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HomeMy WebLinkAboutBurkeen Brian 03-13-2007FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Brian Burkeen OFFICE USE ONLY Name ~j ,~ _~ ~' (2) 786 Concha Drive Address (number and street) Sebastian, Florida 32958 City, State, Zip Code ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): © Candidate (Office Sought): Sebastian City Council ^ Political Committee ^ CHECK IF PC HAS DISBANDED ^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED ^ Party Executive Committee ^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From / TR ! To / / Report Type TR ~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash 8~ Checks $ 0.0 0 Expenditures $ 19.0 0 Loans $ 0.00 Transfers to Office Account $ 0.0 0 Total Monetary $ o . 0 o Total Monetary $ 0.0 0 In-Kind $ 0.0 0 (8) Other Distributions $ 0.00 (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 80.00 $ 80.00 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (TYPe name) ~ ~ i (~*J ~v i'~-E'~~ 1. (Type name) ~f ~ l~ ~.,J" 1~-e~.~ Qlndividual (only for ^Treasurer ^ Deputy Treasurer ^/ Candidate ^ Chairperson (only for PC, PTY & electioneerin commun.) electioneering commun. organization) X X Signature Signature DS-0E 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Brian Burkeen (2) I.D. Number (3) Cover Period / TR / through / TR / (4) Page 1 of 1 (5) Date (7) Full Name ($) Purpose h ~ 19) h of (~~) (s) Sequence Number (Last, Suffix, First, Middle) Street Address 8 City, State, Zip Code t (add office soug contribution to a candidate) Expenditure TYpe AmendrtatM Amount 05 15 07 American Cancer Society 3375 20th Street MON $19.00 2 Vero Beach, Florida 32960 1 DS-0E 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES cmoF ~' ~- >~ - .- HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 589-5330 phone - (772) 589-5570 fax May 14, 2007 Brian S. Burkeen 786 Concha Drive Sebastian, FL 32958 Dear Mr. Burkeen: Just areminder -- In accordance with Florida Statutes 106.07 a campaign treasurer's termination report for (TR) for your campaign must be filed by June 11, 2007 and will include all lawful expenditures in accordance with 106.11(5) and final disposition of surplus funds in accordance with 106.141. If you have any questions or if there is anything I can do to assist you, please do not hesitate to contact me at 589-5330. Sinter ly, ~~ Sally A. aio, MMC City Clerk sam anoF ~~~~~ lii^ HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 589-5330 phone - (772) 589-5570 fax March 14, 2007 Brian S. Burkeen 786 Concha Drive Sebastian, FL 32958 Dear Mayor Burkeen: Though you were not successful in your bid for re-election, I applaud your effort to continue to represent the citizens of Sebastian. In accordance with Florida Statutes 106.07 a campaign treasurer's termination report for (TR) for your campaign must be filed by June 11, 2007 and will include all lawful expenditures in accordance with 106.11(5) and final disposeion of surplus funds in accordance with 106.141. I have enclosed a Form 1 F which must be filed with the Supervisor of Elections within 60 days of March 19, 2007. Although you are sending them Form 1 F, you will still receive a Form 1 to file later on this year, because that will be for the time you served in the year 2006. If you have any questions or if there is anything I can do to assist you, please do not hesitate to contact me at 589-5330. Sin ely, Sally aio, MMC City Clerk sam } . I FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT. SUMMARY (1) ~ Y.' 1 ~ ~i,,9 C"~-~ ~~ ~ ~ ~QFFt~E USE ONLY ~~ . Addr ss (number and street) '' ~~~ ~ti F'l - 3~~ ~';' City, State, Zip Code ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): , [Candidate (office sought): ~ %-' ~' ` C'/t ~ ^ Political Committee CHECK IF PC HAS DISBANDED ^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED ^ Party Executive Committee ^ Electioneering Communication ^ CHECK 1F NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED . .. (5) REPORT.IDENTIFIERS .. Cover Period: From ~ / ~ / ~ To ~ / ~ ~ / ~ Report Type [Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ `~ Expenditures $ Loans $ •-~- ~ Transfers to Office Account $. _..~-- Total Monetary $. ---~-- Total Monetary $ ,~.~~ . ~ In-Kind-: .. .$ - "~'... . . (8) Other Distributions $ •°~-` (9) TOTAL Monetary~Contributions To Date (10) TOTAL Monetary Expenditures To Date $ ~3~ -- $ 1 ~-X--.J (11) CERTIFICATION It. is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that 1 have examined this report and it is true, I certify that I have examined this report and it is true; correct, and complete. correct, and complete. (Type name) ~~~ ~ ~vY~f' e,J (Type name) I Individual (only for ^Treasurer ^ Deputy Treasurer Candidate ^ Chairperson (only for PC, PTY 8~ electioneering commun.) electioneering commun. organization) • `. / ,~ X /~ `~~ x . Signature ~ ~ Signature DS-DE 12 (Rev. 08104) INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT SUMMARY (1) Type full name of candidate, political committee, committee of continuous existence, party executive committee, or individual or organization filing an electioneering communication report: (2) Type the address (include city, state, and zip code). You may use a post office box If the address has changed since the last report filed, check the appropriate box. (3) Type identification number-assigned by the Division of Elections. (4) Check one of the appropriate boxes: Candidate (type office sought -include district, circuit, or group numbers) Political Committee Committee of Continuous Existence Party Executive Committee Electioneering Communication If PC or CCE has disbanded and will no longer file reports, check appropriate box. If individual or organization will no longer file electioneering communication reports, check appropriate box. (5) Type the cover period dates (e.g., f=rom 07/01/03 To 09 30 03 Enter the report type using one of the following abbreviations (see Calendar of Election and Reporting Dates). If report is for a special election, add °S° in front of the report code (e.g., SG3). Quarterly Reports General Election Reports January Quarterly ........................................................... Q4 46d' Day Prior.........................:.......................................G1 April Quarterly ................................................................ Q1 .32nd Day Prior ....:........................................................... G2 ........................................ July Quarterly ......................... _ Cl2 18"' Day Prior.............:...................................................G3 .......................................................... October Quarte . Q3 4"' Da Prior ................... ~' ............................................... .G4 Primary Reports 32"d Day Prior ..................................................................F1 90-Day Termination Reports (Candidates Only) 18d' Day Prior ..................................................................F2 Termination Report ...............................................:........TR 4m Da Prior ....................................................................F3 Check one of the appropriate boxes: Original (first report filed for this reporting period) Amendment (an amendment to a previously filed report) Special Election Report Independent Expenditure Report (see Section 106.071, F.S.) (6) Type the amount of all contributions this report: Cash & Checks Loans Total Monetary (sum of Cash & Checks and Loans) In-kind (a fair market value must be placed on the contribution at the time it is. given) (7) Type the amount of all expenditures this report: Monetary Expenditures Transfers to Office Account (elected candidates only) Total Monetary (sum of Monetary Expenditures and Transfers to Office Account) (8) Type the amount of other distributions (goods & services contributed to a candidate or other committee by a PC, CCE or PTY). (9) Type the amount of TOTAL monetary contributions to date (parties keep cumulative totals for 2 year periods at a time (e.g., 01/01/02.-12131/03). Candidates keep cumulative totals from the time the campaign depository is opened through the termination report). (10) Type the amount of TOTAL monetary expenditures to date (parties. keep cumulative totals for 2 year periods at a time-(e.g., 01/01/02 -12/31/03). Candidates keep cumulative totals from the time.the campaign depository is opened through the termination report). (11) Type or print the required office's name and have them sign the report: Candidate report (treasurer & candidate must sign) PC report (treasurer & chairperson must sign) CCE report (treasurer must sign) PTY report (treasurer & chairperson must sign) Electioneering Communication report (individual or organization's treasurer & chairperson must sign) AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, & fund transfers being reported as additions or deletions. Read the instructions for the sequence number ~ amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. The Division will summarize all reoorts submitted for each reporting period and for the filer to date. CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS ('f) Narne -~ n~6y~ E~-»`~~J .E2) LD, Number (3) Cover Period ~ / ~ / ~ through ~ / ~ / ~~~ (4) Page ~. of 1 (5) Date . (~) Full Name (8) ~ (9) (10) (11) (12) (6) Sequence Number (Last, Suffix, First, Middle) Street Address & Ci ,State Zi Code Contributor T e Occu ation Contribution T e In-kind Descri tion Amendment Amount ~ ~ / , . / / _ --~ °_; I _ ~ ~. ~ {'' f W) ~- ~ J 1 DS-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Type candidate's full~name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTY). (2) Type the identification number assigned by the Division of Elections. (3) Type cover period dates (e.g., 7/1/03 through 9 30 03 (See Calendar and E/ecfion .Dates for appropriate year and cover periods.) (4) Type page numbers (e.g., 1 of ~. (5) Type date contribution was RECEIVED (Month/Day/Year). (ti) Sequence Number.- Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification, is required for responding to requests from the Division and for reporting amendments. For example,. a Q1 report having 75 contributions would use sequence numbers 1 through 75. The next report (Q2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended Q1 reports would begin with sequence number 76 and on amended Q2 reports would begin with sequence number 41. See the Amendment Type instructions below. . (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Individual = 1 Business = B (also includes corporations, organizations, groups, etc.) Committees = C (includes PC's, CCE's and federal committees) Political Parties = P (includes federal, state ad county executive committees) Other = O (e.g., candidate surplus funds to party, etc.) Type occupation of Contributor for contributions over $100 only. (If a business, please indicate nature of business.) (9) Enter Contribution Type using one of the following codes: NOTE: Cash includes cash and cashier's checks. DESCRIPITION CODE Cash CAS Check CHE In-kind INK Interest INT Loan LOA Membership dues DUE Refund REF (10). Type the description of any in-kind contribution received. Candidate's Only - If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) - To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amending an original Q1 report that had 75 contributions, means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original Q2 report that had 40 contributions, the s'ucth "ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Committees of continuous existence ONLY: Any contribution which represents the payment of dues by a member in a fixed amount pursuant to the schedule on file with the Division of Elections need only list the aggregate amount of such contribution, together with the number of members paying such dues and the amount of membership dues. CAMPA~N '~REASI~RER'S REPORT -ITEMIZED EXPENDITURES (1) Name~~ ~ ~h'~~~~J (2) i.D. Number (3j Cover Period _~/ ~ 1 ,.~Z through ? ~_/ ~ ~ (4) Page ~ of (5) .Date • (7) Full Name (8) Purpose ~ (9) (~ 0) (~ 1) (6) Sequence Number (Last, Suffix, first, Middle) • Street Address & City, State, Zip Code (add office sought if . contribution to a candidate) F-xpenditure TYPe mendment mount _, _:,,.} 6~, - _. a-~ DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTI~: (2} Type identification number assigned by the Division of Elections. (3) Type cover period dates 07/01/03 through 09130103. (See .Calendar and Election Dates for appropriate cover periods.) (4) Type page numbers (e.g.,1 of ~. (5) Type date of expenditure (Month/Day/Year). (6) Sequence Number -Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each~type of detail line. Thus the report type,~detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This. method of unique identification is required for responding to requests from the Division and for reporting requirements. ~ . For example, a Q1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (Q2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Q1 reports would begin with sequence number 41 and on amended Q2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Type full name and address of entity receiving payment (including city, state and~zip code). (8) Type purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does .not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates), CCEs and party executive committees contributing to candidates must report office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: DESCRIPTION _ CODE Disposition of Funds (Candidate) DIS Monetary ~ MON Petty Cash Withdrawn ~ PCW Petry Cash Spent PCS Transfer to Office Account TOA Refund REF (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original Q1 reports that had 75 expenditures, means the. sequence number of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. To correct a previously submitted expenditure use the following dropladd procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Type amount of expenditure. cmoF ~~~ ~~ _~ I ~~~ HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax March 2, 2007 Brian S. Burkeen 786 Concha Drive Sebastian, FL 32958 Dear Mayor Burkeen: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period February 17, 2007 through March 8, 2007 is due in the Office of the City Clerl~ by 5 pm on Friday, March 9, 2006. Do not accept any campaign contributions after midnight on Thursday, March 8, 2006. Any contributions accepted after that time will have to be returned. For future reference and in preparation of your termination report, which will be due by June 11, 2006, please see FS 106.11 and 106.141 relative to expenditure of remaining funds and final disbursement of funds. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. Please read FS 106.07(2)(a) for further details. If you have any questions, please do not hesitate to contact me at 388-8214 or a-mail me at smaio@cityofsebastian.org. Sin rely, ~_ Sally A. aio, MMC City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) . ~~\ n _ j - ~ ~~.~~~ ~ ~ ~ OFFICE USE ONLY Name (~ ` , . er and street b Address (num '~'' -- ll '' City, State, Zip Code - ~ " ~' ~ `= - ^ CHECK IF ADDRESS HAS CHANGED . ,~ (3) ID Number: -- .~ _ (4) Ch ck appropriate box(es): ~ ~~_ .~ !_' ~~ ' [Candidate (office sought): - _ ,~ - __- ^Political Committee -_. _ _ -- ^ -CHECK IF CHAS DISBANDED ~, ~ - ^ Committee of Continuous Existence ^ CHECK IF.CCE HAS DISBANDED ^ Party Executive Committee . ^ Electioneering Communication ^ CHECK 1F NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED . .. .. (5) REPORT-IDENTIFIERS .. - Cover Period: From a / ~ / ~ To ~ / ~ (p ~ / Q ~ Report Type ~ 3 ©Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT ~ (7) EXPENDITURES THIS REPORT Cash & Checks $ `~" Monetary - Expenditures $ --~-= Loans $ ~" Transfers to Office ~ - .. - Account $. -- - Total Monetary $. ~~`" Total Monetary $ --~- : .$ . - In-Kind: (8) Other Distributions $ -'~" (9) TOTAL Monetary Contributions To Date - (10) TOTAL Monetary Expendi ures To Date $ - ~-~- ~~~ $ - C, i ..- (11) CERTIFICATION It.is a first degree misdemeanor for any person to falsify a public record (ss. 839.'13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true; correct, and complete. correct, and complete. (Type, name) , l AJ ~ ~-~'v (Type name) ~ {~ ~, ndividual (only for ^Treasurer ^ Deputy Treasurer Candidate ^ Chairperson (only for PC, PTY 8~ e-ectioneeri mmun.} electioneering commun. organization) X X ~ --~` Signature ~ Signature DS-DE 12 (Rev. 08104) INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT SUMMARY (1) Type full name of candidate, political committee, committee of continuous existence, party executive committee, or individual or organization filing an electioneering communication report. (2) Type the address (include city, state, and zip code). You may use a post office box. If the address has changed since the last report filed, check the appropriate box. (3) Type identification number.assigned by the Division of Elections. (4) Check one of the appropriate boxes: Candidate (type office sought -include district, circuit, or group numbers) Political Committee Committee of Continuous Existence ~ . Party Executive Committee Electioneering Communication If PC or CCE has disbanded and will no longer file reports, check appropriate box. If individual or organization will no longer file electioneering communication reports, check appropriate box. (5) Type the cover period dates (e.g., From 07 01 03 To 09 30 03 Enter the report type using one of the following abbreviations (see Calendar of Election and Reporting Dates). If report is for a special election, add °S" in front of the report code (e.g., SG3). Quarterly Reports General Election Reports January Quarterly ........................................................... Q4 46"' Day Prior.........................:.......................................G1 April Quarterly ................................................................ Q1 .32'~ Day Prior ....:........................................................... G2 July Quarterly ................................................................. Q2 18"' Day Prior.............:...................................................G3 ... October Quarte ........................................................... Q3 4"' Da Prior ................................................................... G4 Primary Reports 32"d Day Pridr ..................................................................F1 90-Day Termination Reports (Candidates Only) 18~' Day Prior ..................................................................F2 Termination Report...............................................:........TR 4"' Da Prior ....................................................................F3 Check one of the appropriate boxes: Original (first report filed for this reporting period) ~ ~ . Amendment (an amendment to a previously filed report) Special Election Report . Independent Expenditure Report (see Section 106.071, F.S.) (6) Type the amount of all contributions this report: Cash & Checks Loans Total Monetary (sum of Cash & Checks and Loans) In-kind (a fair market value must be placed on the contribution at the time it is. given) (7) Type the amount of all expenditures this report: Monetary Expenditures Transfers to Office Account (elected candidates only) Total Monetary (sum of Monetary Expenditures and Transfers to Office Account) (8) Type the amount of other distributions (goods & services contributed to a candidate or other committee by a PC, CCE or PT1~. (9) Type the amount of TOTAL monetary contributions to date (parties keep cumulative totals for 2 year periods at a time (e.g., 01/01/02-12/31/03). Candidates keep cumulative totals from the time the campaign depository is opened through the termination report). (10) Type the amount of TOTAL monetary expenditures to date (parties. keep cumulative totals for 2 year periods at a time.(e.g., 01/01/02 -12131103). Candidates keep cumulative totals from the time.the campaign depository is opened through the termination report). (11) Type or print the required officer's name and have them sign the report: Candidate report (treasurer & candidate must sign) PC report (treasurer & chairperson must sign) CCE report (treasurer must sign) PTY report (treasurer & chairperson must sign) Electioneerin Communication re ort individual or or anization's treasurer & chaff erson must si n AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, ~ fund transfers being reported as additions or deletions. Read the instructions for the sequence number 8: amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. The Division will summarize all re orts submitted for each re ortin eriod and for the filer to date. CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS ('1) Name `~~CZn (~ ~ yr ~.e~l .(2) LD, NuEnber _ (3) Cover Period a / ~ /~ through ~ /~ / ~_ (4) Page ~_ of ~ Date . Full Name (6) Sequence Number (Last, Suffix, First, Middle) Street Address & C' ,State, Zi Code Contributor T e Occu ation Contribution T e In-kind Descri tion Amendment Amount ! / 1 1 / .. 1 / / ~ ,. , . R-- . __ / / r DS-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES . ~ INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Type candidate's full~name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTY). ~ . - (2) Type the identification number assigned by the Division of Elections. - (3) Type cover period dates (e.g., 71/03 through 9 30 03 (See Calendar and Election Dates for appropriate year and cover periods.) (4) Type page numbers (e.g., 1 of 3~. (5) Type date contribution was RECEIVED (Month/Day/Year). (6) Sequence Number.- Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification, is required for responding to requests from the Division and for reporting amendments. For example, a Q1 report having 75 contributions would use sequence numbers 1 through 75. The next report (Q2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended Q1 reports would begin with sequence number 76 and on amended Q2 reports would begin with sequence number 41. See the Amendment Type instructions below. . (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Individua4 = Business = B (also includes corporations, organizations, groups, etc.) Committees = C (includes PC's, CCE's and federal committees) Political Parties = P (includes federal, state ad county executive committees) Other =-O (e.g., candidate surplus funds to party, etc.) Type occupation of contributor for contributions over $100 only. (If a business, please. indicate nature of business.) (9) Enter Contribution Type using one of the following codes: NOTE: Cash includes cash and cashier's checks. DESCRIPITION CODE Cash CAS Check CHE In-kind INK Interest INT Loan LOA Membership dues DUE Refund REF (10). Type the description of any in-kind contribution received. Candidate's. Only - If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) - To add a new (previously unreported) contribution for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amending an original Q1 report that had 75 contributions, means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original Q2 report that had 40 contributions, the sixth "ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be corrected. In combination with the report number being amehded, this sequence number will identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Committees of continuous existence ONLY: Any contribution which represents the payment of dues by a member in a fixed amount pursuant to the schedule on file with the Division of Elections need only list the aggregate amount of such contribution, together with the number of members paying such dues and the amount of membership dues. CAMP N TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name ~ ~(~ ~~, (2) LD. Number (3) Cover Period ~~~ /C.~7 through _~/~_~~ (4) Page 1 of (5) .Date •(7) Full Name (8) Purpose ~ (9) (10) (11) (6) Sequence ' Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add ofFfce sought if . contribution to a candidate) Expenditure Type Amendment Amount . ~ ,. .~~ ~,~. . C._ ... _ I F .i ~_ 1 DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUGTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Type candidate's full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTI~: (2} Type identification number assigned by the Division of Elections. (3) ~ Type cover period dates 07/01/03 through 09/30/03. (See .Calendar and Election Dates for appropriate cover periods.) (4) Type page numbers (e.g.,1 of ~. ~ _ (5) Type date of expenditure (Month/Day/Year). (6) Sequence Number -Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, ~ detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer.. This- method of unique identification is required for responding to requests from the Division and for reporting requirements. ~ . For example, a Q1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (Q2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Q1 reports would begin with sequence number 41 and on amended Q2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Type full name and address of entity receiving payment (including city, state and zip code). (8) Type purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does _not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates), CCEs and party executive committees contributing to candidates must resort office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: DESCRIPTION _ CODE Disposition of Funds (Candidate) DIS Monetary MON Petty Cash Withdrawn ~ PCW Petty Cash Spent PCS Transfer to Office Account TOA Refund REF (10) Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original Q1 reports that had 75 expenditures, means the. sequence number- of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be corrected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary con•ections thus replacing the dropped data. Assign the sequence number as described above. (11) Type amount of expenditure. mvoF j,I i~~~IR ~~~ , HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org February 15, 2007 Brian S. Burkeen 786 Concha Drive Sebastian, FL 32958 Dear Mayor Burkeen: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period February 3, 2007 through February 16, 2007 is due in the Office of the City Clerk by 5 pm on Friday, February 23, 2007. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. Please read FS 106.07(2)(a) for further details. I also want to notify you that the Canvassing Board for the City of Sebastian will meet at the Supervisor of Elections Office on Wednesday, February 21, 2007 at 2:30 p.m. and immediately following will witness and certify as to the accuracy of the public test of the election equipment as required by Florida law. This test is open to the public. For your information, the Canvassing Board is the City Clerk (chair - by Charter) and the City Attorney (by Charter); and I have selected the City Manager as the third member. If you have any questions, please do not hesitate to contact me at 388-8214. Sincerely, -~-----. Sally A. Mai , MMC City Clerk .;: - _ FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) ~\ i~ ~~~ f ~ OAF-1GE USE ONLY ^ Party Executive Committee ~ _ ^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED . .. (5) REPORT-IDENTIFIERS - Cover Period: From ~ / (, ~, / ~7 To ~ / ~ ~ /~~'~ Report Type ~ - [Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT ~ (7) EXPENDITURES THIS REPORT ~, Monetary c~ Expenditures $ ~ ~- Cash & Checks $ ~ ~ {{ ii r l.~ i-:. ~ 4. :1 ei I ~i~~i ~ 1 1 .- (3) ID Number: ~I ^ Committee of Continuous Existence ^ CHECK IF.CCE HAS DISBANDED Name Address (number and stree~ J :~~~~~ ~~,~s- ., ~~ d City, State, Zip Code - ^CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): ~~~~ ~~ /~ [a'Eandidate (office sought): ~ ~.~17A~~~'l ~'y l..l _.. _- __ . ^ Political Committee ^ CHI Loans $ Total Monetary $ In-Kind' ~ ~~ ~ '~ Transfers to Office Account $, ~" Total ~ Monetary $ ($) (9) TOTAL Monet Contributions To Date ~ (10) TOTAL Mon, etpry Expenditures To Date (11) CERTIFICATION It.is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true; correct, and complete. correct, and complete. (Type name} ~ (Type name) ` ~ ndividual (only for ^Treasurer ^ Deputy Treasurer Candidate ^ Chairperson (only for PC, PTY 8~ electi commun.) ~J eleotioneering commun. organization) X` X Signature ~ Signature Other Distributions $ - DS-DE 12 (Rev. 08104) INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT SUMMARY (1) Type full name of candidate, political committee, committee of continuous existence, party executive committee, or individual or organization filing an electioneering communication report. (2) Type the address (include city, state, and zip code). You may use a post office box. If the address has changed since the last report filed, check the appropriate box. (3) Type identfication number.assigned by the Division of Elections. (4) Check one of the appropriate boxes: Candidate (type office sought -include district, circuit, or group numbers) Political Committee Committee of Continuous Existence Party Executive Committee Electioneering Communication If PC or CCE has disbanded and will no longer file reports, check appropriate box. If individual or organization will no longer file electioneering communication reports, check appropriate box. (5) Type the cover period dates (e.g., From 07!01/03 To 09 30 03 Enter the report type using one of the following abbreviations (see Calendar of Election and Reporting Dates). If report is for a special election, add "S° in front of the report code (e.g., SG3). Quarterly Reports General Election Reports January Quarterty ........................................................... Q4 46d' Day Prior.........................:........................:..............G1 April Quarterly ................................................................ Q1 .32"d Day Prior ....:........................................................... G2 July Quarterly ................................................................. Q2 18"' Day Prior.............:...................................................G3 October Quarte ..........:................................................ Q3 4"' Da Prior...................................................................G4 • Primary Reports 32nd Day Prior ..................................................................F1 90-Day Termination Reports (Candidates Only) 18~' Day Prior ..................................................................F2 Termination Report...............................................:........TR 4"' Da~ Prior ....................................................................F3 Check one of the appropriate boxes: Original (first report filed for this reporting period) Amendment (an amendment to a previously filed report) Special Election Report Independent Expenditure Report (see Section 106.071, F.S.) (6) Type the amount of all contributions this report: Cash & Checks Loans Total Monetary (sum of Cash & Checks and Loans) In-kind (a fair market value must be placed on the contribution at the time it is. given) (7) Type the amount of all expenditures this report: Monetary Expenditures Transfers to Office Account (elected candidates only) Total Monetary (sum of Monetary Expenditures and Transfers to Office Account) (8) Type the amount of other distributions (goods & services contributed to a candidate or other committee by a PC, CCE or PT1~. (9) Type the amount of TOTAL monetary contributions to date (parties keep cumulative totals for 2 year periods at a time (e.g., 01/01/02-12/31/03). Candidates keep cumulative totals from the time the campaign depository is opened through the termination report). (10) Type the amount of TOTAL monetary expenditures to date (parties. keep cumulative totals for 2 year • periods at a time.(e.g., 01/01/02 -12/31103). Candidates keep cumulative totals from the time.the campaign depository is opened through the termination report). • (11) Type or print the required officer's name and have them sign the report: • Candidate report (treasurer & candidate must sign) PC report (treasurer & chairperson must sign) CCE report (treasurer must sign) PTY report (treasurer & chairperson must sign) Electioneerin Communication re ort individual or or anization's treasurer & chaff erson must si n AMENDMENT REPORTS: An amendment report summary should summarize only contributions, expenditures, distributions, 8: fund transfers being reported as additions or deletions. Read the instructions for the sequence number ~ amendment type fields on the back of forms DS-DE 13, 14, 14A and 94. The Division will summarize all reports submitted for each reporting period and for the filer to date. CAMPAtGW TREASURER'S REPORT -ITEMIZED CONTRlSUTIONS (7) Name ~~'~.~ AnJ ~v Ck~~ ,(2) I.D.. Number ~ ~ • (3) Cover Period ~ f ~ ~ lo~~ through o2 / ~ /~(z11 (4) Page ~_ of (5) (7) Date . Full Name (6) {Last, Suffix, First, Middle) Sequence Street Address & Number Ci ,State, Zi Code (8) ~ Contributor T e OCCU ation (9) Contribution T e (10) In-kind Descri tion (11) mendment (12) mount ~~ /~ c~e~~ ~ ~ ~~CoU~~~ ~S~ ~ C~~ • ~ _' ~ ~ ~ ~ . ~ ~ ~ ~ 4-. - . ~. -~ • _ ~ ~ ~..~ _ - -- ~-, DS-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Type candidate's full~name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTI~. (2) Type the identification number assigned by the Division of Elections. (3) . Type cover period dates (e.g., 7/1103 through 9 30 03 (See Calendar and Election .Dates for appropriate year and cover periods.) (4) Type page numbers (e.g., 1 of ~. (5) Type date contribution was RECEIVED (Month/Day/Year). (6) Sequence Number.- Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer. This method of unique identification, is required for responding to requests from the Division and for reporting amendments. For example,. a Q1 report having 75 contributions would use sequence numbers 1 through 75. The next report (Q2), comprised of 40 contributions would use sequence numbers 1 through 40. Contributions on amended Q1 reports would begin with sequence number 76 and on amended Q2 reports would begin with sequence number 41. See the Amendment Type instructions below. . (7) Type full name and address of contributor (including city, state and zip code). (8) Enter the type of contributor using one of the following codes: Individual = I Business = B (also includes corporations, organizations, groups, etc.) Committees = C (includes PC's, CCE's and federal committees) Political Parties = P (includes federal, state ad county executive committees) Other = 0 (e.g., candidate surplus funds to party, etc.) Type occupation of contributor for contributions over $100 only. (If a business, please indicate nature of business.) (9) Enter Contribution Type using one of the following codes: NOTE: Cash includes cash and cashier's checks. DESCRIPITION CODE Cash CAS Check CHE In-kind INK Interest INT Loan LOA Membership dues DUE Refund REF (10). Type the description of any in-kind contribution received. Candidate's Only - If in-kind contribution is from a party executive committee and is allocable toward the contribution limits, type an "A" in this box. If contribution is not allocable, type an "N". (11) Amendment Type (required on amended reports) - To add a new (previously unreported) contribution for the reporting period being amended, enter °ADD" in amendment type on a line with ALL of the required data. The sequence number for contributions with amendment type "ADD" will start at one plus the number of contributions in the original report. For example, amendirg an original Q1 report that had 75 contributions, means the sequence number of the first contribution having amendment type "ADD" will be 76; the second "ADD" contribution would be 77, etc. When amending an original Q2 report that had 40 contributions, the sixth °ADD" contribution would have sequence number 46. To correct a previously submitted contribution use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the contribution to be con'ected. In combination with the report number being amended, this sequence number will identify the contribution to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (12) Type amount of contribution received. Committees of continuous existence ONLY: Any contribution which represents the payment of dues by a member in a fixed amount pursuant to the schedule on file with the Division of Elections need only list the aggregate amount of such contribution, together with the number of members paying such dues and the amount of membership dues. • CAMPAI~TREASUR R'S REPORT -ITEMIZED EXPENDITURES (1) Name ~~n~ ~C~~ (2) I.D. Number (3) Cover Period ~ ~ b /~2 through ~~.~~~ (4) Page ~_ of (5) .(7) (8) - (9) (10) (11) .Date Full Name Purpose (Last, Suffix, First, Middle) ' ~ Street Address ~ s (add office sought if . contribution to a lacp ndeture ence• Sequ Number City, State, Zip Code candidate) T Yp Amendment Amount ~-- ,l ~•, ~.. ~r ~. / / w DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES INSTRUGTIONS FOR CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Type candidate`s full name or name of the political committee (PC), committee of continuous existence (CCE) or party executive committee (PTI~: (2) Type identification number assigned by the Division of Elections. (3) Type cover period dates (07/01/03 through 09130/03). (See Calendar and Election Dates for appropriate cover periods.) (4) Type page numbers (e.g., 1 of 3). ~ . (5) Type date of expenditure (Month/Day/Year). (6) Sequence Number -Each detail line shall have a sequence number assigned to it. Sequence numbers are to be assigned within each reporting period and for each type of detail line. Thus the report type, ~ detail line type, and sequence number will combine to uniquely identify a specific contribution, expenditure, distribution or fund transfer.. This. method of unique identification is required for responding to requests from the Division and for reporting requirements. ~ . For example, a Q1 report having 40 expenditures would use sequence numbers 1 through 40. The next report (Q2), comprised of 30 expenditures would use sequence numbers 1 through 30. Expenditures on amended Q1 reports would begin with sequence number 41 and on amended Q2 reports would begin with sequence number 31. See Amendment Type instructions below. (7) Type full name and address of entity receiving payment (including city, state and~zip code). (8) Type purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLEASE NOTE: This column does .not apply to candidate expenditures, as candidates cannot contribute to other candidates from campaign funds. However, PCs (supporting candidates), CCEs and pary executive committees contributing to candidates must resort office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: DESCRIPTION . CODE Disposition of Funds (Candidate) DIS Monetary MON Petty Cash Withdrawn PCW Petty Cash Spent PCS Transfer to Office Account TOA Refund REF (10} Amendment Type (required on amended reports) - To add a new (previously unreported) expenditure for the reporting period being amended, enter "ADD" in amendment type on a line with ALL of the required data. The sequence number for expenditures with amendment type "ADD" will start at one plus the number of expenditures in the original report. For example, amending an original Q1 reports that had 75 expenditures, means the. sequence number- of the first expenditure having amendment type "ADD" will be 76; the second "ADD" expenditure would have sequence number 39. To correct a previously submitted expenditure use the following drop/add procedure. Enter "DEL" in amendment type on a line with the sequence number of the expenditure to be con•ected. In combination with the report number being amended, this sequence number will identify the expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required data with the necessary corrections thus replacing the dropped data. Assign the sequence number as described above. (11) Type amount of expenditure. < p r,~~c~ ~~ ~ ~~~ ~~e ~ ~, ~ ~ \ ~ 'I J ~ o Q ~~ ~n ~~ ~ O ~ ' ~ ~ ~ a ~ ti C'- J J ~ O O M ~r ` =~U~, '~ ~ aZWLL ~ o ~~ $ ~ o ZaNg ~ G o N ti F- o ~ O JNZ~ ~o m ~ ~V~N ~~ ,~ ~ ' ~,u . R <~ ~ _,~ ~ ~~ ~ ~~~ G o ~~~~ U) ~G ~/~; ~a ~~I~ Le l „, / ~a~ ~ -_ ~ (`~ c o P ~l f'`~ ~~ t.; t-. ~,., ",{ L , =~'-~~ e~,~o ., , .~ ~ _ y~,.....,.,.,,~e ~, i ._ . _~ ~ ,~,_ _. ,~. a_ cmroF ~~ HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org January 30, 2007 Brian S. Burkeen 786 Concha Drive Sebastian, FL 32958 Dear Mayor Burkeen: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign fior the period January 16, 2007 (the day yoer became a candidate) through February 2, 2007 is due in the Office of the City Clerk by 5 pm on Friday, February 9, 2007. Any report postmarked by the United States Postal Service no later than midnight 4f the due date, shall be deemed to have been submitted in a timely manner. Just a reminder, in accordance with the Land Development Code, political signs can be posted beginning on February 11, 2007. Please refer to the candidate handbook for LDC sign provisions and FS 106 for applicable campaign advertising provisions. If you have any questions, please do not hesitate to contact me at 589-5330. sin y, ~~ V / < Sally A. , MMC City Clerk sam LOYALTY. OATH . _ ~ _OF~~c~ ~~~~r ; ,, CANDIDATES WITH NO PARTY AFFILIATION ` ' ' ~ 5 ~ I' ~ I ~ 1 (Sectlons 876.05-876.10, Florida Statutes) - STATE OF FLORIDA _ ~; ~~ ~ ; ~ ~;~' COUNTY PLEASE PRIN I ~'' j -- , . , ~ First Name Middle Name/initial Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. OATH OF CANDIDATE (Section 99.021, Florida Statutes) .h ~~ ~~ ~~a ~.~ r~'-~c~i - - ~ (PLEASE PRINT NAME AS YOU WISH R TO APPEAR ON THE BALLOT -NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the office of ~ , (office) (district) (circuit) . I am a qualified elector of ~.;1~ r (~N ~ v ~.~` County, Florida. I am qualified (group) under th.e 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 atty office from which I am required to resign pursuant to Section 99.012,. Florida Statutes. UNDER `L~FIO1~P~~RJ~~f~~LA1;tE`THAT I HAV~~EAD THE ~OREGC~k C~,'Li~~A-C~~?~TiAND~,4~'F~ ~~° CANQ~Q,~ ~L+l ~~TA'~'TH CT~~~TAT~D IN EACH ARE-TRl3~ ~"'~~ ~~ - ~ ~ P _: ~- _ ~ ~ -- SIGN HERE __ _ - Signature of Candidate Mailing Address Day Phone Fax Number City State Zip Code Date Signed DS-DE 24B (Rev. 08/03) CITY OF SEBASTIAN CITY CLERK'S OFFICE 3 8 O RECEIPT V Name f,(. r ~ e ~~ ^ Cash Date ~ ' ~. ~ " ~ 7 Check#~ _ No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501 341930 Elecction Qualifying Fees ~ r, , v~ 601010343800 Cemetery Lots LotMiche ,Block ,Unit 001501 343805 Cemetery Fees Total Paid Initials White - Dep . of Origin • Yellow -Finance • Pink - Applicant n. V-~~ , o _ ,~ O mg O~ ~ V ~ ~~ b9 , ~ !'' * b ~ ~ ~~ c,6j . ` i y.. ,y~ ~ ~ ~ ~ ~ ~ _ ~ ~ ~ O ~.o ~0 ~ I ~ 1 ~ ~ ~ ~ h - i /w~ ~~ O O ~^ '~/ =~ LJ • ~~ ~~ ~ ~ : O ~ ~ (`~` ~ ~.. ~ R~ u. ~ ~ ^ ^ r' ~'4 ~ r.~~ .r HOME OF PEI.iCAN 15IAND ELIGIBILITY, TO HOLD OFFICE OF COUNCILMEMBER 2.02 -ELIGIBILITY No person shag be eligible to hold the office of council member unless he or she s a qualified elector in said city and actually cgntinually resided in .said city for a period of one (1) year immediately preceding the final date for qualification as a :andidate for said office." I, /_~~.~~ ~ ~~.~~. o~ candidate for the office ouncilmember; meet the qualifications to be eligible to hold office as required ection 2.p2 of the City of Sebastian Charter, above. Signature of Candidate ern to and subscribed before me this day of , ~• -~ ~, otary r nc ,.Q~~~:dL~;: Sally A. Maio tate o Florida =~ Commission # DD595269 's~F~.~;= Expires October 5, 2010 ~~ ~~~~ri~y~~ Bonded Troy Fain insurance. Inc. 800.385.1019 FORM 1 STATEMENT OF 2005 Piease print or type your name, mailing FINANCIAL INTERESTS address, agency name, and position below: LAST ME -FIRST NAME - MIDDL E : FOR OFFICE CY~C?P..eIJ (mil ~ USE-ONLY: MAILING ADDRESS ( ! ~ j~, ~~~~ ~ ~ "~-- ID Code ~Y~f I (,~~i' / ~ ~N`V1 !~ ~ v`im' _. CITY : ZIP : COUNTY : -- - ~ '• ID No. E, ,. ,- C.71 NAME OF ADEN Y : ~ , ",, /` ~/,, Conf. Code , _ NAME OF OFF E OR POSITION HELD OR SOUGHT : P. Req. Code , -" dV ~.~t ~~ CHECK ONLY IF CANDIDATE OR ^ NEW EMPLOYEE OR APPOINTEE ~' PDF 2005 "*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 (check one): DECEMBER 31, 2005 QB ^ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS 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).. PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one): ^ COMPARATIVE (PERCENTAGE) THRESHOLDS 4$ ~ DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person] NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY tf rv ~ I C~ 5'~ ~ ~ ~ ~• ~`C,~~T X~~ PART B -SECONDARY SOURCES OF INCOME [Major customers, Gients, and other sources of income to businesses owned by the reporting person] NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for when and where to file this form are locat- n ~ ~/ "Y~/ ed at the bottom of page 2. INSTRUCTIONS on who must file thi f d h i fi l b s orm an ow to n l it out eg on page 3. OTHER FORMS you may need to file are described on page 6. CE FORM 1 - Eff. 1/2006 (Continued on reverse side) PAGE 1 PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E -LIABILITIES [Major debts] NAME OF CREDITOR ADDRESS OF CREDITOR ,lr jc.~ ~ JNFS~+t~WN PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses] BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTNITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0 SIGNATURE (require DATE SIGNED (req ired): u ^ ~ ~/ 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 Inifially, each local officer/employee, state signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified state employee must sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to file within 30 days of the date of his or her that location. appointment or of the beginning of employ- if you have nothing to report in a particular Local o~cers/employees file with the Supervisor ment. Appointees who must be confirmed by section, you must write "none" or "Na" in that of Elections of the county in which they perms- the Senate must file prior to confirmation, even if that is less than 30 days from the date of their section(s): nently reside. (lf you do not permanently reside appointment. in Florida, file with the Supervisor of the county Facsimiles will not be accepted. where your agency has its headquarters.) Candidates for publicly-elected local office NOTE: State officers or specked state employees must fife at the same time they file their MULTIPLE FILING UNNECESSARY: file with the Commission on Ethics, P.O. Drawer qualifying papers. Generally, a person who has filed Form 1 for a 15709, Tallahassee, FL 32317-5709; physical Thereafter, local officerslempioyees, state calendar or fiscal year is not required to file a address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are second Form 1 for the same year. However, a 201, Tallahassee, FL 32312. required to file by July 1st following each candidate who previousty filed Form 1 because Candidates file this form together with their calendar year in which they hold their posi- of another public position must at least file a copy qualifying papers. lions. of his or her original Form 1 when qualifying. To determine what category your position Finally, at the end of office or employment, see the "Who Must File" Instructions falls under each local officedemployee, state officer, and , on page 3. specified state employee is required to file a final discosure form (Form 1F) within 60 days of leaving office or employment. CE FORM 1 - Eff. 1/2006 PAGE 2 - STATE OF FLORIDA o~F~c~ ws~;oMiY _, , APPOINTMENT OF CAMPAIGN TREASURER ,;; P - - ~r ~ ~ AND DESIGNATION OF CAMPAIGN ~._ ,,__- . ~ DEPOSITORY FOR -CANDIDATES _ . ' ~, L -' ~ 1 ~. ~ `' (Section 106.021(1), F.S.) (PLEASE TYPE) CHECK APPROPRIATE BOX: ^ Original Appointment ^ Deputy Treasurer ^ Reappointment of Treasurer ^ Secondary Depository Name of Candidate 1. Address (include post office box or street, city, state, zip code) . -~ ~ ~ ~~ '1 ~ (~ ~-'-~ri?C~A ~c ti{' ~ jv ~ J~Cz.i ~ ~ elm ~~~ }-1 3a~ S~ Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit, group number) I have appointed the following person to act as my ~ Campaign Treasurer ^ Deputy Treasurer 4. me of Treasurer or Deputy Treasurer - S ~~ 5. Mailing Address (If post office box or drawer add street address) 6. Telephone ~~ ~~ ~~:~ ~y.3 ~ ~ ~ ~ 7. City 8. County 9. State 10. Zip Code I have designated the following named bank as my ^ Primary Depository ^ Secondary Depository 11. Name of Bank 12. Street Address .-, 11 ^_ 2 ~V~ V 13. City 14. County 15. State 16. Zip Code 17. Si nature~o rididate Date ~ l~ ~e~ --- -- - Campaign Treasurer's Acceptance of Appointment - -- ~- I, 1~(~ ~ `~, ~,,~~p~ _ , do hereby accept the appointment as (Please Print or Type) '"-> Campaign Treasurer ^ Deputy Treasurer for the campaign of ~-~(~„~ ~ , ~jt~.rl(J2~ who is seeking nomination or election as a candidate to the office of (Party) ~~~}.,.~} ~ ~,/ ~~l~t ~~ ~ As a duly registered voter in ~{yL,~~~ ~~V~~" County, Florida, I am qualified to accept this appointment. UNDER PENALTIES OF PERJURY, i DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE. - ~c~~a~~~ ~i~~ X ` ~~-' r2 ~ J _ Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 02!06) STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) I, t' ;';, OFFICEUSE D~II~1F candidate for the office of~~~.~,~ ~~.~~I~',~1 ; have received, read and understand the requirements of Chapter 106, Florida Statutes. X Signa ure of Candidate ~ -- I t~ -a~c,~j - ~i 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 (Rev. 08103}