HomeMy WebLinkAboutkljackson_candidate_qualifying_paperwork_202308SUN SPACE AND SEA
THE SPACE BETWEEN
CITY OF CAPE CANAVERAL, FLORIDA
CANDIDATE PACKET ACKNOWLEDGMENT
I, , would like to announce my candidate for City Council and do
hereby acknowledge receipt of:
1. July 27, 2023 Candidate Qualifying Information Memo
2. 2023 Election Information
3. Qualifying Statement— Domicile Within the City Form + copy of Resolution No. 2023-06 (adopted 5/16/23)
4. Form DS-DE 9(rev.07/23), Appointment of Campaign Treasurer and designation of Campaign Depository for Candidates
5. Announcement of Intention to Become a Candidate for Office
6. Form DS-DE 302NP (rev. 2023), Candidate Oath— Nonpartisan Office
7. City Oath of Candidate
8. CE Form 1 (January 1, 2023), Statement of Financial Interests and Instructions
9. Form DS-DE 84 (rev.05/11), Statement of Candidate
10. Election Laws of the State of Florida as of August 2022
11. Candidate and Campaign Treasurer Handbook as of April 2022
12. 2023 Campaign Treasurer's Report Due Dates for Announced Candidates and general information for filing reports
• Reminder:The Final "Terminal Report" (TR) must reflect TOTAL contributions and expenditures being equal.
13. Do's & Don'ts for Campaign Treasurer's Reports
14. Form DS-DE 12 (rev. 11/13), Campaign Treasurer's Report Summary
15. Form DS-DE 13 (rev. 11/13), Campaign Treasurer's Report— Itemized Contributions
16. Form DS-DE 13A (rev. 11/13), Campaign Treasurer's Report— Fund Transfers
17. Form DS-DE 14 (rev. 11/13), Campaign Treasurer's Report— Itemized Expenditures
18. Form DS-DE 14A (rev. 11/13), Campaign Treasurer's Report— Itemized Distributions
19. Form DS-DE 87 (rev.06/15), Waiver of Report
20. Public Service Request Form
21. Political Sign Regulations
I understand to have my name appear on the November 7, 2023 Municipal Election Ballot, I must complete
qualifying paperwork and pay qualifying fees during the qualifying period which begins on August 7, 2023 at
noon and ends August 18, 2023 at noon.
OFFICE USE ONLY
RECEIVED
Kay Jackson AUG 1 1 2023
Signature MG
Enter Date & Time Received
Date: August 11, 2023 and Initials of Clerk's Office Staff Member
SUN SPACE AND SEA
CITY OF
CAPE CANAVERAL
P.O. Box 326 100 Polk Avenue Cape Canaveral, FL. 32920-0326
(321) 868-1220 www.cityofcapecanaveral.org
CITY OF CAPE CANAVERAL, FLORIDA
QUALIFYING STATEMENT— DOMICILE WITHIN THE CITY
Any registered voter of the City of Cape Canaveral, Florida who desires to qualify as a candidate
for the office of mayor and councilmember of the City of Cape Canaveral, Florida ("City Council")
is hereby advised:
Section 2.02(b) of Article II of the Cape Canaveral City Charter provides:
"Each candidate seeking the office of the city council shall be domiciled within the
city at least one (1) year immediately prior to the time of qualifying." In addition,
"[t]he members of the city council shall be domiciled within the City of Cape
Canaveral and shall have and possess the qualifications of registered voters of the
City of Cape Canaveral. Any member of the city council who shall cease to have and
possess the qualifications imposed on such office shall forfeit his or her office and
said office shall immediately become vacant."
For purposes of adopting and interpreting the aforementioned City Charter provision, the City
Council and citizens of Cape Canaveral relied upon the meaning of the term "domicile"interpreted
by Florida Courts as follows:
[Domicile] is of more extensive signification and includes, beyond mere physical presence
at the particular locality, positive or presumptive proof of an intention to constitute it a
permanent abiding place. 'Residence' is of a more temporary character than 'domicile.'
'Residence' simply indicates the place of abode, whether permanent or temporary;
'domicile' denotes a fixed, permanent residence, to which, when absent, one has the
intention of returning. 'Residence' has a more limited, precise and local application than
'domicile,'which is used more in reference to personal rights, duties, and obligations.That
there is a difference in meaning between 'residence' and 'domicile,' is shown by the fact
that a person may have his residence in one place while his domicile is in another. It has
also been said that domicile and residence are not synonymous for the reason that a
person may have more than one residence at the same time, but only one domicile.
Minick v. Minick, 149 So. 483, 488 (Fla. 1933) (quoting 19 Corpus Juris 395). Accord Kevoloh v.
Carter, 699 So. 2d 285 (Fla. 5th DCA 1997); In re DeFelice, 172 B.R. 130 (Bankr. S.D. Fla. 1994).
City of Cape Canaveral
Qualifying Statement—Domicile within the City
Page 1 of 2
STATE OF FLORIDA
COUNTY OF BREVARD
BEFORE ME, the undersigned authority, did personally appear
Kay Jackson (print name),who,upon being duly sworn,did
depose and state as follows:
1. My name is Kay Jackson (print name), I am
over the age of eighteen years and I have personal firsthand knowledge of the facts and
information set forth herein.
2. I am candidate for the City Council of Cape Canaveral in the election scheduled
to be held on Nov 7th, 2023 ; and I agree to serve on the City Council if I am
elected.
3. Before signing this Qualification Statement, I have read and fully understand the
aforementioned advisory regarding the qualification requirements to be a candidate to run for
the office of City Council of Cape Canaveral, Florida, and if elected, to serve on said City Council.
4. I currently reside at 8600 Ridgewood Avenue
(print street address), Cape Canaveral, Florida 32920, and re• esent to the City of Cape Canaveral,
other candidates that may be running against me, and the citizens of Cape Canaveral that I am a
registered voter of Cape Canaveral, and I am currently, and have been for at least one (1) year
immediately preceding my qualifying herein, domiciled within e ity of Cape Canaveral at the
following address(es): 8600 Ridgewood Avenue . (print
street address(es))
FURTHER YOUR AFFIANT SAYETH NAUGHT.
Kay Jackson
Kay Jackson (print name)
Sworn to and subscribed before me by means of ®"physical presence OR ❑online notarization,
this 17th day of August , by Kay Jackson
whose address is 8600 Ridgewood Avenue, Cape Canaveral, FL 32920
❑ Personally Known OR X Produced Identification
Type of Identification Produced: FLDriver Lic
Mia Goforth
NOTARY PUBLIC
Mia Goforth
Notary Public
State of Florida
Comm# HH108700
Expires 5/16/2025
City of Cape Canaveral
Qualifying Statement - Domicile within the City
Page 2 of 2
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) RECEIVED
(PLEASE PRINT OR TYPE) AUG 1 1 2023
NOTE: This form must be on file with the qualifying officer MG
before opening the campaign account. 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)
Kay Jackson
3. Address (include post office box or street, city, state,
zip code)
P.O. Box 1029
Cape Canaveral, Fl. 32920
4. Telephone
(321) 297-7559
5. Candidate's Voter Registration #:
(Not required for Qualifying Purposes)
(Not required for Qualifying Purposes)-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):
Kai Jack-Sun
6. Office sought (include district, circuit, group number)
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 o Treasurer or Deputy Treasurer 11. Telephone
Kay Jackson 321-297-7559
12. Mailing Address 13. City 14. State 15. Zip Code
P.O. box 1029 Cape Canaveral FL 32920
16. I have designated the following bank as my X Primary Depository ❑ Secondary Depository
17. Name of Bank 18. Address
Sunrise Bank 5604 N. Atlantic Ave
19. City 2 . County 21. State 22. Zip Code
Cocoa Beach Brevard Fl 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.
23. Date 24. Signature of Candidate
8-11-2023 X Kay L Jackson
25. Treasurer's Acceptance of Appointment (fill in the blanks is and check the appropriate block)
I, Kay Jackson , do hereby accept the appointment
(Please Print or Type Name)
designated above as: X Campaign Treasurer. I I Deputy Treasurer.
8-11-2023 X Kay Jackson
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 07/23) Rule 1S-2.0001, F.A.C.
SUN SPACE AND SEA
THE SPACE BETWEEN
CITY OF CAPE CANAVERAL, FLORIDA
ANNOUNCEMENT OF INTENTION
TO BECOME A CANDIDATE FOR OFFICE
I, Kay Jackson , hereby notify the City of Cape Canaveral that I have filed
Form DS-DE 9, Appointment of Campaign Treasurer and Designation of Campaign Depository for
Candidates, with the City's Election Filing Officer, and that I intend to become a Candidate for the
Office of City Council Member in the City of Cape Canaveral's Municipal Election on November 7,
2023.
I understand it is my responsibility to comply with all applicable election laws and municipal sign
codes, and that I must complete and file all required qualifying papers and pay the qualifying and
election assessment fees with the City's Election Qualifying Officer during the City's Qualifying
Period of Monday, August 7, 2023 at Noon to Friday, August 18, 2023 at Noon, in order to duly
qualify as a Candidate for the Office of Council Member during the City of Cape Canaveral's
November 7, 2023 Municipal Election.
I also understand that within ten (10) days after filing Form DS-DE 9, Appointment of Campaign
Treasurer and Designation of Campaign Depository for Candidates, with the City's Election Filing
Officer, I must file form DS-DE 84, Statement of Candidate with the City's Election Filing Officer.
Kay Jackson 8-17-2023
Signature Date
OFFICE USE ONLY
RECEIVED
AUG 1 7 2023
MG CCO
Enter Date &Time Received
and Initials of Filing Officer or designated Staff Member
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 17 2023
MG CCO
OFFICE USE ONLY ,y
Candidate Oath
Name for Ballot: Kay / Lyn / Jackson /
First Middle Name/Initial/and/or/Nickname Last Name Suffix
(See reverse side for Nickname Affidavit.)
I swear or affirm that I am a candidate for the nonpartisan office of City Council , 2
(Office) (District#)
, ; I am a qualified elector of Brevard County, Florida;
(Circuit #) (Group or Seat#)
I am a qualified elector 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.
Statement of Outstanding Fines, Fees, or Penalties
I owe outstanding fines,fees,or penalties,that cumulatively exceed$250,for ethics or campaign finance violations(s. 99.021(1)(d), F.S.).
YES,I Do NO, I Do Not X
If you do,you must also specify the amount owed and each entity that levied the same on the reverse side.
X Kay Jackson (321) 297-7559 kay4council@att.net
Signataure of Candidate Telephone Number Email Address
8600 Ridgewood Ave Cape Canaveral FL 32920
Address of Legal Residence City State ZIP Code
STATE OF FLORIDA Mia Goforth
COUNTY OF Brevard Signature of Notary Public
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
this 17th day of August ,2023
Personally Known ❑ OR Produced Identification X
Type of Identification Produced: FLORIDA DRIVER LICENSE
Mia Goforth
Notary Public
State of Florida
Comm# HH108700
Expires 5/16/2025
DS-DE 302NP (Eff._/2023) Rule 15-2.0001, F.A.C.
SUN SPACE AND SEA
THE SPACE BETWEEN
OATH OF CANDIDATE
I, Kay Jackson , 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.
Kay Jackson
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
17th day of August, 2023 by Kay Jackson ,
who is personally known or produced Florida Driver Lic Identification.
Mia Goforth
Notary Public
State of Florida
Comm# HH108700
Expires 5/16/2025
Mia Goforth
Signature of Notary Public
Print, type or stamp Commissioned Name of Notary Public
FORM 1 STATEMENT OF 2022
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below: RECEIVED
LAST NAME-FIRST NAME-MIDDLE NAME: AUG 17 2023
Jackson, Kay, Lyn MG CCO
MAILING ADDRESS:
P.O. Box 1029
Cape Canaveral, 32920 Brevard
CITY: ZIP: COUNTY:
City of Cape Canaveral
NAME OF AGENCY:
City Council
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
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, 2022.
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
Salary P.O. Box 1029 Vacation Rentals
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
None -
PART C - REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report, write"none"or"n/a")
8600 Ridgewood Ave, Unit 3210
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, 2023 (Continued on reverse side)
Incorporated by reference in Rule 34-8.202(1), F.A.C.
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
None
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
Rushmore Mortgage 15480 Laguna Canyon Rd #100
Irvine, CA 92618
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 Anchor Condos
ADDRESS OF BUSINESS ENTITY Services
PRINCIPAL BUSINESS ACTIVITY P.O. Box 1029
POSITION HELD WITH ENTITY Vacation Rentals
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS Owner-more than
NATURE OF MY OWNERSHIP INTEREST Principal 5%
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:
Kay Jackson
Date Signed:
8-17-2023
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 contact.
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 papers.
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 1F (Final Statement
of Financial Interests) does not relieve the flier or filing a CE Form 1
if the flier was in his or her position on December 31, 2022.
CE FORM 1-Effective:January 1, 2023.
Incorporated by reference in Rule 34-8.202(1), F.A.C.
PAGE 2
STATEMENT OF OFFICE USE ONLY
CANDIDATE RECEIVED
(Section 106.023, F.S.) AUG 1 7 2023
(Please print or type)
I, Kay Jackson
candidate for the office of City Council ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X Kay Jackson 8-17-2023
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 08/17/2023 14:56
100 POLK AVE. Number: 94186
CAPE CANAVERAL, FL 32920 Cashier: D.GETZ
(321) 868-1220
Received Of: CAMPAIGN ACCOUNT OF KAY LYN JACKSON
The sum of: $39.00
ELE TAX ELECTION TAX PAYABLE $24.00
MISC MISC $15.00
Total $39.00
Remaining Balance: $0.00
TENDERED: CHECK 001001 $39.00