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COY ANDREA 11-08-2011
02/6/2 e ( 2 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) n N 0 £A IS Cc OFFICE USE ONLY RECEIVED NOV 2 2 2011 City of Sebastian City Clerk's Office Name (2) SO k. PeA IA 04?...v■%)-42- Address (number and street) ��"'��5` s �,�; �.-. _ ► City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): ` Candidate (office sought): Se_\,c, .s-kr'•a.. -� C.•-y C...cay.-rc_• ❑ Political Committee ❑ CHECK IF P HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee 1 Electioneering Communication C CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From / 1 / y / ,2o) ( To 1 1 / 02 1 / 020 1 I Report Type Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT 0 o Cash & Checks $ d "—"` (7) EXPENDITURES THIS REPORT Monetary / tj Expenditures $ Q �7 6 Loans $ o 00 Transfers to Office op Account $ 0 Total Monetary $ Up Total I Monetary $ 1-18 6. T"""` In -Kind $ d 6'c7 (8) Other Distributions p $ 0 (9) TOTAL Monetary Contributions To Date $ 31 800 =°- (10) TOTAL Monetary Expenditures To Date $ 3) SOD °O (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 hCl. cCSa_ - CO I certify that I have examined this report and it is true, correct, and complete. (Type name) A /v O t2 ErA- 6. �e ❑ Individual (onl ■ ® Treasurer • Deputy Treasurer electioneering m n.) '—\ X ` Candidate ❑ Chairperson (only for PC, PTY & el-ctioneeri ommun. organization) X Signature Signature DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name f A re-o- '3 . COe (2) I.D. Number through 1 1 / O1 k (4) Page 1 of DS -DE 13 (Rev. 08/03) 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 (1 0) In -kind Description (1 1) amendment (12) Amount (6) Sequence Number fi lj G C »'fse�141/ / / cc 0 / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Nov ? n CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURESP'tyofs 2 20, (1) Name Yi r.c�.c, - U. C—oy (2) I.D. Number 4' C/erkebasGa (3) Cover Period 1 1 / c -/ / 02011 through l / a l / .20 t / (4) Page 1 of c2 Of ce (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 (8) Sequence Number ®/ n/ 1 1,„.A.3C"_\.tn.�G›,C ,200 1. U. S. ;,,3�- 5c 4o� ;a.,. lc-L._ 3,296 8 E \�Gk..., ,C),�/ S �e � ;nilp ;� I, 0 /A) 3 .4 36 1 t /D6 h 1 / ©/ .2 l,,J c \ ke.-.. k 2 a o l U. S o/ ScD c>...s -: a.r c L 3.2.gS 5 © v vv / / o q %2 I ..— 1 1 l 0 7! 1 l) /0 7/ ,1 vFW 'f`'os+ - Ia2IU ca I S ,,..o ,...z s. c.L ►c o _ . `c JC�bcS -vmac-„ ) L._ 3258 ��, , :..., �� r\ AO ` V \� /, ova /100 .� 0 0S 0 /os/ I I 1 3-I3 S k-t, s, v-k,3 3 ,-. be ocs4,c—, , cL_. 3,295-E3 y� i �, \ 1V/ � /a 0U-1 [I /op/ I I vFw 90s-\-- 1v .2'0 815 L. ,: s:..._ _ Akio-- 5��,� s.�, -�, 3 .9 .Ss tvVc, ,v 00 G 03- 1 I /o S/ / 0,„,,,..,, 00,,,, t CO 0 O C.I . S �t -t :2- 1.20, N� - (\A° ,A) (J /� ° 8 ' - Ooh � 3 �o,sk-. c.„r , 1--. 3 .2 958 !a /30 /(I ti.) c��w,e.f \- 200\ 0..S, irl„.1/-� L �c1,-, o .•. o 5,ee ;es o v� &L o3 —X70 C., `I ood 5 ,,� �s�-. ,,.-., , c L 3,275E5 /0/36/11 ,2vo ∎ �.. 5 , 4 .— n0. r Tv /� / l /o"0 non +_$7013- GW Os`"'3e Se_\.Qsk.,.1 C 32758 DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 41 01/ ' — EXPENDITURES CtyyofS ?0/% CAMPAIGN TREASURER'S REPORT Number E C4, of�an (1) Name rd4-�- c6, (3) Cover Period I 1 / 0 '1 1020(1 through 1 ( / 21 / .201 (4) Page 2 of o2 (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 Nummber ber N ) 0 p8/ 1 1 ece...ss Sa.Ac.r�� ego. U . S. �.ay -a. Ue�c, G �ti,-,3 971 tveJ.as Qal� Ad WI. 0r' OE. 62 64 7 G,i 003 10/a8/t1 Pc Q s S Sp v.< v.0.\ U.S. 1801 ..3ylt-1 ve-ro 13 ec.�� I t� 1.._ 3,2c/71 ��.J paDcc ��\ .�,. �.Z 01'-I tl /t8 /tl o G% �e � , S Q - ` o a . . s 1 c ; o•-• -. 1 CL- 3z �'SS Re-f°1 L e o l s AVA 190263 0 0 7 / / �y 1J / / / / DS -DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CIHYOF HOME OF PELICAN ISLAND SEBASTIAN CITY COUNCIL MEMBER OATH OF OFFICE I, Andrea B. Coy, do solemnly swear that I will support, protect, and defend the Constitution and Government of the United States, and of the State of Florida; that I am duly qualified to hold office under the Constitution of the State; and that I will faithfully perform the duties of the office of Council Member for the City of Sebastian of which I am now about to enter, so help m�Go Swo Andrea B. Coy Sebastian City Council Member subscribed before me this 16th day of November, 2011. Sally A. City Clerk (SEAL) o, MMC CTYOF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org November 9, 2011 Andrea B. Coy 501 Palm Avenue Sebastian, FL 32958 Dear Ms. Coy: Congratulations on your re- election to Sebastian City Council. 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. Investiture of newly elected officers will take place at the November 16, 2011 Regular Meeting at 6:30 p.m. If you have any questions, please don't hesitate to contact me at 388 -82145 or smaio @cityofsebastian.org. Sin - _ I Sally A. M. ., MMC City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) iq ry OR.2.64 6. C cy Name (2) 50 (4) Address (number and street) 3 a 9,5_53 City, State, Zip Code ['CHECK IF ADDRESS HAS CHANGED Check appropriate box(es): ,Candidate (office sought): OI EC IVED LY NOV 04 2011 City of Sebastian City Clerks pie (3) ID Number: 50.5: C C \ ❑ Political Committee ❑ Committee of Continuous Existence 111 Party Executive Committee [j Electioneering Communication ❑ CHECK IF P HAS DISBANDED ❑ CHECK IF CCE HAS DISBANDED ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED Cover Period: From (5) REPORT IDENTIFIERS 10 l IS l 2Ot I To I I /-3/ 2O I I Report Type ( W Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks Loans Total Monetary In -Kind $ 1050 $o oe� oO $ Ioso $ o GO — 00 (7) EXPENDITURES THIS REPORT Monetary Expenditures Transfers to Office Account Total Monetary 00 $ $ a, 39O Ey (8) Other Distributions 00 $ (9) TOTAL Monetary Contributions To Date $ 3 ) 800 (10) TOTAL Monetary Expenditures To Date $3)31S (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 ct 6 . CGY ❑ Individual (only for Treasurer ❑ Deputy Treasurer electioneering c• n.) X Signature I certify that I have examined this report and it is true, correct, and complete. (Type name) landidate X Signature ❑ Chairperson (only for PC, PTY & electioneeringgmun. organization) DS -DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name Ay.As�.. 6 is I X01 I through (2) LD. Number 11 / 03/ a o 11(4) Page ,J� VV��i■ ■ v■■vv (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 I D aS 11 /� GOES - \ Cl- P B I\ ; :,,5t;� e A C Fwd (� LL ,2 7Ft, 3<<a Pau,. ,,.-. a mow. Q�y� Uo 00\ v. as. 1 R e- ,A.kors P /4 G CI_ 7oas /� u .�5� -�- r),`�_.- .�n�.�� O. Oc XO; ' L 22 -6012 �� R�kko� - GNL_ qp, A)m co Sao - 0002 / o, 026 / r I .3a �b�k-;� ��Gf 1580 u:s. KWyi. 4 —.. ct,. 3a�S8 b NiA 0266 D 03 I t I o 3 1 1 .\11,,._ , C- 4-S J. .v.K 1Ko k u, s, N,� +>r.1_ v� �d PAa� FL 3ag6Q T "i 1 vdca Oeo- e_C C N L Yv///JXI / i� I au �Dd O0Ll N0 0 /� G o� C Of .0 C / ergs ?III / / / DS-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES fi CAMPAIGN TREASURER'S REPORT - ITEMIZED EXP (1) Name f'(t� [3 (2) I.D. (3) Cover Period 10 / 16 / c20ll (through 1 / C 1.2p 1 1 (4) Page RECEIVED 4114111 !Sebastian erk's Office 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/ 1g/ l I )55 s so ,. .L t Sir- r v•c 7 (R— 32q611 nr.\ r`.t,k.:,c- 51 , r or r / It/S.9 --- 001 U /428 /l1 `%s. Spa.O Comm- Rolo ■ 0235 Cam" s 4'9`d~PFC5S vuo ib-- k, >F�_ ' 3� c160 �dc��O � Mom) �/A $7 etc 0o a 1 °/°29// Prez 5 3' 1 (v AA ry o a10 067 I8Ot U.S. Nuoy V e....--c. d ��, F l_ 3x.571 003 1° /3I /r1 t,,,a.s. PaL.v.,,e.s gas u; Lt s v, 3a5S-8 v rno f.. 1,v /A. eo Pio 10/31/11 S .0._\ cU Q i{6 ( Geo <t C3 ` �co MoN N R ov $7S 00.5".. Wa��w"..clucF 5 0.--.1c-.% • c- L- 3 2 1.5-8 E.�..h :o�. °y `5"'Q () %.-� iv\ 0 iN f\,/k) 03 $ 70 o 06 ,, / �/1f 50..x- ^Md,,, 5 , sic2cS N�yF A o� 00 4as 70'7 �5, 007 r� 3 a5S8 /1/07/11 00 -(30. Gc:l\ 13 ,-t a t r t, s, v\ w y L t� 1A1 '' ooh c�/1 ► loN IV �1 ,29 4 /bio — C�1- 3o2'LC DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name i'I v► Are,- € . (2) I.D. Number (3) Cover Period 10 / 1 s /02011 through / 1 / Q 3 / a 0 11 (4) Page OZ of o2 (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) (0) Expenditure Type (10) amendment (11) Amount (6) Sequence Number a 11 // pot O,..- .� SkocesS t �.,` !WI U.s. �wy� F1— 3a 7S8 P�� S (1. V�e on N X18 i 7 11/2/11 (lei/ U.s. 1- -1-'/ -'42- 0 ex° 6 e_o-c\— % e L 396.0 SA---ck.--o ,,,,T Vvlo ,-\ I� , 14. �( a 1U 1° /d6 /II n ' "- (V\t.S:e( S .�, �5 Movv N %f} $�IaS 1b61 W. i,- cA4.._ar'; .-.4i O -. \ 1^ �1 a 9s"f o /a5//iI e.■k.5 Cc.-.< o i6IH u,s, Nwy 1. S�No0.s�: o.,., c 1,.. .3a ',.TB. 6 5e,�..): re_e_ Y►�o+N A)frt so Y 0 1 a / Q RF co, litk to / / G O ?c' C /esbp°fS 'h % /< / / O( ` DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES J1Y F SEBAkSTaN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - smaio @cityofsebastian.org October 25, 2011 Andrea B. Coy 501 Palm Avenue Sebastian, FL 32958 Dear Ms. Coy: 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.AlI 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. If you have any questions, please do not hesitate to contact me. Sinc-rely, Sally A. M. o, MMC City Clerk ,koe, tO /2IA I FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY r1c3t r c= o / Name Address (number and street) EL 3 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 RECEIVED OCT 2 0 2011 City of Sebastian CitY Clerk's O�ca (3) ID Number: ❑ CHECK IF PC HAS DISBANDED ❑ CHECK IF CCE HAS DISBANDED —I CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED Cover Period: From I() / (6) Original ❑ Amendment (5) REPORT IDENTIFIERS / / a0 I I To 1 © / / / / ,2 61 Report Type 6 3 ❑ Special Election Report ❑ Independent Expenditure Report CONTRIBUTIONS THIS REPORT Cash & Checks Loans Total Monetary In -Kind $ [,gCDC $ I, 00 (7) EXPENDITURES THIS REPORT Monetary Expenditures Transfers to Office c�G Account $ Total Monetary (8) Other Distributions $ C --- (9) TOTAL Monetary Contributions To Date $ ,-75 0 (10) TOTAL Monetary Expenditures To Date $ 9 �a (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) 1 certify that I correct, and c (Type name) ❑ Individual electioneers have examined this report and it is true, omplete. tJ (� . Co/ (o y for gTreasu ❑ Deputy Treasurer Signature DS -DE 12 (Rev. 08/04) I certify that I have examined this report and it is true, correct, and complete. (Type name) andidate x ❑ Chairperson only for FC, PTY & tionee coprhun. organization) Signature CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIVED (1) Name A v\-cAs-e v Period / / 2t j through (2) I.D. Number OCT 2 0 2011 City o Sebastian / ity 0 / l / C.201 t (4) Page C�erk's�ffice (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 jam} yn' a kip 5 ,i,., r�L -) 32sSd Re**, 0C) \ D8 A Relivl c:,� C._ '•U� ,� ��,� cy� 6 S Ls k,e,..... 'ti\+i , ,Se-)0c:,sr,c ,1 - 3 ons f5 B Z-st-, -��c� C-l-t- I iv) i ) Iti / / `` (CiC, 0 a, f �e, e.,s� 6,14 ,A LAD . ,c1/4, wex 3 2 556 --r �.1 � ,;,, ,,t c k4 L r� /� NVA 509—c? X 0 1 / 0 1 1 I/ 501 /N c-__,--, (=3 ` 3;2.558 n 1 �\ y oc; c /0110111s,,)/ tL��a �� � � P.C\ Q e< 90 / 6 Ls c.t.vc�c -> A. 6 *-0,,,,1/4--, d=L 3115.95---501 - . of �.\ PG■S Les _. � L f ! e,P i S 60 O /.< 101 / 0 111 , ' cL c- C,w.V (c. 'S.,' I i 6 as' 1L, , e1: :SI Ro5c-\.c., -ck) �L '3 ,-/5"7 ._ / ,�1 o 0 6 f 0 / l 0 / I I „, , C ..kk 5q ott, O.:, ( .1c,«. t CA1E.. i� iA $100-- 0 07 7 a -.Lc ‘.3 ■ A..e._ C-1- % 52003 1 0 1 / 0 1 11 /0 1' e. s S t( . n1SO 153 i 5 R.- +, to C .. ill t vU >I vo ' ' `� $ 3 -CO-- ooh :1' 3z .53 DS -DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS per, through (2) I.D. Number 10 / l `/ / c2011 (4) Page 02 of 02 (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 10 / 10 / 1 1 1531 S �. Lt. 3aS5 --� a0 1 / iv�i �1 6 Fc)L._ l_C'�- / / / / REE OCT Ci4, /1/o I / C /erk 4-07 s pace 1 / / 1 / / DS -DE 13 (Rev. 08 /03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name p, -A ce c:. (2) I.D. Number (3) Cover Period 10 / C5 1 / „20 1 I through / 0 / ! `1 / (20 1 1 (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 7 <7 CO S , R _.,e'-- , rvioN Nyici- "4/ii 7 — 10/ 8/ 11 E.x ce.sS Sc ,,,,,S 15-5 ag 56,4A -1. G..--, Rd �� �" ��a«cA.e_) c� 3,'/ S NA QY\ 10/4 0 Ig,002 - 00 02 lom /Jf 1- -l0 w.0 Q0.._ ®--c 13361 as / a-- S �� ,��. F t,� 3 a15 8 s; �, 'n'� a�� , `iV�ovti /4 87 0 0 3 /6////// I 1 7 ( U. S k-k :c -- 3,)--Y` ,`l \.:, a_co 6 a.....41,, a 1 3029.40 5' ,_LR ,,2.___,s OA o 1\)/1-1 IY) . -' OO' fC / i3/ I ( S <1/4_ v,,, FL 3 ,2558 5-�- -,.,� �io,A vt Li y 005 \-\ k ev G ` G 1..._ 1.... 0 l . '� �-___S / / REC 0CT2U?011 City o ElVFD f `Sebeati$n / / 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 October 10, 2011 Andrea B. Coy 501 Palm Avenue Sebastian, FL 32958 Dear Ms. Coy: 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(ccityofsebastian.orq. Sincerely, Sally A. Maio, MMC City Clerk 4 0/77/1 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) /"tAcA re-a (5 . Goy OFFIa \ p;i� bY OCT 0 3 2011 City of Sebastian. City Clerk's Officc Name (2) 6o t eo,k A 0 e.-4" ' Address (number and street) CvGL �.s -: -^ C.(-- 302 5 1 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): g- Candidate (office sought): Se _c, ss c-_, C-`'�1 ��- - A^G.-A.\ ❑ Political Committee ❑ CHECK I PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee fj Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From `'7 / / 7 1 a?OI To ' / 3) / (2©/ 1 Report Type &a XOriginal ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT r o O Cash & Checks $ I) 0 .50 __--- (7) EXPENDITURES THIS REPORT Monetary o 0 Expenditures $ D ---- Loans $ 9 Do vo Transfers to Office o Account $ 0 -- co Total Monetary $ ) d 60 ---- Total Monetary $ © °L° — v1 In -Kind $ A)//q (8) Other Distributions o $ (3 - ----"_ (9) TOTAL Monetary Contributions To Date $ °°- (10) TOTAL Monetary Expenditures To Date $ -$s= 6/ = Arc_. 13 .c0 (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, ACI C �' Col I certify that I have examined this report and it is true, correct, and complete. (Type name) JACI C e_c.. (3 , Cam / e❑Individual (only for Treasurer Deputy Treasurer lectioneerin mmun.) X /h �_.. Candidate ❑ Chairperson (only for #C, PTY & electioneering .mmun. organization) X 1 - _ Signature ,r Signature DS -DE 12 (Rev. 08/04) RECEIVED CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS CT 0 3 2011 (1) Name Adree_ct- k7. Coy (2) I.D. Number 3 Cover Period C7 / / -7 / 020 1 through 0 S / 3 0 / .2 011 (4) Page City of Sebastian City Clerk's Office 1 of a (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 [ / 02 l / 1 i Teo.r.netke. M. 0e,,,tor� 11 45 iQos l a.d 12d Se-koe.sk, ....... , FL- 3 A.cfSS x 12e-k. r..ck G K 0 N /A t 1°6 — 00 1 c? IZ4) e-c k' Q e -...kc, v . I AL'S Rose...), Rel 5e...ko .o..,, , L .3,2958 1 (? �- �;etie). e.A.-4 E_ rJ /p r )/i9 1 100 002 i / ay/!J A...4,-e.- B. Goy S 01 c.a ,, t4 u e.. S e....k.00..sk; a..... , 1 L 3.2.`F33 l c,-.4.1...6 L 0 A AV4 /A boo 003 6 ne- ce'1',ne. Se-b c- 5k..,,- el- 3:;15,s- S Re,V, re c\ cFi E' tv/ti Z lso 6 0 `i 641 Doe *cI- /v 3 ,2558 ry q ..t /YO cc 1020 l 11 0 Mora r. 1-1e :ne ELK- P, 0. 4ox 7P0 6-7`i Sr- _b ,,k.„ CI- 3 ,z `S€ C� kc, GN NA 1U A au �Sn 006 GI / •. / 1 J r.,-,c..c.c e ' J, nc, 600 1.-. ..,.4 s'. c.-.., 4ue CU- 3,;7' 5E' o A ,....k ,....k o izC!e:• (,. N i. 414 n / 4 `U QOC) q / 02 % / 1 A-1 ,'tr... Pikw�.a.� 5-63 Gross 4...k Gc. YZe.k . se� CA-I i 1 //1 j� �i _°0 r�d 0 ©8 5ebo��..c.,�.i Cr 1.. 3ags8 DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name RECEIVED CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS. 0 3 2011 City of Sebastian (2) I.D. Number City Clerk's Office through 0 `j / .� 0 1 .2 d 1 (4) Page c2 of c�1 (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) Amend/nerd (12) Amount (6) Sequence Number C� 1 / ,27 1 II 50_r..L.el f CaxolZwe. 6oc�.w :.� 66'7 0�-�� aye- 5e.b�.5V,c. - i �L 3 ,295'8 7 t Fick r cl-t�_ ro fr / oa loo._._ 007 1 1 /%1 Off. t 1 / 0 1 / O 1 1 1 / 1 / DS-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES RECEIVED OCT 0 3 2011 City of Sebastian CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES City Clerk's Office (1) Name And e.o. Q • j (2) I.D. Number (3) Cover Period 7 / `7 /02.01 / through 3o/aat1 (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 (s) Sequence Number / 1..1 O / / 1/ / 1 /1 / 1 1 / 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 Andrea B. Coy 501 Palm Avenue Sebastian, FL 32958 Dear Ms, Coy: 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 @citvofsebastian.orq. Sin er--1y, Sally A. M. o, MMC City Cle FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) f � . 1 1 Ack.cc:r_ ' J . C,C.t,� OFFICE USE ONLY RECEIVED i n 9 SE IC 2011 of Sebasdsn Name / (2) 50 t PcA.,r,,. lA) "../.-e.., Address (number and street) S`bc S ,c•c-.r.. \ 3;� 13(e 1 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): jaCandidate (office sought): S_.\,..,c k , _.� citiCY y � ;rer1( Olyl�i (3) ID Number: Cl_., -ss- y Cer --t- " c_A. ❑ 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 / 7 / c90 I ( To / /6 / 'o f i Report Type C., I 6riginal ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 0 ---- (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT 0 $ . 1 o Loans $ ! bO c2-''—) to Office $ c 5 Total Monetary $ 100 " o �� $ 6 / °—° In -Kind $ ()-°°— (8) Other Dist ibution�s�) $ (9) TOTAL Monetary Contributions To Date $ ADO 51( (10) TOTAL Monetary Expenditures To Date $ 6 f -4" (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) /0 Ac ,�e.� . 6 . Cry I certify that I have examined this report and it is true, correct, and complete. �� (Type name) AAA A c-c_a bJ • Cc, y ❑ Individual (only for laTreasurer ❑ Deputy Treasurer electioneering co ) X N.Candidate ❑ Chairperson (only fofPC, PTY & electioneering electioneering co ► mun. organization) ,i Signature Signature DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS /1:4 ,1,-.. L3., Co/ 3) Cover Period 0 9 / 0 7 /a01 1 through oci (2) I.D. Number / / 6 / 20 ! 1 (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 69, c 57, t t rG\SL cc�6.C�,� 50, c `v.. R Silo � : �..,/\ t^ 3 a`i 5;. LOA ��n.k ck« C k-1 c, rvr, N fr 1.00---- o1.- _../ / / / 2 (/.. G 0 v' ° / / ti`s\ 0 RECEIVED SEP City 2 0 2011 of Sebas clerks O;tice ian / / City / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name b.. Co/ .,/ (3) Cover Period 097 / b ! lad 11 through C)1 / (4 / C( (2) I.D. Number (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 °` /07 /` C-'• 3c c,Cr Jc: O..SC..,— 1 cti :—, SLR�k- 5�b c. . c-.,.' , c L 3 2958 c,„k•CXc..m c:\ -_,- c ,� rv1©ry ry �1 / 4‘ 1 0 1, / / RecetveD SEP 2 0 2011 -City -of Sebastian X / / City Clerk's Office / / ■rC' / / ,be Q / / / / / / x DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES arvoF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388 -8214 phone - (772) 589 -5570 fax smaio @cityofsebastian.org September 13, 2011 Andrea B. Coy 501 Palm Avenue Sebastian, FL 32958 Dear Ms. Coy: In accordance with Florida Statutes Section 106.07, the G1 campaign treasurer's report for your campaign for the period September 7, 2011 (the day you qualified) 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. 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 NC 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 19t" and Thursday, September 22nd or the report can be mailed anytime after September 16th up to midnight of the due date September 23`d 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�cityofsebastian.org. Sinc Sally A. Maio, MMC City Clerk CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4324 Name % 7/1/ ❑ Cash Date f 7/1/ heck# 00/ No. Amount Paid 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 , Unit Cemetery Fees 02 S 3 t nitials White — Dept. of Origin • Yellow — Finance • Pink - Applicant Total Paid STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) OFFICE USE ONLY RECEIVED SEP 0 7 2011 City of Sebastian City Clerk's Office candidate for the office of St_.L, C 7 Co,I C have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Signature of Can i to "?/7 /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 (05/11) HOME OF PELICAN ISLAND ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY RECEIVED SEP 0 7 2011 City of Sebastian City Clerk's Oftice "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. Coy , 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 • subscribed before me this 7 2011. Notary Pub 'c State of Florida SEAL 4- day of ti :''''''F,. SALLY A. MAIO a Y alp Commission $ FP f19d3F(1 "' ' Expires October 5, 2014 '4;0 :nit'? Bonded Thru Troy Fain Insurance 800. 385-7019 *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 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) RECEIVED SEP 0 7 2011 City of Sebestlan City Clerk's Office OFFICE USE ONLY OATH OF CANDIDATE �r`� (Section 99.021, Florida Statutes) 1, !el r.Ace-r.,1_ (3 , Ca (PLEASE PRINT NAME AS YOU WISH IT APPEAR ON THE BALLOT * -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of a�_�� ; �,, �;.� �,,,...� c., \ , (office (district #) ; I am a qualified elector of 1„�a�'• 0..,. s 0e--‹ County, Florida; (circuit #) (group or seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. X (7 zo 3 s 8 0 , 6 ( gGC S C. ay ...\40 eA 50u 1--L • A- L Signature of Candida Telephone Number Email Address SO Pe-Lt. v„ tl 0�Ike- S Lc c;«- c 3'68 Address % City / State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): i 0q64/85.4/6 * 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): AIIIcl ., e.�L/L\e\._ V.0% STATE OF FLO DA COUNTY OF / 9.- daydiiii = \ — - 1 ' i , 20 // Sworn to (or affirmed) and subscribed before me this Personally Known: or t AL. _ / -• Produced Identification: ignature Print, o otary Public T • -, or Stamp Commissioned Name of Notary Public Type of Identification Produced: 4,10;1'.,, , SALLY A. MAIO f...� • Commission # EE 024350 ;,, ;7 Expires October 5, 2014 �,✓3 'is. • Bonded Thn, Troy Fan Insurance 800 -385 -7019 DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C. FORM 1 STATEMENT OF FINANCIAL INTERESTS RCCC PVC D 2010 Please print or type your name, mailing address, agency name, and position below: City of Sebastian r City Clerk's Office ` AST NAME — FIRST NAME — MIDDLE NAME : FOR OFFICE USE USE ONLY: MAILING ADDRESS Ms Andrea Coy R�G� /It 1- St? 0 pis G� G \etK� G \� Sebastian rrt 1D code r 4 ID No Conf. Code Q rrit P. Req. Code 2011 .� _ CITY : 501 Palm Ave Sebastian, FL 32958 eba�ba --- -- , NAME i �O�(f,��G 'w `� NAME OF OFFICE OR POSITION HELD OR SOUGHT : - You are not limited to the space on the lines on this forth. 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 otlit DECEMBER 31, 2010 OR ❑ 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 (must check COMPARATIVE (PERCENTAGE) THRESHOLDS OR X DOLLAR VALUE THRESHOLDS ON A CALENDAR YEAR OR ON EITHER (must check one): YEAR: DOLLAR VALUES, WHICH ON PERCENTAGE VALUES (see one): PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, you NAME OF SOURCE OF INCOME 'Z. [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 =..,_ 9..:,a tom. CokX C.. 320 V, ,...; Rv�<. Fk P.�.- J CL_ 3 tic? f3 C Li- rr Ca« .._. 0�4e .. 4t-;(. «..,,r. IFtc c..6,,,,. .t;� Su .,;c., �.Q. ' oc, }`7130 to .ar 141/4 410 7."eA - 7130 fN\ L; (2....k;,--.............-4,-. G«t � �.pcT Sic cry -+ Y ) ..S titi .,.. - . s� ..... L. 3a_4,56 ,o 6 w\.. .,:.Qas. 6c,�e.;,".,...„&. -.4- PART B -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to ADDRESS OF SOURCE businesses owned by the reporting - person] (If you have nothing to rep NAME OF BUSINESS ENTITY ort , you must write "none" or "n /a ") NAME OF MAJOR SOURCES OF BUSINESS INCOME 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 when are located INSTRUCTIONS file this begin OTHER to file INSTRUCTIONS for and where to file this form at the bottom of page 2. on who must form and how to fill it out on page 3. FORMS you may need are described on page 6. SO I Pcziw� AJe��u.� - Se.S.c,c ► CL 3 95 - 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, (If you have nothing to report, you must write TYPE OF INTANGIBLE bonds, certificates of deposit, etc.] "none" or "n/a") ENTITY TO WHICH THE PROPERTY RELATES 5 , ( -& ` `B`USINESS sc rC+-\ `G �:7...�SO � 4'x-5 ` Cam` -z. c__. C.64 PART E — LIABILITIES [Major debts] (If you have nothing to report, you must write NAME OF CREDITOR "none" or "n/a ") ADDRESS OF CREDITOR r0 C. c.,. .....m. j 9.0. 1: `at0 0 v. 0 ' . 6 D (— 820 sN v� Q 0 .. Q)c- 3 a997 .t a :.e. .. 1 - 3291 ,53.20 PART F — INTERESTS IN SPECIFIED (If you have nothing to report, BUSINESSES [Ownership you must write BUSINESS or positions "none" or "n /a ") ENTITY # 1 in certain types of businesses] BUSINESS ENTITY # 2 BUSINESS ENTITY # 3 NAME OF BUSINESS ENTITY q AVA} ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY 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 SIG ED (re aired): - -WHAT— TO_ FILE.__ _ -- -- __.__ After completing all parts of this form, signing and dating it, send back sheet (pages 1 and 2) for filing. If you have nothing to report in section, you must write "none" or section(s). Facsimiles will not be accepted. NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed calendar or fiscal year is not required second Form 1 for the same year. candidate who previously filed Form of another public position must at least of his or her original Form 1 when ILING INSTRUCTIONS: TO FILE: -_ _- _---- -____- ]IVHERETO FILE: including If you were mailed only the first on Ethics or a County your annual disclosure that location. a particular Local officers/employees "n /a" in that of Elections of the nently reside. (If you in Florida, file with where your agency State officers or file with the Commission Form 1 fora 15709, Tallahassee, to file a address: 3600 Maclay However, a 201, Tallahassee, FL 1 because Candidates file this file a copy qualifying papers. qualifying. To determine falls under, see the on page 3. WHEN the form by the Commission Initially, each local officer /employee, state Supervisor of Elections for officer, and specified state employee must filing, return the form to file within 30 days of the date of his or het appointment or of the beginning of employ- file with the Supervisor ment. Appointees who must be confirmed by the Senate must file prior to confirmation, ever county in which they perma- if that is less than 30 days from the date of their do not permanently reside appointment. the Supervisor of the county has its headquarters.) Candidates for publicly- elected local office specified state employees must file at the same time they file their on Ethics, P.O. Drawer qualifying papers. FL 32317 -5709; physical Thereafter, local officers /employees, state Boulevard, South, Suite officers, and specified state employees are 32312. required to file by July 1st following each form together with their calendar year in which they hold their posi tions. Finally, at the end of office or employmein what category your position each local officer /employee, state officer, anc "Who Must File" Instructions specified state employee is required to file a final disclosure form (Form 1F) within 60 day: of leaving office or employment. CE FORM 1 - Effective: January 1, 2011. Refer to Rule 34 -8.202 (1), F.A.C. PAGE 2 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. RECEIVED SEP O 1 2011 City of Sebastian City Clerk's Office c C4141- OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) A11A�e,-ti S -• �O y 3. Address (include post office box or street, city, state, zip code) s -0 t CPak 0-. Pi -e_v■v-� 5 ,. c L. 3, 5' sg 4. Telephone `I C i 0 ( 77d ) 389 - e�bc 5. E -mail address SdSco y e�al� w�. Lek 6. Office sought (include district, circuit, group number) St�G,-s ; C� G; -y c_c, ,\ 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 • artisan 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 21 Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer r\ ac- 2c� cS G0 11. Mailing Address LS-0 1 ec •�-. A v c:2_.,",� ...__ 12. Telephone ( 772) 3 C3 -0 °i 61 13. City S cab o sk'. - 14. County 1, A; eL,.. e:. „ 15. State c- L- 16. Zip Code 3 .2 ei s' j 17. E -ma.l address 1` so s c_c y _p�. \sows,--i,.. --,24c- 18. I have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank ! /J c. \\ s cc,_ < r O 20. Address 151' -1 ULS \ck4., -) <, 1- 21. City 5�� -c 22. County 1-,,, -- -� _ c-. J •< 23. State c:: A— 24. Zip Code 3a9 .56 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 cri7/ i 26. Signature of Candidate X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1, 4 'NJ <�,� fiS . C,L,' , do hereby accept the appointment (Please Print or Type Name) designated above as: , Campaign Treasurer Deputy Treasurer V7/1 X Date Signature of Campaign igri rer or Deputy Treasurer flq -r1F Q /Pau 1 A/1 n1 u 7J- Z.uuui, r. H. .