. Political Sign Regulations 19. 2015 General Election Canvassing Board Dates 20. 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 10, 2015 at 9:30 a.m. and ends on August 27,2015 at 5:00 p.m. E Er„I clavz D Signature AUG 1 3 2015 � 3 Ai& 6 . zoo Date Enter I Al 71►ie Recetve and Initials of Clerk's Office Staff Member APPOINTMENT OF CAMPAIGN TREASURER E C IE0 V 1 AND DESIGNATION OF CAMPAIGN ' DEPOSITORY FOR CANDIDATES AUG 14 2015 (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) L:%_I. _g:-.S75-j.. NOTE: This form must be on file with 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 0 Office El Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Brendan Wallace McMilin code) 4. Telephone 5. E-mail address ,;�r .vpf},✓ PO Box 1018 (321 ) 431-6257 F0209A49-vL2/3LG1ri CauNci Cape Canaveral, FL (� GN/i4n- .Cb M 32920 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Cape Canaveral City Council applicable: ElMy 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 0 Party candidate. 9. I have appointed the following person to act as my n Campaign Treasurer n Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Brendan McMillin 11. Mailing Address 12. Telephone PO Box 1018 ( 321 ) 431-6257 13. City 14. County 15. State 16. Zip Code 17. E-mail address r'; Cape Canaveral Brevard FL 32920 eAvi .`,rZ�'�x1n '�'-I�-6%n/� '- ,4 (�q,9-4.-,E74.11 18. I have designated the following bank as my ❑ Primary Depository 0 Secondary Depository 19. Name of Bank 20. Address Wells Fargo 7801 Astronaut Blvd I 21. City 22. County 23. State 24. Zip Code Cape Canaveral Brevard FL 32920 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. 1 25. Date 26. Signature of Candidate 14 August 2015 �� --__. X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) Brendan McMilin , do hereby accept the appointment (Please Print or Type Name) designated above as: E✓ Campaign Treasurer El Deputy Treasurer. 14 August 2015 X ,rl. f ,--------` ------,14-- --., Z--..----______ Date Signature of Campaign Treasurer or Deputy Treasurer I CANDIDATE OATH - E © E 0 V F NONPARTISAN OFFICE AUG 1 4 2015 (Not for use by Judicial or / _5'S S School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) Brendan McMillin (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 Cape Canaveral City Council na (office) (district#) na na ; 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. X 21-431-6257 br ndanforcanaveralcitycouncil Signature of Candidate Telephone Number Email Address PO Box 1018 Cape Canaveral FL 32920 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): 101052163 * 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): Bren-dan mc-Mill-in STATE OF FLOA COUNTY OF Przwi92 f Sworn to (or affirmed) and subscribed before me this /� ±day of , 20 Personally Known: or • /t-11Q--"C4.2 gnature of Notary P lic Produced Identification: L/- 4rin , t yp�,y or amp b"u+ I Name o otary Public ``� PHV PJB' Notary Public -State of Florida Type of Identification Produced: Le iZ(S✓7 / p�, C� L -'• '�' My Comm.Expires May 16,2017 ' YP 1 ' ",��� : Commission # EE 866939 , Euf F "t'. I ���4444t Bonded Through National Notary Assn. /Qct, S/11\ D I 1 C )nnni G A r 'ti.. 4ACE Aka 11ECEOVE- /1,44'i, � AUG 142015 ni J 4:riggr ....-..4r __ `_S-c-,Tor OATH OF CANDIDATE FOR CITY COUNCIL I Bo EN pc►-&) NI (*Nil LUN do solemnly swear or affirm that I am qualified under the City of Cape Canaveral Charter and Ordinances to hold the Office of Council Member, to which I desire to be elected and I will support the City of Cape Canaveral Charter and Ordinances. /"/ ' . / Signature of Candidate State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me this j day of August, 2015 by - -,e7Q n2c/717/1.4/ , who is personally known or produced /Lo2"l ;ve L c_e_.-cc Identification. •` ,PSB••, MIA GOFORTH ...- ; ?Q. (1,I. Notary Public-State of Florida 0 + _• My Comm.Expires May 16,2017 ( � (2 4 =�. . 1 o`c Commission # EE 866939 ,`' Bonded Through National Notary Assn. ` 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 FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME : McMillin, Brendan Wallace MAILING ADDRESS : PO Box 1018 ( C V CITY: ZIP: COUNTY Cape Canaveral 32920 Brevard AUG 14 2015 NAME OF AGENCY: none NAME OF OFFICE OR POSITION HELD OR SOUGHT: ,-460„.Airs Cape Canaveral City Council You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF er 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 Canaveral Pilots PO Box 816, Cape Canaveral, FL 32920 Harbor Pilot 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 See Attached 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 395 Holman Road, Cape Canaveral, FL 32920 located at the bottom of page 2. INSTRUCTIONS on who must file 310 Meridian Drive, Cocoa Beach, FL 32931 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 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 Stocks TD Ameritrade Bank Accounts Wells Fargo PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR none 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 none 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: %G $ 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 sections . 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. A candidate who previously filed Form 1 because State officers or specified state employees 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. Statement of Financial Interests Form 1 Attachement Part B: Secondary Sources of Income Name of Buss Entity Name of Major ; Address of Source Pri Sources of Buss /' Business Income / //� Activity of „,, „ ,�_q�`,dH�. .� „„tea, /��/� i, � Disney Cruise Lines Pilot Fees 9155 Charles M Rowland Dr, Cruise Line Port Canaveral, FL 32920 Carnival Cruise Lines Pilot Fees 3655 NW 87th Ave Cruise Line Doral, FL 33178 Royal Caribbean Cruise Pilot Fees 1050 Caribbean Way Cruise Line Lines Port of Miami Norwegian Cruise Lines Pilot Fees 7665 Corporate Center Drive Cruise Line Miami, FL 33126 „ ,y ,/% //�%' j OFFICE USE ONLY STATEMENT OF TCEOVE CANDIDATE (Section 106.023, F.S.) AUG 14 2015 (Please Type) YP ) Brendan McMillin candidate for the office of Cape Canaveral City Council • have received, read and understand the requirements of Chapter 106, Florida Statutes. X % _ ` /1/ Signature of Can:T. 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 (Rev. 08/03) r