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HomeMy WebLinkAboutmkellum_qualifying_elections_paperwork_201908CITY OF CAPE CANAVERAL, FLORIDA CANDIDATE PACKET ACKNOWLEDGMENT I, Mhki Ulu,m would like to announce my candidacy for City Council and do hereby acknowledge receipt of: 1. April 18, 2019 Candidate Information Memo (Amended August 8, 2019) 2. 2019 Election Information (Amended) 3. Form DS-DE 9 (rev. 10/10), Appointment of Campaign Treasurer and designation of Campaign Depository for Candidates 4. Form DS-DE 302NP (rev. 11/17), Candidate Oath — Nonpartisan Office 5. City Oath of Candidate 6. CE Form 1 (January 1, 2019), Statement of Financial Interests and Instructions 7. Form DS-DE 84 (rev. 05/11), Statement of Candidate 8. Election Laws of the State of Florida as of as of August 2019 9. Candidate and Campaign Treasurer Handbook as of September 2018 10. 2019 Campaign Treasurer's Report Due Dates for Announced Candidates and general information for filing reports 11. Do's & Don'ts for Campaign Treasurer's Reports 12. Form DS-DE 12 (rev. 11/13), Campaign Treasurer's Report Summary 13. Form DS-DE 13 (rev. 11/13), Campaign Treasurer's Report — Itemized Contributions 14. Form DS-DE 13A (rev. 11/13), Campaign Treasurer's Report — Fund Transfers 15. Form DS-DE 14 (rev. 11/13), Campaign Treasurer's Report — Itemized Expenditures 16. Form DS-DE 14A (rev. 11/13), Campaign Treasurer's Report — Itemized Distributions 17. Form DS-DE 87 (rev. 06/15), Waiver of Report 18. Public Service Request Form 19. Political Sign Regulations 20. 2019 Municipal & Special Districts Canvassing Board Dates I understand to have my name appear on the November 5, 2019 Municipal Election Ballot, I must complete qualifying paperwork and pay qualifying fees during the qualifying period which begins on August 9, 2019 at noon and ends August 19, 2019 at noon. Signature Date: e //&//9 Enter Date & Time Received and Initials of Clerk's Office Staff Member APPOINTMENT OF CAMPAIGN TREASURERRffogn 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. •1' AUG 1 6 2019 / /� O �_ By: _ --� C� C- OFFICE USE ONLY 1. ECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ■; Depository ❑ Office ❑ Party 2. Name IYIAck.7% of Candidate (in this order: First, 4 inicheilQ. Middle, keUt Last) en 3. Address (include post office box or street, city, state, zip code) tri to Co j L1 iU A arve Q. p 2. C ZIli 'a()(ram. �y4 1 4. Telephone 5. E-mail address 6. Office sought (include district, circuit, group number) C:1-v y (oiu-c 7. If a candidate for a non 'artisan office, check if applicable: My intent is to run as a Write -In candidate. 8. If a candidate for a 'artisan office, check block and fill in name of party as applicable: My intent is to run as a ❑ Write -In ❑ No Party Affiliation I Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer , 11. Mailing Address ' % (0 Coqa.\NP lain 12. Telephone (! )53B 13. City r14. C"�c3e eskak)e c .l County elftwarCI 15. State i t. 16. Zip Code .3 12 17. E-ma I address min Kek n a had ai I .con, y, 18. I have designated the following bank as my Z Primary Depository ❑ Secondary Depository 19. Name of Bank LLC s e- ?DR n K, 20. Address 510 ° 0 J\4ten*t c AN_. 21. City Cocoa 6., 22. County C.eoarci 23. State kociel A. 24. Zip Code 3a R 3 I 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 1 li 1% 11 26. Signature of Candidate Xau . /7/ 27. Treasurer's Acceptance I, M R EA p! K'Q.aitir1 of Appointment (fill in the blanks and check the appropriate block) , do hereby accept the appointment (Please Print or Type Name) designated above as: j' Campaign Treasurer ❑ Deputy Treasurer. 412) i 70 I q X `-2,2077 ie ie Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate ©.3...pR AUG 1 9 2019 1) U CC � /0: 3 � By: OFFICE USE ONLY I, INI .t re MR IG�i Candidate Oath (Section 99.021(1)(a), Florida Statutes) �\ IJ(- (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of C. t -k CO U T CA I ' i (Office) (District #) , ; I am a qualified elector of -ece a. ('d i 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. Candidate's Florida Voter Registration Number (located on your voter information card): I 0 0 96t t 6 (o 1 Phonetic spelling for audio ballot: Print name phonetically ballot as may be used by persons with disabilities (see M H - ��� - U " M I ._Kee` on the instructions on line below as you wish it to be pronounced on the audio p ge 2 of this form): (Not applicable to write-in candidates.] RBI — tA.m x (3al) 5 3 & - KQ. hcfk• I , Signature of Candidate I elephone Number al to Ccsiri -;tN lot Lao Q- C�'ap.Cauaie Email Address rS2— -PI. 3D9ap Address 0 City State ZIP Code STATE OF FLORIDA Signature of Notary Public COUNTY OF g4457/11Print, Type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me this / 9 A Daniel Roy LeFever /� �t G' NOTARY PUBLIC day of A Grs / , 20 / -[ . STATE OF FLORIDA •k. � ._ �.�.,- . Comm# FF984423 Personally Known: or Produced Identification: \ e Expires 4/20/2020 Type of Identification Produced: R., Be- DS-DE 302NP (Rev. 11/17) Rule 1S-2.0001, F.A.C. OATH OF CANDIDATE MAai,R, lcdUArrl (1\A,e,1<i'0 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. Signature of Candidate State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me this of August, 2019 by #(1,—)A 4-zGeey` personally known or produced Signature of Notary Public l� day , who is Identification. Daniel Roy LeFever NOTARY PUBLIC STATE OF FLORIDA Comm*FF984423 Expires 4/20/2020 Print, type or stamp Commissioned Name of Notary Public FORM 1 STATEMENT OF 2018 Please print or type your name, mailing address, agency name, and position below: FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME — FIRST NAME — MIDDLE NAME : P 1 UM rn lki R PliaiwkC amieKCei IL G A DRESS : g t' 10 Cluj N R Lan o_ apt Pe aaoau �c-LQ.. 3?c Pxeoac� gR1121 CITY C (� b-c C 1 �P Z� �I'� alb `G(cQ�l - n — v 19. 2019; NAME OF E CY : , 1 Li I-oUrsa[1 AUG NAME OF OFFICE/OR POSITION HELD OR SOUGHT : ,: 344 You are not limited to th space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF CANDIDATE OR U NEW EMPLOYEE OR APPOINTEE �y� **** 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 O A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER ( st check one): DECEMBER 31, 2018 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATAREABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY B SED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions] write "none" or "n/a") SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY /tk PART B — SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses report, write "none" or "n/a") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVITY OF SOURCE N • to 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 ile this form and how to fill it out begin on page 3. 1•::::::°:::::f ���D �+N��a�����a avr �� CE FORM 1 - Effective: January 1, 2019 Incorporated by reference in Rule 34-8.202(1), FA.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, write "none" or "n/a") TYPE OF TANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] "'n(If-you have nothing to report, write "none" or "n/a") ► 7 NAME OF`CREDITOR ADDRESS OF CREDITOR Lingoo Sp ci �r Gareth anfCf\ './" / /err berr'L( Rci / 2 6- AJ A- I arr/ e . AVQ_ Cocos 39 3 l 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") NAME OF BUSINESS ENTITY" 6 11 BUSINESS ENTITY# 1 BUSINESS ENTITY # 2 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: Signature: Date Signed: 1 CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or 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. CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format) and send it to CEForm1@leg.state.fl.us. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is Tess than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2018. CE FORM 1 - Effective: January 1, 2019. PAGE 2 Incorporated by reference in Rule 34-8.202(1), F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) CGo j.— /0:31,4 I, 1.A- iaM Kdui'r CM;cK,�1 candidate for the office of Cry C,r:l have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. /f/'? 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) City of Cape Canavera Cash Receipt #: 100 Polk Avenue P.O. Box 326 Cape Canaveral, FL 32920 (321) 868-1220 www.cityofcapecanaveral.org Cash Receipt Received From For Payment Received Cash Check Total Amount Due Date: 1/ /`// / ? Amount Received. `Balance Due 3. o0 9r City Employee CAMPAIGN TREASURER'S REPORT SUMMARY / _D1 (1) fjpQ i pi it7 If le(6eU . EE I V; ^ s\Name (2) ligIn (oq..uua,ec. Address OP (numb rand treet) C-a.K ac�.r (, an SEP 0 6 2019 L , Cit ,7)a9 r, State, Zip Code121, / , Oe0 ❑ Check here if address has changed (3) ICD' um•er: (4) Che k appropriate box(es): \ Candidate Office Sought: C 1,*rock (1(?_ (' i A'i C. Cak)a0e1CAZ ❑ 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] (i Cover Period: From / 6 l / 0 To / / 3/ / / Report Type: 6 J Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $2 D® oce, imoco • ,ybbna (7) Expenditures This Report Monetary Expenditures $3955' , jab' , . Transfers to Office Account $ . five? / 66b', Loans $ , , Total Monetary $ 33D0 , Do ' /o66 • 1'000 Total Monetary $ 310 %iS' . / pab 1000 In -Kind $ , , • (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date co $ %63cc , /6/30 . /DoO (10) TOTAL Monetary Expenditures To Date $ 39ar , o ,• c., /©DD /000 It is a first degree misdemeanor I certify that I have examined this report 9' (Type name) PiK.(it. IIY 1"Cri Q.,h�l14,Alt (11) Certification for any person and it is true, correct, to falsify a public record (ss. 839.13, F.S.) and complete: / J% (Type name) mR Q1 R. t /� I1CkiP . 1.' 1litin • Individual (only for IE Treasurer ■ Deputy Treasurer or electioneering comm.) / Candidate ■ Chairperson (only for PC and PTY) S X�i/7 �_ Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS � (1) Name Mp R ► A11►li(!�1�K€jGnyl (2) I.D. Number (3) Cover Period / D ( / / 9 through 6 / 3 / / /9 (4) Page % of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number Ke(LLm cam Lama etaS2- Y,t, ��te� Lai IV ttiT�-_ 50-1 r 3 00 an / 22 / 16/, -re---C. %€ tuuei 9ctip Corm/CA 1 1-45` I14 0, K j DO. oa / �� / 1,VS1a u� No PP ►a-- $Sb 1 A54, or,2w1-Q t Oee eao3e�art, 8 C�� j 0oo °� l ro/ ; 1 3 / A /1°r PG Gh U� a26 V+) CeJ-t-cQQ 610 C ex C` > oec i, ri 3,2%a3 B cite- 66. 1000 - / at,2 ( iY ---t SI / c2 I- /19 OSkRL_ 1 &A 1 6-w &eaFr hBl Cc3eoa Ee�b �f0- 3093t P N nOOoa 5 / a fo / I R © WAOQ_ .one. p pczt, Acei- ie3 V) I�ocoz B Ile- 66 PVao j o �V Caus ...a,,31 O'oeoa .0-e-kJ / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES � CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS (1) Name 1 F A-R,l A HMI0�1�' �.p�Jlli7'1 (2) I.D. Number (3) Cover Period lj / D / / / of through / 3( / /q (4) Page 1 of (5) Date (7) Name of Financial Institution Street Address & City, State, Zip Code (8) Transfer Type (9) Nature of Account (10) Amendment (11) Amount (6) Sequence Number /19 / i9 Cao*Ao cLQ__ C i --y Cc Cz f S /•Oo Pd (Y Ads- I Fare Oakya°aro. F Ja %2O GHt aa(nP a(,n G?ual.iryi( rem o Q6 1 / 3 / Cr / / / M5on cad J 35 P' n‘edrt (ot - tr).0-tba rno e. FM- C4E e, Campaign ?rc-iu.re- % ��co / / / / / / // // / / DS-DE 13A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY l (1) MA k.:1 ►l i ere. 1 e,Ut. rn D E 1 V E' Name (2) o SEP 2 3 2019 Address (number nd street) r il) V O 0r /� g: ecd City, Sthte, Zip Code By: /'2,� ,a ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought: 4 ( I g �� y OLC,i'tl�.c ❑ 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 Dyck / p/ 1 ri To i?,p / 1 / 11 Report Type: Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $`aeo, , • (7) Expenditures This Report Monetary Expenditures $('V b,2 Transfers to Office Account $ , , . Loans $ , Total Monetary $11) °, , • Total Monetary $ 35,02 , loe , . In -Kind $ , • (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date $ I2 , /oo. a, , * 1 tb • 6 (10) TOTAL Monetary Expenditures To Date $ .3 `l , d0°° , ,Z6 • 39 It is a first degree misdemeanor I certify that I have examined this report (Type name) VI .. 0.6. (11) Certification for any person and it is true, correct, ket l itin to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) ■ Individual (only for IE Treasurer ■ Deputy Treasurer or electioneering comm.) 9 -02e-- iri r1,14, • Candidate • Chairperson (only for PC and PTY) X /.2,,di'Z Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name nAR et Pc. A.itg (3) Cover Period / / through (2) I.D. Number / / (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number CILa 6�'.at=con 7 �'eAkiit►a I-(, t ur aro Ca f Q3 iV 1 Via`( pi(� i- jao.6o I / / / / / / / / / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGNITREASURER'S REPORT - ITEMIZED EXPENDITURES t itrn (2) I.D. Number (3) Cover Period dA / 6 j / (Ct throughoq / !3 / L� (4) Page of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number c'/Z1/ lc 6--V-- cQ `2rf- ,mQ.co 11- ory4c( eswy ill a ni T ®---c;c� su { Il-es 'KMB 0,409 1 6/2bm oaf 1eS 155 0o1umbIA .&uct fly o iC._ S FIrQS f(nB Z2,% /V/ ► P- crID- -3 (5s o�oi —i Po5A C Rrds 8 59 f/ l,rn u,s (�. u� Ile. t /Ici/i9 6-5 DMA,/ I4H53 N (-la den aS vJeb .(-1,e.__ Rrn S �d. (� 9 /0 /i9 .,/ B,,,A-.. Q R-bosil ge.e....62, Qyvt b 265470 / / / / / / DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES City of Cape Canaveral September 23, 2019 VIA CERTIFIED MAIL & E-MAIL Maria "Mickie" Kellum 8910 Coquina Lane Cape Canaveral, FL 32920 Re: 2019 Campaign Treasurer's Report G2 09-23-19 Dear Ms. Kellum, The City Clerk's Office received your Campaign Treasurer's Report, 2019 G2, for period 09/01/2019 — 09/13/2019, due Friday, September 30, 2019, on Monday, September 23, 2019 via hand delivery. Per Section 106.07(8)(b), Florida Statutes, a fine of $50.00 per day for the first 3 days late and, thereafter; $500.00 per day for each late day, not to exceed 25 percent of the total receipts or expenditures, whichever is greater, for the period covered by the late report, must be paid to the filing officer (me) within 20 days after receipt of the Notice of Payment Due. In accordance with Florida Statute, you are hereby assessed a fine of $102.16. This fine must be paid using your personal funds within 20 days of the receipt of this notice. You will need to submit a personal check made payable to the City of Cape Canaveral by mail or via hand delivery to the City Clerk's Office at 100 Polk Avenue. If you have any questions regarding this letter, please do not hesitate to contact me at 321-868- 1220 x206 or via e-mail at diefever@cityofcapecanaveral.org. Sincerely, Interim City Clerk/Elections Qualifying Officer Cc: Mia Goforth, Interim City Manager John DeLeo, Administrative/Financial Services Director Anthony Garganese, City Attorney THE SPACE BETWEEN' 100 Polk Avenue — P.O. Box 326 • Cape Canaveral, FL 32920 (321) 868-1220 • Fax (321) 868-1248 Visit us at www.cityofcapecanaveral.org • info@cityofcapecanaveral.org • #TheSpaceBetween U.S. Postal SprviceTM CERTIFIED MAIL° RECEIPT Domestic Mail Only For delivery information, visit our website at www.usps.como. F F I C 1 A L Certified Mall Fee Extra Services & Fees (check bow add fee as appropriate) ❑ Retum Receipt (hardcopy) $ ❑ Retum Receipt (electronic) $ ['Certified MeiI Restricted Delivery $ ❑Adult Signature Required $ 0 Adult Signature Restricted Delivery $ t) Postage Total Postage and Fees Sent To • I e Lyt 6✓f Street ant.(ApT (o.,or Pb Box I to Co&t tilA City, State, ZIP+48 CC- F 3� 0 Po`$tfjark D D PS Form 3800, April 2015 PSN 7530-02-000-9047 See Reverse for Instructions SENDER:. COMPLETE THISSECTION • Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailp or on the front if space permits. 1. Article Addressed to: APRA4 V/o co W new C J,OVC(4O 1, FL 3242_0 IIIIIIII IIIIIIIIII9402215III 6 II619I3IIIII8131III82IIII 9590 COMPLETE THIS SECTION ON DELIVERY ❑ Agent ❑ Addressee B. Received b' (Pnn>•ed Name) r l'ci( i /hell D. Is delivery address different from ite If YES, enter delivery address below: No C. Date ot; De'v74/ a Gf1/' L7� m 1? es 2. Article Number (Transfer from service label) 3. Service Type ❑ Adult Signature ❑ Adult Signature Restricted Delivery 0 Certified Mail® 0 Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery _a insured Mail Insured Mail Restricted Delivery 17018 06&O11O O2 92 $1 2U,26 _ (over$500) PS Form 3811, July 2015 PSN 7530-02-000-9053 ❑ Priority Mall Express® ❑ Registered MairM ❑ Registered Mail Restricted Delivery O Return Receipt for Merchandise 0 Signature ConfirmationTM ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt I I i i 1111 USPS TRACKING # I I 9590 9402 2156 6193 8131 82 United States Postal Service First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4® in this box• CITY OF CAPE CANAVERAL City Clerk's Office P. O. Box 326 Cape Canaveral, FL 32920-0326 ,i1.1i,1I11.1111iiI1jai III11I iiilli$1i"iill'1111.11111111111111111 ty of Cape Canaveral 100 Pollc Avenne OroK 326 Cape Canaveral, FL 32020 (321)068.1220 wutw,citybfcapatanavera bong Date: l@'__� rl,c tal _ i 0 bue; a1a64P Diie /f _ r CAMPAIGN TREASURER'S REPORT SUMMARY (1) MARit MiJ e K(LirY \ DReggAv Name (2) 4 QI 10 Co tAi L-zx p O C T 04 2019 Address (number and street) U 0 D Po_JA0 WJ1ri_O (1 339 av 2, OrClty, _ State, Zip Code � c� Bv: ❑ Check here if address has changed (3) ID Number: (4) Ch k appropriate box(es): 011 Candidate Office Sought: C (f Cif \ ' -0/(w_ 1 ❑ 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 pq / Ill / ici To Qq / gI7 / fl C Report Type: (- 3 Original Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , , taw . Do (7) Expenditures This Report Monetary Expenditures $ , 3 , VIA . '7'7 Loans $ , , • . Transfers to Office Account $ . Total Monetary $ , , (DO • O Total Monetary $ . In -Kind $ , , - (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date $ cno (10) TOTAL Monetary Expenditures To Date $ ,_3-_,-yz/ • %et ,,aa0 • ______ It is I certify that I have (Type name) a first degree misdemeanor examined this report Mk RI' 11; � (11) Certification for any person and it is true, correct, ati (,�,m to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) IN Individual (only or electioneering comm.) X ` for IE I4reasurer ,� 27 lead IN Deputy Treasurer ■ Candidate ■ Chairperson (only for PC and PTY) X 401t .-Q� Signature Signature .-...- .-.--T—r rI1e% 11.1e,r1Tht ,rTIr ,. O DS-DE 12 (Rev. 11/13) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name ht\PFK( et"tvliaL' 141Lnr‘ (3) Cover Period —I / 'i9 through (2) I.D. Number /„v2.2/ (9 (4) Page 1 of (5) Date (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code 9/'4/tct 01-A (33 DAJi3 Poe. 0bese®n ,403 C H E d00co 9 /21 /1q H�5gr K4pf kal-f,rn4 `1 E MO. Oc. IAQQ cs4. 9 / .1 / 1 °I (t\ cLSt16.4) Qom)/ hWyk CA E- t00. 00 550 s w -itle eat C-2013a.aca. / I / g S(cR-a.h (`� ux. (wan, (-1S .6 c0 5 tck 3 i-a.. (Y1Q cc1-h1 TsiwyS rI 3a9s2_ all (� Q. q / 1 / n 3 ei)ha0 G-ige. r aye al3a Q J J C A 5 00.°J clt / a( / lot O —bacA hatZot 550 Geb6A Ave Ca aK auesag. ll,4 3a990 C A-5 60ao % / al / 1� C�ai c� Q \ /� Cape Clarua o raL r Qe DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name 0(1 A `t fl;ekk" k?i(1u\ (2) I.D. Number (3) Cover Period 9 / /4 / -1 q, through £ / - / /9 (4) Page (5) Date (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & State, Zip Code q / al / 19 �Citty,, �sl wefiruk TotT1((o'l15 e3o 7 L► n Qo(111 AtP Cape emaita-a- e As Ot c.9 C/ / a/ 1 /9 Alicia ici iu. 1 . o4 K L-aQ 022 t)er'caL o' o7U �. / / / / / / / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES -*. (1) Name ifYt, A-e I p► IAIC.' i CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (2) I.D. Number (3) Cover Period 01 / YI / 19_ through 0 c / / aU t Q( (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) ,, Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number di /19/Pi ii5 Q9oo. ‘0 o ost 6-s g, CIA jZ��n�ln P 5 can l,6ty .99 Lto'1 Peeah -fee. S1- CocoA FIA 3a00.0 vp5 C_Pt- IQ 351,79 0- ct / l f /� �1 V V i + 155r1 tau) Wader- AJ i%lA Kt �K r Qom- �t P ra-falnil C� V V\ 3 q /90/i°1 Do ltzr-vee. zb 16 �SA1sr ic, Q� Coco. beach pav ( C R 0 if CA / / wb 1( t pif 1�Mic. 5�� Cocoa_ eeaah F IA' Qart-4 C � ��.24 CI �1 t1 / / At+ro n R(* gl li-/P050 Siam ps asQ tk.b6 b 0ape 0-smasiera.Q. CIA ct /0/1/ 1°t PLA.ID 14 5634‘ WeL4-191 (t19nfie, t6r1C-ate P� e �a� a,16.3(0 C�2ah Q ;3/ loi BIAS ,+ ---D.,u ' L.u,tniaer ,-or 5i,115 n A 0 1-f7• all Ocx,F0w 0- DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name alp, t'k cKr2 (2) I.D. Number (3) Cover Period Q / (4 / ict through C( / a l I aV 19 (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number 4/03/19 4c4-- lkardware .�y(caoawE' �o Czf �zNau�r s Pl��s 5t5a5 e 14 I`) Dos Q / l .AC,_ kAare e- cafe, pc.c:0/Lt _cor s 1905 o -io 31,0 l lb a /a111q Lt S P, S4-rarlet elLIQ tr7oa Cam— O 5-Eamp� Cif ►� g6`6 6 l 1 ct/9'7 Val A e.e_ tic artiu. ar 42- �'ioz .45f �LIacQ- u2sdLoa ce_ CA-N 0)40$ / / / / / / / / DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT: (I) AAA" V1ieX l, Jerlg _ D r_ .: , v MillnismumwmilEtiMEINIValtill Name (2) V 01 IUD CoQuaiAck. ,Ne O C T 11 2019 Address (numbet'and street) Li a: City, State, Zip Code By: CBS ,z l{ 39,p GGv 42-.— 3: (,o,pev► ❑ Check here if address has changed (3) ID Number: (4) Che k appropriate box(es): StCandidate Office Sought: c is eb,,,,, \,Clt 1 ❑ 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 q / at,/ `s To 0 / 6 q / tq Report Type: & Li ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , ,p . b0 (7) Expenditures This Report Monetary Expenditures $ , • Loans $ , , • _ Transfers to Office Account $ , Total Monetary $ > led • o0 Total Monetary $ , • In -Kind $ , , • (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date $ ,_,,_'_• O (10) TOTAL Monetary Expenditures To Date $ ,-3_,v4s" . S'. (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) ('ri%iti k eXtRN. K to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) ❑ Individual (only for IE IErTreasurer ■ Deputy Treasurer or electioneering comm.) 1r7416AX.dX ■ Candidate ■ Chairperson (only for PC and PTY) Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name MAR, A "nlitAe.l leelti,rr, (2) I.D. Number (3) Cover Period 9, / a"ZQ. / 19 through Lo / 04 / 1, (4) Page (5) Date ,.e (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code 9, / 2Se / Ft Lzrry (ot.ir Q8 zt®ce %%tK 110Q ee C C le 100.oa I or / Sa / R Chem{( Calm 13617 CkPlie of Tykrct T514,,:i -T__ Cite_ So.Gs a. / / / 1 / / / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name Ma, Ri R tt Mt eieram KKQ.G(t,rn (3) Cover Period Q, / al / tel through (p / O / / ! CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (2) I.D. Number (4) Page L of I (5) Date (7) v Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number a lacy Ace- ti a- risinorraLunk 111010. tiiovv.. 5 vans- a4.4S' 360144 \ 06r1+ , Cam. C'"`'' . eawyn2A-.• a. 10 /o t /1g city tor 4p2.e P Cwe, c. e � � +, 33�bC4 3 // // // // - // DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REP • r III Ill `;C';r,r** ,�- Ea(1) f1( 1•,M;af, el111 I L 1 1C�V.`4• 5:, Nare (2) aLit Ili ID CocL) (() ►.. Lan ,(2- OCT 1 8 2019 Address (number and street) ci ee._e ocIfyk.aweAcx_ --/ eeo City, State, Zip Code SY• _- ❑ Check here if address has changed (3) ID Number: (4) Che appropriate box(es): Candidate Office Sought: 0i ` 000L1 0- j I 6 (F% tJQ'� ❑ 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 Cov r Period: From (0 / 5 / i ci To 0 / i / Report Type: 6 Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , , • (7) Expenditures This Report Monetary Expenditures $ , , J341 . 6E5 Loans $ , , • Transfers to Office Account $ , , . Total Monetary $ , , • 0 Total Monetary $ , . , In -Kind $ , , • i (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date $ , 5- ,3'7r•00 (10) TOTAL Monetary Expenditures To Date $ , q ,1®6-•/3 (11) It is a first degree misdemeanor for any 1 certify that I have examined this report and it is true, (Type name) ek t I IINCA\1 � ,\ _Atit Certification person correct, to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) ■ Individual (only for IE eTreasurer ■ Deputy Treasurer or electioneering comm.) C It irC 4/114 ,•... IN Candidate ■ Chairperson (only for PC and PTY) X Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name MAP; a rlfie/�j� Kati (2) I.D. Number (3) Cover Period J6 / 05 / /�J through /p / // / l 9' (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number / / / / / / / / / / / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES 1 Name /P,�(F M eit t 'Vl (2) ID. Number (3) Cover Period iQ / 65 /G through %v / / / / sit (4) Page of (5) Date (6) Sequence Number (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment Amount 1L /QS/let 1 In /0°i/1°j Aso -Roles eapz C'c tea. S u er-,1 & fQ *014 fl 0 r7 PQaelA ZReo 6-1- Q Oo QL f1. 3a�a CR ki 53-:00 I Cd 66 / / / / / / / / DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 039, R E©fRI L WAIVER OF REPORT OCT 2 5 2019 , (Section 106.07(7), F.S.) By: 111. (PLEASE TYPE) OFFICE USE ONLY ev't&t, Name Office Sought ?i C Loi.nt C Ca44 c.4v44w/ / ,7s.Z11•ZO Address City State Zip Code ndidate ❑ 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.). 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) MONTHLY REPORT ❑ PRIMARY ELECTION ❑ GENERAL ELECTION OTHER REPORT TYPE Indicate report# Indicate report# Indicate report# Indicate report type and # as applicable: M P G I I TERMINATION REPORT SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF to t (al q -- THROUGH 10 in ` ( 01 /&164#/4 PC/ Z5/I a 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) Ng., A meices2_. /<•eittAxix " l 21 vill tit. Name (2) 10 ?�qtZtriet3 Cittj NA Li'. NOV 01 2019 Address (number and street) Cave CaN av,2ra�Q. fl..3a9r O City, State, Zip Code _ �® i.V.A. • A ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): (' n andidate Office Sought: CousW 11 - C. C5 c Cape Calk aL�(�L. L ❑ 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 . v / lc\ / Lot To `b / 3 l / 19 Report Type: (7 Original ❑ Amendment ❑ Special Election Report / (6) Contributions This Report Cash & Checks $ , (7) Expenditures This Report Monetary Expenditures $ , , 3g2 , Loans $ , • Transfers to Office Account $ , ... , _ . Total Monetary .$ , - `, Total Monetary $ ,?0,A- 577 •�0 In -Kind $ , , - (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date $ , 6 , VP) . Oa (10) TOTAL Monetary Expenditures To Date $ , 3 , 1.L. . q& (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report andit is true, correct, (Type name) ne), Q i IV `t r, y.. t�p,,,LLyn to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) ■ Individual (only for IE • Treasurer ■ Deputy Treasurer or electioneering comm.) - X ■ Candidate • Chairperson (only for PC and PTY) X Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name INCf - t({1\;[+k; 14.24LtA.M (2) I.D. Number (3) Cover Period [0 / 19 / 1,9 through tb/ 31 / 19 (4) Page of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type yP (10) Amendment (11) Amount (6) Sequence Number ID /a/ /rq Go tbddj • co fyi 'web s;te. C R tJ 2.o.od I to /3a2bei oily Aye- Cape. CeoWercia. A C'.fln1 33.E a 10 /30/%aq LI 5 P5 cape, C voec��. CA (6:0� 10 /3i /ace caps(?).. Fla cik J oZ'7�.5'J // // // // DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES • CAMPAIGN TREASURER'S REPORT SUMMARY ARi pi Y " (2)q Io � �o '�IECEVL 2020 ddress ( u ber and street) FEB 0 3 City, State, Zip Code (7 0 ❑ Check here if address has changed (3) ID Number: . (4) Check appropriate box(es): 0-; Candidate Office Sought: 11 a(LtVC , ‘ ❑ 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 / 6 l / l 9' To /> ca_ / 03 / o20 Report Type:TR ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , , DC) . p p (7) Expenditures This Report Monetary Expenditures $ , eZ , 332 • 9a Loans $ , , • Transfers to Office Account $ , , . Total Monetary $ , , Ibb • o 0 Total Monetary $ , g_ ,3.3a. q a In -Kind $ , 1 , ale' • b (8) Other Distributions $ , , (9) TOTAL Monetary Contributions To Date $ , V , 1ri0 • 00 (10) TOTAL Monetary Expenditures To Date $ , 6 , `1I5 • 70 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) to falsify a public record (ss. 839.13, F.S.) and complete: (Type name). MA R I A l v�n l i C'(/ � ! C. V1btxr ■ individual (only for IE ■ Treasurer 0 Deputy Treasurer or electioneering coinm.) X • Candidate • Chairperson (only for PC and PTY) /L—' Signature %a , /��iM�' Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS fm (1) Name CAMPAIGN TREASURE S/ REPORT — ITEMIZED EXPENDITURES pi )9 i O 1 e l kt' 'Y\ (2) I.D. Number (3) Cover Period / ( / b I / 1 cj through 0 / 0 3 / (4) Page ( of (5) Date (7) Full Name (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number I (Last, Suffix, First, Middle) j Street Address & I City, State, Zip Code l 1/ D 1/ 1C1 p 0 s.A.,:_w2, 6 e-S QJIi$ cigI 1n i L/86. 03 t 0v( P k d . inth &rnC FI Z-M- 1i /6l /.i 0i `0,,llav C-e-a.Qre.Q- pc lam E tc_ (�°e c zP� cak,a.cgrcQ r (' 'Poc,ki-3 CRr 16, !O it/(s-li 11 (�il5Q.:0 QQ, G2aphicS 10 L( - Uri Et fl 1.� .�n.vn n� O I 3 PO i 3kiko Co-t3oa Jl. ;i.i ticrS 0A1\) 369.,E 4 It / 16/ 1°1 i- lekr erc Pck ka Vic._ Po) 42 Cape_ elJau€,S 0Q 11�1r��1'�rs (- tC R .1 C.,l It /01/ let flc-sas Q. N AkEODwrik,/ Co= QomaL.re sL ��P.C-I' 41,1 �c�Z�e rn ¢ C � �` , . 1 t /v1/ l0, `Z0,rre_ tl AS 1\5;$ o na.wrvk !i.koc0 C-zPQ C..oaoero.Q F.(4 2 i.ceiio n V,L1-ory Park OOi R_29 2- 1l /a/tut W��1nc)r+'2w I\2lpers -i-e, PzcX cAlo Styn5 ilDip0 - DS-DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name (2) I.D. Number (3) Cover Period %/ / 0/ / / 9 through c. / 0,3 /06 (4) Page 1 of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number t i / 0 / / /g /71 _1/272. fdw? /fc rr/,�n PAQ s>2- C �{ 51660 Cepe CacaUeda► \t /aI/tot Ae-ccY.�tl etto Co d:ft. Czpe Czi..aberr Q -�— Rd lc,es- Lev (fir 3G .c6 ,1 to i / tot 5f04A Bee. I fa -apaCalo aw_.c-6_Q_ �, Gczph ies aes- n roic06 11 / 01 / i°i ' 5 nocci5en N16140 Rs;d3e-Aft Cape C,a a\-5evcLQ I. s,lar' ` e-►err --0 5i9ir\ fyitiecta 46,0© t l/ 0-1 / IG 1-� �a d w d� 11(otdv?..),( Aoze Cao2m-ck, Cd mmre�cO, [�o� :r < Cktb o h �A-0 1�� c sc C'oe\ex! C �-7v�� D D / / / / DS-DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES