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HomeMy WebLinkAboutQualifying Forms yJ/ii : 44, kh, 0 i %or CITY OF CAPE CANAVERAL, FLORIDA CANDIDATE PACKET ACKNOWLEDGEMENT I -3o s1n v . 4 . S f P r-c hti vtT 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 fitir 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. D C e �1; it -� Signa re 7 AUG 11 2015 _1 4kir 87" /° °/ S- , A\--5.-.!3 en Date Enter Date&Time Received and Initials of Clerk's Office Staff Member APPOINTMENT OF CAMPAIGN TREASURER lECEllviEl AND DESIGNATION OF CAMPAIGN AUG 2 4 2015 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) `L`(%✓ (/ 2•'2 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: ❑ Treasurer/Deputy ❑ Depository ❑ Office 0 Party 2. Name of Candidate(in this order: First, Middle, Last) 3. Address(include post office box or street, city, state, zip code) 305Hv\ A At.AN.1 SN(Z?ft.ENI ANt'C ZIOE I_o►^3 ?aim- p.r1 . 4. Telephone 5. E-mail address G a cc � , r- L. -e ,,- ( 3H «� 7 ) 3(o7 001'4 jSvee9Ma�l. conn Q, _ u h 37...9,,2. 0 1 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if C ►4`( C OJh . 1 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. I have appointed the following person to act as my E] Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputyy \i") Treasurer - o5c- r\wk J lots fft.Vla A'- 11. Mailing Address 12. Telephone 7.. I ,,ov<� VD;"A". ga • ( 317 )3(•7 0°14 13. City 14. County 15. State 16. Zip Code 17. E-mail address tare CavcaV-e- r-A ge-eva.•1 f . 3zcZo jSt4rprcG W ct. l . coAA 18. I have designated the following bank as my ii.4Primary Depository E Secondary Depository 19. Name of Bank 20. Address \NC11S Hatrk1801 N. lr lat& ri C. Il-VZ • 21. City 22. County 23. State 24. Zip Code Car..- CavkaVe-r-sl revard ClourZah 3Z920 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. Sig tur of Can 'date bil7/7-oi5 X 27. Treasurer's Acceptance of Appointment(fill in t e lanks and check the appropriate block) I, —Sos\A v C. Pr\av\ Sv„r ,i--e vl ct vi'I" , do hereby accept the appointment (Please Prit or Type Name) designated above as: ® Campaign Treasurer El Deputy Treasurer. 6 it-4Z° iS Date gna re of Cam•aign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. CANDIDATE OATH — © 1' lib NONPARTISAN OFFICE1 AUG 2 5 2015 L.) Ji (Not for use by Judicial or PPr School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) I, J cSlnvAU. S ;.kf p evtc,vlt .1— (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 C,ill C oil C . (office) (district#) ; I am a qualified elector of g;r�Jtkf'd`1 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. )( l (3 971 3 tp7 0( j5k,t r-Q r.c. .0 A-u iI. LON\ s.1/' gnature if andidate Telephone Number Email Address 2- Levi) pc,i4 (�- Cf_pe_c_cwtct C � t."1---..\ 'tt."1--- 3ZCRZ0 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): 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): -3-05k-1‘) 51 rZ— P R-0% — r1 A V-► STATE OF FLORIDA \\ COUNTY OF (3 v-e \i ckr , ,, "{h Sworn to (or affirmed) and subscribed before me this 2-✓Cday oft. , 20 IS - Personally Known: ✓ or C� w` C/k�r +� Signat re of Notary Public Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public IL �lr,:;',,,,,, ANGELA M.APPERSON Type of Identification Produced: r •,, MY COMMISSION#FF 095122 ': F"' EXPIRES:April 13,2018 ,t1,s, Bonded Thru NotaryPudic Undenxrders �'�7th�¢, DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. 1 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 Monte Mahn-TAI UH (CHUHRCH)church AW (FAWN)fawn Tanya TAWN-yuh(not TAN) U (FUL)full 00 (FOOD)food OU (FOUND)found O (FO)foe El (FEIT)fight Al (FAIT)fate 01 (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 (PURR)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 (LAIM)/ame 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.5111) Rule 1S-2.0001,F.A.C. CE O Ag„ 11 , t CITY OF CAPE CANAVERAL OATH OF CANDIDATE FOR CITY COUNCIL I, —3-05lnv < Sup >er-e a VV\-- , 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. S : ature of C. die .to State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me this day of August, 2015 by mo s h a A- s�,.rpre.na n t , who is personally known or produced Identification. . ii' ANGELA M.APPERSON _,'�.�' MY COMMISSION 1 tini. CEBVE � EXPIRES:April 1 !4t5` Bonded Thru Notary Pudi g (•- Signature of otary Public 111‘ AUG 2 5 2015 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: flak" address,agency name,and position below: LAST NAME--FIRST NAME-- MIDDLE NAME : Sv1eQc-2 ActAt 765\A c. 14Act MAILING ACTDRESS : 21b C Lorti Poink ill CITY: ZIP: COUNTY: [ © [ O W Cct`?e ��t�tathe V �( 3ZgZo 6rcvcur NAME OF AGENCY: AUG 2 5 2015 NAME OF OFFICE OR POSITION HELD OR SOUGHT: ,, C d UVl G You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF %ErCANDIDATE 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 L. for further details). CHECK THE ONE YOU ARE USING: ❑ COMPARATIVE (PERCENTAGE)THRESHOLDS OR VI4 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 "FOL LSOa,t_ \,‘t\.) E►i.5 t'Tt( 3S0 uNwc( '( IDtvd.w3iiq rl�Yt_ 4-oui25r- D1nEC-To►t Z SPL€ YS Er�TE►�-7c4cnt ,s Td K:��%Tcy.1 c_ ak,,,,(�ta'o L ME P4 . a NVO ,Pt— 3 z S I q (�t1.4491'( til 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 1'64( wya� OL ICK LLC, (iQv���v� qbo r� F(ktrct( \Awy 4T00 �,,uQ�t;c, p-es fytic pr to►J r `1731A222 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 located at the bottom of page 2. 000., 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 +� a c ‘kavtiik ck hi2s PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR 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 V\MA 4o f ptc-''€' y\ LL L ADDRESS OF BUSINESS ENTITY Act LMA fit L`r`pY MtvrIs kol PRINCIPAL BUSINESS ACTIVITY (;41/4\.) s , POSITION HELD WITH ENTITY ?14t I OWN MORE THAN A 5% INTEREST IN THE BUSINESS OS NATURE OF MY OWNERSHIP INTEREST Vt'<ih'�. 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: ' I, prepared �i lei 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: 8117 X7,0 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 Pr or 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: State officers or specified state employees papers. 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 Candidates file this form together with their Finally, at the end of office or employment,each or Supervisor of Elections. officer/employee,oer/employee,state officer,and specified qualifying fy g papers. state employee is required to file a final disclosure To determine what category your position falls form(Form 1F)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. Adopted by reference in Rule 34-8.202(1),F.A.C. PAGE 2 OFFICE USE ONLY STATEMENT OF CANDIDATE C1_ [� E C Q e' LP-Th --- (Section 106.023, F.S.) AUG 2 5 2015 (Please print or type) ._.l I, 734)\el V c. u oT tr-f ►t -r- candidate candidate for the office of C- t ( C cuAc- have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X . e/ z �r/Zoic ` Signature of didate 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(05/11)