HomeMy WebLinkAboutDEVIRGILIO DAVID 11-2-2010FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
TREASURER'S REPORT SUMMARY
CAMPAIGN
J O v 1t2 L. /U
.QFFICEVe@ N,
FICE OF CITY CLERK
2010 I!OU 22 PSI y 16
Name
(2) 13 7 2.-1.- -tc.1w 1SI_).. �l
Address (number and street)
City, State, Zip Code
CHECK IF ADDRESS HAS CHANGED (3) ID Number:
(4) Chec appropriate box(es):
andidate (office sought): C— I "K Cv L. i t-
n Political Committee I CHECK IF PC HAS DISBANDED
Committee of Continuous Existence I CHECK IF CCE HAS DISBANDED
LJ Party Executive Committee
Electioneering Communication CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From i C) 2.') (v To q is Report Type 1 7Z--
El Original n Amendment Special Election Report Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash Checks
(7) EXPENDITURES THIS REPORT
Monetary
Expenditures 3ct
Loans
Transfers to Office
Account
Total Monetary
Total
Monetary
in -Kind
(8) Other Distributions
(9) TOTAL Monetary Contributions To Date
00
(10) TOTAL Monetary Expenditures To Date
f.
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,
correct, and complete.
I certify that I have examined this report and it is true,
correct, and complete.
(Type name) 1,/ e 7�£ V;, L.,
(Type name) t �7 J ec., 0 i
Individual (only for !`Treasurer Deputy Treasurer`endidate
electioneering co u rm.)
X
Chairperson (only for PC, PTY
electioneering commun. organization)
X
Signature
Signature
DS -DE 12 (Rev. 08104)
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(s)
Sequence
Number
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CAMPAIGN TREASURER'S REPORT ITEMIZED EXPENDITURES
(1) Name V r f a r j (2) I.D. Number
(3) Cover Period G Z- u through (t (4) Page
DS 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of
November 9, 2010
David DeVirgilio
113 Pelican Island Place
Sebastian, FL 32958
Dear Mr. DeVirgilio:
CITY OF
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, Florida 32958
(772) 388 -8214 phone (772) 589 -5570 fax
smaio @cityofsebastian.org
In accordance with Florida Statutes Section 106.07, your campaign treasurer's
Termination Report (TR) for your campaign for the period from Friday, October 29th is
due in the Office of the City Clerk by January 31, 2011.
The Termination Report will include a summary page showing the amount of your
expenditures since October 29, 2010 and an equal amount of contributions and
expenditures for the entire campaign. It will also include an expenditure page with all
lawful expenditures in accordance with 106.11(5) and 106.141(4).
You need not wait until the deadline to provide your report. As soon as your funds are
disbursed you may complete the form and submit it.
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. 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 or smaio(a�citvofsebastian.orq.
Sally A. aio, MMC
City Clerk
sam
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPQ3T SUMMARY
I
O CO i E J t (o l'
L lc
1 i' S EB A 'AF�CE USE ONLY
i O E OF CITY C rd\
El 29 Bi 11 02
F
Name
(2) 1( 3 i k c A:.1 i S L.A I) L 2010
Address (number and street)
_5 c (2 14, 5- 1_ 3 7 SJ
City, State, Zip Code
CHECK IF ADDRESS HAS CHANGED
(4) Check appropriate box(es):
Candidate (office sought): I-T-1 C u
(3) ID Number:
t t
Political Committee CHECK IF PC HAS DISBANDED
Committee of Continuous Existence I I CHECK IF CCE HAS DISBANDED
Party Executive Committee
n Electioneering Communication Li CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From /0 01 J To r J ro' (,3 Report Type
►Original Amendment Special Election Report Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash Checks
(7)
Monetary
Expenditures
Transfers
Account
Total
Monetary
EXPENDITURES THIS REPORT
Loans
to Office
Total Monetary
In -Kind
(8)
Other Distributions
(9) TOTAL Monetary Contributions To Date
100
(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 report and it is true,
correct, and complete. y�
(Type name) v CO 1/ X ry
I certify that I have examined this report and it is true,
correct, and complete.
(Type name) 7/I v i F V t is_ i�r
Individual (only for T reasurer Deputy Treasurer
electioneering un.)
X
R'Candidate Chairperson (only for PC, PTY
electioneering commun. organization)
X
Signature
Signature
DS -DE 12 (Rev. 08/04)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Contributor
Type
Occupation
Contribution
Type
In -kind
Description
Amendment
Amount
(6)
Sequence
Number
2010
OF
OC 29
I Y DE SEBA
:ICE OF CITY
N
ti
C
r.:
CLER-r",
(1) Name
3) Cover Period
DS -DE 13 (Rev. 08/03)
CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
r 1 Jk Z v, t-
0 (.2 (u through U 7-
(2) I.D. Number
4) Pa
of
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
T10 OCT 29
.7.)F S
,FFICE OF
All 11 02
TY CLERK
CAMPAIGN REASURER REPORT ITEMIZED EXPENDITURES
(1) Name 1 7 V co i o l 2-L 1 L. 1 (2) I.D. Number
(3) Cover Period 1 0 C7 i b through f t �--t 1 c) (4) Page
DS 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of
October 19, 2010
David DeVirgilio
113 Pelican Island Place
Sebastian, FL 32958
Dear Mr. DeVirgilio:
In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for
your campaign for the period from Saturday, October 9 through Thursday, October
28, 2010 is due in the Office of the City Clerk by 5 pm on Friday, October 29, 2010
(G4).
Please keep in mind that this report has a different reporting period from the previous
two, since it is a longer period; and ends on Thursday, October 28 with the report due
the next day Friday, October 29
In accordance with Florida law, no contributions can be accepted after midnight on
Thursday, October 28 (106.07 (2) a.1.)
Now is a good time to become familiar with FS 106.11(5) and 106.141 in regard to
closeout and disposition of campaign 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.
If you have any questions, please do not hesitate to contact me at 388 -8214 or
smaioCa cityofsebastian.org.
Surely,
Sally A.
City Clerk
sam
‘,1/1
aio, MMC
CITYOF
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, Florida 32958
(772) 388 -8214 phone (772) 589 -5570 fax
smaio @cityofsebastian.org
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
'DAV (D D CV 1�.(o i 1
CITY OFFICE OF CITY CLERK
2010 OCT 15 AE9 10 56
Name f 4Cf9 1 'd i S►_, .,vD ('1
Address (number and street)
EA1S'f7itw FL 3 2--cf
City, State, Zip Code
CHECK IF ADDRESS HAS CHANGED
(4) Ch appropriate box(es):
CO
(3) ID Number:
ciA)C.:
Candidate (office sought): e. T
Political Committee CHECK IF PC HAS DISBANDED
Committee of Continuous Existence n CHECK IF CCE HAS DISBANDED
Party Executive Committee
1 Electioneering Communication U CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From 2- 5 O To 0 1 e) Report Type 3
Original Amendment Special Election Report Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash Checks
(7)
Monetary
Expenditures
Transfers
Account
Total
Monetary
EXPENDITURES THIS REPORT
p�
Loans
to Office
Total Monetary
In-Kind
(8)
Other Distributions
(9) TOTAL Monetary Contributions To Date
(10)
TOTAL Monetary Expenditures To Date
4i
(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,
correct, and complete.
/t:r
(Type name) /9 ✓/i V i
I certify that I have examined this report and it is true,
correct, and complete.
7 V /c) y /2- C /L-✓d
(Type name) I
Individual (only for reasurer Deputy Treasurer
electioneering commu
X
abeandidate Chairperson (only for PC, PTY
lectioneering commun. organization)
X
Signature
Signature
DS -DE 12 (Rev. 08/04)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Contributor
Type
(8)
Occupation
Contribution
Type
In -kind
Description
Amendment
Amount
(6)
Sequence
Number
r
2010 OCT 1
OFFICE C
S OI WU S
SEAS
F CITY CLEk
C77
CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
(1) Name DA V t f) J- -J 1210 IL/ v (2) I.D. Number
(3) Cover Period U through P 0 (4) Page
DS -DE 13 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of
(5)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Purpose
(add office sought if
contribution to a
candidate)
Expenditure
Type
Amendment
Amount
(6)
Sequence
Number
110 OCT 15
'c' F SE
)FFICE OF C
Ail 10 56
TY CLERK
CAMPAIGN TREASURER'S REPORT ITEMIZED EXPENDITURES
(2) I.D. Number
(1) Name D E O I f2 L2/ o
(3) Cover Period g Jo through O F D (4) Page
of
DS -DE 14 (Rev. 08103)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
October 7, 2010
David DeVirgilio
113 Pelican Island Place
Sebastian, FL 32958
Dear Mr. DeVirgilio:
CYOF
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, Florida 32958
(772) 388 -8214 phone (772) 589 -5570 fax
smaio @cityofsebastian.org
In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for
your campaign for the period September 25 through October 8, 2010 is due in the
Office of the City Clerk by 5 pm on Friday, October 15, 2010.
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.
You are welcome to submit your campaign report at any time during the week of
October 11 through October 15, 2010.
If you have any questions, please do not hesitate to contact me at 388 -8214 or
smaio(cityofsebastian.orq.
Sinc,rely,
Sally A.
City Cler
sam
o, MMC
FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS
CAMPAIGN TREASURER'S REPORT SUMMARY
1kV '4) ?i tI Ic. b
VE I T V r UN �K a
OFFICE 0F C IL Y
2010 OCT 1 P 1 2 23
Name
(2) 1 13 p VL L c,a I, 5 L41-0 g) L
Address (number and strut)
City, State, Zip Code
CHECK IF ADDRESS HAS CHANGED
(4) Check appropriate box(es):
[.Candidate (office sought): C. IT 4 1 CA)4aN
(3) ID Number:
C. (L.
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 1 i G To CiP 2. v t o Report Type 2
Original Amendment Special Election Report Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash Checks
(7)
Monetary
Expenditures
Transfers
Account
Total
Monetary
EXPENDITURES THIS REPORT
Loans
to Office
Total Monetary
In -Kind
(8)
Other Distributions
(9) TOTAL Monetary Contributions To Date
Ib°
(10)
TOTAL Monetary Expenditures To Date
C 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 I have examinedthis report and it is true,
correct, and complete.
(Type namerP4 If 4 V Cv (AU 1 C..10
I certify that I have examined this report and it is true,
correct, and complete.
(Type name) —0.041/10-) 7 j,�E JL 12 L /L, 74,
Individual (only for Treasurer Deputy Treasurer
electioneering com
X
�andidate Chairperson (only for PC, PTY
electioneering commun. organization)
X 0C:Q.
Signature
Signature
DS -DE 12 (Rev. 08/04)
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
20
OCT 1
uF SE
PI 2 23
AS irl
E Y CLERK
(1) Name
DS -DE 13 (Rev. 08/03)
CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
D z 'De t /Gic 1 1 6)
over Period f 1 P through q 1 4 Lo 4) Page
(2) I.D. Number
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of
(5)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Purpose
(add office sought if
contribution to a
candidate)
Expenditure
pe
Type
Amendment
Amount
(6)
Sequence
Number
1
1
1
1
201
1
OCT 1
Y 3F SEB
'ME OF CI
1
2 23
64S TI
Y CLERK
1
1
CAMPAIGNJREASUFER'S REPORT ITEMIZED EXPENDITURES
(1) Name 7) V f t/ 1 ea (2) I.D. Number
(3) Cover Period [J 10 through f 12.4i L 0 (4) Page
DS -DE 14 (Rev. 08103)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
of
September 23, 2010
David DeVirgilio
113 Pelican Island Place
Sebastian, FL 32958
Dear Mr. DeVirgilio:
Sincerely,
0)
Sally A. 'Maio, MMC
City Clerk
sam
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, Florida 32958
(772) 388 -8214 phone (772) 589 -5570 fax
smaio @cityofsebastian.org
In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for
your campaign for the period September 11th through 24th, 2010 is due in the Office of
the City Clerk by 5 pm on Friday, October 1, 2010.
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.
You are welcome to submit your campaign report at any time during the week of
September 27 through October 1, 2010.
If you have any questions, please do not hesitate to contact me at 388 -8214 or
smaio(cr�citvofsebastian.orq.
FLORIDA DEPARTMENT OF STATE DIVISION, t
CAMPAIGN TREASURER'S REPR�'
pTIONS
A
TTY�J
(1) DAN/ V i 1Z.( i `i a
OFFICE OF GIFIFIICT=LIMPILY
2010 SEP 17 AM 9 20
Name
J I P i 1, c r} 1 s L Rs p L.-
Address (number and street)
54e7 AST 1�1., -322- ys'i
City, State, Zip Code
CHECK IF ADDRESS HAS CHANGED
(4) Che k appropriate box(es):
Candidate (office sought): C 1 1 (ct
(3) ID Number:
C I C.
Political Committee CHECK IF PC HAS DISBANDED
Committee of Continuous Existence CHECK IF CCE HAS DISBANDED
Party Executive Committee
Electioneering Communication 1 I CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From 3 /0 To q 0 0 Report Type
[Original Amendment Special Election Report Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT
Cash Checks Do
(7)
Monetary
Expenditures
Transfers
Account
Total
Monetary
EXPENDITURES THIS REPORT
j
I
Loans
to Office
Total Monetary
J
In-Kind
(8)
Other Distributions
(9) TOTAL Monetary Contributions To Date
joo
(10)
TOTAL Monetary Expenditures To Date
e9/ E
(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,
correct, and complete.
(Type name) I✓4 v z7 t l /L6 i c
I certify that I have examined this report and it is true,
correct, and complete.
(Typ me) T.qv ,0 p,: I/ /it/IL-1-
Individual (only for reasurer Deputy Treasurer
electioneering co n)
X
Candidate Chairperson (only for PC, PTY
electioneering commun. organization)
X
Signature
Signature
DS -DE 12 (Rev. 08/04)
DS -DE 13 (Rev. 08/03)
CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
(1) Name I II sl 1 4, I
3) Cover Period 9 3 l 0
through
(2) I.D. Number
/0 /0 (4) Page
of
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
(6)
Sequence
Number
C.j
3
to
'Ai .J 1pf V i
c' g 1 ./j
3ti1 8
r,
/mil-
d
ut
2010
SEP 17 FM
9 20
7
r,
P(.
DS -DE 13 (Rev. 08/03)
CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS
(1) Name I II sl 1 4, I
3) Cover Period 9 3 l 0
through
(2) I.D. Number
/0 /0 (4) Page
of
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(5)
Date
Full Name
(Last, Suffix, First, Middle)
Street Address
City, State, Zip Code
Purpose
(add office sought if
contribution to a
candidate)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
9/3/
CI 1't"`' I) F SE /'v` si
il nv,) I Dar<
v.
1
1
1
1 1
2010
1
11
F. SEBt\S
CE OF C\rf
1
g 20
T\t,f
CLERK
1
AJI IPAIGJ1 R RR'S REPORT ITEMIZED EXPENDITURES
(1) Name 7 )4 VV /4./ (2) I.D. Number
(3) Cover Period 1 0 through G I 0 O (4) Page
of
DS -DE 14 (Rev. 08/03)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
September 7, 2010
David DeVirgilio
113 Pelican Island Place
Sebastian, FL 32958
Dear Mr. DeVirgilio:
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, Florida 32958
(772) 388 -8214 phone (772) 589 -5570 fax
smaio @cityofsebastian.org
In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for
your campaign for the period August 31, 2010 (the day you first declared your
candidacy) through September 10, 2010 is due in the Office of the City Clerk by 5 pm
on Friday, September 17, 2010.
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.
You are welcome to submit your campaign report at any time during the week of
September 13 throughl7, 2010.
I am also including updated links to the Florida Division of Elections and paper copies of
revised FS 106 and Candidate and Campaign Treasurer Handbook should you not be
able to access them on the internet.
Florida Election Laws revised August 2010 includes revised FS 106
http: /election. dos.state.fl. us /publications /pdf /2010 /2010ElectionLaws. pdf
State of Florida Candidate and Campaign Treasurer Handbook Revised July 2010
http:/ /election.dos.state. fl. us/ publications/ pdfJ2010 /2010CandCampTreasHandbook. pdf
In 2010, the State Legislature revised certain election laws that pertain to electioneering
communications and disclaimers. The laws went into effect after the City Candidate
Handbook was prepared and I want to be sure you have up to date information.
If you have any questions, please do not hesitate to contact me at 388 -8214 or
smaioCa cityofsebastian.org.
Sin e5ely,
Sally A. M4io, MMC
City Clerk
)141
Name (G71 ,t
�(J /�u� ❑Cash
9 3 0
Date
No.
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC /Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
Lot/Niche Block Unit
001501 343805 Cemetery Fees
a t.tio•ik-
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
Total Paid
Initials
White Dept. of Origin Yellow Finance Pink Applicant
4715
❑-et e k
Amount Paid
I,
a citizen
hereby
Florida.
LOYALTY OATH FOR
NON PARTISAN OFFICE
(Sections 876.05- 876.10, Florida Statutes)
STATE OF FLORIDA
,1 D Ili /LIN/ ,COUNTY
OFFICE USE ONLY
r= S E BAS
OFFICE OF CITY CLERK
2010 SEP 3 Prl 3 56
X v ('1T
1.1 L V I ►'Z- (1 t c. tJ
First Name Middle Name /Initial Last Name
of the State of Florida and of the United States of America, and a candidate for public office do
solemnly swear or affirm that I will support the Constitution of the United States and of the State of
I,
am
My
under
have
with
99.012,
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
D AV ID I V I IL. 4 IL lo
I
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
a candidate for the office of C 1 �t Lv t c. I L.-
I I J PL,i-1 c.1 •d iS`A,uffice) district (group)
legal residence is l 8 ,1 i Ay D A.,., iii ViLez. County, Florida. I am qualified
the Constitution and the Laws of Florida t6 hold the office to which I desire to be nominated or elected.
qualified for no other public office in the state, the term of which office or any part thereof runs concurrent
the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section
Florida Statutes.
X
Signature of Candidate Daytime Telephone Number Emati Address
1 3 Pi- L A c -T.-- i s 1.AF PL Sie54 5,1 /4— P az_ 9,r e
Address
Sworn
Personally
Produced
Type
to (or affirmed) and subscribed
Known: or
City
before me this✓
2 State ZIP Code
day o 2050
v ISGG
Identification:
of Identification Produced:
Signature of No ry Public State of Florida
Print, Type or tamp Commissioned Name of Notary Public
.0. Sally A. Maio
0.P
w S. 1', Commission DD595269
Expires October 5, 2010
'1 Bonded Troy Fein Inewenc4 Inc 900. 385.7019
DS -DE 25 (05/08)
FORM 1
STATEMENT OF
f FINANCIAL INTE
4
G
;j 2009
Please print or type your name, mailing
address, agency name, and position below:
Y CLERK
3 56
LAST NAME FIRST NAME MIDDLE NAME AA
f t e t C L 1 I v 7 �d i �1U
FOR OF
`(7'
)E0
1 41 1
MAILING ADDRESS
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I Lam Ir� j
ID Code
ID No.
Conf. Code
P. Req. Code
—5C6A c r it 2—'9 3 1A/ptifr- P 1VET:
CITY ZIP COUNTY
NAME OF AGENCY
NAME OF OFFICE OR POSITION HELD OR SOUGHT
C ir w e Al ar t_
You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.
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
A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
L' I DECEMBER 31, 2009 Q$ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):
COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS
ON A CALENDAR YEAR OR ON
EITHER (check one):
YEAR:
DOLLAR VALUES, WHICH
ON PERCENTAGE VALUES (see
PART A PRIMARY SOURCES OF INCOME
(If you have nothing to report, you
NAME OF SOURCE
OF INCOME
[Major sources of income to the reporting person]
must write "none" or "n /a
SOURCES
ADDRESS
DESCRIPTION OF THE SOURCE'S
PRINCIPAL BUSINESS ACTIVITY
DA- (-0 )7t V irx i�,o Yi-
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PART B SECONDARY SOURCES
(If you have nothing to report
NAME OF
BUSINESS ENTITY
OF INCOME [Major customers, clients,
you must write "none" or "n /a
NAME OF MAJOR SOURCES
OF BUSINESS' INCOME
and other sources of income to businesses
ADDRESS
OF SOURCE
owned by the reporting person]
PRINCIPAL BUSINESS
ACTIVITY OF SOURCE
PART C REAL PROPERTY [Land buildings owned by the reporting person]
(If you have nothing to report, you must write "none" or "n /a
FILING INSTRUCTIONS for
when and where to file this form
are located at the bottom of page 2.
INSTRUCTIONS how 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.
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CE FORM 1 Eff. 1/2010
(Continued on reverse side)
PAGE 1
PART D INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
(If you have nothing to report, you must write "none" or "n /a
TYPE OF INTANGIBLE
BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
.0 OAIC
1
PART F INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
(If you have nothing to report, you must write "none" or "n /a
BUSINESS ENTITY 1
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST
P e g
/r: f� s L- c r s �.s-J pc.
4E4A- e--C-
0414,- mot 4 /a.) M C w (3 it
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io
PART E LIABILITIES [Major debts]
(If you have nothing to report, you must write "none" or "n /a
NAME OF CREDITOR
ADDRESS OF CREDITOR
ALL9 L t A-
BUSINESS ENTITY 2
BUSINESS ENTITY 3
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
SIGNATURE
ed):
DATE NE equired):
97/3
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 officers /employees file 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 "Who Must File" Instructions
on page 3.
WHEN TO FILE:
Initially, each local officer /employee, state
officer, and specified state employee must
file within 30 days of the date of his or her
appointment or of the beginning of 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 officer /employee, 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. 1/2010
PAGE 2
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
L OFFICE U SE ONLY
>,1 'Jr SEBAS i},+
OFFICE OF CITY CLERK
2010 NG 31 PP1 y 19
1. C APPROPRIATE BOX:
Original Appointment Change in: Treasurer /Deputy Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
DAV ID Dfil( 1 --b It-rj
3. Address (include post office box or street, city, state, zip
code)
.3 Pc 1....0 ik 1 S. i Pt,
4. Telephone (optional)
7 2 633 7/ j v
5. E -mail address (optional)
I FV $!2- 4a) he. 150 A 5.*
.)--5 r I ►CC
6. Office sought (include distriict, circuit, group number)
C. 1 1V CDUI■iC,IL M E/
1 15
7. If a candidate for a nonpartisan office, check if
applicable:
My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write -In
No Party Affiliation Party candidate.
9. I have appointed the following person to act as my Lampaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
ID )*\)t L--1 c7
11. Mailing Address (If post office box or drawer, also include street address)
S/VA.
12. Telephone
13. City
14. County
15. State
16. Zip Code
17. E -mail address (optional)
18. I have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
20. Street Address
21. City
5‘6A-sr.,
22. County
&I D 4r 1 ✓i ,L_
23. Sta
24. Zip Code
3 s t.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
Ave- 3 z.-0 l o
26. Sign- ire o Candidate
X
27. Treas(rer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 72/t✓ ✓6 Pf l K.6 j cr do hereby accept the appointment
(Please Print or Type Name)
designated above as: ampaign Treasurer ty Treasurer.
f 3 /2/0 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 11/09)
S r =A.S 4SE ONLY
QFFICE OF CITY CLERK
2010 RUG 31 Pt'i 9 19
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
1
1, hit
candidate for the office of
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
X
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. 03/08)
Signature of Candidate Date
Charter Section 2.02 ELIGIBILITY
Ms- worcllelection/charter eligibility
OFFICE OF CITY OLL C
SL
°"driAN 2010 AUG 31 N9 9 19
HOME OF PELICAN ISLAND
ELIGIBILITY TO HOLD OFFICE
OF COUNCILMEMBER
lY Jr SEEEAST!
"No person shall be eligible to hold the office of council member
unless he or she is a qualified elector* in said city and actually
continually resided in said city for a period of one (1) year
immediately preceding the final date for qualification as a
candidate for said office."
I,
p/✓ t D i7 ihezt iL i 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 3/ day of
201
Notary P •lic
State o Iorida
SEAL
Sally A. Maio
Commission DD595269
c�
Expires October 5, 2010
•F�PIi iy Bonded Troy Fain Insurance, Inc 800.866.7019
*166.03.? Electors. -Any person who is a resident of a municipality, who has qualified as an elector of this
state, gild who registers in the manner prescribed by general law and ordinance of the municipality shall be a
qualifies( elector of the municipality.