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HomeMy WebLinkAboutdwillis_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. RECEIVED AUG 1 1 2021 MG OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): X- Initial Filing of Form Re -filing to Change: Treasurer/Deputy Depository Office Party 2. Name of Candidate (in this order: First, Middle, Last) DONALD ANDREW WILLIS 3. Address (include post office box or street, city, state, zip code) 8984 Puerto Del Rio Dr. #301 Cape Canaveral, FL 32920 4. Telephone (321 ) 588 1058 5. E-mail address don.willis@porterwillis.com 6. Office sought (include district, circuit, group number) CAPE CANAVERAL CITY COUNCIL 7. If a candidate for a nonpartisan 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 Donald Andrew Willis 11. Mailing Address 8984 Puerto Del Rio DR. #301 12. Telephone (321) 588-1058 13. City CAPE CANANAVERAL 14. County BREVARD. 15. State FL 16. Zip Code 32920 17. E-mail address don.willis@porterwillis.com 18. I have designated the following bank as my X-Primary Depository Secondary Depository 19. Name of Bank WELLS FARGO BANK NA 20. Address 7801 N.ATLANTIC AVE. 21. City CAPE C ANAVERA L 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 8/11/21 26. Signature of Candidate X Donald Andrew Willis 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, DONALD ANDREW Willis, do hereby accept the appointment (Please Print or Type Name) designated above as: X- Campaign Treasurer Deputy Treasurer. Date 8/11/21 Signature of Campaign Treasurer or Deputy Treasurer X-Donald Andrew Willis 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 RECEIVED AUG 11 2021 MG OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Don Willis (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 CAPE CANAVERAL CITY COUNCIL , (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): 119902557 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.] DON WIL-LIS X- Don Willis (321) 588-1058 don.willis@orterwillis.com Signature of Candidate Telephone Number Email Address 8984 Puerto Del Rio Dr. #301 Cape Canaveral Fl 32920 Address City State ZIP Code STATE OF FLORIDA Mia Goforth Signature of Notary Public COUNTY OF BREVARD Print, Type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence -X this 11th day of August, 2021 Personally Known-X OR Produced Identification Type of Identification Produced: n/a FLORIDA NOTARY ASSOCIATION*SINCE 1978* Mia Goforth Notary Public State of Florida Comm# HH108700 Expires 5/16/2025 DS-DE 302NP (Rev. 05/2021) Rule 1S-2.0001, F.A.C. Don Willis PorterWillis Phone: 336.209.6873 Fax: 321.400.1200 don.willis@porterwillis.com Lori Scott Supervisor of Elections Brevard County RECEVIED AUG 11 2021 MG AFFIDAVIT FOR USE OF NICKNAME STATE OF FLORIDA COUNTY OF BREVARD BEFORE ME, the undersigned authority, personally appeared DONALD ANDREW WILLIS who being first duly sworn or placed under affirmation, says: 1. My legal name is Donald Andrew Willis 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 CITY COUNCIL, CITY OF CAPE CANAVERAL 3. My nickname is Don Willis 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: Donald Andrew Willis Signature of Affiant DONALD ANDREW WILLIS Printed/Typed Name of Affiant Sworn to (or affirmed) and subscribed before me by physical __X-or online ____presence this 11th day of August 2021. Mia Goforth Signature of Notary Public MIA GOFORTH Printed Name X-personally known or Produced Identification Type of Identification Produced n/a Mia Goforth Notary Public State of Florida Comm# HH108700 Expires 5/16/2025 Rev. 4/2020 OATH OF CANDIDATE l, Don Willis , 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 will support the City of Cape Canaveral Charter and Ordinances. Don Willis 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 11th day of August, 2021 by Don Willis , who is personally known or produced n/a Identification. Mia Goforth Signature of Notary Public Print, type or stamp Commissioned Name of Notary Public Mla Goforth Notary Public State of Florida Comm# HH108700 Expires 5/16/2025 FORM 1 STATEMENT OF FINANCIAL INTERESTS 2020 Please print or type your name, mailing address, agency name, and position below: FOR OFFICE USE ONLY: RECEIVED Aug 11 2021 MG LAST NAME -- FIRST NAME -- MIDDLE NAME : Willis Donald Andrew MAILING ADDRESS : 8984 Puerto Del Rio Dr. #301 CITY : ZIP : COUNTY : Cape Canaveral 32920 Brevard NAME OF AGENCY : NAME OF OFFICE OR POSITION HELD OR SOUGHT : City Council for City of Cape Canaveral 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 COMPARTIVE 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 THRESHOLD 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 OF INCOME SOCIAL SECURITY SOURCES ADDRESS WASHINGTON, DC DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY RETIREMENT PART B — SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to business owned by the reporting person-See instructions) (If you have nothing to report, write "none: or "n/a") NAME OF BUSINESS ENTITY OF INCOME NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "n/a") 220 Webster Road, Graham, NC 27253 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 Incorporated by reference in 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, write "none" or "n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES CD's, Saving Accounts Well Fargo Bank, NA. Trust Willlis Family irrevocable Trust PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "n/a") NAME OF CREDITOR Rocket Mortgage LLC ADDRESS OF CREDITOR 1050 Woodward Ave Detroit Mich 48226 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 NAME OF BUSINESS ENTITY 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 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. ❑ 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: Donald Andrew Willis Date Signed: 8/11/21 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: prepared the CE 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), send it to CEForm1@leg.state.fl.us and retain a copy for your records. 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 less 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 1F) 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, 2020. CE FORM 1 - Effective. January 1, 2021. Incorporated by reference in Rule 34-8 202(1) F. A.C PAGE 2 STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) OFFICE USE ONLY RECEVIED AUG 11 2021 MG I, Donald Andrew Willis candidate for the office of City Council, City of Cape Canaveral have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Donald Andrew Willis 8/11/21 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) APPOINTMENT 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. RECEVIED AUG 12 2021 MG OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): ❑ Initial Filing of Form Re -filing to Change: -X Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) Donald Andrew Willis 3. Address (include p t office box or street, city, state, zip code) 8984 Puerto Del Rio Dr #301 Cape Canaveral FL 32920 4. Telephone ( 321 ) 588 1058 5. E-mail address don.willis@porterwillis.com 6. Office sought (include district, circuit, group number) CAPE CANAVERAL CITY COUNCIL 7. If a candidate for a nonpartisan 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 Donald Andrew Willis 11. Mailing Address 8984 Puerto Del Rio Dr. #301 12. Telephone (321) 588 1058 13. City CAPE CANAVERAL 14. County BREVARD 15. State FL 16. Zip Code 32920 17. E-mail address don.willis@porterwillis.com 18. I have designated the following bank as my X-Primary Depository ❑ Secondary Depository 19. Name of Bank SUNRISE BANK 20. Address 5604 N. ATLANTIC AVE 21. City COCOA BEACH 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 8/12/21 26. Signature of Candidate DONALD A WILLIS 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, DONALD ANDREW WILLIS , do hereby accept the appointment (Please Print or Type Name) designated above as: X- Campagin Treasurer Deputy Treasurer Date 8/12/21 X- DONALD ANDREW WILLIS Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. CITY OF CAPE CANAVERAL 100 POLK AVE. CAPE CANAVERAL, FL 32920 (321) 868-1220 Received Of: DON WILLIS CAMPAIGN ACCOUNT The sum of: $39.00 RECEIPT 08/12/2021 14:17 Number: 67411 Cashier: j.coldiron ELE TAX ELECTION TAX PAYABLE MISC MISC Total $24.00 $15.00 $39.00 Remaining Balance: $0.00 TENDERED: CHECK 91 $39.00 APPOINTMENT 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 filewith the qualifying before opening the campaign account. RECEIVED AUG 17 2021 CCO DL OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: -X Treasurer/Deputy Depository Office Party 2. Name of Candidate (in this order: First, Middle, Last) Donald Andrew Willis 3. Address (include post office box or street, city, state, zip code) 8984 Puerto Del Rio Drive #301 Cape Canaveral, FL 32920 4. Telephone (321 ) 588-1058 5. E-mail address Don.willis@porterwillis.com 6. Office sought (include district, circuit, group number) Cape Canaveral City Council 7. If a candidate for a nonpartisan 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 Jay Petty 11. Mailing Address 8984 Puerto Del Rio Drive, #401, Cape Canaveral, FL 32920 12. Telephone (321 ) 783-4198 13. City Cape Canaveral 14. County Brevard 15. State FL 16. Zip Code 32920 17. E-ma'I address Jpetty831@aol.com 18. I have designated the following bank as my X- Primary Depository Secondary Depository 19. Name of Bank Sunrise Bank 20. Address 5604 N. Atlantic Avenue 21. City Cocoa Beach 22. County Brevard 23. State FL 24. Zip Code 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 August 17, 2021 26. Signature of Candidate X Donald Andrew Willis 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Jay Petty , do hereby accept the appointment (Please Print or Type Name) designated above as: X- Campaign Treasurer Deputy Treasurer. August 17, 2021 Date X- Jay E Petty Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.