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Home My WebLink AboutGilliams Final Qualifying Docs & Filing ReceiptCANDIDATE OATH — NONPARTISAN OFFICE (Not for user by Judicial or School Board Candidates) i, DA m i tJnl OATH OF CANDIDATE (Section 99.021, Florida Statutes) (5) 1 'LA. L V4 M S RECEIVED AU6 31 2015 City of Sebastian City Clerk's Office OFFICE USE ONLY (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT' — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of �� 1 �� O U 1✓ C i L , (office) (district #) I am a qualified elector or,*I� � t Wo R til -e it County, Florida; (circuit #) (group or seat #) 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, F tatutes; and I will support the Constitution of the United States and the Constitution of the State of Flor a. x (-rz,) !1 13 5-O -i I Z�s 14 VM 1,0 e(o M C &A I , kL4r Signature ofan idate Telephone Number Email Address Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 10 `4 (00-1 317 * Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): A T- P/j - - - - �. - �.� - t+1 •BVI S STATE OF FLORIDA COUNTY OF ,&". ;&tlee qk Sworn to (or affirmed) and subscribed before me this .-':;>/ day of -•�ti�''''•.; s Personally Known: or _*: :.: SALLY A. MAIO Commission # FF 153543 • = Expires October 5, 2018 Signature of No ry Public Produced Identification: � �'Rr 6MdWTWT10yFav,�,�„�ro,eoa=,Ut9 Print, Type, or, tamp Commissioned Name of Notary Public Type of Identification Produced: DS -DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C. INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO BALLOT Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames. Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes (-) to separate syllables. You should also add any notes such as rhyming examples, silent letters, etc. PRONUNCIATION KEY Stressed Vowel Sounds PRONOUNCED AS EE FEET feet I FIT fit E BED bed A KAT cat (KAD) cad AH (FAH-thur) father PAHRpar AH (HART) hot (TAH- dee)Codd UH (FUHJ) fudge FLUHD flood UH CHUHRCH church AW FAWN fawn U (FUL) full OO FOOD food OU (FOUND) found p FO foe EI FEIT fight Al FAIT fate OI 170 1 Q fat YOO (FYOOR-ee-uhs) furious Unstressed Vowel Sounds uh (SO-fuh) sofa (FING- uhr)fln er Certain Vowel Sounds with R PRONOUNCED AS AHR PAHRpar ER PER air IR PIRpeer OR POR) pour OOR POORpoor UHR PUHR purr Samples: NAME ON BALLOT PRONOUNCED AS Mishaud mee-SHO ('d' Is silent) Jahn HAHN (rhyme: fawn) Beauprez boo -PRAT (rhyme: hooray) Maniscalco man-uh-SKAL-ko Tangipahoa TAN-ji-pah-HO-uh Monte Mahn -TAI Tanya rTA—WN-yuh (not TAN) Consonant Sounds B BED bed TS ITS its PITS-feeld Pittsfield D DE debt TH THEI Thigh F FED fed TH THEI Th G GET et ZH A-zhuhr azure VI-zhuhn vision H (HED) head Z (GOODZ) goods (HUH-buhz-tuhn) Hubbardston HW HWICH which J (JUNG) jug K (KAD) cad L (LAIM) lame M MAT mat N NET net NG SING-uhr singer P PET et R RED, red . S SET set T TEN ten V VET vet Y YET et .., ....._,.. . W ICH witch CH CHUCRCH church SH SHEEP sheep r� NOTE: This page should not tie sunmiaea to the Hung umuvg. Page 2, DS -DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C. ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY PeCE/Vke AUG 3) ?D Ci of S Ceb �5 tty Clerk �s pcn "'No person shall be eligible to hold the office of council member unless he or she is a qualified elector* in said city and actually continually resided in said city for a period of one (1) year immediately preceding the final date for qualification as a candidate for said office." I, ptv-)" 1�- VN C.—I l LII 14y" S , candidate for the office of Council Member, meet the eligibility qualifications to hold office as required in Section 2.02 of the City of Sebastian Charter, above. Signature oftandidate Sworn to and subscribed before me this 201'.61 3 day of , Notary Pu is SALLY A. MAIO State oflorida Comcvrgrze Octobers 2018 .y . ��'�•$ , Banded Thu Troy f do IMUS ce E00Ma19 SEAL *166.032 Electors. --Any person who is a resident of a nrtuiicipality, who has qualified as an elector of this state, and who registers in the manner prescribed by general law and ordinance of the municipality shall be a qual f ed elector of the municipality. itils-wo)•d/election/clrarter eligibility STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) I'DVI, Y1n l -F i LC- ✓VI 5 OFFICE USE ONLY RECEIVED AUG 3 1 2015 City of Sebastian City Clerk's Office candidate for the office of 5�GVA S�1 14 �j Ce have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Signature ndidate ?_ 31. 1 Date I Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (05111) FORM 1 . STATEMENT OF 2014 Please print or type your name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agoncy name, and posltlon below: I i E — MIDDLE NAME: LAST NAME — FIRST NV14 iti. i 1-C v% MAILING ADDRESS: lt0 713 V S (*Afy I A : 5- RECEIVED igAm"te ZJ S"S e5AA LWJ CITY: ZIP: COUNTY: AUG 31 2015 NAME OF AGENCY: City of Sebastian City Clerk's Office NAME OF OFFICE OR POSITION HELD 0,B SOUGHT 051-114 1v tC Q&46, L You are not limited tospace on the lines on this form. Attach additional sheets, If necessary. CHECK ONLY IF OR ❑ NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): DECEMBER 31, 2014 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR;-.- EARMANNER MANNEROF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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: im COMPARATIVE (PERCENTAGE) THRESHOLDS QUI• ❑ 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 "nla'l NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY OA ' C -L % i '1:1 ST a -K 1%& 2,1 V E <Jr izn-t 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 "nia") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE tf r NAV pe o c 9c - STS (41 ►- �r I t c� -> 4 c C�-Tc c k? V S (,� • i Q,q S7 t+��l (Zt? :.. 4 PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See Instructions] (If you have nothing to report, write "none" or "nia") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. Pwy- 1 1-84 0t i90 jFL- , v4 I r 19 5r 4t; INSTRUCTIONS on who must file this form and how to fill it out begin o n page 3. � q qo \%S I+w•/- I t`KTt eq,,, 6 N �� i L T i l vLt L L-•�-t o �� (' JZ �tZ. E l o �" vtt � �, l o't � h � t: r� C T+a LLvi ov% otosU-j SE At Te &q.1 FL t.e runm i• taecuve: �aruary =, zu�a (continued on reverse side) PAGE t Adopted by reference in Rule 34-32112(1), FAc- PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions) (If you have nothing to report, write "none" or "nla") k TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "n/a") NAME OF CREDITOR ADDRESS OF CREDITOR G f illyQ-QI►�c dlr. roc LLz A/ Z7 14Z�l02 #ut °fi" �,Eju t,J� � "7'� 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 "nia") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY,mi 0 f!:g Q -E. Sh*. 1Cf!f `r k4-ge�jjt /14/l6 1zrq Afes.. �-if-t. s L ADDRESS OF BUSINESS ENTITY/%23v6 I f9rt*th u �� `� rn�,-� 0Z �j US Aw fi r !- t2 PRINCIPAL BUSINESS ACTIVITY ,!-t - tA7-e fy�P - '� r„q- ,C Pot- ari'' ge POSITION HELD WITH ENTITY -ow^,&- rt �-1141 . I OWN MORE THAN A 5% INTEREST IN THE BUSINESS i ycS P S NATURE OF MY OWNERSHIP INTERESTJ/-Zy,,K d�1rf�-r►-z IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or Signature: 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. Date Signed: CPAlAttorney Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, Including If you were mailed the form by the Commission Initially, each local officer/employee, state officer, signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet (pages 1 and 2) for fling. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local of Icers/employees file with the who must be confirmed by the Senate must file pri30or to if that is less than evete "none" "nfa" section, you must write or in that Supervisor of Elections of the county in which they days from then, their appointment section(s). permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the Candidates for publidy-elected local office must NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY: papers. A candidate who previously filed Form 1 because State ache C or specified state employees Thereafter, local officers/employees, state p y file with the Commission an Ethics, P.O. Drawer of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are required to file by July 1st following each calendar of his or her original Form i when qualifying. A address: 325 John Knox Road, Building E, Suite year in which they hold their positions. candidate who files a Form 1 with a qualifying 200, Tallahassee, FL 32303. officer is not required to file with the Commission Finally, at the end of office or employment, each or Supervisor of Elections. Candidates file this form together with their local officer/employee, state officer, and specified qualifying papers. state employee is required to file a final disclosure To determine what category your position falls form (Form IF) within 60 days of leaving office or under, see the "Who Must File" Instructions on employment. However, filing a CE Form 1F (Final page 3. Statement of Financial Interests) doessnot relieve Facsimiles will not: be accepted, the filer of fling a CE Form 1 if he or she was in their position on December 31, 2014. CE FORM 1 - Effective: January 1, 2015. HAW: z Adcpted by rerererce in Rule 34.8.202(1). F.A.C. CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT 994.0 Name ivu i 4 -MS ❑ Cash Date 3 i i ,heck # CSO % ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 491213YJ M WWALOWAL& Total Paid l- vc) Initials White - Dept. of Origin • Yellow - Finance - Pink - Applicant