HomeMy WebLinkAboutFiling Papers and Campaign Reports BP 2013 O. A O
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CITY OF CAPE CANAVERAL, FLORIDA
C i k.,D IDATE PACKET ACKNOWLEDGEMENT
I �'ZZ 1 c-T-'o3 would like toualify as a candidate for
q
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.
i
oz. zz--' r� OFFICE USE ONLY
Signature a — - .
.. yam
1 1 I v 1 i..---, [.ji i i
(9//3 t
Date in AUG - 9 2813 '
ti 1Enter Date 8c-Time Received--
and Initials of Clerk's Office Staff Member
Eiia iJti 1€54
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN AUG 1 6 2013
DEPOSITORY FOR CANDIDATES I
(Section 106.021(1), F.S.) or
/i. /
IrYi9/yLmm.
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
XD Initial Filing of Form Re-filing to Change: El Treasurer/Deputy El Depository Office L] 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 ) 243-1122 buzzpetsos@earthlink.net
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Cape Canaveral City Council 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
Ei Write-In ❑ No Party Affiliation n Party candidate.
9. I have appointed the following person to act as my Q Campaign Treasurer n Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Buzz Petsos
11. Mailing Address 12. Telephone
618 Madison Avenue ( 321 ) 243-1122
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 111 Primary Depository E 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 Can 'd to _
/.13 7
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
Buzz Petsos , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer ri Deputy Trees,rer.
Ic
8/x(13 a •
Date gnature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
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1
CANDIDATE OATH — {� AUG 1 6 2013 LI
NONPARTISAN OFFICE (
.I s
(Not for use by Judicial or -
School Board Candidates)
OFFICE USE ONLY
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 Council member ,
(office) (district#)
; 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.
XKiee-Z, rv--.e— (321 )243-1122 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 PET-sos
STATE OF FLO9 IDA
COUNTY OF ','V--!/"4.e
Sworn to (or affirmed) and subscribed before me this //-56_ day of 41,f vS T , 20/3
/ /. a .r`
Personally Known: i,- or — r A
Signature of Notary Public
Produced Identification: Print,Type,or Stamp Commissioned Name of Not Public
.1 -'—r—♦
_yNN'N��' MIA GOFORTH 11/
Type of Identification Produced: �V• !7 Notary Public•State of Flodda
r� •z My Comm.Expires May 16,2017 '
i Commission #EE 866939
f~ Boma i nrougn 11auv,1m V..,
DS-DE 25(Rev.5111) — — — — Thule 1S-2x001, 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 :
Petsos Buzz 96411
MAILING ADDRESS:
618 Madison Avenue 1
EE1 II-7,, <,,,,-...,2 ia IJ ' r t ---
[ E IF
CITY: ZIP: COUNTY: i
Cape Canaveral, FL 32920 AUG 1 6 2013
NAME OF AGENCY:
Cape Canaveral ---- J`
NAME OF OFFICE OR POSITION HELD OR SOUGHT: (-76-
-7`Z
Council Member
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):
}c( 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
(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,you must write"none"or"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
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
/BUSSI SS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
0-
. .....
•
,___ ,. _
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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
/ form are located at the bottom
` of page 2.
INSTRUCTIONS on who must
file this form and how to fill it
-r out begin on page 3.
L
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
65' �E�in (yep.., LJ s-
_0/t):P S 4.2 . j e e-4-51-4-4-4(
s', o 4.111:5 <52kfl/A1 ,$ C/f Ett'i-J ,4c '73
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
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 N c 4J 5
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS
NATURE OF MY �f
OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE required): DATE SIGNED (required):
/::-K
/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 dating 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). confirmation, even if that is less than 30
( ) which they permanently reside. (If you do not days from the date of their appointment.
permanently reside in Florida, file with the
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 1 State 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 are required to file by July 1st following
Form 1 because of another public position Candidates file this form together with their each calendar year in which they hold their
must at least file a copy of his or her original qualifying papers. 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 1F)within 60 days
Facsimiles will not be accepted. of leaving office or employment. However,
filing a CE Form IF (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.
k:t ru*w -tttecuve.January 1,[U73.Meter to Kula 34-o.Lu[(i/, -.H.L,. 1-/%L7C L '
OFFICE USE ONLY
STATEMENT OF
CANDIDATE .
(Section 106.023, F.S.) I
`r) AUG 1 6 2013
(Please print or type) 11-41
1, Buzz Petsos
candidate for the office of Cape Canaveral City Council Member ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
r-- f4 B�
X 8/15/13
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(05111)
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Buzz Petsos11 OFFICE.USE ONLY_,
Name
(2) 618 Madison Avenue AY 1 I
Address (number and street) NOV
Cape Canaveral, FL 32920 f�
City, State, Zip Code (PIS—
❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: 02-0703085
(4) Check appropriate box(es):
.7 Candidate (office sought): City Councilmember
❑ Political Committee ❑ CHECK IF PC HAS DISBANDED
❑ Committee of Continuous Existence ❑ 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 08 / 16 / 13 To 11 / 01 / 13 Report Type TR
EZ Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Monetary
Cash & Checks $ 0 . 00 Expenditures $ 200 . 00
Loans $ 200 . 00 Transfers to Office
Account $ 0 . 00
Total Monetary $ 0 . 00 Total
Monetary $ 200 . 00
In-Kind $ 0 . 00
(8) Other Distributions
$ 0 . 00
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ 200 . 00 $ 200 . 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, I certify that I have examined this report and it is true,
correct, and complete. correct, and complete.
(Type name) Buzz Petsos (Type name) Buzz Petsos
❑Individual (only for ✓ Treasurer ❑Deputy Treasurer ❑✓ Candidate ❑ airperson(only for PC,PTY&
electioneering commun.) e��neering commun.organization)
Xc
Signature Signature
DS-DE 12(Rev. 08/04)
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Buzz Petsos (2) I.D. Number 02-0703085
(3) Cover Period 08 / 16 / 13 through 11 / 01 / 13 (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
Buzz Petsos I Facility LOA 200.00
08 / 16 /13 618 Madison Ave. Manager
Cape Canaveral, FL
32920
1
/ /
/ /
/ /
/ /
/ /
/ /
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DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Buzz Petsos (2) I.D. Number 02-0703085
(3) Cover Period 08 / 16 / 13 through 11 / 01 / 13 (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 MON $39.00
08 /16 /13 105 Polk Avenue Fee
Cape Canaveral, FL 32920
01
Buzz Petsos Partial MON $161.00
10 /11/13 618 Madison Ave. repayment of
Cape Canaveral, FL 32920 loan
02
/ /
/ /
/ /
/ /
/ /
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DS-DE 14(Rev.08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES