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HomeMy WebLinkAboutFiling Papers and Campaign Reports JB 2013 416 O %ow-- CITY OF CAPE CANAVERAL, FLORIDA CANDIDATE PACKET ACKNOWLEDGEMENT I would like to qualify as a candidate for City Council and do hereby acknowledge receipt of: • 2013 Election Information • Form DS-DE 9 (rev. 10/10), Appointment of Campaign Treasurer and designation of campaign depository for candidates • Form DS-DE 25 (rev. 05/11), Candidate Oath —Non-Partisan Office • CE Form 1 (Jan 1, 2012), Statement of Financial Interests and Instructions • Form DS-DE 84 (05/11), Statement of Candidate • Election Laws of the State of Florida (September 2012) and HB 569/Chapter 2013-37 • Candidate and Campaign Treasurer Handbook (November 2011) • 2013 Campaign Treasurer's Report Due Dates and General information about filing reports • Do's and Don'ts for Campaign Treasurer's Reports • Form DS-DE 12 (rev. 08/04), Campaign Treasurer's Report Summary • Form DS-DE 13 (rev. 08/03), Campaign Treasurer's Report— Itemized Contributions • Form DS-DE 14 (rev. 08/03), Campaign Treasurer's Report — Itemized Expenditures • Form DS-DE 87 (rev. 07/10), Waiver of Report • Notification of Public Logic and Accuracy Tests / Canvassing Board Meeting • Certification of Municipal Elections Results • Public Service Request Form • Political Sign Regulations for City and County I understand to have my name appear on the November 5, 2013 Municipal Election Ballot, I must complete qualifying paperwork and pay qualifying fees during the qualifying period which begins on August 9, 2013 at noon and ends on August 23,2013 at noon. OFFICE USE ONLY Signature Date AUG 1 3 2013 IE 1417.411 14.34 Enter Date&Time Received and Initials of Clerk's Office Staff Member r- APPOINTMENT OF CAMPAIGN TREASURER r, 'C �l I AND DESIGNATION OF CAMPAIGN ,t I l DEPOSITORY FOR CANDIDATES AUG 1 4 2013 (Section 106.021(1), F.S.) C ' (PLEASE PRINT OR TYPE) ` J NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. C ECK APPROPRIATE BOX(ES): 12 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 code) 4. Telephone 5. E-mail address (32-/ ) z 9B. //g Dms 0/7 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: My intent is to run as a Write-In candidate. GWA/G/G 7" 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 cp Write-In ❑ No Party Affiliation fl Party candidate. have appointed the following person to act as my ❑/ Campaign Treasurer ❑ Deputy Treasurer Name of Treasurer or Deputy Treasurer //// //v' -/d /v/ 1//23 11. Mailing Address 12. Telephone ,9?2 ie/A- • (3z/ )27////3 13. City 14. County 15. State 16. Zip Code 17. E-mail address Ci /rr/UC L it7/? /=Z /p/, /0//i11 /1/ •/1'/ 18. I have designated the following bank as my [ Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Gi/5 45 /-c/Z6v 7g�/Ay2/W/ ,&Z 21. City 22. County 23. State 24. Zip Code G/ati/ vL 4/ $z7zo 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 07/5—o/� X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) M/G,¢`P -/D'1// /1/6 , do hereby accept the appointment (Please Print or Type Name) designated above as: E( Campaign Treasurer ❑ Deputy Treasurer. o/f5/2D/.3 X Date Sign.ture of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. p �� l CANDIDATE OATH - AUG 2 2 2013 NONPARTISAN OFFICE I 1. (Not for use by Judicial or 0.7 40n School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) I, —io%'lU SJ 4/Z) (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 Ci/7'J/ CwA/G/G ",,2,4/7/ /±-72 (office) (district#) ; I am a qualified elector of i?j?,,c A'�Z/) 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. (3Z4 2v.///e'_ h/oM e10//fi - /m.A/4-T Signature of Candidate Telephone Number Email Address 891/GAS D1f•, *aZ 0/9/7/1- c/9/Y, / .PL /1:2 �z9zD 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): Jl'4'/ /5i4 W/4/ STATE OF FLORIDA COUNTY OF -`' Sworn to (or affirmed) and subscribed before me this 2-G�day of .`-v r , 20 • Personally Known: or �� ignature of Notaryblit Produced Identification: Print.Type,or Stamp Commissioned Name of Notary Public MIA GOFORTH Type of Identification Produced: �J ? A Notary Public-State of Florida •s My Comm.Expires May 16.2017 rece Commission#EE$6693$ '" Bonded Through MOW Rotary ailo. DS-DE 25(Rev.5/11) • 2.0001,F.A.C. FORM 1 STATEMENT OF 2012 Please print or type your name,mailing FINANCIAL INTERESTS address,agency name,and position below: FOR OFFICE USE ONLY: LAST NAME--FIRST NAME--MIDDLE NAME : /3" '# y J/�/ MAILING ADD ESS : 3'q2/ 4A' 2/ - 3yon CITY: ZIP: COUNTY: AUG 2 2 2013 NAME OF AGENCY : 'if a,:: X697/ GX1/4 ;t, ,/2'2_ -/ NAME OF OFFICE OR POSITION HELD OR SOUGHT: //'(S�j�4( You are not limited 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, 2012 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS 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 ee 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,you must write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY 07i1.'�iII. G�'SO1r / 1Z1 7 '//1 ✓/if/6 tdist i I i2F/e F-57.'74"9/PG/Ot 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 PART C--REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] FILING INSTRUCTIONS for (If you have nothing to report,you must write"none"or"n/a") when and where to file this gale-/P:G /''Pi d, • formarelocatedocated at the bottom of pa 9e INSTRUCTIONS on who must Z '''/�U,4 4'4*� G/ZJQ. file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. (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,you must write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES r«j �G/Y l A'Y AJ 6011freG a/ G / ALJ /ay/1/ 7-N /171?jA4P 4 ?l1+'A/IK:,G %• ShG�.0"•actin PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,you must write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR air /r,n 6iri.C. /97h /7/./s6,lNvi,' /SSG AV az/0/7 Gir/on/ 7).0447/7-c /$6/940/ G PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,you must write"none"or"n/a") BUSINESS ENTITY#1 BUSINESS ENTITY#2 BUSINESS ENTITY#3 NAME OF BUSINESS ENTITY 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 `'lair IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE (required): DATE SIGNED (required): ftio"--%-- ---- z-/Zep/zP. FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, If you were mailed the form by the Commission Initially, each local officer/employee, including signing and datina it,send back on Ethics or a County Supervisor of Elections state officer, and specified state employee only the first sheet(pages 1 and 2)for filing. for your annual disclosure filing, return the must file within 30 days of the date of form to that location. his or her appointment or of the beginning If you have nothing to report in a particular Local officers/employees file with the of employment. Appointees who must be section,you must write"none"or"n/a"in that Supervisor of Elections of the county in confirmed by the Senate must file prior to section(s). which they permanently reside. (If you do not confirmation, even if that is less than 30 permanently reside in Florida, file with the days from the date of their appointment. NOTE: Supervisor of the county where your agency Candidates for publicly-elected local office MULTIPLE FILING UNNECESSARY: has its headquarters.) must file at the same time they file their Generally, a person who has filed Form 1Stafe officers or specified state employees qualifying papers. for a calendar or fiscal year is not required file with the Commission on Ethics, P.O. Thereafter, local officers/employees, state to file a second Form 1 for the same year. Drawer 15709,Tallahassee, FL 32317-5709. officers, and specified state employees However, a candidate who previously filed Candidates file this form together with their are required to file by July 1st following Form 1 because of another public position qualifying papers. each calendar year in which they hold their must at least file a copy of his or her original positions. Form 1 when qualifying. To determine what category your position falls Finally, at the end of office or employment, under,see the"Who Must File"Instructions on each local officer/employee,state officer,and page 3. specified state employee is required to file a final disclosure form(Form 1 F)within 60 days Facsimiles will not be accepted. of leaving office or employment. However, I- filing a CE Form 1F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if he or she was in their position on December 31,2012. CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. PAGE 2 -- OFFICE USE ONLY STATEMENT OF1: ���1 a 3 :_f L1 ` CANDIDATE [ AUG 222013 11 (Section 106.023, F.S.) ,i I (Please print or type) a gym../ dvi /G/, 4,%4/, /9//) , candidate for the office ofl77 ,i© ,,o), //MAri*/�,,� _ ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X 77,---- .Z/'/j" Slgnatu e 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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). r.. DS-DE 84(05/11) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY LI (1) O�ljyOFFICE USE ONLY Name (2) f�3/l- 1',fPl'. 7�'� SIJ Ill I, Address (number and street) t NOV 2 0 2013 I City, State, Zip Code /0,i5;9,)7 ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): ® Candidate (office sought): ,d',�1. 1 ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence n CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Electioneering Communication CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 63 I Z IZf/f To /t2- / /6 l 'g/$ Report Type /A' ❑ Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary k,,, Cash & Checks $ Expenditures $ /Ov Loans $ /�0- €® Transfers to Office Account $ Total Monetary $ /00 Ole Total Monetary $ In-Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ ;'->: 9,2 $ (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, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) (Typ name) ❑Individual(only for Treasurer ❑Deputy Treasurer LJ candidate ❑Chairperson(only for PC,PTY& electioneering commun.) electioneering commun.organization) Signature Signature DS-DE 12(Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name .J �/44//i0i''✓J (2) I.D. Number (3) Cover Period �.?9/ 22-- / 2"/T through /o / /' /Z.67/,? (4) Page // of / (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 .!0/0if:91 .i.647 l ���/17/�� �� 1 / / / I I / I / I I Awe I I I I DS-DE 13 (Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES . CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name ,.4040/.X2/1/A (2) I.D. Number (3) Cover Period Og /°7- / 26"through ,/B I 11 / W- - (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 0/ /i''7'/mssp�X"l�yY�'�.F 1 dOUA4/M" / / G Gl y/,/ � �'' �9 o a Cu 4Va li0/2i r> ,2i?/✓,e ,vey, ' iC/7 /�15?,t, /17/07-4-VA/77/ ,;ov �Cr ��" /Y�o� /4-9. ' � zyz0 JoA1Ma/V) /� pip:,04)/4 ,./e- *et �v�� Ohl '-' L / / / / / / / / / / DS-DE 14(Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES