HomeMy WebLinkAboutAnnouncement of Intention to Run NC X47.
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CITY OF CAPE CANAVERAL, FLORIDA
ANNOUNCED CANDIDATE PACKET ACKNOWLEDGMENT
I, Pr. M P.(‘vv C G'Cd I n Q t e, would like to announce my candidacy for City
Council and do hereby acknowledge receipt of:
1. May 17, 2017 Candidate Information Memo
2. 2017 Election Information
3. Announcement of intention to become a Candidate for Office
4. Form DS-DE 9 (rev. 10/10),Appointment of Campaign Treasurer and designation of campaign depository
for Candidates
5. Form DS-DE 84 (rev. 05/11), Statement of Candidate
6. Election Laws of the State of Florida as of July 2016
7. Candidate and Campaign Treasurer Handbook as of January 2016
8. 2017 Campaign Treasurer's Report Due Dates for Announced Candidates and general information for
filing reports
9. Do's & Don'ts for Campaign Treasurer's Reports
10. Form DS-DE 12 (rev. 11/13), Campaign Treasurer's Report Summary
11. Form DS-DE 13 (rev. 11/13), Campaign Treasurer's Report—Itemized Contributions
12. Form DS-DE 13A (rev. 11/13), Campaign Treasurer's Report—Fund Transfers
13. Form DS-DE 14 (rev. 11/13), Campaign Treasurer's Report—Itemized Expenditures
14. Form DS-DE 14A (rev. 11/13), Campaign Treasurer's Report— Itemized Distributions
15. Form DS-DE 87 (rev. 06/15), Waiver of Report
16. Public Service Request Form
17. Political Sign Regulations
I understand to have my name appear on the November 7, 2017 Municipal Election Ballot, I must
complete qualifying paperwork and pay qualifying fees during the qualifying period which begins
on August 11, 2017 at noon and ends August 25, 2017 at noon.
OFFICE USE ONLY
Csa,,,,L,atz,
lECEOVE ,
Signature JUN 2 6 2017
Date'
Q -2h-2
t0In Enter s. - :• --• - - - -..
and Initials of Clerk's Office Staff Member
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t,Espem BErvdtEN
CITY OF CAPE CANAVERAL, FLORIDA
ANNOUNCEMENT OF INTENTION
TO BECOME A CANDIDATE FOR OFFICE
I, b r, L ly . C n rc j ylcst - , hereby declare and announce my
intention to become a Candidate for the office of City Council in the City of Cape
Canaveral General Election on November 7, 2017.
I understand it is my responsibility to comply with all applicable election laws and
that I must be a resident and registered voter of the City of Cape Canaveral.
Lr 1\(\r 2 C. n - 3 — o V1
Signature Date
OFFICE USE ONLY
1 --) L-ECEOVEf
I
' JUL 0 3 2017
1\ [ _..)
ocro ,?,'Z,7r
Enter Dat Sr..-limp R eccixed _ _
and Initials of Clerk's Office Staff Member
APPOINTMENT OF CAMPAIGN TREASURER DEC a i V
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUL 0 3 2017
(Section 106.021(1), F.S.)
r
(PLEASE PRINT OR TYPE) CCO 9L -"%'
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
n Initial Filing of Form Re-filing to Change: n Treasurer/Deputy n Depository n Office n Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
br Welly , LgiAin41 -e L \ E,cer, rc.1 Bl vd3
4. Telephone 5. E-mail address 1 i
(321 )531-1-3M y\CRIMQte�5Ma►1,c0M CQ fp
CQ n�.Ue rQ` ? 29 ? 0
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
0Dune
i i WOmq h applicable:
I I 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 Li No Party Affiliation Party candidate.
9. I have appointed the following person to act as my I •I Campaign Treasurer I I Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
DJC . t\1 P i hi S , L'g r c I YI k-
11. Mailing Address 12. Telephone
I7E, CQ >ni-rct 6IvJ ( )
13. City 14. County15. State 16. Zip Code 17. E-mail address
Cope C4hq�erc1 13reucr� f l 32120 hcqrAinette-e3Pnlik,com
18. I have designated the following bank as my ❑, Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
�cnn cl , (-resA U ell 0 IA 300 S, 1l(01 05S--1
21. City 22. County 23. State 24. Zip Code
i(4) tnR--td601 ,1 tre,,uc\--ci -V \ ' 1-z ck's L
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
9 -3 - i 01 Xc)f S, -T
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, Dr, Nell\I S , CEJ q fd i n G 1 -- , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 1.7>1 Campaign Treasurer I I Deputy Treasurer. -�� ��►
`3 —2--o t ' 7 x(-},, , r),-;_oj C�.�-97---,. __.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
i
�. z
OFFICE USE ONLY
STATEMENT OF
CANDIDATE DEC C II `� C
(Section 106.023, F.S.) 1
I JUL 1 9 2017
(Please print or type) ��
j
I
1, Dc, ILC1I C_� �� � 1)s
y
candidate for the office off`► l b
CSU � I r�e���.r � -0 C k-k
`it
C_q Com. uercLt
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x C --, 1, 1 t � _ O i
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)
ReF4 3
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Ndti
NIS D r---
(2) 3l9' E, Cenkf Ql BW d AUG 11 2017
�ddress (number and street)
q e 4 nc -FI 3232, 0
City, tate, Zip Code !
❑ Check here if address has changed (3) ID Number: It.\
(4) Check appropriate box(es):
8 Candidate Office Sought: C4 CI 6. coulic',
❑ 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 ars ❑Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From �� / a / 1 To 0 / ZO I Report Type:
9 Original ❑Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary N,C
Cash & Checks $ Expenditures $ , 3 q3 . q
Loans $ , , Transfers to
Office Account $ ,
Total Monetary $
Total Monetary $ .
In-Kind $ , ,SC�b • b
(8) Other Distributions
$ 9 ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , 5 . 0 $
(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) `l Cq r n ql 2 (Type name)Dr, �ec, , C rj ) C`y e-
❑Individual(only for IE Tr4asurer ❑Deputy Treasurer (_C]Candidate ❑Ctlairperson(only for PC and PTY)
or electioneering comm.)
X X
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
M3
Dr, MAIt TRASU�ER'S REPORT- ITEMIZED EXPENDITURE
(1)Name Qr inn e_ (2)I.D. Number b
(3)Cover Period /(/ through 0/'�l TtMZ0Ij (4)Page l 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
Dr. NU CaF�. C�',I1��1/�r�
1 E,ce n r�1 �v� ��-y � A N ►,� � '3g3.9'1
's
3 � l
CAnR1tQ�� �� 3�92 d C O V n c�'
DS-DE 14(Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
M3
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
(1) Name Or. WeRj C4r91 Qle,, (2) I.D. NumberN 1b
I
(3) Cover Period 09 /0 /�01 I through�� /3 I / (4) Page of I
(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 CQde. Type Occupation Type Description Amendment Amount
'1 2 �?D)q °i; �CynCr�l AW c�c� 1z p tob
s� Tw k, 1
q Cs�►►�RI,ef41 �F) S rr r
� 32920
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DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
p
CAMPAIGN TREASt�RER'S REPORT— FUND TRANSFERS
(1) Name or , N Cg r in ei (2)I.D. Number
(3)Cover Period 89--/ V / q through Q9 /S 1 /2019 (4)Page of
(5) (7) (8) (9) (10) (11)
Date Name of Financial
(6) Institution
Sequence Street Address& Transfer Nature of
Number City,State,Zip Code Type Account Amendment Amount
MO aur 4 Cr I. r�)ole CAer—kinN
300 f to moSj j oc��DO
S
3Z�S
l.guh & C��t Uhlo� n 1 1
M -� , jqu l Q. o-O
3
OD Cis osq - - 1
b F1
Z kf-. h�32S5`7-
lzq l7
i -F- C�ec�1U,n
DS-DE 13A(Rev.11/13) SEE RF-VERSE FOR I STRUCTIONS AND CODE VALU S
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319 E Central Blvd
Cape Canaveral,FL 32920-2609 ` .. � 1
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