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Hill James A 11-4-08
~~~~ FLORIDA DEPARTMENT OF STATE DIVISION OF ELE CAMPAIGN TREASURER'S REPORT SUMMARY (1) James Hill OFFICE USE ONLY Name (2) 113 Morgan Circle ^~ Address (number and street) ° T :, Sebastian, FL 32958 -r, _ ~ ~ -; City, State, Zip Code Z `~' ~; ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: ~° ~' (4) Check appropriate box(es): 3 ~ a © Candidate (office Sought): Sebastian City Council E..a n ^ Political Committee ^ CHECK IF PC HAS DISBANDED ~ rn ~ ^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED t~+ ~ -t x ^ Party Executive Committee ^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIf1ERS Cover Period: From ~ / ~j / ~ ~ To ~~ / ~ 3 / ~ Report Type TR ~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ 0.00 Expenditures $ 103.00 Loans $ o . 00 Transfers to Office Account $ Total Monetary $ o . o o Total Monetary $ In-Kind ~ o . 00 (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 3,440.00 $ 3,440.00 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) t 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) Carleen Hill (Type name) James Hill ^Ind' ' ual (only for /^Trea urer ^ Deputy Treasurer ^/ Candida ^ Chairperson (only for PC, PTY & ele n 'ng mmun.) electioneering commun. organization) X ` tgn re ture ~~ CTIONS ~y~p '~- r ~, :~: r _. DS-0E 12 (Rev. 08/04) ~c ~o{ 1~~~~ g CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name James xi11 (2) I.D. Number (3) Cover Period / / through / / (4) Page 1 of 1 {'~ (5) (7) ($) l9) (~O) (~~) Date Full Name Purpose (8) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address 8 contribution to a Expenditure Number City, State, Zip Code candidate) TYPe Amendment Amount Pig and Whistle Pub Lunch MON $25.00 10 31 08 1401 Indian River Dr Sebastian, FL 32958 1 Bizzarro's Pizza Lunch MON $17.00 11 03 08 957 Sebastian Blvd Ste B Sebastian FL 32958 , 2 Ball Park Supplies MON $60.00 it 03 08 9360 90th Ave, FL 32967 Vero Beach , 3 Jim Hill Repay Loan MON $1.00 11 03 08 113 Morgan Circle ti FL 32958 S b an, e as 4 r~.a °~ G to -n ~ CJ _. , ' . ~ ~ t N O ~; ' ' ~ t ~ ~ ~ m *-+ r- ~ ~. ~ ~ DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CITY OF SET~~1 HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax January 5, 2009 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes 106.07, following the election a campaign treasurer's termination report (TR) must be filed with me by February 2, 2009. The TR report (blank forms enclosed) will include a summary page showing the amount of your expenditures from 10/31/08 and an equal amount of total contributions and total expenditures for the entire campaign period. It will also include an expenditure page showing all lawful expenditures in accordance with 106.11(5) and 106.141(4) You need not wait until February to submit the TR report. Once your funds are closed out you can bring in the completed form at any time. If you have any questions or if there is anything I can do to assist you, please do not hesitate to contact me at 388-8214. Sinc ~y, I `', '~~_ ~,~ Sally A. Maio, MMC City Clerk sam :u cnv ~-~ SSE;~AS'~L~N .-::1. - HOME OF PELICAN ISLAND SEBASTIAN CITY COUNCIL MEMBER OATH OF OFFICE I, James A. Hill, do solemnly swear that I will support, protect, and defend the Constitution and Government of the United States, and of the State of Florida against all enemies, domestic and foreign; that I will bear true faith, loyalty, and allegiance to the same; that I am duly qualified to hold office under the Constitution and Laws of the State of Florida; and that I will faithfully perform all the duties of the office of Councilmember for the City of Sebastian of which I am about to enter, so help me Go . es A. Hill Sebastian City Council Member Swo~ii aid subscribed before me this l Ot" day of November, 2008. l -, . ~._ U~ ~ Sally A. aio, MMC City Clerk (SEAL) ~~ U ~u~ CfTY OF sE~~~, HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax November 3, 2008 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes 106.07, following the election a campaign treasurer's termination report (TR) must be filed with me by February 2, 2009. The TR report (blank forms enclosed) will include a summary page showing the amount of your expenditures since 10/31/08 and an equal amount of total contributions and total expenditures for the entire campaign period. It will also include an expenditure page showing all lawful expenditures in accordance with 106.11(5) and 106.141(4) (enclosed). You need not wait until February to submit the TR report. Once your funds are closed out you can bring in the completed form at any time. If you have any questions or if there is anything I can do to assist you, please do not hesitate to contact me at 388-8214. Since~'ely, ~, ~~ ~' `~ Sally A. Maio, MMC City Clerk sam Enclosures (2) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) James Hill OFFfCE USE ONLY Name (Z) 113 Morgan Circle ~ ~ ~ ~ ~1 -ft ~ ~ ~~ `~ ri _t Address (number and street) Sebastian, FL 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 io / li / 08 To io / 30 / 08 Report Type G4 ~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ 9 5 0. 0 0 Expenditures $ 1, 12 9.6 9 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 $ 3,440.00 $ 3,336.69 (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) C~-t"~'~ ~ RYPe name) > . ~r :.S ~'~ C- ^Individual (only for Trea urer ^ Deputy Treasurer . ©"~andidate ^ Chairperson (only for PC, PTY & electi ee ~jng commun.) ~ electioneering commun. organization) Signature Sig ture CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name James Hill (2) I.D. Number (31 Cover Period l o / 11 / o s throucth l o / 3 0 / o $ 141 Pane 1 of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number Cit ,State, Zi Code T e OCCU ation T e Descri tion Amendment Amount Capt Hiram's B Resort CHE 200 10 / 13 /08 1580 US Highway 1 Sebastian Florida, 32958 i 1 10 16 8 Realtors PAC B Realtor CHE 500 I~ / P 21 82 Ponce de Leon Circle ~ Vero Beach, FL ' I 2 I TCBA B Builder CHE 200 10 / 23 0~ 6560 S. Federal Hwy Port St. Lucie, FL 3 34952 / / U~ / / ~_. `~ _. ~3 --~-~ ~~ _. / / / / / / DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES James Hill (3) Cover Period t o / 11 / o e through t o / 3 0 / o s (2) I.D. Number (4j Page 1 of '~2 ~i (5) (~) ($) (9) (10) (~~) Date Full Name Purpose (s) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYPe mendment mount Giuseppes Pizzeria Lunch MON $14.31 10 14 08 935 Sebastian Blvd, Sebastian, FL, 32958 1 Vero Beach Press Journal Advert MON $281.02 10 14 08 717 Coolidge St S b ti FL 32958 e as an, 2 USPS Stamps MON $27.00 10 19 08 Main Street S b ti FL 32958 e as an, 3 Giuseppes Pizzeria Lunch MON $20.33 10 23 08 935 Sebastian Blvd, i S b 32 8 e ast an, FL, 95 4 7-Eleven Supplies MON $5.00 10 23 08 US Hwy One _ Vero Beach FL 32966 ~~ , L 5 Vero Beach Press Journal Advert MON .~ , - $.562.04 10 24 08 717 Coolidge St S b i r e ast an, FL 32958 6 Jim Hill Repay Loan MON $140.00 10 7 08 113 Morgan Circle Sebastian, FL 32958 7 Dunkin Donuts Supplies MON $5.85 10 27 08 US Hwy One Sebastian FL 32958 , 8 DS-DE 14 (Rev. 08!03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name James xill (2) f.D. Number (3) Cover Period t o / 11 / O e through t o / 3 0 / 0 8 (4) Page 2 of 2 (5) (~) (8) (9) (~ 0) (~ ~ ) Date Full Name Purpose (s) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYPe mendment mount Mobay Grill Lunch MON $12.68 10 28 08 13435 Us Highway 1 Sebastian, FL 32958 9 Giuseppes Pizzeria Lunch MON $11.63 10 28 08 935 Sebastian Blvd, ti n FL 32958 S b , e as a 10 Cumberland Farms Supplies MON $5.46 10 28 08 Sebastian Blvd. S ti FL 32958 b as an, e 11 USPS Stamps MON $27.00 10 30 08 Main Street FL 32958 ti S b an, e as 12 Penny Hill Subs Lunch MON $17.37 10 30 Og Sebastian Blvd Sebastian FL 32958 , 13 ~--- ~~ _- ,.._, - C:~ ~ .. DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CfTY OF S~~A~T~~V HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax October 20, 2008 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period October 11, 2008 through October 30, 2008 is due in the Office of the City Clerk no later than 5 pm on Friday, October 31, 2008 (G4). No further contributions can be accepted after midnight on Thursday, October 30, 2008. 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. Please familiarize yourself at this time as to proper disbursement of remaining campaign funds in accordance with FS 106. A termination report (TR) will be due once all funds are disbursed properly. The TR report submittal deadline is February 2, 2009. If you have any questions, please do not hesitate to contact me at 388-8214 or e- mail me at smaio@cityofsebastian.org. Sincerely, J(` /~! ~. , ~~ .~~ Sally A. M io, MMC City Clerk sam FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) James Hill OFFICE USE ONLY ' ., . _... , Name _ ~ , , ~ (2) 113 Morgan Circle ~ ~ ~ ~"1'~ 2 ',Z Address (number and street) - ~ ~ °~ Sebastian, FL 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 o 9 / 2 7 / o a To t o / l o / o s Report Type G3 ~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks ~ 5 5 0. 0 0 Expenditures $ 5 2 6. 0 0 Loans ~ Transfers to Office Account $ Total Monetary ~ 5 5 0 .0 0 Total Monetary $ 526.00 In-Kind ~ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 2,490.00 $ 2,207.00 (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) ~~ /~~'P/1/ ~ ~ (TYPe name) J~ 1~'~~ ~ M~t UL, ^Individual (only for ®Jreasu er ^ Deputy Treasurer Candidate ^ Chairperson (only for PC, PTY & electioneer' mmun.) electioneering commun. organization ) X ~~ /~ Signat Sin ure CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name James Hill (2) I.D. Number /'~1 (_nvor Porinri 09 / 27 / 08 thrOUOh 10 ~ 10 ~ 08 141 P9C1e 1 of 1 (5) (~) (8) (9) (10) (~ ~) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number Ci ,State, Zi Code T e Occu ation T e Descri tion Amendment Amount Realty King B Realtor CHE 200 10 ~ 01 X08 945 Sebastian Blvd Sebastian, FL 32958 1 Waddell Insurance B CHE 100 10 ~ 03 P8 Group 645 Beachland Blvd Vero Beach, FL 2 32963 CFPBA, CFPEA g Union CHE 250 10 ~ 07 0~ 1162 Pelican Bay Drive, Daytona Beach, FL 32119 3 / / / / ;---, p._, GJ _'7i `: -_ _ ~~ / / -,. _ N . C f"V - / / / / DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name James Hill (2) I.D. Number (4) Page 1 of (3)CoverPeriod o9 / 27 / 08 through to / to / 08 (5) (~) (8) (9) (10) (~ ~ ) Date Full Name Purpose (s) Sequence Number (Last, Sufhx, First, Middle) Street Address S City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYI~ mendment mount USPS Stamps MON $351.00 10 O1 08 Main Street Sebastian, FL 32958 1 USPS Stamps MON $27.00 10 02 08 Main Street Seb ti n FL 32958 , as a 2 Office Depot Supplies MON $62.59 10 03 08 20th Street V B h FL 32960 ero eac , 3 USPS Stamps MON $81.00 10 03 08 Main Street ti FL 32958 S b an, e as 4 Hess Supplies MON $4.80 10 07 08 US One Sebastian FL 32958 , 5 r ~ ~~ ;. ~~ DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES cm ~~ HOME OF PELICAN ISLAND 1225 Main Streei Sebastian. Florida 32958 (772) 388-8214 phone - (7?2) 589-5570 tax October 6, 2008 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period September 27, 2008 through October 10, 2008 is due in the Office of the City Clerk no later than 5 pm on Friday, October 17, 2008. 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. Sincerely, ~~ ~ ~~ Sally A. M~o, MMC City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) ~ ~~~ ~ ~~ t ~ OFFICE USE ONLY Name `~~' -. ~:~: .... . (~ A Address (number ands°ltreet) (~ r ~ ~ t :.~ ~ -~- 4- ~ G J ~ ' N ~. , , -s \ ( -- te City, State, Zip Code' u~ ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Che~lc appropriate box(es): f, ~ ~ , -7E~'~ ~ ~ ~ ~ ['Candidate (office sought): - ~i-~ uwv1 -c rv' ^ Political Committee ^ CHECK IF 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 ~~ / ~.3 / ~ ~ To ~-~ / ~, ~;, / Q~ Report Type ~ ~, Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT ~~ Cash & Checks $ ~ ~~ Monetary Expenditures $ S „~ ~ ~ ~ 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 (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, lete. correct, and co mp correct, and complete. / ~ (TYpe name) ~~ ~ ~•~~ ~ ~ ~~ S L ~.. (Type name) .tom ~ ,l Individual (only for ~T ea urer ^ Deputy Treasurer [Candidate ^ Chairperson (only for PC, PTY & electi +ng commun.) t electioneering commun. organization) X X Signature Sig ture DS-DE 12 (Rev. 08104) t CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name ~Q.V\/l'~-S t't t L I-,. (2) I.D. Number (31 Cover Period ~~1 / ~ ~ / ~~~ through ~ (~ / %~, / (7~, (41 Paae i of ~ (5) Date (~) Full Name ($) (9) (10) (~~) (~2) (6) Sequence Number (Last, Suffix, First, Middle) Street Address & Ci ,State, Zi Code Contributor T e Occu ation Contribution T e In-kind Descri tion Amendment Amount O~i ~ ! ~ ~(?~ ~~ ll ~ ~~. Lf~k~ 1 Q/~ ~~~~~ / / <.-, ~J J ' DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name 5~.~.,..c~ ~,~ ~ ~~ (2) I.D. Number (3) Cover Period p r`L /~/~ through c'i / 'Z.~, /~ (4) Page ~ of (5) Date (~) Full Name ($) Purpose (9) (10) (11) (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYPe Amendment Amount ~ ~1G,c) S. µ,1C ~c,~~~ll~.~ p y[ /J '~~~t,r ~ ~,.~~ ~ .; ~~$ ~~.~ ~., _._ ' J7 DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CITY OF ~~~ ~~~~-s~'1~ HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org September 25, 2008 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes Section 106.07, the G2 campaign treasurer's (32"a day) report for your campaign for the period September 13, 2008 through September 26, 2008 is due in the Office of the City Clerk by 5 pm on Friday, October 3, 2008. 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. Sincerely, (~,' ~- ; Sall A. Maio, MMC Y City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) - „. ~OFFICE'{1S~ ONLY 2 ' ?i r ~ erc~~n, J Address ( umb and street) i 2 ~ Q .~.". C/, T~ ~L 3 t ~J City, State, Zip Cod ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): ~~ [Candidate (office sought): G a~.S lG.~. V l ^ Political Committee ^ CHECK IF P AS 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 ~ ~ / ©~ / ~ To Q~ / ~ / ~ Report Type [~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT ~ ~/~~ ~ C Monetary ~ q n ~ ` l t~Jv Cash & Checks $ Expenditures $ ~ j~ D'o' 1 , Loans $ ~ l v ~ Transfers to Office ~' ~ ~ ~ O Account $ Total Monetary $ Total Monetary $ In-Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ $ tTg~to'~' $ t~t`~Z°''' (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 co lete. (Type name~~~.u ~• j (.,,` (Type na e) ~ ~ . ~ L L Individual (only for reasurer ^ Deputy Treasurer andidate ^ Chairperson (only for PC, PTY & elect' a ing commun.) electioneering commun. organization) Signature Signa re DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name _~~1~IV~'~-5 ~`~ (2) LD. Number 131 Cever Period ~ / /'~ 1 / ~~ through ~ / ~ ~ /~~i (41 Paae ~ of (5) Date (7) 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 4~1 / o /06 5~c-~ctW~.K~ o 1 tl.Q~ ~L 32a6~ ~ SGb. fit„ 32°58 O / / d ~i~~~~t 1c3 ~ ~. c; r. 9~ ~ L 0~ ~~s ~ ~~ ~~'~ s~. S~~~L32as8 l e°ue.~-~ ~,D~ 2'00 0~ / t1L /D8' Ji M~~,~. 4. ~t~ I~ot'~o~. ~~ ~1.32~58 1 ~ ~ ~.~ '~ , - . 0 ~ / l Z ~ 0~ ~AN ~u~~t,L, " . ~O ~~ 1 '~ ~C~cr ~~L32g5~ t Q~~ ~~ `~ ~ ~, ~~ ' d / 1,2 / 0 ~~ ~v~ ?,ig ~,~„~,-~ P.J. tip :~-~ 32gb3 ~:0~5. ~Es ~~Z1".'' / / DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIG REASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name ~1,~ ~,` (3) Cover Period ~/ (~~ /~ through Q~ L ~•/ (,~ 8 (2) LD. Number (4) Page ~_ of (5) Date (7) Full Name (8) Purpose (9) (10) (11) (s) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYPe Amendment Amount ~$ 2, ~ No~Ohw~ ~~~~ ~ 28N0 ~!~~~, cr:.~ p~ ~ L 32x05 ~~ ~~~a ~ r r . 1`~0.+~4- S ~~y~~~1~''T{.. ~ `~J ~ ~ V ~ ~_. ~; ~ ~: r- -r -; DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CfIY OF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian . org September 10, 2008 Jim Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes Section 106.07, the G-1 (46t" day) campaign treasurer's report for your campaign for the period July 1, 2008 through September 12, 2008 is due in the Office of the City Clerk by 5 pm on Friday, September 19, 2008. 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. Just a reminder, in accordance with the Land Development Code, political signs can be posted beginning on October 5, 2008, however, based on an opinion from the City Attorney regarding a challenge to the thirty day time limit for installation of signs, City Council passed a motion on a 4-1 vote "that the time frame for the installation of political signs be suspended indefinitely in code section 54-3-16.5 (4) (d) -„ If you have any questions, please do not hesitate to contact me at 388-8214. Sincerely, R- Sally A. aio City Clerk I.L. ~7- MMC sam LOYALTY OATH FOR OFFICE USE ONLY NON-PARTISAN OFFICE - - -- -, I -- . (Sections 876.05-876.10, Florida Statutes) I - `' ' ~ ~' ~ ' STATE OF FLORIDA ~_, ~ (~ ;j ,COUNTY ~~ N~ S ~ ~ ~ t I, r . , , t,1 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) I, Sly. E~.~L (PLEASE PRINT NAME AS YOU WISH IT TO BE WRITTEN IN ON THE BALLOT -NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the office of ,~Gy, G~ l~1VKG~ rou ffice) (district) ( ) g p `` tp My legal residence is (~3 ~ (~a tr . ,g C1oG!t't i ~ ~L ~JC _ County, Florida. I am qualified under the Constitution and the Laws of Flori a 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. Daytime Telephone Number Signature of Candidate c // t 1 -!~ i G~ ~ L 3 ~ ` ~ b ~ - , r C.... G ~eC. ZIP Code Address City ~_8tate (~ Sworn to (or affirmed) and subscribed before me this::h~f day 200 Personally Known: ~~~ or ` ~~ Produced Identification: C , Type of Identification Produced: Signature of ry Public -State of Florida Print, Type Stamp Commissioned Name of Notary Public '""' Sally A. Maio .~iCax' PL~r o: ~ Commission # DD595269 :~ ; . ~ Expires October 5, 2010 =;~; , ~~~ri~~ Bor10la Trq Fam Insurance Inc gp~.38S?0'~b DS-DE 25 (08107} ~~ r =w Q U F LL LL Q O ~ m !~ ~ N Y C LL W LL O ~ Q U F N V U ~ a ~ ,' 3 0 a ~ .~ O M H m l0 LL c v c_ a O '~ N N ~ O ~ ~ J a i L °~ l m ~ m ~ d Z, a' Z' H• N C d L V .N-. y O o i ~° "a U ~ E j E U m U U ~ C7 ~ W ~ ° ° ° 0 o o o rn r rn rn M rn o ao ao OO O N N t at V M ~ M V N M M M M M M O O ~ ~ ~ ~ O ~ O ° Z O O O O O ( D O r~, ,,..~ ~. ~~, a R a 'a '3 a 0 t- .,~ a v c W 1 m • C O 0 m 0 l` \ ~ r ~3 'm c 4 FORM 1 STATEMENT OF 2007 Please print or type your name, mailing FINANCIAL INTERESTS address enc a name and ositi n b l , g y , p o e ow: LAST NAME -- FIRST NAME -MIDDLE NAME : FOR OFFt~f ~ Hill James A. USE ONLY: ~ ' ~' `"" MAILING ADDRESS ~' r, ~ r ~ +: ~; ~~ .- 113 Morgan Circle : ID Code CITY : ZIP : COUNTY Sebastian FL 32958 tD No. NAME OF AGENCY Conf. Code NAME OF OFFICE OR POSITION HELD OR SOUGHT : P. Req. Code Sebastian City Council You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. ' i PDF 2007 CHECK ONLY IF ~ CANDIDATE OR Q 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 (check one): DECEMBER 31, 2007 OR ~ 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 ~ ~ 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 Innovative Drain Technologies 19019 Fern Meadow Loop, Lutr, FL 33558 Golf Course Services 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- ed at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. OTHER FORMS you may need to file are described on page 6. CE FORM 1 - Eff. 1/2008 (Continued on reverse side) PAGE 1 L PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] I TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E -LIABILITIES [Major debts] NAME OF CREDITOR ADDRESS OF CREDITOR National City Mortgage PO Box 1024, Dayton, OH 45401 Capital One Auto PO Box 260898, Plano, TX 75026 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 Innovative Drain Technolo 12S g ADDRESS OF Lutz FL 33558 BUSINESS ENTITY , PRINCIPAL BUSINESS Golf Course Services ACTIVITY POSITION HELD Owner WITH ENTITY I OWN MORE THAN A 5% YeS INTEREST IN THE BUSINESS NATURE OF MY 5O% OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE (required): DATE SIGNED (required): ~/~ ~~ WHAT TO FILE: After completing all parts of this form, including signing and dating it, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section(s)- Facsimiles will not be accepted. NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form 1 for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. FILING INSTRUCTIONS: WHERE TO FILE: 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. Local otftcers/employeesfiIe with the Supervisor of Elections of the county in which they perma- nently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 3600 Maclay Boulevard, South, Suite 201, Tallahassee, FL 32312. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see the "1Nho Must File" Instructions on page 3. WHEN TO FILE: Initially, each local officerlemployee, state officer, and specified state employee must file witfrin 30 days of the date of his or her appointment or of the beginning of employ- ment. 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 for publicly-elected local office must file at the same time they file their qualifying papers. Thereafter, local officers/employees, state officers, and specified state employees are required to file by July 1st following each calendar year in which they hold their posi- tions. Finally, at the end of office or employment, each local officerlemployee, state officer, and specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. CE FORM 1 - Eff. 1/2008 PAGE 2 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMM`, - Y-, - (1) ~ C.~iA.'l ~ ~~ ~ L L OFFICE USE ONLY C ~I~ ~~ CZ '' ~'' ~ ~i~ Name „ . Address (number and street) City, State, Zip Code ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): C [~ Candidate (office sought): ~+~~jc,S~tc`v. ~~'~~ ~ji,~~C,i ^ 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 (~ ~ / ~ ( / ~ To d(„ / 3 ~ / p~, Report Type Q ~ - [~'~riginal ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT ~,~~ $ ~©d `"' Monetary ~I Rte E dit 3~ I - Cash & Checks xpen ures $ Loans $ Transfers to Office Account $ Total Monetary $ Total ~~ Monetary $ ~~~ In-Kind $ (8) Other Distributions (9) TOTAL Moneta Contributions To Date (10) TOTAL Monetary 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. 1 (TYpe name) ~ *- ~ ti'.'G+J~ ~ ~~ ~ ~~ ' (TYpe name) ~c~.~^-, ~ s ~ l~~ ~. ^ Indivi I (only for reasure ^ Deputy Treasurer ~ Candidate ^ Chairperson (only for PC, PTY & election erin~bommun.) ~ electioneering commun. organization) X l X -_ Sign Si ature DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name ~(7u.~~.cy ~;1-`fit (2) I.D. Number (31 Cever Peried ~ / ~ / L~ ~ through ~n ~ _~.~ i !7 ,~ id- c~..e I .,F I (5) Date (7) Full Name (8) (9) `(10) y (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 5 / 2 /nf~ A~c~ner~~~ ~~~~,~~. ~~ 3n~78o~~~ Se~.3,~-u~~~ ~L32~'1~ ~ Glcw•c t~xt~t~~ S (.~~E ~~C~G~~~. 5 / ~ / 0~ ~~ ~ ~~• ~ ~~e~ ~~ o~ S~ FL 32 ~fS (~.. ~ a ~ ~~~UiV~t~f L--R t' ,~~ ~vV / / / / K •.. 3" t.:.. , o ,. / / r r:.. ... - ' / / C. / / / / us-ut ~s trcev. ussiosJ 5EE REVERSE FOR INSTRUCTIONS AND CODE VALUES cc trAMPAI~N TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Ja`^~ P~ ~~ (( (2) LD. Number (3) Cover Period ~~ / ( / ~ ~ through ~ / 3 ~ / ~ ~ (4) Page / of (5) Date (~) Full Name (8) Purpose (9) (10) (11) (s) Sequence Number (Last, Suffix, First, Middle) .Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure Type Amendment Amount Z~ ~~ ~~ ~5 ~ ~~~ SI~~ ~ ~ n :1 -- J v DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CITY OF SE -T~~y HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org June 27, 2008 James A. and Carleen Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. and Mrs. Hill: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period April 1, 2008 through June 30, 2008 is due in the Office of the City Clerk no later than 5 pm on Thursday, July 10, 2008. You may submit the report beginning July 1St 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. The official qualifying period for the November election will begin on August 21, 2008 and run through September 5, 2008. The qualifying fee and all other forms not submitted during pre-qualifying should be filed at this time. Please call me at 388-8214 or contact me by e-mail at smaio~a cityofsebastian.org if you have any questions. Sincerely, t_. Sally A. Maio, MMC City Clerk sam FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS- CAMPAIGN TREASURER'S REPORT SUMMAf~ ' ` t1 (1) -~o~ e S t~~ ~~ OFFICE USE ONLY . Name __ is ~~ l~ ~~ ~~ ~t~ (2) ~ l3 M r C;~~. Address (num er and street) ~ L 3 2 5 5 8 S ~ ~: e. oo.g a.~- City, State, Zip Code ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Che appropriate box(es): Candidate (office sought): ~ ICnv~ C.~-.~ ~~v`~~ ^ Political Committee ^ CHE 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 ©3 / 2,1 / 2.00$ To D3 / 3 ( l 2048 Report Type riginal ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT pG ~ Q Monetary ' Cash & Checks $ Expenditures $ Loans $ Transfers to Office Account $ Total Monetary $ Total Monetary $ In-Kind $ (8) Other Distributions $ (9) TOTAL Mone 7 ntributions To Date ~ TAL Mon o Expenditures To Date (10) t l $ ~ $ `. (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) ~ Ee.~ ~~L~ (Type name) ~ ~~~ S ~ ~ ^ Individual (only for Q Treasurer ^ Deputy Treasurer ~endidate ^ Chairperson (only for PC, PTY & elec' ne ing commun.) electioneering commun. organization) X ~ X Signature Sig re DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS S ~~ (1) Name AVweS ALL (2) I.D. Number (31 Cover Period G 3 / ~ I / ~~ through ~ / 3 ~ / Q~ (41. Paae of / (5) Date (~) Full Name ($) (9) (10) (~~) (~2) (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 C`) 3 ~ .31 ~ 4 ~ Soa~eS ~~;~~ Od 113 1,1~p~,~.G r Seb,FL 32k58 , L Old, 5o ~ i i ~ i ~ ~ i i i ~ i ~ ~ ~ DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (2) LD. Number (3) Cover Period / / through / / (4) Page of (5) Date (7) Full Name (8) Purpose (9) (10) (11) (s) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditu e Type Amendment Amount DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ~~ ~~iS~~~ HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org March 31, 2008 James A. Hill 113 Morgan Circle Sebastian, FL 32958 Dear Mr. Hill: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period March 21, 2008 (the date you became a candidate) through March 31, 2008 is due in the Office of the City Clerk no later than 5 pm on Thursday, April 10, 2008. You may submit the report beginning April 1St. 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. For your information, I am scheduled for knee replacement surgery and may be out of the office for several weeks. Either of my staff members will be able to take your report in my absence. I will be available by phone at home at 589-0020 or by a-mail at smaio(c~cityofsebastian.org during my absence if you have any questions. Sinc fly, ~. ti~, ,~ Sally A. aio, MMC City Clerk sam an a S~B~T~IV ~ __. . ~. HOME OF PELdUN ISLAND ,. ~ ~~. ELIGIBILITY TO HOLD OFFICE `~=} OF COUNCILMEMBER =; ~ ~_ ~--~ Charter Section 2.02 -ELIGIBILITY ~ ~' ---- n "No person shall be eligible to hold the office of council meo~be unless he or she is a qualified elector in said city and ac>~alFy continually resided in said city for a period of one (7) year immediately preceding the final date for qualification as a candidate for said office." I, ~ ~in.F,.S ~, c~ _, ,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 of Candidate Sworn to and subscribed before me this ~~" day of , ~?ara 8 . ,,,,,,, °ora~'P~~;= Sally A. Maio =•~ :Commission # DD595269 ~' ~ `' Expires October 5 2010 ~ otary Ublic ~ i , j~~~~~` eo"tle°Troy fam Insurence Inc. 8W38S7015 State of Florida ,~or.~~~~ ,W ~°°~^s°~ °,°~~1~°°°8~,~.,~~1 ~ 0602 'S aagoto0 sandx3 ~,; ,~ :~:~: 69ZS65aa # uoisswuwo0 •• ~•= SEAL olew •y ~IIeS ~L3y,;~;;b' wp-elect) eligible. wpd STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) I, candidate for the office of 5~~~g~ tG ti ~~'Y Cny6JC< L have received, read and understand the requirements of Chapter 106, Florida Statutes. x ---_ 3~ 2 l- O S Signa ure 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 (Rev. 08/03) STATE OF FLORIDA OFFICE USE ONLY -'= ~, APPOINTMENT OF CAMPAIGN TREASURER -=~ AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES rv < - _ (Section 106.021(1), F.S.) ~ '' J __ (PLEASE TYPE) ~ _, H-~+ ~ f V ~-- _. CHECK APPROPRIATE BOX: ~ r~~ Original Appointment ^ Deputy Treasurer ^ Reappointment of Treasures \ Name of CandidateT' 1. Address (include post office box or street, city, state, zip code) Jahn e~ ~ . ~r, t.l It3 N~orga~ Cii' ; Sa~y~;~„- ~ ~L 3z gSg 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. Name of Treasurer or Deputy Treasurer ~-ai'`l~t~ ~ . ~ ~ L 5. Mailing Address (If post office box or drawer add street address) 6. Telephone I~3 !-hoc a~• G.r. ` t1~,2 - 3~~ -2~~ 7. City 8. County 9. State ~ 10. Zip Code 1 d..~. ~ ~ 3 I have designated the following named bank as my Primary Depository ^ Secondary Depository 11. Name of Bank 12. Street Address ~ ~ ~ ~ ~~ 13. Cit ~ ~ ' 14. Count y I ~ 15. St ~ 16. Zi Code 32 S . ~. 17. Si nature of didate Date 0~ ( 3-2 - Campaign Treasurer's Acceptance of Appointment ' I t ~ ~ ~ ~}..~ t , I, , do hereby accept the appointment as ~ ~~ (Please Print or Type) ® Campaign Treasurer ^ Deputy Treasurer for the campaign of Sl~f`~~ ~,L 1 , who is seeking nomination or election as a .--- 1 l ,~ ~ candidate to the office of ' 1/ (Party) -~- UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AN AT THE FACTS STATED RE TRUE. ~~~''~~ Date ignature of Campa~ Tr surer or Deputy Treasurer DS-DE 9 (Rev. 01/08)