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Home My WebLink Aboutmbrown_cocc_election_qualifying_paperwork_202108APPOINTMENT 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. AUG 04 2021 OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): X- Initial Filing of Form Re -filing to Change: Treasurer/Deputy Depository 0 ; Office Party 2. Name of Candidate (in this order: First, Middle, Last) Mike, R. Brown 3. Address (include post office box or street, city, state, zip code) 562 Casa Bella Drive, Cape Canaveral, FL 32920 4. Telephone (321) 302-3032 5. E-mail address Trooper0625@gmail.com 6. Office sought (include district, circuit, group number) Mayor - City of Cape Canveral 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 partisan office, check block and fill in name of party as applicable: My intent is to run as a Write -In No Party Affiliation Party candidate. 9. I have appointed the following person to act as my X-Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Mike Brown 11. Mailing Address , 562 Casa Bella Drive 12. Telephone (321) 302-3032 13. City Cape Canaveral 14. County Brevard 15. State FL 16. Zip Code 32920 17. E-mail address Trooper0625@gmail.com 18. I have designated the following bank as my X-Primary Depository Secondary Depository 19. Name of Bank Regions Bank 20. Address 7750 N Wickham Rd 21. City Melbourne 22. County Brevard 23. State FL 24. Zip Code 32920 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 8/4/2021 26. Signature of Candidate X Mike Brown 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Mike Brown, do hereby accept the appointment (Please Print or Type Name) designated above as: X-Campaign Treasurer Deputy Treasurer: 08/4/2021 Dat Signature of Campaign Treasurer or Deputy Treasurer X Mike Brown 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: AUG 10 2021 ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a),Florida Statutes) I, Mike Brown (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 I I (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 Mayor (Office) (District#) (Circuit #), (Group or Seat #) ; I am a qualified elector of Brevard County, Florida; 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): 100994968 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities(see instructions on page 2 of this form): [Not applicable to write-in candidates.] MI-KE BR-OWN X Mike Brown (321) 302-3032 Trooper0625@gmail.com Signature of Candiate Telephone Number Email Address 562 Casa Bella Drive Cape Canaveral, Fl 32920 Address City State ZIP Code STATE OF FLORIDA COUNTY OF Brevard Print,Type,or Stamp Commissioned Name of Notary Public below: Swom to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence -X this 10th day of August , 2021 Personally Known-X OR Produced Identification ❑ Mia Goforth Signature of Notary Public Print, Type, or Stamp Commissioned Name of Notary Public below: Mia Goforth Notary Public State of Forida Comm# HH108700 Expires 5/16/2025 Type of Identification Produced: DS-DE 302NP(Rev.05/2021) Rule 1S-2.0001, F.A.C. Lori Scott Supervisor of Elections BREVARD COUNTY AFFIDAVIT FOR USE OF NICKNAME STATE OF FLORIDA COUNTY OF BREVARD BEFORE ME, the undersigned authority, personally appeared Mike Brown who being first duly sworn or placed under affirmation, says: 1. My legal name is Michael Rown Brown I am over the age of eighteen (18) and the contents of this affidavit are true and correct. 2. I am a candidate for the office of Mayor 3. My nickname is Mike I am generally known by this nickname or have used it as part of my legal name. I have not created the nickname to mislead voters. I plan to designate this nickname on my candidate oath as the name I wish to have printed on the ballot when I submit the candidate oath form during the qualifying period for the above office. 4. Attached are 1 documents that show that my nickname is one by which I am generally known or is one that I have used as a part of my legal name: Michael R. Brown, Signature of Affiant Michael R Brown Printed/Typed Name of Affiant Sworn to (or affirmed) and subscribed before me by physical ✓ or online presence this 10th day of August , 2021 Mia Goforth Signature of Notary Public Mia Goforth Printed Name X- Personally known or Produced Identification Type of Identification Produced Mia Goforth Notary Public State of Florida Comm# HH108700 Expires 5/16/2025 Rev.4/2020 MIKE BROWN COUNCIL MEMBER www.cityofcapecanaveral.org 100 Polk Avenue P.O. Box 326 Cape Canaveral, Florida 32920 c: (321) 302-3032 o: (321) 868-1220 x208 m.brown@cityofcapecanaveral.org City of Cape Canaveral OATH OF CANDIDATE I, Mike Brown , do solemnly swear or affirm that I am qualified under the City of Cape Canaveral Charter and Ordinances to hold the Office of Mayor, to which I desire to be elected and I will support the City of Cape Canaveral Charter and Ordinances. (Signature) Mike Brown Signature of Candidate State of Florida County of Brevard City of Cape Canaveral Sworn to (or affirmed) and subscribed before me by physical presence this 10th ____ day of August, 2021 by Mike Brown , who is personally know or produced N/A Identification. Mia Goforth RECEIVED Signature of Notary Public AUG 1 0 2021 MG Print, type or stamp Commissioned Name of Notary Public FORM 1 STATEMENT OF 2020 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME : Brown Mike MAILING ADDRESS : 562 Casa Bella Drive CITY: ZIP: COUNTY: AUG 10 2021 Cape Canaveral, FL 32920-4329 Brevard MG NAME OF AGENCY: Cape Canaveral NAME OF OFFICE OR POSITION HELD OR SOUGHT: Mayor CHECK ONLY IF X-CANDIDATE OR NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2020. 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): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR X- 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 State of FL-Pension Plan P.O. Box 9000, Tallahasssee, Fl 32315 State Pension Social Security 310 Canaveral Groves Blvd., Cocoa, FL 32926 Social Security Nationwide Deferered Comp P.O. Box 182797 , Columbus, Ohio 43218 State of FL Deferred Comp Bonfacu Hiers, Chry, Dodge, Inc. 1775 E. Merritt Is, Merritt Is Cswy, FL 32952 Contract Work 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 Cracker Is Grille LLC No Income Recevied 629 N. Atlantic Ave, Cocoa Beach, FL 32926 Restaurant PART C–REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] (If you have nothing to report,write "none"or "n/a") 7801 Ridgewood Ave, Cape Canaveral, FL 32920 You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for 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 out begin on page 3. CE FORM 1-Effective January 1.2021 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.20211), F.A.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 NVDIA Corporation Stock Disney Corporation Stock Stocks Apple Corporation Stocks State of FL Deferred Comp Retirement Account PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report, write "none"or "n/a") NAME OF CREDITOR ADDRESS OF CREDITOR Regions Bank- Mortage 7750 N. Wickham Rd, Melbourne, FL 32940 Superior Lending Mortage P.O. Box 619083, Dollox, TX 75267 American Express 200 Uersey St, Manhattan, NY 10285 Space Coast Credit Union 445 Fortenberry Rd, Merritt Island, FL 32952 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 Cracker Island Grille ADDRESS OF BUSINESS ENTITY 6290 N. Atlantic Blvd, Cocoa Beach, FL 32926 PRINCIPAL BUSINESS ACTIVITY Restaurant POSITION HELD WITH ENTITY None-Silent Partner I OWN MORE THAN A 5% INTEREST IN THE BUSINESS 25% NATURE OF MY OWNERSHIP INTEREST Partner Investment PART G—TRAINING For elected municipal officers,appointed school superintendents,and commissioners of a community redevelopment agency created under Part III, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S. X- 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 Signature: If a certified public accountant licensed under Chapter 473, or attorney Mike Brown 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. Date Signed: CPA/Attorney Signature: 8/10/2021 Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers. Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY: A candidate who files a Form form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission under, see page 3 of instructions. or Supervisor of Elections. Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer, of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment. where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their Supervisor of Elections for the mailing address or email address to appointment. use. Do not email your form to the Commission on Ethics, it will be returned. Candidates must file at the same time they file their qualifying State officers or specified state employees who file with the papers. Commission on Ethics may file by mail or email. To file by mail, Thereafter,file by July 1 following each calendar year in which they send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions. 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1 F (Final Statement your completed form and any attachments as a pdf(do not use any of Financial Interests) does not relieve the filer of filing a CE Form 1 other format), send it to CEForm1@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31, 2020. for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CE FORM 1-Effective.January 1.2021. Incorporated by reference in Rule 34-8.202(1), FA C Page 2 OFFICE USE ONLY STATEMENT OF RECEIVED CANDIDATE AUG 10 2021 (Section 106.023, F.S.) MG (Please print or type) I, Mike Brown , candidate for the office of Mayor-City of Cape Canaveral have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X (Signature) 8/10/2021 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) SUN SPACE AND SEA RECEIPT CITY OF CAPE CANAVERAL 08/10/21 100 POLK AVE. Number: 67346 CAPE CANAVERAL, FL 32920 Cashier: j.coldiron (321) 868-1220 CITY OF CAPE CANAVERAL Received Of: MIKE BROWN CAMPAIGN ACCOUNT The sum of: $47.00 ELE TAX ELECTION TAX PAYABLE $32.00 MISC MISC $15.00 Total $47.00 Remaining Balance: $0.00 TENDERED: CHECK 91 $47.00