HomeMy WebLinkAboutQualifying Packet BP - 08-26-2016SUN SPACE AND SEA
CITY OF CAPE CANAVERAL, FLORIDA
CANDIDATE PACKET ACKNOWLEDGMENT
I BUZZ PETSOS would like to announce mycandidacy candidacy for City
Council and do hereby acknowledge receipt of:
1. 2016 Election Information
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, 2016), 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 July 2016
8. Candidate and Campaign Treasurer Handbook as of January 2016
9. 2016 Campaign Treasurer's Report Due Dates for Announced Candidates and general information
about filing reports
10. Do's & 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. 11/13), Waiver of Report
17. Public Service Request Form
18. Political Sign Regulations
19. 2016 General Election Canvassing Board Dates
20. Certification of Elections Results for Municipal Elections. MG 8/24/16
I understand to have my name appear on the November 8, 2016 Municipal Election Ballot, I must
complete qualifying paperwork and pay qualifying fees during the qualifying period which begins
on August 12, 2016 at noon and ends August 26, 2016 at noon.
Buzz Petsos
Signature
Date: 8/ 24/ 16
RECEIVED
AUG 24 2016
MG CCO 4:17 AM
Enter Date & Time Received
and Initials of Clerk's Office Staff Member
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(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
RECEIVED
AUG 24 2016
CCO DL 4:17 PM
1. CHECK APPROPRIATE BOX(ES):
X- 1 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 street, city, state, zip
Buzz Petsos code)
618 Madison Avenue
4. Telephone 5. E-mail address Cape Canaveral, FL 32920
(321) 799-1876 buzzpetsos@earthlink.net
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
City Councilmember applicable:
O 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
O Write-In O No Party Affiliation O Party candidate.
9. I have appointed the following person to act as my X- Campaign Treasurer O Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Buzz Petsos
11. Mailing Address 12. Telephone
618 Madison Avenue ( 321) 799-1876
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Cape Canaveral Brevard FL 32920 buzzpetsos@earthlink.net
18. I have designated the following bank as my O Primary Depository O Secondary Depository
19. Name of Bank 20. Address
Sunrise Bank 5604 N. Atlantic Avenue
21. City 22. County 23. State 24. Zip Code
Cocoa Beach Brevard FL 32931
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
8/24/16 X Buzz Petsos
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, Buzz Petsos , do hereby accept the appointment
(Please Print or Type Name)
designated above as: X❑ Campaign Treasurer , Deputy Treasurer
8/24/16 X Buzz Petsos
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
RECEIPT No. 621602
DATE 8/26/16
FROM Buzz Petsos
$39.00/xx
---- Thirty-nine and 00/100 DOLLARS
O FOR RENT
O FOR Qualifying Fee
ACCT. O CASH
PAID X- CHECK
O MONEY ORDER
DUE O CREDIT CARD
FROM TO
BY Tom Gsoud A-1152
T-4161
CANDIDATE OATH -
NONPARTISAN OFFICE
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
RECEIVED
AUG 26 2016
MG CCO 10:46 AM
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 Cape Canaveral City Councilmember
(office) (district#)
_________, ___________; I am a qualified elector of Brevard County, Florida;
(circuit #) (group or sea t#)
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 Buzz Petsos (321 )799-1876 buzzpetsos@earthlink.net
Signature of Candidate Telephone Number Email Address
618 Madison Avenue Cape Canaveral FL 32920
Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): 101039421
* 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):
Buzz Petsos
STATE OF FLORIDA
COUNTY OF Florida
Sworn to (or affirmed) and subscribed before me this 26th day of August , 2016.
Personally Known: or
Produced Identification: X
Type of Identification Produced: P322052514220
Susan La Marr
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public
SUSAN LAMARR
MY COMMISSION # FF 118066
EXPIRES May 11, 2018
Bonded Thru Notary Public Underwriters
DS-DE 25 (Rev.5/11) Rule 1S-2.0001,F.A.C.
RECEIVED
AUG 26 2016
MG CCO 10:46 AM
SUN SPACE AND SEA
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 Council Member, to which
I desire to be elected and I will support the City of Cape Canaveral Charter
and Ordinances.
Buzz Petsos
Signature of Candidate
State of Florida
County of Brevard
City of Cape Canaveral
Sworn to (or affirmed) and subscribed before me this 26th day
of August, 2016 by BUZZ PETSOS , who is
personally known or produced P322052514220 Identification.
Susan La Marr
Signature of Notary Public
Print, type or stamp Commissioned Name of Notary Public
NOTARY PUBLIC
STATE OF FLORIDA
SUSAN LAMARR
MY COMMISSION # FF 118066
EXPIRES May 11, 2018
Bonded Thru Notary Public Underwriters
OFFICE USE ONLY
RECEIVED
AUG 26 2016
MG CCO 10:46 AM
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
I , Buzz Petsos
candidate for the office of Cape Canaveral City Councilmember ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X Buzz Petsos 8/26/16
Signature of Candidate 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)
FORM 1 STATEMENT OF 2015
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below; RECEIVED
LAST NAME--FIRST NAME--MIDDLE NAME: AUG 26 2016
PETSOS ARTHUR L "BUZZ" MG CCO 10:46 AM
MAILING ADDRESS:
618 MADISON AVE
CITY ZIP COUNTY
CAPE CANAVERAL 32920 BREVARD
NAME OF AGENCY:
CITY OF CAPE CANAVERAL
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
CITY COUNCIL MEMBER
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF X- CANDIDATE OR O 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):
X- DECEMBER 31, 2015 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(must check one):
X- 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
ACCOM CORP KSC, FL 32815 m/s 6300 FACILITY MANAGEMENT
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
BUSINES ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
N/A
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
N/A 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 1,2016 (Continued on reverse side) PAGE
Incorporated by reference in Rule 34-8.202(1),FA.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
STOCKS BOEING, JACOBS ENGINEERING, URS CORP,
BONDS U.S. SAVINGS
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 N/A
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
PART G—TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142,F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G 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 attorney
Signature: in good standing with the Florida Bar prepared this form for you, he or
Buzz C Petsos "BUZZ: 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:
CPA/Attorney Signature:
8/ 25/ 16
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 must file at the same time they file
NOTE: county where your agency has its headquarters.) their qualifying papers.
MULTIPLE FILING UNNECESSARY: Thereafter,file by July 1 following each calendar
State officers or specified state employees
A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer year in which they hold their positions.
of another public position must file a copy of 15709, Tallahassee, FL 32317-5709; physical Finally, file a final disclosure form (Form 1F)
his or her Form 1 when qualifying. A candidate address: 325 John Knox Road, Building E, Suite within 60 days of leaving office or employment.
who files a Form 1 with a qualifying officer is 200,Tallahassee, FL 32303. Filing a CE Form 1F(Final Statement of Financial
not required to file with the Commission or Interests) does,not relieve the filer of filing a CE
Supervisor of Elections. Candidates file this form together with their Form 1 if the filer was in his or her position or
qualifying papers. December 31,2015.
Facsimiles will not be accepted. To determine what category your position falls
under.see page 3 of instructions
CE FORM 1-Effective: January 1,2016 PAGE 2
incorporated by reference in Rule 34-8.202(1),F.A.C.
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Buzz Petsos
Name
(2) 618 Madison Avenue
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
RECEIVED
SEP 09 2016
CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑✓ Candidate Office Sought: Cape Canaveral City Councilmember
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 08/ 26 / 16 To 09 / 02 / 16 Report Type: 2016 G1
®Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , . Expenditures $ , , 39 . 00
Loans $ , , 200 . 00 Transfers to
Office Account $ , , 0 . 00
Total Monetary $ , , 200. 00
Total Monetary $ , , 39 . 00
In Kind $ , , 0 . 00
(8) Other Distributions
$ , , 0 .00
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 200 . 00 $ , , 39 . 00
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name) (Type name)
Buzz Petsos Buzz Petsos
Individual (only for IE X- Treasurer ❑ Deputy Treasurer X- ❑Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X Buzz Petsos X Buzz Petsos
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 08/26/16 through 09/02/18 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State,Zip Code Type Occupation Type Description Amendment Amount
08 / 26 / 16 Buzz Petsos
618 Madison Avenue
Cape Canaveral, FL
1 32920 S FAC. MGR. LOA 200.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 08 / 26 / 16 through 09 / 02 / 16 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
Sequence Street Address & contribution to a Expenditure
Number City, State, Zip Code candidate) Type Amendment Amount
City of Cape Canaveral Qualification Fee
08/ 26/ 16 105 Polk Avenue
Cape Canaveral, FL 32920
CAN 39.00
1
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
RECEIVED
SEP 23 2016
DL CCO
OFFICE USE ONLY
BUZZ PETSOS CAPE CANAVERAL CITY COUNCIL MEMBER
Name Office Sought
618 MADISON AVE CAPE CANAVERAL FL 32920
Address City State Zip Code
X- Candidate O Political Committee ❑ Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization(ECO). An ECO must file a report(not a
waiver) that no reportable contributions or expenditures were made during the reporting period(s. 106.0703(6), F.S.).
O Check here if address has changed since last report. O Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
O MONTHLY REPORT O PRIMARY ELECTION ® GENERAL ELECTION ❑ OTHER REPORT TYPE
Indicate report # Indicate repor t# Indicate repor # Indicate report type and #
M P G 2016 G 2
as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
08/ 26/ 16 THROUGH 09/ 02/ 16
X Buzz Petsos 09/ 22/ 16
Signature Date
X
Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account(no funds expended or
received) the filing of the required report is waived. However,the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS-DE 87 (Rev.06/15)
PETSOS
618 MADISON AVE
CAPE CANAVERAL, FL 32820
CAPE CANAVERAL, FL
OCT 2016
USPS-FLORIDA
CITY OF CAPE CANAVEAL
P.O. BOX 105
CAPE CANAVERAL, FL 32920
ATTN: CITY CLERK
POSTMARKED OCT 5, 2016
RECEIVED
OCT 10 2016
CCO DL
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
POSTMARKED
OCT 5, 2016
DL
RECEIVED
OCT 10 2016
CCO DL
OFFICE USE ONLY
Buzz Petsos Cape Canaveral City Councilmember
Name Office Sought
618 Madison Avenue Cape Canaveral FL 32920
Address City State Zip Code
■Candidate I I Political Committee I I Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report(not a
waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.).
O Check here if address has changed since last report. O Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
O MONTHLY REPORT O PRIMARY ELECTION X- GENERAL ELECTION O OTHER REPORT TYPE
Indicate report # Indicate report # Indicate report # Indicate report type and #
M P G 2016 G3
as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
9/ 17/ 16 THROUGH 9/ 30/ 16
X Buzz Petsos 10/5/ 16
Signature Date
X
Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account(no funds expended or
received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS-DE 87 (Rev.06/15)
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
RECEIVED
OCT 14 2016
CCO DL 1:15 P
OFFICE USE ONLY
Buzz Petsos Cape Canaveral Councilmember
Name Office Sought
618 Madison Avenue Cape Canaveral FL 32920
Address City State Zip Code
❑ Candidate Political Committee P1 Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report(not a
waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.).
I I Check here if address has changed since last report. I I Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
O MONTHLY REPORT O PRIMARY ELECTION X- GENERAL ELECTION ❑ OTHER REPORT TYPE
Indicate report # Indicate report # Indicate report # Indicate report type and #
M P G 2016G4 as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
10/01/16 THROUGH 10/07/16
X Buzz Petsos 10/14/16
Signature Date
X
Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account(no funds expended or
received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS-DE 87 (Rev.06/15)
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Buzz Petsos
Name
(2) 618 Madison Avenue
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 20 2016
MG CCO
O Check here if address has changed
(4) Check appropriate box(es):
❑✓ Candidate Office Sought: Cape Canaveral City Councilmember
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 10 / 08 / 16 To 10 / 14 / 16 Report Type: 2016G5
✓❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , 200. 00 Expenditures $ , , 0 . 00
Loans $ , , . Transfers to
Office Account $ , , .
Total Monetary $ , , .
Total Monetary $ , , 0 . 00
In-Kind $ , , 175.00
(8) Other Distributions
$ , , .
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , 400 .00 $ , , 39 . 00
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name) Buzz Petsos (Type name) Buzz Petsos
❑ Individual(only for IE 2 Treasurer ❑ Deputy Treasurer X- Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X Buzz Petsos X Buzz Petsos
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 10/08/ 16 through 10/ 14/ 16 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State,Zip Code Type Occupation Type Description Amendment Amount
10/ 11 / 16 Citizens 4 A Better
P.O. Box 560137
Rockledge, FL 32956 F N/A CHE 100.00
01
10/11/ 16 C. Shannon Roberts
703 Solana Shores Dr.
Unit 501
Cape Canaveral, FL I N/A CHE 100.00
32920
02
10/12/ 16 Buzz Petsos
618 Madison Ave
Cape Canaveral, FL
32920 S Candidate INK Old Campaign 175.00
Signs
03
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
/
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 10 / 08 / 16 through 10 / 14 / 16 (4) Page of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
Sequence Street Address & contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
/ / NONE
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/ /
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DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
WAIVER OF REPORT
(Section 106.07(7), F.S.)
(PLEASE TYPE)
RECEIVED
OCT 28 2016
CCO DL
OFFICE USE ONLY
Buzz Petsos Cape Canaveral Councilmember
Name Office Sought
618 Madison Avenue Cape Canaveral FL 32920
Address City State Zip Code
■ Candidate Political Committee n Party Executive Committee
NOTE: This form does not apply to an electioneering communications organization (ECO). An ECO must file a report(not a
waiver) that no reportable contributions or expenditures were made during the reporting period (s. 106.0703(6), F.S.).
O Check here if address has changed since last report. O Check here if PC has DISBANDED and will no longer file
reports.
TYPE OF REPORT (Check Appropriate Box and Complete Applicable Line beneath Box)
O MONTHLY REPORT I I PRIMARY ELECTION X- GENERAL ELECTION ❑ OTHER REPORT TYPE
Indicate report # Indicate report # Indicate report # Indicate report type and #
M P G 6 as applicable:
❑ TERMINATION REPORT ❑ SPECIAL ELECTION
NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF
10/15/16 THROUGH 10/21/16
X Buzz Petsos 10/27/16
Signature Date
X Buzz Petsos 10/27/16
Signature Date
REQUIRED SIGNATURES FOR: Candidates:
Candidate and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Political Committees:
Chairman and Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.)
Party Executive Committees:
Treasurer and Chairman (s. 106.29(2), F.S.)
Except as noted above for an ECO, in any reporting period when there has been no activity in the account(no funds expended or
received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed
reporting date that no report is being filed.
DS-DE 87 (Rev.06/15)
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Buzz Petsos
Name
(2) 618 Madison Avenue
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
NOV 04 2016
CCO DL
• Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑✓ Candidate Office Sought: Cape Canaveral City Councilmember
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
O Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 10 / 22 /2016 To 11 / 03 /2016 Report Type: G7
❑✓ Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , 0 . 00 Expenditures $ , , 21 . 95
Loans $ , , Transfers to
Office Account $ , , .
Total Monetary $ , , 0 . 00
Total Monetary $ , , 21 . 95
In-Kind $ , , 25 . 00
(8) Other Distributions
$ , , 0 . 00
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , 400 . 00 $ , , 60 . 95
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name) Buzz Petsos (Type name) Buzz Petsos
❑ Individual(only for IE X- ❑Treasurer ❑ Deputy Treasurer X- Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X Buzz Petsos X Buzz Petsos
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 10/ 22/ 2016 through 11/ 03/ 2016 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address & Contributor Contribution In-kind
Number City, State,Zip Code Type Occupation Type Description Amendment Amount
10/ 24/ 16 Buzz Petsos
618 Madison Ave.
Cape Canaveral, FL
32920 S INK PVC, poles, 25.00
01
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DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 10 / 22 /16 through 11 / 03 / 16 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last, Suffix, First, Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City, State,Zip Code candidate) Type Amendment Amount
10/24/ 16 Staples Office Products Business size palm
3155 Columbia Blvd. elections cards
Titusville, FL 32780
CAN 21.95
01
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DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Buzz Petsos
Name
(2) 618 Madison Avenue
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
FEB 06 2017
CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑✓ Candidate Office Sought: Cape Canaveral City Councilmember
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 11 / 04 / 2016 To 02 / 06 / 2016 Report Type: TR
❑✓ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , 00 . 00 Expenditures $ , , 329. 05
Loans $ , , 00 . 00 Transfers to
Office Account $ , , 00 . 00
Total Monetary $ , , 00 . 00
Total Monetary $ , , 329. 00
In-Kind $ , , 00 . 00
(8) Other Distributions
$ , 00 . 00
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , , 400 . 00 $ , , 400 . 00
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, correct, and complete:
(Type name) Buzz Petsos (Type name) Buzz Petsos
❑ Individual (only for IE easurer ❑ Deputy Treasurer X- Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm.)
X Buzz Petsos X Buzz Petsos
Signature Signature
DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 11 / 04 / 2016 through 02 / 06 / 2016 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix, First, Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State, Zip Code candidate) Type Amendment Amount
11/ 04/ 2016 City of Cape Canaveral Friday Fest Booth CAN 31.95
105 Polk Avenue
Cape Canaveral, FL 32920
01
01/ 12/2016 American Cancer Society Donation to ACS DIS 97.10
5545 N. Wickham Road #107
Melbourne, FL 32940
02
01/ 12/ 2016 Buzz Petsos Reimbursement of RMB 200.00
618 Madison Avenue loan
Cape Canaveral, FL 32929RME
03
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DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Buzz Petsos (2) I.D. Number
(3) Cover Period 11/ 04 / 3026 through 02/ 06 / 2016 (4) Page 1 of 1
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City, State, Zip Code Type Occupation Type Description Amendment Amount
NONE
/ / NONE
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES