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HomeMy WebLinkAboutMILLER AMBER 11-8-2011FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) (2) knc,yM N -et bAph i v Arc Address (number and street) \. as 1an w 37A City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): Candidate (office sought): ❑ Political Committee ❑ Committee of Continuous Existence ❑ Party Executive Committee • Electioneering Communication OFFICE USE ONLY (3) ID Number: (Luic ['CHECK IF PC HAS DISBANDED ❑ CHECK IF CCE HAS DISBANDED U CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From \ \ / / ' \ To ' / / J I Report Type EtOriginal ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ Loans $ Total Monetary $ In -Kind $ (7) EXPENDITURES THIS REPORT Monetary Expenditures $ Transfers to Office Account $ Total Monetary $ acqco (8) Other Distributions (9) TOTAL Monetary Contributions To Date $ 100-C .0 (10) TOTAL Monetary Expenditures To Date $ C_)c CC (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) ) name) ATIVOCr. I l I ❑ Individual (only for 71,Treasurer n Deputy Treasurer electioneering commun.) X110 X tak 1 it Signature I certify that I have examined this report and it is true, correct, and complete. (Type name) VI Candidate X Signature rn1 ,rMIl' 0 Chairperson (only for PC. PTY & electioneering commun. organization) DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name (2) I.D. Number 3 Cover Period through 4 Pa of DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) to (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) A• endment (12) Amount (6) Sequenc Number / / /6,of ** C‘F 444 4 / / / / / / / / / // / / i� f / / e' ' f I DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name C MPAIGN.T EASURER'S REPORT - ITEMIZED EXPENDITURES JV ►I (2) I.D. Number (3) Cover Period I I / / through 1 I / 1 S / (4) Page of (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 11/1/1( ell X. ti t %c,`a m ,r k- 32ck s -2 kiqi94-A7 1\1\0 32.0'6 1 Ii la 1 i A r Y1 X k,k,1 ler (V1F) IbOul ve,poorntyJ ps A-v-yo--4,1- ),ktuti (t<(.\ 1 DM ieVi PIS 61 ,lill S �I / I�/ I I Wks � . uL.t-ki),/ 1 \-----L f-o '\,,un % G-0, i"2.-‘00.--.\-)c....0 / / Pe, / / C8v Cletko / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org November 9, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL 32958 Dear Ms. Miller: In accordance with Florida Statutes Section 106.141, a Termination Report (TR) for your campaign is due within 90 days of the day of the election, which is no later than February 6, 2012. A copy of FS 106.141, which sets out that manner is which excess funds in your campaign account can be disposed, is attached for your review. If you have any questions, please don't hesitate to contact me at 388 -82145 or smaio @cityofsebastian.org. Sincerel Sally A. City Clerk io, MMC a FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Aim ye Mt 11.&Y OFFICE USE ONLY RECEIVED NOV 0 4 2011 feitr.-- City of Sebastian City Clerks Office Name (2) 144 ,Do i h t vi. J1 ur Addre s (num er and street) 2 G 1 + F L 32 5P City, State, Zip Code I ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): 0 iy Candidate (office sought): �U (3) ID Number: ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee n Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From ' 0 / 15- / I [ To 1 / 3 / 1 1 Report Type G14 Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 3s O a°° (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 'C.3 , ce 0 Loans $ to Office $ Total Monetary $___3__ j c-fi' $ 3 - tp In -Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date $ Iva.O . (10) TOTAL Mo etary Expenditures To Date $ %•E!..- �►r. it 753.. 75- (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�(/f M 1 1 J( I certify that I have examined this report correct, and complete. �p �/ (Type name) / T 1 /( 7 Al and it is true, le ) "`-. ❑ Individual (only for Treasurer ❑ Deputy Treasurer electioneering commun.) X fn SI LUC Candidate ❑ Chairperson (only for PC, PTY & electioneering commun. organization) X k i A L! • Signature Signature DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS 001( 'VW Lex through (2) I.D. Number 4) Paae 1 of (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 / l �� ' '730 Lz z o..rct SA. p". tS 6 32ci sq /' Ioo ID / A5 / I( asi 32119 UU CIAS" / / .1 / Not. 0 1 / Hof 'Vi C' Seb Clerk's ��� Q , / / / / / / DS -DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 9 Y ►PAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name YZX AA I I,(�1/ (2) LD. Number (3) Cover Period ) O / / 11 through )1 / 3 / )1 (4) Page 1 of (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 Number M I `,� ,FL 3Zc� 1 2v 11 RN 1i y R O 1 + dale 10 / I NAY) n �� 100 L t '(l Swksho-likr Pu321S. A �- - n -,yea* �d W 4qq 3 I I/ 2/ I I it ii■, F(- ; -q s-9 ( 1A c u.4)p, 1 s fond I, 1 101 4- / / / / RECEIVED NOV 0 4 2011 City of Sebastian City Clerks fr"'f / / ice / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES OTYOF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org October 25, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL 32958 Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the G4 campaign treasurer's report for your campaign for the period Saturday, October 15, 2011 through THURSDAY, November 3, 2011 is due by Friday, November 4, 2011. This is the 4th day prior to the election and the due date is governed by FS 106. Please keep in mind that this report is different than the previous three. The reporting period ends on a Thursday, November 3rd and is due the next day on Friday, November 4th. No further contributions can be accepted after midnight on November 3rd. This means midnight on Thursday night, not Wednesday night. This always causes confusion. (2)(a)1.All reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m. of the day designated; however, any report postmarked by the United States Postal Service no later than midnight of the day designated shall be deemed to have been filed in a timely manner. Any report received by the filing officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the designated due date. A certificate of mailina obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailing in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. If you choose to mail, please make sure the form is completely filled out and signed. If it is not and received after the deadline, it will be deemed not timely filed and penalties must be imposed. If you have any questions, please do not hesitate to contact me. Sincerely, Sally A. -Maio, MMC City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) ' - Y to M 1- 11e OFFickeg %L OCT 18 2011 City of Sebastian City Clerk's Office N e (2) aJ. iii Ne A dress (nurhber and street) ljas- fi F(, 32%5 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): [ Candidate (office sought): G j .nu (3) ID Number: ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee P Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Co v r Period: From 10 / 1 / 1 ( To 10 / ) `1 / 11 Report Type ? 2� Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT ) o e $ p Cash & Checks $ { ST , Loans $ to Office $ Total Monetary $ 6-0,00 $ NO ,W In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ k) 70, (10) TOTAL Monetary Expenditures To Date $ (pko,15r (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) P"y\A\7 i 1 rW I certify that I have examined this report and it is true, correct, and complete. (Type name) Aryl 4- j\A` ` ..,v- ❑ Individual (only for , Treasurer ❑ Deputy Treasurer la Candidate Chairperson (only for PC, PTY & electioneering commun. organization) Ok, Y Lipp electioneering commun.) X a bei(j `rY\A L1 et-, X Signature t../ Signature DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS A-nrirz)( AA I.e-}' 3 Cover Period 10 / / / / / through to / (2) I.D. Number (4) Page (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 1 C) /// th 1365 extbvic l lit Y'S4 oc -iwl, FL 32. Sv 32.a5b T � C H'� ) 01 illy ' '''i�S` Gw ff - .. €o tQKu)l k�; VA, 3-)CIS; CHI 5b.bo 3 1 / / / / OCT City RE'CEIVEO 18 20f1 ,a of setatian / / City Clerk s mice / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 1� CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name 17), .t/- AA i 1 L6t/ (2) I.D. Number (3) Cover Period Ub / / /0 through /o // (4) Page 1 of (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 10/11/ 11 1 o us 1 l K u., t7 1J 2_ s(:) oct.a 'a xN FA, 3a q Sv 10 /1, 6/Il J 4k, s; ,( Y\ (ox)4 " Pe;,\4. ii-nwo,cLgs a , FL 3444 9 5vAs MO lid , to pill / l N yrt-itt c RoubkalA.s $q' LI sw Sire UQ-yo tic , PL 3 aci too CctwtcU AzLii ch 4 f/ ftnu wt JUO M 11 ,(TO a 1 / / / OC, �, C c/A se . o 2011 / / 4 s pt,600 ice / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CITYOF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org October 10, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL 32958 Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the G3 campaign treasurer's report for your campaign for the period October 1, 2011 through Friday, October 14, 2011 is due by Friday, October 21, 2011. This is the 18th day prior to the election and the due date is governed by FS 106. City Hall is closed for a furlough day on Friday, October 21st, and during evenings, furloughs, weekends and holidays when City Hall is closed, all doors lock automatically and A/C systems shut down. Because the due date is governed by Florida law, I cannot extend the due date to the following Monday, so I am asking that you either hand deliver your report anytime between Monday, October 17th and Thursday, October 20th or the report can be mailed anytime after October 14th up to midnight of the due date October 21st if it meets the requirements set out in FS 106.07 (2) (a) below: (2)(a)1.All reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m. of the day designated; however, any report postmarked by the United States Postal Service no later than midnight of the day designated shall be deemed to have been filed in a timely manner. Any report received by the filing officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the designated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailing in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. If you choose to mail, please make sure the form is completely filled out and signed. If it is not and received after the deadline, it will be deemed not timely filed and penalties must be imposed. Just a reminder that the Sebastian Property Owners Association and Chamber of Commerce candidate forums will take place in the City Council Chambers with live broadcasts - -- SPOA October 13th 7 -9 pm and Chamber October 19th – 7 – 9 pm. You will be contacted by them. If you have any questions, please do not hesitate to contact me at 388 -8214 or smaio cCr7cityofsebastian.orq. Sin .- - ly, Sally A. Maio, MMC City Clerk DS -DE 12 (Rev. 08104) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) i1/ I l (I,?N OFFICE USE ONLY RECEIVED OCT 0 3 2011 City of Sebastian City Clerk's office Name (2) �i41 Doi h e n Address (numbe and street) i ( L � 5 ��c �'Jc�STi Gt.r� 1 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): A Candidate (office sought): Ul 1 C,61A�c� 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 ci / 11 / 1 l To 1/ C/ 1 1 Report Type G a. [Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ o (7) EXPENDITURES THIS REPORT Monetary Expenditures $ ) 1.Q , 4 Loans $ SO 0-2- to Office Account $ Total Monetary $ ` (� Total Monetary $ J 5• o. S L1 In -Kind $ ...,------------ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ a-o - (10) TOTAL Monetary Expenditures To Date $ In q 3c- (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) f / /i i 1124/ 7 iY 1 I certify that I have examined this report and it is true, correct, and complete. (Type name) rn ∎ i \y,I tt5 dividual (only for gi Treasurer ❑ Deputy Treasurer - ectioneering commun.) X Ili &jai ' " i...-__■._ 1 • Candidate ❑ Chairperson (only for PC, PTY & \ electioneering commun. organization) X ) A. Signature Signature DS -DE 12 (Rev. 08104) (1) Name CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS Army ►►,ICJ►' M i' through (2) I.D. Number / c) / i l (4) Page l �.,� ...,..........._ (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 / / a'+ / J f`n 17ranS if7 1357" 13an � a s Wel, Fl. 32358 -- 1 t �� C�1't C/ ` ,S-e� 55 ' { / (ZS/ (1 > ' kkil gtX iri,.,0-y...QT to.„,,) LOA So °--° !Q / / RE c:EIVCD / / OCT 03?011 City of Sebas City Clerk's Office Gan Pc,vs- / / / / / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES AA/ /l y (2) I.D. Number ir:i (3) Cover Period / / / 7 / 7/ through / 301 /7 (4) Page / of (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 9 ! I / / Ci o >c .fir s han i 4 Mc 5� /a,n, FL 32c 5 Cad4 ca. c , / C1 1471? 1/ Si VlS on B he l 11 25 .s tb Skirt e Ho Stv aao Alain ,TY 1V-151S Y`9 � S- 4 N / � <2 L / / / / RECEIVED / / OCT 032111 City of Sebastian City Cleric's Office - / / / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org September 29, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL 32958 Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the G2 campaign treasurer's report for your campaign for the period September 17, 2011 through Friday, September 30, 2011 is due by 5 pm on Friday, October 7, 2011. This is the 32nd day prior to the election and the due date is governed by FS 106. As I have advised previously, reports can be mailed if they meet the requirements set out in FS 106.07 (2). (2)(a)1. All reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m. of the day designated; however, any report postmarked by the United States Postal Service no later than midnight of the day designated shall be deemed to have been filed in a timely manner. Any report received by the filing officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the designated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailing in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. If you have any questions, please do not hesitate to contact me at 388 -8214 or smaio(c�cityofsebastian.orq. Si -ly, Sally A. City Clerk io, MMC FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) NYY N bur r ■A i I IC( OFFICE USE ONLY �,iV�D SEP 19 2011 city otI►atian CV Clarit'i QM Name (2) (1 `4`1 I:lp{'11p1 A1r Address (number and street) 1000- I rL 3 -2-ci> ,yj City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): Candidate (office sought): G ki L L l,Li C� (3) ID Number: ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED (l Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee 1 Electioneering Communication 1 1 CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS C ver Period: From JA./ / 1 / 1 ( To q l /6 l / f Report Type LI_ Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ �� C, ~�' (7) EXPENDITURES Monetary Expenditures Transfers Account Total Monetary THIS REPORT _ $ ti- ; S- Loans $ :)-0 ��- to Office ' (-fl Total Monetary $ " c7" $ $ 30-g , 01) In -Kind $ 3 (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ L • 07 • (10) TOTAL $ Monetary Expenditures To Date g s (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) A rita ri l I ICY- I certify that I have examined this report and it is true, correct, and complete. (Type name) Alr-YllOeAr M. I I Lc y Individual (only for Treasurer ❑ Deputy Treasurer electioneering commun.) Candidate ❑ Chairperson (only for PC, PTY & electioneering commun. organization) Signature Signature DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBRF MED ,- \}lip ,r Lc( 3) Cover Period f / / /1 through (2) I.D. NumbgP 1 9 2011 City of Sebastian 4) Pa Clerks Ofol e (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 g , /) I c�'� i I y -t- 0,1 3104 wioctorYley'e 1(00 2_ I pj / -1 / I Pwr ►V ,k /Sv ∎ l Ley (peAoiko-1 u curt) ._,,.- LOPc 200c't / / 1 L scv lc, r t 1e; 701 Pa(tzr Ailif S €Ix ticiil 'PL 32�i� — C-4 S (-30 . CD R /(),1 /11 kiII St -0.04 V t (V; FL .32A.cL ( A 2t, .6-1) / aCi / 1 \ iC'a`%vl C� .,iStiiu(ct �„, pea, 0, CA quit .�. lJ ,__./ / i 3 / ) 1 Teel, Pcultae w' . cc- 100 i IN . Lakeoie - 32 cos T 1 W ,K """ ' i"' i iiec. '1 nej. (.0 / ! / 1 I w�cL Harr ti (A 120 p>cv, tai 1 1 u UvvuI~ h l.. 3'`1t,' -- Ca pa )c 1112c: 1I lL, TV / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES RECEIVED CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES 1 9 2011 (1) Name 1"\--0 l 19,(A7 NI I V i% (2) I.D. Number City of F siimti fl City Cioi� (4) Page ( of �f (3) Cover Period 1 / ) / / 1 through 1 / (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 /2" 1 i 12 voc !alt VW' QJECLC t FL 32Q (cr- 1 CLArt $ ,_ . '') 1—cluk_kA ik,:- (.,, 6cl ill (-z, i,, , A0, A 0 Lt.A. 21 MQN\ .01 14 3 2 200 I ecr, N tk.j1 1 -.1c00 h rL , F 1(1 /Mw 4 25 3 „ lffil ck De_ It' \te tr 'c -k_c i c-L ,3 2Sti,,, 0 Y i ,l { vAc ti,;,1() I,tc 0101 154 -c)�j 4- /Z �/ i Rcvvlaki's TY LTV ie� Tee �, `oat • l�S ��' ► =ct., -i curl. C L 3 2 9' I f h1, ,r k �_ mon Ili -,1 5 v iC / t hi y r c,-C_ x. h (1 ( cl vk af-IC ''cl -tj[ wit,vL ,2(1' t,., C 1cch 1,-n. IP N cU LIcks I.- lei x s- i c m ,1= L 2��9 > '''.I,l .ci 1 ve s S CAA r ViA'31.tr tte (o , 7q1 c'i 1 1 ! 1 RC `�upevt'i'� 'r ec E1ec a� ,��, � � 1. �; L(t� ki ..A(U P c_ l� C 7 voi- 'S Mon DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN D EXPENDITURES TREASURER'S REPORT — ITEMIZED Name % / K /�,� 1 I V- " (2) I.D. Number (3) Cover Period l / / / / ( through 9 / l w / //' (4) Page of (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 / q/ ii J Tru YI1 ez , TeQZ. jtp IBS 1r ,-,--, c a ri--/CLn FL- 2.(lsg t__.Shir tS AA ONI 7 th Cl / / RECEIVED / / X192011 city ofstibto city cietv *11 / / / / / / / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 1TYOF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - (772) 589 -5570 fax smaio @cityofsebastian.org September 13, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL 32958 Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the G1 campaign treasurer's report for your campaign for the period July 1, 2011 through Friday, September 16, 2011 is due by 5 pm on Friday, September 23, 2011. This is the 46th day prior to the election and the due date is governed by FS 106. Your last quarterly reporting period ended on June 30, 2011, and you reported that period on July 7, 2011 prior to the due date of July 10th. Now your reports will be submitted on the 46th 32nd 18th and 4th days prior to the election. City Hall is closed for furlough day on Friday, September 23rd, and during evenings, furloughs, weekends and holidays when City Hall is closed, all doors lock automatically and A/C systems shut down. I'd be glad to be here on that Friday, but I would have to park a desk by a first floor doorway to let you in. Because the due date is governed by Florida law, I cannot extend the due date to the following Monday, so I am asking that you either hand deliver your report sometime between Monday, September 19th and Thursday, September 22nd or the report can be mailed anytime after September 16th up to midnight of the due date September 23rd if it meets the requirements set out in FS 106.07 (2) (a) below: (2)(a)1.All reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m. of the day designated; however, any report postmarked by the United States Postal Service no later than midnight of the day designated shall be deemed to have been filed in a timely manner. Any report received by the filing officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the designated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailing in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. This same situation is going to occur for the October 21st report as well but I'II send another reminder at that time. Remember that the funds used to open your account are contributions, and your filing fee is an expenditure and both should appear in your G1 report. When I receive the legal ad for the City Canvassing Board meetings that will take place at the Supervisor of Elections office, I will forward it to you. You had a memo from the SOE in your packet citing the times, but she will be running a legal ad prior to the first meeting which is scheduled for October 19th One other item I wanted to remind you of was that the Sebastian Property Owners Association and Chamber of Commerce have been approved to conduct candidate forums in October in the City Council Chambers with live broadcasts - -- SPOA October 13th 7 -9 pm and Chamber October 19 – 7 – 9 pm. You will be contacted by them. If you have any questions, please do not hesitate to contact me at 388 -8214 or smaioCa�citvofsebastian.orci. Sally A. Maio, MMC City Clerk sam CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4318 Name /4J11 J &1 &4 Date g zs /ii 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 001501 343805 Cemetery Fees 0 Cash , Unit Amount Paid Total Paid !n 1, i White - Dept. of Origin • Yellow - Finance • Pink . Applicant STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, All )96. M i I I,x OFFICE USE ONLY RECEIVED AUG 2 5 2011 City of Sebastian City Clerk's MOO candidate for the office of 5.E } t S-i-i oin G Cou-nu I have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. .shut- 1 LOA) Signature of Candidate as Da e Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (05/11) CANDIDATE OATH — NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) RECEIVED AUG 2 5 2011 City of Sebastier, City Clerks Office OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) I, / m °X MiIkr (PLEASE PRINT NAME AS am a candidate for the nonpartisan YOU WISH IT TO APPEAR ON THE BALLOT' -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) office of C 1 kl ELI nu 1 , ; 1 am a qualified elector Florida the Constitution (office) (district #) of `n OtA j9 Y \Z t •V ?X County, Florida; (circuit #) (group or seat #) I am qualified under the Constitution and the Laws of elected; I have qualified for no other public office in concurrent with the office I seek; and I have resigned from Section 99.012, Florida Statutes; and I will support the State of Florida. X ( (TO `I.i to hold the office to which I desire to be nominated or state, the term of which office or any part thereof runs any office from which I am required to resign pursuant to of the United States and the Constitution of the 3'3(p 1 ho ) . Signature of Candidate Telephone Number Email Address WA Doi ph �- Av Se bas -tia-V1 1- I— 5aCIsSII Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 1 0401 8 3(04 * Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): ice( • - h ugh- IA 1--1 u h Y STATE OF FLO/ DA �,D COUNTY OF .. &% 1�-4 L 07541 day of r%� , 20 // . Sworn to (or affirmed) and Personally Known: l''''.--- subscribed before me this or Produced Identification: Signature Notary Public +"c: "ty)'k;, SALLY A. MAIO Print, Ty e, or Stamp Commissioned Name of Notary Public Type of Identification Produced: it,: ,A, ' Commission # EE 024350 - ° Expires October 5, 2014 .....w DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C. FORM 1 STATEMENT OF 2010 Please print or type your name, mailing address, agency name, and position below: I FINANCIAL INTERESTS 1 v RECE� E'O LAST NAME — FIRST NAME — MIDDLE NAME : V M i I In �rn /..L' /Qxel. FOR OFFICE USE ONLY �o,, 2 5 2011 r'f n "'9� owe MAILING ADDRESSSj : 1 1 1 /���I hill AV L 9 Nee L S 1 � — L 3? )nAi a i ✓z /`yeK ID Code ID No. Conf. Code P. Req. Code CITY : ZIP : COUNTY : NAME OF AG NC e.)1 Gtr,{/"\ NAME OF OFFICE O POSITION HELD OR SOUGHT : C� C6 0CA You are not limited to the pace on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF Dek CANDIDATE OR 0 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 EAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): DECEMBER 31, 2010 OR 0 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 (must check one): 0 COMPARATIVE (PERCENTAGE) THRESHOLDS OR ti DOLLAR VALUE THRESHOLDS 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 ") SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY A an AA e Nar ' , t . . . Li ti loo-ux - .. t,�e d � , .. , �, .' PART B — SECONDARY SOURCES (If you have nothing to report NAME OF ENTITY OF INCOME [Major customers, clients, , you must write "none" or "n /a ") NAME OF MAJOR SOURCES BUSINESS' INCOME and other sources of income to businesses ADDRESS OF SOURCE owned by the reporting person] PRINCIPAL BUSINESS ACTIVITY OF SOURCE (BUSINESS / V e AU/4- / v // I N/ N / " ' 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 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. N 6Y1 e CE FORM 1 - Effective: January 1, 2011. Refer to Rule 34- 8.202(1), F.A.C. (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 n/A PART E — LIABILITIES [Major debts] (If you have nothing to report, you must write "none" or "n/a ") NAME OF CREDITOR Ghcvs.e- ac.,k <IrYk�`ca., -, £d14,c hn- Srv✓rcf=S &AL /C/ � Al ACc .77iiT Servca ,-ICS, Inc . ADDRESS OF CREDITOR JP Mo-r a,,-, Chad.e, N. A . P.e,4,,ns '7,��,; a PO i .+caii(l thutit4s&44 PA 1710a 09 aak 9 58Q Woks/ cc, PA / 773 .. 3 a /oy 9a? 13i- c�v- AiJ,/d w �_9(30P5- - CA3o`@ fbI2X 705/ � / Cft, AY 1 s - 7o&i 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 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY N/ N/A PRINCIPAL BUSINESS ACTIVITY 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 SIGNATURE (required : DATE SIGNED (required• K/ 1( 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 - Effective: January 1, 2011. Refer to Rule 34 -8.202 (1), F.A.C. PAGE 2 t FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) An' MY Ml I k r OFFICE USE ONLY ,e o'c 11111 j Q _ ..,t Name (2) CjHO J ),Lpi nil JiLT' Address (number and street) City, State, Zip Code • CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): Candidate (office sought): Ikk, \_:�ikVl CI ■ (3) ID Number: Political Committee 1 CHECK IF PC HAS DISBANDED • Committee of Continuous Existence [ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee rl Electioneering Communication 1 CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 4 / ) / ) 1 To (• / 3C) / 1 I Report Type G Report ❑ Independent Expenditure Report 0 Original ❑ Amendment • Special Election (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT /- $ .x/ Loans $ }X v to Office $ _l/ Total Monetary $ ,% / $ Es/a7 In -Kind $ ,Lr (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ --e" (10) TOTAL Monetary Expenditures To Date $ fr- . (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\ (1/09C1( iy i i r k I certify that I have examined this report and it is true, A correct, and complete. (Type name) mi,r,Y M, 11CiY Individual (only for 12 Treasurer Deputy Treasurer X Candidate • Chairperson (only for PC, PTY 8 electioneering commun.) XC�,.. e� electioneering commun. organization) �V,,vz \ , e,1 ■Z?.18__ Signature Signature DS -DE 12 (Rev. 08/04) C OF SBN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - (772) 589 -5570 fax smaio @cityofsebastian.org June 17, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period April 1, 2011 through June 30, 2011 will be due on the tenth day following the quarter, however, due to the fact that the deadline falls on a Sunday, the report is due in the Office of the City Clerk no later than 5 pm on Monday, July 11,2010. Any report postmarked by the United States Postal Service no later than midnight of the due date (July 10, 2011), shall be deemed to have been submitted in a timely manner. The official qualifying period for the November election will begin on August 25, 2011 and run through September 9, 2011. The qualifying fee and all other forms not submitted during pre - qualifying should be filed at this time. The City will be closed for furlough day on Friday, August 26, 2011 and Labor Day on Monday, September 4, 2011. Please call me at 388 -8214 or contact me by e-mail at smaio(c�cityofsebastian.org if you have any questions. Sin.oeiel Sally A. Fvfaio, MMC City Clerk sam WAIVER OF REPORT (Section 106.07(7), F.S.) S E C A S ;,, OFFICE OF CITY CLERK 2011 APR 6 A19 8 14 (PLEASE TYPE) OFFICE USE ONLY Y'- be CLU1C1i Name Office Sought M Candidate A∎rt l (J371 L 32 j5b Address City State Zip Code [1 Committee of Continuous n Electioneering Communication Organization Existence n Political Committee n Party Executive Committee ❑ Check box if address has changed since last report. ❑ Check here if PC, CCE, or ECO has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION ❑ January ❑ 32nd day prior ❑ 46th day prior • April ❑ 18th day prior ❑ 32nd day prior ❑ July ❑ 4th day prior ❑ 18th day prior ❑ October ❑ 4th day prior ❑ TERMINATION REPORT ❑ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 2,0 I ( THROUGH �> `a SIGNATURES REQUIRED FOR: Signature INIcor 31 0-01 1 Date Candidates Candidate, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees Chairman, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Committees of Continuous Existence and Electioneering Communication Organizations Treasurer (s. 106.04(4)(c), F.S.) Party Executive Committees Treasurer or Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS -DE 87 (Rev. 07/10) CIROF HOME OF PELICAN MAW 1225 Main Street Sebastian_ Florida 32958 (772) 388-8214 phone - (772) 589 -5570 fax smaio @citvofsebasti n.oro April 1, 2011 Amber Miller 944 Dolphin Avenue Sebastian, FL Dear Ms. Miller: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period March 18, 2011 (the date you became a pre - qualified candidate) through March 31, 2011 is due in the Office of the City Clerk by April 10, 2011. Because April 10th falls on a Sunday, the report can be submitted through Monday, April 11, 2011. You may submit the report beginning anytime after today (April 1). 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. This report will include all contributions and expenditures made to or from your campaign for the above referenced period. J)41 Sally A. aioo,,( MMC City Clerk sam APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. 8/25/1/ Pr J S E B 1-1 S i I .. /IL�� 4 OFFICE OF CITY CLERK A 6 "x_ 2011 �flfl 18 fill 10 59 OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): xInitial Filing of Form Re- filing to Change: J Treasurer /Deputy (J Depository D Office D Party 2. Name of Candidate (in this order: First, Middle, Last) 61beAr M C- �M►Ih� 3. Address (include post office box or street, city, state, zip code) 9144 DOI P h � n i 3 _bqs 4-t can 1 1, S 4. Telephone (112 ) 453 33(o, 5. E-mail address hor-1-14 e 00 6. Office sought (include district, circuit, group Se,lcas- ice,,,, CA C� > ,mot Plumber) I 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 J No Party Affiliation J Party candidate. 9. I have appointed the following person to act as my IN Campaign Treasurer J Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer 1'1�X ) t 1( L LJ f � 11. Mailing Address 12. Telephone ( ) 13. City 14. County 15. State 16. Zip Code 17. E -mail address 18. I have designated the following bank as my pf Primary Depository fl Secondary Depository 19. Name of Bank 20. Address W a.ck►ov► & ahem d-h0 W` o 1.524 lAs ►-►w 1 �22. 21. City &i✓bc sh oul 1 1IrY, County lax, lei ti 23. State FL 24. Zip Code q2g58 UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 3- IS) 1 I 26. Signature of Candidate X airY\I\Vb TR '41A1A) 27. Treasurer's Acceptance I, � Mk,1 1 of Appointment (fill in the blanks and check the appropriate block) ( 'eX , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer fl Deputy Treasurer. ' 1 - i ( x , 711-,■. L� Date S : a ure of ampaign Treasurer or Deputy Trdsurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. tr FICE OF CITY CLERK. 2011 F1RR 18 1101 10 59 OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): XInitial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) ��l'1 ��' M Gll �' Mil VI( 3. Address (include post office box or street, city, state, zip code) 1,i`) !�(.'! I9 �'1 , (1 AV'(' 1 Cas 1l GL. , I- �. 3 2 et Es s 4. Telephone (1l2) 3 .3' �.7 5. E -mail address 1 �ry( 1 I> ' 6. Office sought (include district, circuit, group Se vS-t- i„h--1 (a C,-(A..0 i number) ) 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 Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer / 11. Mailing Address 12. Telephone ( ) 13. City 14. County 15. State 16. Zip Code 17. E -mail address 18. I have designated the following bank as my cg Primary Depository ❑ Secondary Depository 19. Name of Bank W01/4Ci10 v! k, 20. Address 1.14 t1, -> it t. 1 21. City ,bc s -h cul 1 22. County IirIA tan lei v-ev 23. State L 24. Zip Code qici J 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 26. Signature of Candidate X r Vt I ' l.s 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, ;I )6,,,v `u t ' e,Y , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ❑ Deputy Treasurer. 1 '1,,* ampaign Treasurer or Deputy Trr asurer Date Signature of c DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) OFFICE 1.,1§ ONLY OFFICE: OF CITY CLERK 2011 PIRR 18 Arl 10 59 1, `A 1- V;y_A7 jk,u candidate for the office of )ca S CU'1 �l �a i� 1.�.:rt () have received, read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candidate ( 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. 03/08) .)F E iCE OF CI FY CLERK cm a SEBASTIAN 2011 f`1RR 18 Ail 10 59 HOME OF PELICAN ISLAND ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY "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." 1, 0.\\). ; v \k; ,l to v , 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. Th11,AV Signature of Candidate Sworn to and subscribed before me this 2011. 1c. Notary Publip' State of Florida SEAL .tip. SALLY A. MAIO .,,1 Commission # EE 024350 Expires October 5, 2014 y, of °!�� Bonded Thru Troy Fain Insurance 800,1ES7019 day of *166.032 Electors.- -Any person who is a resident of a municipality, who has qualified as an elector of this state, and who registers in the manner prescribed by general law and ordinance of the municipality shall be a qualified elector of the municipality. Ms- word/election/charter eligibility