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Home My WebLink AboutHeptinstall Michael 3-9-2004�. � Z�� ._.... � � , 10� '�� o� , _..� �� c� .��(�� — �- �.. � �.� , �., � �� S em.� -��r�s-�� --s� c�e. i-�.� lu; l 1 �l� , � �� a ��o e.�., � a ��,az, � ( ��.rz.� ��-r�. �� -� � �I�O�s . i� ' t � ' (� Cau�' �� H�2. �� fg� �� I { �� y4"�'' � �r��G� E • r_r FLORIDA DEPARTMENT OF STATE, DIVISI QN�1� ;�tE�T�k�� ;'` �; CAMPAIGN TREASURER'S REPORT' OFFICE USE ONLY c�� 'M", ,.�.�� l-, ��N�'�� ?oow c�►�Y 27 p� � ly Candidate Com ittee or Party Name (2) �� c�►�� s-t Address (number a street) S��t.s-� �,,. �r1a 3Z�� City, State, Zip Code ❑ Check box if address has changed (3) ID Number: (4) Check appropriate box(es): �}- � (� , � � Candidate (office sought): ��a-5 � 1 A�n v�� 1�1L �( ❑ Political Committee ❑ Check if PC has DISBANDED ❑ Committee of Continuous Existence ❑ Check if CCE has DISBANDED ❑ Party Executive Committee (5) REPORT IDENTIFIERS Cover Period: From �� /�/ � To Q� l D z� 4� Report Type �� Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Re�port (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary � Cash 8� Checks $ �0%�l� Expenditures $� �� J __ Loans $ Transfers to Office Account $ Total Monetary $ Total $g Monetary $ �� 1 In-Kind $ (8) Other Distributions $ -- (9) TOTAL Mo e a Contributions To Date (10) TOTAL Moneta�[ Expenditures To Date $ ��C� $ �l�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, I certify that I have examined this report and it is true, correct and complete. conect and complete. �� 1 �-�� f � �1 � ��1 � Name of [�Trea urer � Deputy Treasurer Name of Candidat � Chairman . (P PTY Ohly) Signat e Signatur DS-DE 12 (Rev. 08103) , �. M AIGN T�R� SU R'S REPORT - ITEMIZED EXPENDITURES (1) Name ��- 0.�� L�b� I»°�10�' (2) I.D. Number (3) Cover Period � 3/ ��/� through � S /D �-- /� (4) Page � of 2. (5) ��) �8) �9) ��) ��) Date Full Name Purpose �6� (Last, Suffix, First, Mfddle) (add office sought if Sequence Street Address & contribution to a Expendeture Number City, State, Zip Code candidate) YP Amendment Amaunt 0� DZ � � A;►- Q.� VE2 �u � 1�� D'`' �d � �'� I�S9 or� A� A�1� .Do.� G� io po� Cartt� 1 I�TK sr• V.� 8ba�l. �ta,3�62 DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ..-- �-"��1T HOME OF fELICAN ISLAND 1225 Mairi Street Sebastian, Florida 32958 {772) 589-5330 phone - (T/2) 589-5570 fax March 5, 2004 Michael Heptinstall 834 Barker. Street Sebasiian, FL 32958 Dear Mr. Heptinstall: In accordance with Ftorida Statutes a campaign treasurer's�termination report must be fiied by June 7, 2004 �nd witl include ali lawful expenditures in accordance with 106.11(5} and final disposition of surplus funds in accordance with 106.141. if you have any questions, please do not hesitate to contact me at 589-5330. Since ; � Sally A. Maio, CMC City Clerk sam �- � . � � � �fi � � �,nl� c�'� � .�- . , T Page 1' of 1 Jeanette Wiliiams From: MLHEPTINSTALL�aol.com Sent: Monday, March 22, 2004 7:48 PM To: jwilliams cL'Ocityofsebastian.org Subject: Re: (no subject) MIKE HEPTINSTALL AND WIFE LEILA HAVE LIVED IN SEBASTIAN SINCE 1997.MIKE WORKS FOR VER�O BEACH CHRYSLER AND THE MOTORHOME SUPERSTORE WHERE HE IS SERVICE MANAGER FOR THE RV DIVISION.MIKE AND LEILA HAVE 5 CHILDREN AND 3 GRANDCHILDREN,A BASSETT HOUND NAMED P.J. AND A CAT CALLED IROC.MIKE AND LEILA ARE MEMBERS OF THE COMMUNITY BAPTIST CHURCH ON ROSELAND RD.MIKE IS THE CHAIRMAN OF THE BOARD OF TRUSTEE AT HIS CHURCH. YES I WILL BE ABLE TO ATTEND THE THE JUNE PROGRAM THANKS MIKE HEPTINSTALL 3/23/2004 .� �� SE�r�s ��!�N .� HOME Of PELICAN ISLAND SEBASTIAN CITY COUNCIL MEMBER OATH OF OFFICE I, Michael Heptinstall, do solemnly swear that I will support, protect, and defend the Constitution and Government of the United States, and of the Sta.te of Florida against a11 enemies, domestic and foreign; that I will bear true faith, loyalty, and allegiance to the same; that I am duly qualiiied to hold office under the Constitution and Laws of the State of Florida; and that I will faithfully perform all the duties of the office of Councilmember of which I am about to enter, so help me God. Sebastian City Council Member Sw d subscribed before me this 15th day of March, 2004. � — Sa11y A. 'o, CMC City Clerk (S E A L) % ^ �, .0 J ^ � 1r' U 1/ -------------- ---- ---------------- ------------- -- - - - J ---- - - ----_�- ,�./ - -�__ ---_=="__=-=__==_---_ _--==__:- ____-__- -�__-_=-----------------_ � i .,..�,�--- n,.�...�,.P-- _,.-�,,.,,- ,._,�__� -_.. .�.... -_,,..,�... I� Name No. 001001 208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 i� CITY OF SEBASTUIN CITY CLERK'S OfFICE �I`� �' RECEIPT �r ❑ Cash ;� o•e�i'eck: ��L� ' Amount Paid Sales Tax Garage Sales CopieslBid Specs. LDGC'ode of Ordinances Electlon Quali�ing Fees Cemetery Lots LotlNiche . Blodc : Unk 001501 343805 Cemetery Fees �r� mt ��lf� �'?,A.�, �� , R' � � � ' ,,. i ,\lll�r� . . �� . TotalPaid �,' � IniUalt White — Dapt of Origin • Yellaw — Finanee • Pink • Applicmt . A N Z a � N� R E 4 e Q � � � � 0 yU U � N � h O h d m � Q �� m � m y STATE OF FLORIDA CHECh APPROPRIATE BOX APPOtNTMENT OF CAMPAIGN TREASURER � originei Appointment :� AND DESIGNATION OF CAMPAIGN DEPOSITORY � Deputy'freasurer ,::_� ,o FOR CANDIDATES � Reappointment of Treasurer � --� �, (Section 106.021(1), F.S.) � 5econdary Depository � � � � (PLEASE TYPE) � e of Candidate 1. Address (incfude post office box or street, city, state, zip code) �' � c�an 834 BARKER ST SEBASTIAN FL 32958 � ` �;1 � MICHAEL L HEPTINSTALL Tefeph �(optionel) 2. Perty (Partisan candidates oniy) 3. Office (edd district, circult or group number) ( `;F, CITY COUNCIL OF SEBASTIAN I have appointed the following person to act es my Campaign Treasurer � Deputy Treasurer 4. Name of Treasurer or Depury Treasurer MICHAEL L HEPTINSTALL 5. Mafling dress (If post office box or dravver add street address) 6. Telephone �3 .� � ��1- R�6 7. cfty 8. Cou ty �� 9. St� 10. Zi�� e J � 1 "'� � Q. 3 � I have designated the following named benk es rny Primary Dep�itory � Secondery Depository 11. Name of Bank 2. Street Address BANK OF AMERICA 71 13. City 14. Counry 15. State 16. Zip Code SEBASTIAIV INDIAN RIVER FLORIDA 32958 17. Signeture e Da l� paign Treasurer's Acceptance of Appointment . A i, � N S�'I , do hereby axept the appointmant as Pleeee Pdnt or Type) . r ' � Campaign Treasurer � DepuiY 7re�surer for the cempaign of ��/ ��,� � J, who is seeking nominetion or election as a r C� �'1 \ 1;IA1J �1 � cendidate to the office of � ' �Pe�� - �%� � . ��AO� 1 . As e duly repistered voter in ��Y�iO"� /C-I UB'�[ �� County, FI rida, i am qualified to eccept this appointment UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE F GOING CAINPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE � �U G�' Dete ignature Ca Treasurer or Dap Treesurer D5-Dt a (rtev. ��u7) G� � �` ��:: = W S �F- a°n tWd � CLL.' LL Ov� C� �� s a � � �� = Y A � v O � �. � �� ; � �'i ,`� � � 'fi,{ -_ �""�. � *y � �` j ;� u� `�.� t "i„i . � � �� m LL � � � �, X � � m � � � N � � � � ' � � � � � J v � � O M f� � � � � � � 8 � � �i � o z° 8 8 8 8 8 0 � � ° S a� '`,�. `i.� y e � a d o � � � e � m e e 3 � a . 0 e � � � I tic; m �� r � ``,J tp 3 �r C FLORlDA DEPARTMENT OF STATE, DIVI510N C1F ELECTIOt�S C�►MPAIGN TREf�SURER'S RE�ORi SUMMARY , (,) � i1� N - i2) Candidate, Committe or Party Name I.D. Number 1 c3) �� cU��b�z S�' S��"i-�t-ti. �a. �Z�S'�'' Address (numberand street) City State Zip Code ❑ Check box if address has ct�anged since last report (4) Check appropriaie box(es): � � , C ' � �j Candidate (office sought): � �j G��,� _ _ � �� ] Political Committee ❑ Check if PC has DfSBANDED � �'' �_ C� -T ❑ Committee of Coniinuous �xistence ❑ Check if CCE has DISBA�VOED °° �'' � ❑ Party Executive Commfttee � 3 � (5) REPORT IOHNTJ.FlERS °°` r ;. � �t) ' rn Cover Penod: From � I l'C / Q To l� I, ��' Report Type � �. �� ❑ Original ❑ Amendment ❑ Special Election Report ❑ Independent �xpenditure Report (6) CONTRI6UTIONS THtS REPORT (T) EXPENDITURES THtS REPORT / �p Monetary `� '� Cash & Checks $ / , � ,� . � Expenditures $ p`, q $ ,'`' Transfers to L�� $ , , . Offica Account $ � , Totai Monetary $ , , , Total Monetary $ � � Other In-kind $ , � � � (S) Distribu�ons $ , , . (9) $OTAL on Contr�{fions to Date (10) T�OT��E.xp�n �ures to Date . '� �� (11) CERTIFICATION tt is a first degree misdemeanor for any person to faisify a pubiic record (ss. 839.13, F.S.) i certify that I have axaminsd this report and it is true, 1 certify that I have examined this report and it is true, co ect �nd omplete + correct a d complate , � —�- S � r � I� Name f Treesurer ❑ De uty Treasurer Name of Candidate ❑ Cheirman (PC/PTY _........,.,,_ niy , . Signatur Signatur DS-DE 92 (9/01) SEfl R�VERSE FOR INSTRUCTI� S AND CODE VAl.UES � � <� r1 -C rn � AMPAIGN TREAS FZER'S REP�RT - ITcMtZED CONTRlBUTIDf�S (1) Name ' " + (2) l.D. Number (3) Cover Period �� /�`' l� through Q� lQ_/ (4) Page � of �_ t�� R) (8) t9) (10) (�'�) ('�2� Dete Full Name Contrt6utor �g� (Lsst, SufFix, First, Middle) Sequence 5treet Address & Contrfbution fn-kind Number Clty, Siate, Zip Code Type oecupation Type Descri tion Amendment Amoumt A�N 8�� -�"n�. Z � �� c2.�� R I R �" �. �� -� � S�Q�� -�Ia 32g5� �� v-�b�NN �� 3 3 0� �38 ��k E� 5Z- n � /G U� a � I `� S�I�a�e�..�i 3�� J�t�l�t �►'►��,NN� 0 3 � D r 1 R� �/ L l/�✓ �i) 5 � -� 3 �, � � CAMPAIGN T EA U R'S REPC�RT - ITEMiZcD EXPENDITURES (1) Narne S '� (2) l.Q. Number (3) Cover Period �Jl`r /� through �!�/� (4) Page � _ of � (s) �7� (8) (g) (h �) (� � ) Qate Fuil Neme Purpose (6) (Lssf, Suffix, Firsf, Middle) �edd office sought ff 5equence Street Addre�s & contrlbution to a Expendtture Number Clty, Stste, Zip Code cendidete) fYPe Amandment Amounf � D 5 ic�n� �o�.sfi� � �� 5 � lu 3 r�.�, s-r `� � ,� P��vil�� Al� 3�d6� �� 2 ? d S ��'"� � � � 5 �'�,�, ST'ak�s �� SZ �1 I� �iki��i' �� ° �,"`,.� P C S . , �.errt,� �6�.-��, 3Zq bZ o Z ��n � o� i�r�. �2i cc� �vi e� � ;o . �5� � C�`a,�.. 3 Z P �x �, AcC��►,� �� 33bZ2 , P3 0l �w� g��r�.. ��;,�,—� �b�'1�"s �,�,� �-•,- �'� � �t- �- �. � A��-- S�bc�i�-- � 3Z95�d j� '(� � V SALE MasterCard Exp. Date: Name: Auth. Code Trans. ID: Sign Master 156 West Third Street Prattville, AL 36067 02/24/2004 x�000cxxx�oocx1213 01 / 07 Michael Heptinstall 024060 QuickBooks Trans. No: VGVA26137578 Merchant No.: Thank you for your business CUSTOMER COPY Total $171.85 482591781992 � . � �.�: i ; �.3�t�t1��+�t�?� , � � � � � �� Y�ge 1 of` � � �� Bank of 1Americe►, N.A, Accauat ;�pt�ber: �'.O. Aoz 2.41�8 i�1i t� OC �'�ttclr�sut � i 4i Tu►r�pt►, 1T1. 33�22n5i18 9Fai.�rrt I�eri�et l.tq10.932.380U t�21�i)U+i t�roz�g#r ti�1�"1/�4 rMf�3�:3 w�w�r.banlcofntrrarri�a.�om '' , � F��,.r�r�tri,�►�,�r�t.��,�.��r��,�i��,��,i�s��t��s#��,�t� roaosaa4 � �t o.�� +� +�1c�, ��r .� �C �► ; br��a�� , `��r+�sfi�c.� : � W��4�� 4�Lii/�� .k . j .. .. . .�i�/p } ��w'+1'� ��y��y�A4�7.1F �� ;. : �� : � . �C��.# i�� '�� i.'7��`�� .. , . � �.. . El�irr Frac� CMIiY�et ��cing a�vi+�. �Iiaws you #an c�seck �uilrrt, b�la►accs. �it!C�A�tplll�� i1Eri��* �1�►!! Stat�ri�ELt PeriOd 42/Ul/CF4 tI►rottg;lt 't��9�1� � Number of D+�asi�slCrec#it� i, �? Nurnber of Withc�ra'w�t.le�%�bit� 2 . ,� Number of Depc�sit+�+r1 Ttern� � ` � Number af �;neloaura� 3 , ,� �111i1kl43' fl� �Aj'� ll1 �i;�'C143 +`,� �j' ` �►�it� �unr� �i# :�Ql71 ��,t Et�din� B�I�n� ��e ��eci�c�r $�i�nce r�'t�+� Gk+i�rga �7i}.Of} ll�� ; '�i#�rdr��s �udt�l ��bi�s: s ,��;,, ...� r,^= .:�� 83.U0 27�.OU 31�i.t1{? �13 U0 `�$J.ti8 : 1G.tx1 �;�ra�e __.. .„� � Y A � �., _ [iOME OF PELKAN 19AP� 1225 Main Stree# Sebastian, riorida 32858 Phone (772) 589-5330 — Fax (772} 589-5570 E-Afiait: citvCa�citvofsebastian.om March 8, 2004 Michael Heptinstall 834 Barker Street Sebastian, FL 32958 Dear Mr. Heptinstali: .�2�►.i� e CQ � Y�y.� e. �✓ , r �G ��.____--- After reviewing Florida Statutes and opinions of the Florida Elections Division (DE 91-07) and (DE 00-04} and City Attomey, Rich Stringer, I must inform you that your campaign tr+easurer's report is considered three days late, and a fine of $224.06 is imposed. Florida Elections Division opinion (DE 91-07) states: `..calculation of/ate days begins on the dayafter the campaign tr�asurer's report is due, including weekends and holidays, and continues end includes the day of the postmaric, courier nsceipt, or certificai+s of mailing, whichever is earlier." In the opinion of the City Attomey, date of receipt of the report falls under the same definition as "day of postmark, courier receipt, or certificate of mailing", I received your report on Mqnday, March 8, 2004. Florida Elections Division opinion (DE 00-04) states: "A filing officer has no discretion with r+egard to fines imposed pursuant t� section 106.07(8), Florfda 5tatutes. The filing officer's duty is ta notrfy a candidate or chairman of a political comrnittee ot' ihe failur� to file a report; defennine the arnount of the fine based upon the formula provided in secfion 106.07(8)(b), Florida Statutes; and noiify the candidate or cheirman of ihe political commiftee of the amount of the fine due. ° I understand your concems that rny February 11, 2004 letter regarding the due date for your first report (18�' day prior} did not arcive until February 24, 2004 because the letter was inadvertently routed through Richmond, Virginia by the postal service. You also stated that you have not yet received the letter I mailed regarding your second report (4�' day prior) due date. Though I sympathize with your situation, these letters were a courtesy and not required by Florida Statutes. I did comply with Florida Statutes by includirig the reporting periods and due dates in your candidate packet. I have no discretion under the law but to impose a fine as set out in the statutes. FS 106.07 sets out the formula for determining the fine. For failure to file the report due on the 4�' day prior to the election, the fine is $500 per day but no more than 25 percent of the contributions or expenditures, whichever is greater for this reporting period. Your expenditures for this report were �298.75 and were greater than the contributions. The formula for your fine is therefore, $298.75 X.25 X 3 for a total of $224.06. In accordance with Florida Statutes, your fine cannot be paid from the campaign account, shouid be made payable to the City of Sebastian, and will be deposlted into the City of Sebastian general fund. Please refer to FS 106.07 for �provisions regarding your right of appeal to the Florida Eleciions Commission. Si cer y, �c , ��/ Sally A. M o, CMC City Clerk cc: City Atiomey, Rich Stringer Ann Rousseau From: Ann Rousseau Sent: Monday, March 08, 2004 9:53 AM To: Rich Stringer Subject: Heptintall's Campaign Report Hi Rich - Mr. Heptinstall brought me the 4th day prior campaign report this moming at 8 am which was due by 5 pm Friday, March 5th. He was out of town on Friday and did not get back until after 5 pm. He said he had written today's date as the due date on his calendar rather than Friday's date for some reason. He brought with him the first letter I sent out for the first report, which is date stamped through our postage meter on February 11th and then postmarked in Richmond Virginia on February 19th. He said he received it at his address on February 24th. It was slit open on the top and sides �nd stapled back together. He says he has no connection to Richmond Virginia and that he has never received the second letter I mailed out on February 20th for the second report. I mailed another letter last Friday for the termination report due in June. I asked him if he should receive either of these letters to bring them to me so I can make a copy of the envelopes. I will contact the post office to ask them how a letter addressed to 834 Barker Street, Sebastian, FL 32958 endeci up in Richmond, Virginia. I would like to talk to you about whether I am bound by state law to impose a fine. It states: "Upon determining that a report is late, the filing o�cer shall immediately nofify the candidate or chair of the political committee as to the failure to file a report by the designated due date and ihat a fine is being assessed for each late day...... " My first question is, would I count Saturday and Sunday in the count of late days or not? If not, then it is less than a day late since he had no opportunity to bring it to me after the 5 pm deadline until first thing this moming. Notification is unnessary since he has already submitted the report. It continues......... "however, for the reports immediately preceding each primary and general election, the fine shall be $500 per day for each late day, not to exceed 25 perceni of the totoal receipts or expendiiures, whichever is gre�ter, for the period covered by the late report, Upon receipt of the r�sport the filing officer shall determine the amount of th�e fine which is due and shall notify the candidate or chair. The filing officer shal/ determine the amount of the fine bas�d upon the earliesf of the following: 1. When the report is actually neceived by such o�cer. 2. When the r�sport is postmarked. 3. When the certificate of mailing is dated. 4. When the receipt from an established courier company is dared. Such fine shall be paid to the filing of�icer within 20 days afler r�eceipt of the notice of payment due, unless appeal is made to the Florida E/ections Commission pursuant to paragraph (c). (c) Any candidate or chair of a political committee may appeal or dispute the fine, based upon unusual circumstances surrounding the failure to file on the designated due dafe, and may request and sha/l be entitled to a hearing before the Florida Elections Commission, which shall have the authority to waive the fine in whole or in part ................................. My next question is, do I have the authority to waive the fine based on unusual circumstances or am 1 simply bownd by Florida Statutes to impose a fine for any late filing? Is the Florida Elections Commission the only authority for waivers? If I must impose a fine, it would be based on his expenditures ($298.75) which are greater than his contributions ($175.00) for this report. His fine would be $74.70 if his submittal was considered one day late. I suspect that although the candiate did have the cor�ect date for submittal in his candidate packet and submitted a 106 �, form with his qualifying papers, the facts surrounding receipt of the first letter and his claim that he never �eceiveid the � second letter might be considered a special circumstance in an appeal. •S�� - I � Please advise me. If you would like I can also contact the Florida Elections Commission. � ll Thank you - Salty �,, � �,c.��.o,y�� :,�=- �'� ��. C, �r' � �� no �� 1 � � E �--' �.. �--- ;��,� � :�.�� HOME OF PELICAN ISlAND t2?5 Main Street Sebastian, Fiorida 32958 (772) 589-5330 phone - (772) 589-5570 fax March 5, 2004 Michael Heptinstall 834 Barker Street Sebastian, FL 32958 Dear Mr. Heptinstall: In accordance with Florida Statutes a campaign treasure�'s�termination report must be filed by June 7, 2004 and witl include all IawFul expenditures in accordance with 106.11(5} and final disposition of surplus funds in accordance with 106.141. if you have any questions, please do not hesitate to contact me at 589-5330. Since , � � 4 . Sally A. Maio, CMC City Clerk sam � a � � M ` '� '�' L . , iM �m ,� - ,;j c� ,�' �xr. � i r � �,' . �t IIL ^ � ��I �,n �`�''�. ;� ;,. , �: ti 'ai �� I'� S �' �� .,.{� �� 1 y— I�II� AI � �f.l 'i�f�.) �,'t�f � `�. � ��'1 ��J�e�r ;7 '�� •o 11 qn � S� Cti� '`15 � „� �, �,Mt 4� .:;� ,:r J wNk ' <n ` �.• ,�. 'c�i ,.� i; . '�1t +.. r.; ..n _ .._ �[ .� \ A . . ..�.... � W.^ YI � /!� Vr �� . N � M C �`-� J p. � LL = N C � � � � m � .a � � � � Q � ,�} Z u7 � ,� s � � _ �, r.. � �- � � �� o �.. W � LL �� W l[] � �O N :�, �:..:� W! r (iS � • kp' t c � � a' _ � t ..� � � � .�r .�r� r� �'" �}i .� •r"f ��} � !� ! :�'� �� =w� �, i '', �� , h � � 2 li T F' � � 7 � �. � � �,4 � .: u 4 . ' # �I� �.. � _ ... �J e. , �(\� � ti_ �� `, !7 � \ . `�� - � .� � � �J � . � � � � � � � � ,' rnvuF SE�`�T�N HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 589-5330 phone - (772) 589-5570 fax February 20, 2004 Michael Heptinstall 834 Barker Street Sebastian, FL 3295 Dear Mr. Heptinstali: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your campaign for the period February 14, 2004 through March 4, 2004 is due in the Office of the City Clerk by 5 pm on Friday, March 5, 2004. 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. Ptease read FS 106.07(2)(a) for further details. The March 5th report will include all contributions and actual expenditures for the period 2/14/04 through 3/4/04. No contributions can be accepted after midnight of March 4th For future reference, a termination report must be filed within 90 days of the election (deadline June 7, 2004) and will include all lawful expenditures in accordance with 106.11(5) and final disposition of surplus funds in accordance with 106.141. I have enclosed additional forms should you need them. If you have any questions, please do not hesitate to contact me at 589-5330. Sin , . 1'/ . �J Sally A. aio, CMC City Clerk sam rnvoF SE�, ,,,,, N � :._. _ HOME OF PELICAN ISLAND t225 Main Street Sebastian, Florida 32958 (772) 589-5330 phone - (772) 589-5570 fax February 11, 2004 Michael Heptinstall 834 Barker Street Sebastian, FL 32958 Dear Mr. Heptinstall: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for the period January 1, 2004 through February 13, 2004 is due in the Office of the City Clerk by 5 pm on Friday, February 20, 2004. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. Please read FS 106.07(2)(a) for further details. For your information, City Hall will be closed on Monday, February 16, 2004 in honor of Presidents' Day. If you have any questions, please do not hesitate to contact me at 589-5330. Sin ely, � , c ^ Sally A. Maio, CMC City Clerk sam FLORlDA QEPARTMENT OF STATE, DIVlStON OF ELECTIDNS CAMPAlGN TRE�4SURER'S REPORT SUMMARY (�) r� �, L ; s _.�2� Candidate, Committee or Party Neme l.D. Number r3, �� z�� 5�a�-- -�'l �. 3 Zg s � Address (number and street) City State Zip Code ❑ Check box if address has changed since last report �.T (4) Check appropriaie box(es): , p , � J � � C� � � '� <� j� Candidate (office sought): I�. � C j '�_m.� , ❑ Political Committee ❑ Check if PC has DlSBANDED �,, �� ❑ Committse of Coniinuous Existence ❑ Check if CCE has DlSBAN�ED Q�� ❑ Party �xecuiive Committee 3 � � G'� (5) REPORT IDENTIFl�RS �� , �- �1 �--► t;. Cover Period: From Q � / � � / �—1 To QZ- / � � / � Report Type �_ ❑ Original ❑ Amendment ❑ Special Election Report ❑ independent Expenditure Repart (6) CONTRIBUTIONS THlS REPORT (7) EXPENDITURES THIS REPORT c� ay Monetary 6 Cash & Checks $ , , �J . -- Expsnditures $ � � � �- Transfers to Loans $ , , . Office Account $ � , Total Monetary $ , , , Totel Monetary $ , � Other In-kind $ , , � . (8) Distributions $ , � , (9) TOTAL NFonetary Contributions to Daie ('10) TOTAL Monstary Expendttures to Date � S�� °-° � , , I s$ . 36 , . (11) CERTIFICATION !t is a first degree misderneanor for any person to felstiy a public recard (ss. 839.�t3, F.S.) i certify that i have examined this report and it is true, i certify that I have examined this report and it is true, correct an ncompiete ;�� correct and compleie � 1 �' Neme of �] 'ireasurer ❑ Deputy Treasurer Name of ,� ' ate ❑ Chairman (PC/PTY i nIY) Signature Sign r DS-DE 12 (9/07) SEE REVERSE FOR INSTRUGT NS AND CODP VALUES � CAMPAt�N TREA�Ui�ER'S REPORT - ITEMiZED CONTR[BUTIOhS (1) Name �, � / � (2) l.D. Nurnber (3) Cover Period �_/�/� through�� / � � (4) Page � of � �g) R) i8) �9) i'��) i��) i'�2� Date Fu11 Name Contributor �g� (Lect, Suffix, First, Middle) Sequence 5treet Addrees 8 Cormibution in-kind Number City, Stete, Zip Code Type Oecupation Type Descri tion Arnendment Amoumt �.b i � 0.. � �b�ii � 1V , �l c� o�� 3� ��.k�.. s-� r� u( 1� l�o � 5��n�,�a�-- ��°" 3Z�S� �b E v�� J� ��b �'��,l,ut " � l r .�� j� �� - �,�./� — 6c�.c.� ( a- � , n,� e � S � 0 Z. b 12,q3a N 1.�.�� bh. �l, +� 6a- D�r� l:� 7U �a�G-- �a- �� - �s � �Z D3 C �(� � �� C�b 0 2. 0 3 ��`' � rc�w � �,S . � b ov s��- �ia c.�• � S�i� �� ', �� $Rb�rr� � � d .° OZ d3 � �$� ��°� � . S�.-w.. �'i� oz a3 0� ��ll ��e. Ca"5 �p v� 1�� C�it,�. Ci�,�, c� �� -�►.k �5� oZ o3 0� s�o�s . ��Z sc CoA— 50 "—° � �� s;�� > �� .�. � � � _ � �`i�a�� "i��*� ��r — �� c�i��m��$ � . " , � . ' � �.11. �►%r' t�� 1� i�� c�wr �rri�.�..{..l.,,�..�t.�: ��Q� ,� � ��;;�� {� �p�r,,,�,�,,,�',�„�.�.�. �`.�....�..._ t� r t i � C�il,�„ �:�r a a � �� ,� �� l�r+Ryl�lm � �.''�' � �� » �� ! ; , 1�1�5 ` �� .r�� r�� , � 6��. �i�. , � � . ��I �1�� $ 4� °= 4b1 G�i�.. ��:d s�la�� - . � /6� , jo�a �,�. e�►� �{� ; ��s�i Q.�v t�� M � �� t�t. � ��",,,t,,�.+. �t .� :� � � � �� , � , � � i . # , , � � 1�l5TRUCTIONS FDR CAMPAIGN TREaSURER'S REPORT SUMMARY (1) Type candidate's full name or narne of the political commtttee (PC), commfttee ofi coniinuous existence (CCE) or party executive comrnittee (PTY). (2) Type the idenfification number essigned by the Division of Eleciions. (3) ��) 7ype the addrsss, including c)ty, stete and zip code (may use post ofFice box). If the address has changed since the iast report filed, piease check the box. Check appropriate box(es): Candidate (type ofFice sought including district, circutt or group numbers), PC, GCE, or PTY, tf PC or CCE. hes disbanded end will no ionger file reports, piease check the respective box. (5) Report fdentiiiers: Type cover period detes (e.g., From 1/1lD1 To 9i30/01 ). (See Ca/endar snd Elecfion D�tes for appropriate year and cover periods.) Enter the Report Type using one of the foliowinp abbreviations: iF A SPECIAL ELECTION REPC3RT ADD "S" IN FRONT OF THE REPORT CODE (i.e., "SG3"). DUARTERLY REPORTS GENERAL ELECTION REPORTS Januaryquarterly .....................................................Q4 46�' day prior ........................................................G1 Apriiquarterly ..........................................................Q1 Julyquarteriy ...........................................................Q2 Octoberquarteriy .....................................................G13 PRlMARY REPORTS 32"d day prior ........................................................... F1 18�' day prior ............................................................ F2 4"' day prior .............................................................. F3 32"� day prior ........................................................G2 18�' day prior ........................................................G3 4"' day pnor ..........................................................�4 90-DAY REPORTS (Candidates Oniy) Tetmination report ............................................... TR Indicate whether this is the Original (first) report for this pericd or if this is an Amendment. Also check the appropriate box to indicate if this is a Speciai FJection Reporf or an Independent Fxpendlture Report (5ection 106.071, F.S.). (6) Type the amounts of ali Cash & Checks, Loans, Totel Monetary and In-kind contrtbutions identffied on tfiis rec�ort on the appropriate iine. (Tote/ Monefary is the sum of Cash & Checks and Laans.) (7) Type the amount of ail Monetery Expenditures, Transfers to Ofi'ice Accaur�t and Tota! Monetary Expend'rtures identified on this renort on the appropriete line, (Tata/ Monetary is the sum of Monetery ExpeadPtures and Transfers to Office Account.) (8) Type the amounts of OfherDisfributions identi�ed on th s re ort on the appropriate fine. (�therDistrfbutiona are goocis or aervices contributed to a candidate or other committee by s politicai commfttee, commlttee of continuous existence or a party executive committee.) (9} Type the amount of TOTAL Monetary Contributions to Date on the appropriate fine. (10) � Type the amount of TOTAL Monetary Expendltures to Dete on the appropriate tine. NOTE: For (9) and (10) above — Committees and party exectrtive committees will keep cumutative totals for 2 yeer periods at a iime (example: January 1, 2000 throu0h December 31, 2001). Candidates will ke�p cumuiative totals from the time the campaign depository is opened through the termination report. (11) Type or print required nerne and heve them sign: ♦ Candidate Report (treasurer and candidate must sign) � PC Report (tressurer and cheirrnan must sign) ♦ CCE Report (treasurer must sign) ♦ PTY RePort (tressurer and cheirman must sign) AMENDMENT itBPORTS; An amendment report summery is to surnmerize only the conMbutions, expenditures, distributions end fund transfers being reported as additions or deletions. Pieese read the instructions for the sequence number fieid and the amendment type fieid on the back of forms DS-DE 'l3, 'f4, 14A end 94. The Division wlll summarize all reports subrnitted for each reporting period and for the filer t� date. INSTRUCTIONS FOR CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIOhS (1) Type candidate's iull name or neme of the political committee (PC), comrnittee of continuous e�astence (CCc) or party executive cornmittee (PTY). (2) Type the fder�ti�cstion number assigned by the Division af E.lections. (3) Type cover period detes (e.g., 411/04 through _ 8I30/D4 ). (See Ce/endar and Flection Dates for eppropriate year and cover periods.) (4) TYPs P89e numbers (e.g., 1 of ,3„_). (5) Type date corrtribution wes RECEIVED (MonthlDay/Year). • (6) Sequence Nurnber - Each detail line shail heve e aequen� number assigned to ft. 5equence numbers ere to be assigned within each reporting penod end for eech type of dstsfl Ifne, Thus the report type, detafl fine type, and sequence number will combine to uniquely identffy a specffic contrlbution, expenditure, distrfbution or fund transfer. This method of unique iderrtffication is required for responding to requests from the Divieion end for reporting emendments. For exempie, e C�1 report having 7� mnMbuutions would use aequenca numbers 1 thru 75. The r�xt report (Q2), compnsed of 40 corrtributions would use sequence nurnbers 1 through 40. ContNbutions on amended Q1 reports woutd hegirt with sequence number 76 and on amended Q2 repor� would begin with aequence number 41. See the Amendment Type instrucfions below. (7) Type full name and address of contributor (indudinp ctty, state and zip codej. (8) Enter the type of corrtributor using one of the folfowin8 codes: Individual = I Business = B (eiso fnciudas corporations, organizstions, groups, eta.) Commlttees C C (includes PC'c, CCE's and hderal committaes) Politfcal Partias = P (indudas federal, state and courrty executive commtttees) Other = O (e.p., candidabe surplus funds tc parly, etc.) iype occupation of corrtributor for cor�Mbutions over �100 only. (If a busfness, piease indicete nature of business.) (9) Errter ConMbution Type usin8 one of the following codes: NOTE: Cash inctudes cash and cashfer's chscks. (10) Type the description of eny in-kind cordribution received. Cash Check In-kind Interest Loan Membership dues Reiund CODE CAS CHE INK iNT LOA DLIE REF Candidate's Only —�If in-kind contribution is from a psrty axacutive committae and is allocable toward the contribution limtts, type an "A" in this box. If aontribution is not aliocabie, type an "IV". (11j Amendment Type (required an emended reports) . To add e new (previousiy unreported) contrtbution for the reporting period being emendad, entec "ADD" in amendment type on a line with ALL of the required deta. The sequenoe number for cornributlons with amendmerrt type 'ADD" wlll start et one plus the number of contributions in the onginal report. For example, arnendin8 en onpinel Q1 report thet had 7� contributions, means the sequence number of the i'irst contribu�on havin8 amendmant type •ADD" wtll be 76; the second "ADD" corrtributfon would be 77, etc. When amend'mg en originel C12 report that hed 40 conMbt�tions, the aixth "ADD" contribution would have sequence number 46. 7o correct e previously submitted contrlbution use the following drop/edd procedure. Enter "DEL° in amendment type on e line wlth the aequenc� number of the contribution to be corrected. In combinetion with the report number bein� amended, this aequence number wUl identlfy the conMbutlon to be dropped from your ective reccrcis. On the next line enter ADD" fn amendmerrt type end ALL of the required dete with the necessery corrections thus reptean� th� dropped data. Assign the aequence number es described sbova. (12) Type emount of conMbufion recaived. Commktees of continuous exiatence ONLY: Any corrtMbution which represerns .the peyment of dues by a member in e fixed emourrt pursuerrt to the schadule on file with the Division of Eiections need onry Ifst the egpregete emount of euch contrlbuUqn, together wlth the number ct members paying such dues and the emourit of rnembership dues. CAMPAtGN TREASURER'S REPORT - ITEMiZcD EXPENDITURES (1) Name � 1`i� INst+�'�l (2) l.D. Number (3) Cover Period �/�/ 0� through� �- /� 3 / �� (4) Page of i5) �� (a) j9) (10) (� � ) Date Full Neme Purpose (6) (Lsst, Suffix, First, Middie) (edd office soupht If Sequence Straet Addreas & cor�tMbution to s �Penditure Number Clty, State, Zip Code cendldate) TYPB �+m.ndmsnt Amount o► � a �- �'°r � a R� 6l� ( �P�N-t� ZN�.- � � 132.. S 1�' � '� a s,� �►u � A� ,N�, ��g � bs2o�D DixiE � v�. a 324�� INSTRUCTIONS FOR CAMPAIGN TRcArSURcR'S RFPORS - IT�MIZED EXP�ND(TUR�S (1) Type candidate's tuil name or name of the poqtical committee (PC), comrnittee of continuous existence (CCE) or party executive committse (PTY). (2) Type identification number assigned by the Division of Elections. (3) i ype cover period dates (e.g., 7/1 /01 through 9130/01 }. (Ses Calendar and Flection Dates for appropriate cover periods.) (4) Type page numbers (e.g., 1 of 3). (5) Type date of expenditure (Month/Day/Year). " (6) Sequence Numbe� - Each deteii fine shall have a sequence number assigned to f� Sequence numbers �re to be assigned within each reporting period end for each type of detatl line. Thus the report type, detail line type, and sequence number will combine to uniquely identify a specific contribu4on, expenditure, distribuiion or fund transfer. This method of unique identtficetion is required for responding to requests from the Division and for reporting amendments. For example, a Q1 report having 40 expenditures wouid use sequence numbers 1 thru 40. The next report (02), comprised of 30 expendttures wouid use sequence numbers 1 thru 30. Expenditures on amended �1 reports would begin with sequence number 41 and on amended Q2 reports woutd bepin with sequence number 31. See �4mendment Type instructions belov�r. (7) Type full name and address af entity receiving payment (inciuding city, state and zip code). (8) Type purpose of expenditure (if expenditure is a contribution to a candidate, also type the office sought by the candidate). PLE,0.SE NOTE: This coiumn does not apply to candidate expenditure�, as candidates cannot contribute t� other esndidates from cempaign funds. However, PCs (supportin8 car�didates), CCEs and party executive committees contributing to candidates must reoort office sought (Section 106.07, F.S.). (9) Enter Expenditure Type using one of the following codes: DESCRIPTION I CODE DisposiUon of Funds (Cend.) DIS Monetery MON Petty Cash Wlthdrawn PCW Petty Cesh Spent PCS Trensfer to Office Account TOA Refund �F (10) Amenciment Type (required on amended reports) - To add a new (previousfy unreported) expenditure for the reporting period beinp amended, errter "ADD" in amendment type on a line wlth ALL of the required data. The sequence number for expenditures with amendme� type "ADD" will start at one plus the number of expenditures in the original report. For exemple, amending an original Q1 report that had 75 expenditures, meens the sequence number of the first expendtture heving emendment type "ADD" wlil be 76; the second "ADD" expenditure would be 77, etc. When emendin� en originel C12 report that had 30 expenditures, the nin�h "ADD" expenditure would heve sequence number 39. To correct a previ�usiy submitted expenditure use the foilowin8 drop/edd procedure. Enter "DEL° in amendment type on a fine with the sequence number of the expenditure to be corrected. in combinefion with the report number being emended, this sequence number wiil ldentffythe expenditure to be dropped from your active records. On the next line enter "ADD" in amendment type and ALL of the required deta with the necessary corrections thus repfacing the dropped data. Assipn tha sequence number as described above. (11) Type amount of expenditure. � I T�TAL PRiN'�", ��s� 1 i32 U.S, Highway '� �eba�tian, �Ir�rir�� 9�1 �.Mpif• p�intitnow+�aai:com (7`72) 5�8-9fia8 � {7T2j ��-5Q�4 (��Cj SOi.D Tt1: Niichwel Nepti►�#ttall Compai�►� 567-3694 1.0(?0 .,,...,.wr.» � � � � � ' '. � � No, � t� V V � Dat� t127'/Qi4 Cwtonar P.t). �io. 1�L�'iiBE P�iY Ri� THH�S I�tM� Paat � �ts �re st�i�isc�t to /et� ip�Yr»� .�r�»rre � d� t,6�6 p�ar rrta+�h. {�t P'a�+rt�ye �► W► ��,�. Bt��+as £art�s �fih�lc N�kj,, 3.5: �� V�i�eaw 8�f Mlhi�r t"�rer �+9 N�e. ccpi� 34 up c�n 1 �da � � � t b�' � �� "* ��. � �M ""��. a � ,� �,. � �� „ ''~�� :��' .� � � � `` N .�- �: �� z$.00 � .�s 2s.�s , � � ' �� 652 OLD DIXtE HtGHWAY VERU BEACH, Fi. 329�2 PX (569 j 552-122$ FX (�fi1) 5�2-98$1 _ _ _ . _ __..._. _ . __.__.._ _ _.__._. _ _..._, BfLL TO � � � �� , .... .... _ ... ._...... . .. .. . ..-____._...,..._.- .___ .............___ _..... .. . . .. � MICHEaC. HEPT�lYSTALL CAMPatGN 834 BARKER ST. ' ` SEBASTIAN, FL. 32958 581-9976 � � , _ . _ _. .. _ _ .: ., __ _._ ...._� Inw�itQ DATE INVO#�E NO. . _ _ _ , _ _._ . 1/29l2004 ` 12+�09 ___ _ __ { SHtP TO E �..._.... ......._......__...._..__.._ . __..�.__.... . _ _. , �, . _. ... _.__ , s M/CKEAL HEPT�NSTAIL CAl�lPAIG(�t ; 83+� B�Rl�R ST. ! SEBIRSTIAIV, FL. 32958 i 58i-fi►S76 _�_..__ .. � ...._ . . . . ; . __._ . _ . .. .. , . ....,... .._.._. .. ...„.�.�_..,_....._ y . .. . ....... . .. . ...... ..T...,..._.. .. . .....„_... ._ ... ... .. . . P.O. NO. ; TERMS ; REP SI-ttP DATE ? SHIP V!A ; JOB : __ __ __ _ � _ _ �_.. _... .._ ._. _ _ . Due an r�caipt TMS � 9/29J2t��1 � PJCK UP HEPT'JN DiELL2 _._.._ ___.____�_ __ ________ __ _ _.. __ _ __ _ tTEM � L?ESGRIPTIC3N � QTY RATE AMC)UNT 13 � __ _..... _.,...._.m ::�;.____�.��__..... ._._._.__ _ � . _._�_:__ ._�_____ _ _._ _.�. _ _ _ . MAf,NETIC MATEiRtAL (12 X24) SlGNS .t 4� f__ ,30. dfJ t'20. CXI' T ; F�R CAMPAl�N llli 1R�7) LETT�Rl�I1G S j SAI.ES TAX �� y �� 7.0�% . � 8.4a � � � ; � , � � s ; i ; ; ___ ____�__. -,-- _ _.. . ___ _. .. , Thank ,you for ynur busrness. r.:,,.:�:�°� : G > m.r �s � ; ,� _ _.__ . __ ._ __ � Totai �,�2$.ao LOYALTY OAiH CANDIDATES WITH NO PARTY �FFIL? Q TION (Secrians 876.05-876.10, Fiorida Statutes) STATE OF FLORIDA TNnTAN RTVER COUNTY lease Print j� M HEPTINS L Firat Name Middie NamelInttial Laat Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do bereby soleinnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. OATH OF CANDIDAiE (Section 99.021, Fiorida Sfatutes) j, MICHAEL TiEPTIN mAL.r. (pLEA6E PRINT NA1►� A6 YOU WISH IT TO APPEAR ON THE BALLOT — NAME MAY NC3T BE CSANGED APTER TSE END OF QUALIFYING) am a candidate farthe officeof CTmv (`f1iiN('TT. MF'MRFg � � (0$lca) (diatrict) (cirCUit) . I am a c�uaiified elcctor of INDIAN RIVER Coutrty, Florida. I am (group) qualified�under the Consiituiion �d the La.ws of F"lorida to hold the office to which I desire to be nominated. or elected. I have qualified for no ot�ier public office in the state, the term af which office or any part theseof runs concw.rent with the o$'ice I seek; and I ha.ve resigned from any office from which I am required to res�ign putsuant to Section 99.012, Florida Sta.tutes. ITND�R pENAL1'IES OF PERTURY, I DECLARE TSAT I HAVE READ TH� FOREGOING LOYALTY OAT'g AND OATH OF CANDIDATE .AND THA.T THE FACTS STATED IN EACH ARE TRUE. , SIGN HERE igna of Candidate ( ) �772 )567-�694 ° 834 BARKFR cm '7��-�6�--663' ° Mailing A.ddress Day Phone Fax Number � - T ^� _ L� JANUARY 1 9 2 0 0� City State 'p ode Dau 5igned �+ cn m CiD a> cr, -t z, : DS-DE 2dB (Rev. 8�99) 43 _ � -i 3 -� � � r- � � aV � . n c� rn C � e� �i'�T�MENi' OF RE�EIYE� i �. � �AN D I ��4�� (Section 106.023, F.S.) (Please Type) � MICHAEL L HEPTINSTALL � OF CIiY CLE��:; �� P�i � �� candidate for the office of CITY C�UNCIL MEMBER OF SEBASTIAN FL. ' , have received, read and understand the requirements of Chapter 106, Florida Statutes. , �... x �� ignat e of didate Date Each candidate must fife a statement with the quafifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is fiied. Wil�Ful faiiure to file this form is a first degrse misdemeanor and a civil vioiation of the Campaign Financing Act which may resul� in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS-DE 84 (Rev. 8/99) an a �� -- ��.�� HDME Oi PEUCAN 15iJ1ND REC�IYE9 ,.�I J ASTI;",i'� :=c=ICC 4F CITY CLE:�;',; �o�y �� P� � �� ELIGIBIL(TY TO HOLD OFFtCE OF COUNCIl.MEMBER ction 2.02 - ELIGIBIL(TY o person shall be eiigible to hold the office of council member unless he or st�e a qualified eiector in said city and actually continualfy resided in said city for a :riod of one (1) year immediatefy preceding the final date for quaiificaiion as a .ndidate for said office." � �� ,I�(1 � C �� 1 '�� Ns p, � � , candidate for the office unciimember, meet the quaf�ficaiions to be efigible to hoid office as required ction 2.02 of the City of Sebastian Charter, above. , , ..�, ��tc... ... � . . ... rn to and subscribed before me this � 5 day of � , 3� . � C'��Q, `YY1- � �tary Public �te of Fforida "�� Carol M Echeverri .;�rsv vue'; =_•�� `� = Commission #DD250966 �;�.P�; Expires: Se� 21, 2007 ' •ol,: Bond � '�.,'F oF t� ,. Atlentic Bonding Co., lnc. PART A- PR�IMARY SOURCES OF INCOME [Required by Sec. 112.3145(3)(a)1 or (b)1, Fta.'Stat) Part A)s intended to require the disclosure of your prinaipai aources of income during the disclosure period. You do not have to disclose the amount of income received. The sources ahouid be listed fn descending order, with the largest source first.. Please list in this part of the form the name, address, and pnncipal business �ctivity of each source of your fncome which (dapend- ing on whether you heve chosen t� report bssed on peroentege thresholds or on dollar value thresholds) efther: exceeded five percent (5g6) of the gross income recefved by you in your own name �r by eny other person for your beneflt or use during the disclasure period, or exceeded $2,500.00 (of gross ir�come roceived durinp the disclosure period by you in your own name or by any other person for your uae or beneflt). You need not list your pubifc safary resumng from pubNc ernployment, but this amount should be included when calculating your gross income for the disdosure penod. The income of your spouse need not be dfsdoeed. However, ff you are repordng based on percentsge thresholds and if there is joint income to you and y�ur spouse from property held by the enbreties (such as interest or dividends frorn a bank account or stodcs held by the entlretlas), you should include all of that incorne when calculatlng your groas income and disclose the source of that income if it exceeded the 5% threshold. "Gross income" means the eame as it does for incorne tax purposes, including all Income from whatever aource derived, such as compenaetlon for services, gross income from business, gains frorn property dealings, interest, rents, dividends, pensions, distributive shere of partnership pross lncome, and alimony, but not chiid support Examples: — If you were employed by a company that manufactures cornpute�s and received more than 5% af your gross income �salery, commissions, etc.) frvm the company (or, altemetively, �2,500j, then you should list the name of U�e company, its eddress, and its prinapal business ecHvlty (computer menufacturing). — If you were a partner in a law firrn end your distributive share oi partnership gmss lncome exceeded 5°� of your gross income (or, alter- natively, $2,500), then you should liet the narne of the flrm, Its add►ess, and its prinapal busineas ectivlty (prsc�ce of taw)• — If you were the sole proprietor of a retail gift busineas and your Aross income from the busineas exceeded 5°� of your totel gross Income (or, eltematively, �2,500), then you shouid list the name of the buainess, its addreas,•and tts pnnapsl business activiry (reta(I gift sales). — If you received income from investme�ts in stodcs end bonds, you are requirod to list only eech fndividuaf company from which you derived more than 59� of your grnss income (or, altematively, $2,500), rather than eggrepating all of your investment income. — If more then 5°k of your groas income (or, eftemativsly, $2,500) wes gain from the sele of property (not just the selling price), then you should list es a source of income the name of the purchaser, the purcheaer's address, end the purcheser's prindpai business activtty. If the purchas- er's identity is unknown, such as where eecutitfes listed on an exchange are sold through e brokerage firm, the source of income ehould be listed simply as "sele of (name of compeny) stock," for example. — if more than 5% of your gross fncome (or, altematively, $2,500) was in the fortn of interest from one particular finandal institution (apgreBat- ing interest from all CD's, accounts, etc., at that insUtution), liat the neme of the inatltution, its address, and its principal business activiry, 'ART B- SECONDARY SOURCES OF INCOME jRequired by Sec. 112.3145(3)(a� or (b)2, Fla. Stet.] This part is iritended to require the disdoaure of major custome�s, cli- nts, and other sources of income to businesses in which you own an inter- st. You wfll nof have anything to report unless : (a) If you ere reporting based on peroe�tage thresholds: (1) You owned (either directly or indirecdy in the brtn of en equi- tebie or beneficiai interest) dunng the disdosure period more than five percent (5%) �f the tatal assets or capital stock of a buslne entity (a corporetion, parinership, limited pertnership, proprieto ship, joint venture, trust, firm, et�., doing business in Flaida); an (2) You received more then ten percent (10%) ofyouFgross incom during the disclosure period from that business entity; end (3) You received more than $1,50D in gross income ihvmthat bu ness entity du�ing the period. (b) If you ere reporttng based on dollar value thresholds: (1) You owned (etther directly or indirecUy in the form oi an equ teble or beneflclal intarost) during the disciosure period more tha five percent (5%) of the totel aesets or capfial etock of e buslne entitty (e corporetion, pertnership, IfmRed partnership, proprieto ahip, jofnt venture, trust, firm, etc., doing business in Floride); an (2) You raceived more then $5,000 of your pross incorne dunn the disclosure period from that business enUty. . If your irrterests and gross income exceeded the appropnate thrsshdds liste above, then for that business entity you must list every source of income the business entity which exc�eded ten perceM (10°�) of the businees entliy groes income (computed on the basis of the business enttty's mast recen completed fiscal year), the source's address, and the source's ptincipal bu ness activlty. Exampfes: — You are the sole prop►ietor of a dry cleaning business, fran whi you received more than 10°� of your gross income (en amauntthat w more then $1,500) (or, altemadvefy, more then $5,000, if you are usin dollar velue thresholds). If only one customer, a uniform rer�sl compan provided more then 10% of your dry cleening business, you must list th neme of the uniform rentel company, Its address, end its prinapel bu ness activity (unfform rerrtals). — You are a 20% perfier in a partnership thet owns a shopping m and your pertnerahip inc�rne exceeded the thresholds Usted above. Yo should list eech tenant of the mall that provided more than 10°k oF th partnership's gross income, the tenanYs eddress and prinapsl busine ectivity. — You own en orange grove and sell ell your oranges to one merketin cooperative. You ehould iist the cooperative, Its address, and tts prin pei 6usiness acdviiy if your income met the thresholds. PART C - REAL PROPERTY [Requfred by Sec. 112.314b(3)(a)3 or (b)3, Fle. Stet] In fhis pert, pleese list the locetion or description of all real property (len and buildings) in Fforide in which you owned dirediy or indirecdy et eny tim dudng the previous tau yeer in excess of five percent (5%) of the property value. This threshold is the seme, whether you are using percentage thres olds or dollar thresholds, You are not required to list your residences an vace�on homes; nor are you required to state the value of the property o the bmt. Indirect ownershlp fncludas sltuetions where you are e benaflciary a trust that owms the property, as well as situations where you ere mo then a 5� pertr�ar in a partnership or stodcholder in a corporstion thet ow the property. The value of the proparty may be determined bN the mo receMly aeaessed velue for tax purposes, in the ebsence of e mcire curre appraiael. The location or description of the propetty should be autfficient enable anyone who looks at the form t� Idantlfy the property. Althouph lepa� deacxipfion of the property wlli do, such a lengthy descrip�on fs n required. Using simplar descriptions, such as "duplex, 115 Terrace Avenu Tallahessee" or 40 ecres located ffi the iMereectlon of hiwy. 80 and I-95, La County" � suifiaent. In some cases, the property tex identiflcetion number the properry wlll help in Idantirying ft: "120 acre ranch on Hwy. 901t, Hend County, Tax ID # 131-45883." (CONTINUED on page 5)' � � Il'�STRUCTIONS FOR COMPLETING FORM 1 STATEMENT �F FINANCIAL INiERESTS W80 MUST FILE FORM 1: q�i pBrsons who fall within the cetegorfes of "stete officers," "local offlcers/employees," "specified state employees," as well es candidetes for elective iocal offi are required to file Form 1. Posttions withtn these cateeorfes are listed below. Persons requlred to flle fuli financial disclosure (Form B) and officers of the judic branch do not flle Form 1(see Form 6 for a Itst of persons who must file that form). iSTATE OFFICERS include the foliowing positions for state aftfcfals: municfpal building inspector, county or municipal water resourCesco�rdinet 1) Elected pubiic officiais not serving in e polfticel subdivision of the county or municipal poliution control director, county or munia�al environme state and any person appointed to flIl a vacsncy In such office, uniess requfred te► control .director; county or municipal administrator wlth pawer to grant to flle fuil disclosure on Form 6. deny a lend development permit; chief of police; fire chfef; nnunicipel cle 2) Appointed membsrs of each boerd, c�mmission, euthority, or council district school superintendent; community college president; rlistrict medi having statewide jurisdiction, excluding members of solely advisory bodles, examiner, purchasin8 agent (regardless of btle) having the authaity to ma but lncluding Judicial nomineting commissian mernbers end Dfrectors of the FL eny purchese exceeding $15,000 for the locel govemmental unft. Black Business Investrnent Board, Enterprise Ftorida, and Workforoe Florida. SPECIFIED STATE EMPLOYEES indude the bllowing positio 3) Members of the Board of Repents, the Chancellor and Vice for state employees: �hancellors of the state university system, and Prestdents of state universi- 1) Employees in the office of the Govemor or ot a Cabingt rnernber w ;�gs, ere exempt from the Career 5ervice Systam, exduding secr�tedal, cleric LOCAL OFFICERS/EMPLOYEES include the followinp positions and similar positions. or officers and empioyees of locai governmerrt: 2) The following positlons in each state departrnent, comr�iesion, boa 1) Persons etected to office in any politicel subdivision (such es munici- or council: 5ecretary, Asefstent ar Deputy Secretary, Faceautive Direct �alfties, coun6es, and special districts) and eny person appointed to flll a �s��nt or Deputy Executive Director, and enyone havfng the power norma �acancy in such office, uniess required to file full disdosure on Form 6. �►�ferred upon such persons, regardiess of tlUe. 2) Appofnted members of the following boards, councils, commissfons, � 3) 'The foilowing postUons in each state depertment ordivision: Direct iuthorities, or other bodies of any county, municipaUty, school district, indepen- �sistant or Depury Director, Bureeu Chief, Assistant Bureau Chief, and a lent special district, or other politicel subdivision: the 8oveming body of the Person having the power nortnally conferred upon such persons, regardless ubdivisfon; en expressway suthority or transportatlon authority estebiished �le. �y general law; mernbers of the Tampa Bey Commuter Reti Autho�ity; a com- 4) Aseistent Stete Attomeys, Asststant Public Defenders, Pub iuniry colle8e or junior college distri�t board of trustees; e boerd havinp the Counael, full-time state empioyees serving as counsel or assist�nt counsei ower to enforce loca� code provisions; a planning or zoning board having g state agency, adminfstretive taw judges, and hearing officers. ie power to recommend, cxeate, or modiiy land planning or zoning witfiin the 5) The Superintendetrt or Director of a state mental heaith instltute esta otitical subdfvision, except for cl�zen advisory comrnittees, technical coor- ��ahed for trafning and research in the mental health field, or a�y major sta inafing committees, and similar groups who only have the power to make institution or fecility established for comections, trainin8, treatment, or rehab 3commendatfons to pfanning orzoning bosrds; a penston board or retirement ��on. • oard empowered to invest peneion or reGrement funds cr to determine enUUe- 8) Stete agency Busfness Managers, Finance and Accounting Directo ient to or amount of a pensien or other retiromer�t beneflt Personnal Ofiicers, Grant Coordinators,and purchesing agents (regardless 3) Any other eppointed member of e local govemment boerd who is �e) with power to make e purchaee exceed"mg $15,000. �quired to flle a statement of flnancial interests by the appointine authorlty or �) The foltowing positions in IeBislative branch agenaes: eech emplo �e enabiinp legislatfon, ordinance, or resolution crentlng the boerd, ee (other than those employed in maintenance, clerical, secretel�iel, or sim 4) Persons holding eny of these positions in iocel govemmerrt: Meyor, p°S�ons end lepisletive assistan� exempted by the preslding mffic�r of th �unty or city menager; chfef edministrative employee of a counry, municipal- house); and each employee of the Commission on Ethics. i, or other poiitical subdivision; county or munidpal attomey; chief county or INSTRUCTION5 FOR COMPLETING FORM 1: JTRODUCTORY INFORMATION (At-rop of Form): If your name, maiifng address, public apency, and poaition are elready printed on the form, you do not nead to provide thi� Informe- tion uniess It should be changed. 'fo change any of this fnformatfon, simpfy atrike through It and write in the correet Information. NAME OF AGENCY: This should be the name of the govemmental unit which you aerve or served, by which you are or were employed, or for which you are a cendidate. For exemple, "City of Tailahassee," "Leon Counry," or "Depertrnent of Transportstion." OFFICE OR POStTION HELD OR 50UGHT: Use the ti�e of the oflice or positlon you hold, are seekinD, or held during the disclosure period (in some cases you may not hold that position now, but you sUll would be required to flie to disclose your interasts during the last yeer you held that position). For example, "City Council Member," "County Administretor," "Purchasin8 Agent," or "Bureau Chief." If you ars e candidate for office or are a nAw employae or appointee, chedc the appropriate box. MAILING ADDRESS: If your home eddress appears on the fortn hut you prefer enother address be shown, mark throuph the sddress provided end insert your office or other current address. The followin8 psrsons should nof use their home addresses: active or former lew enior�ment person- nel, fnduding correctional and correcti�nal probation officers, personnel of D.C.F.S. whose duties indude the investigetion cf abuae, neBlect, explolte- tion, fraud, theft, or other criminal ectivities, pereonnel of the Departrnent �f Health whose duties are to support the invesrigetlon of chAd abuse or neglect, and personnel of the Department of Revenue or local povem- ments whose responsibfpties include revenue collec�ion end eniorcem or child aupport enforcement; current or former stste attom4ys, assist stete attomeys, stetewide prosecutors, or easistent stetewide prosecuto current or former code enforcement officers; current ar fomter local g emrnent a8ancy or water management distrfct employees with peraonn releted duties; cerUfied flreflghters; jusUces and judges; and spouses a children of the above. DlSCLOSURE PERIOD: The tax yser for most individuals ts the calen year (Januery 1 through December 31). If thet is the cese for you, th your financisl interests ehould be reported for the ceiendar yasr 2002; J check the box and you do not need to edd any informetion ih this par the fortn. However, ff you flle your IRS tex retum based on a tei�c yeerthe not the calendar year, you should specify the detes of your tek yeer in t portion of the fam and check the appropriate box. This is the dme fra or "dlsdosure period" for Kour report. MANNER OF CALCULATING REPORTABLE INTERESTS: As noted this portlon of the form, the Legisleture hes given fliers the optlion of repo ing bsaed on �� thresholds that ere comparative (usuel�r, based percentege vaivas) p� threshcids thet are based on abBOlute �olller velu The instructions on the fallowing pages specifically descrtbe the differ thresholds. 5imply check the box thet reflects the choice you :have ma You must use the type of threshold you have chosen far eadh part of form. In other words, if you choose to report besed on ebSolute do value throshoids, you cennot use a percentsge threshold on any part the form. (CONTiNUED on page 4) �r Exemples: — You own 113 of a partnership or small corporation that owns both a vecent lot and a 12% interest in an office building. You shouid disclose the lot, but are not required to disclose the office building (because your 1/3 of the 12% interest—which equels 4%—doas not exceed the 5% threshold). — If you are a beneficiary of e trust that owns real property and your interest depends on the duretion of an individual's life, the value of your interest should be determined by appfying the appropriate ectuarial ffible to the value of the property ftself, regardless of the actual yield of the property. . P�►RT D- INTANGIBLE PERSONAL PROPERTY [Required by Sec. 112.3145(3)(e}3 or (b)3, Fla. 5tat.J Provide a generel description of any intangible personal property that was worth more than: (1) ten per�nt (10°k) of your totel assets at the end of the disclosure period (if you are usinp peroentsge thresholds), B[ (2) $10,000 (ff you are using dollar vslue threshoids), and state the business entity to which the properly relatad. intanpibie personel oroperty includes such things as rnoney, stocks, bonds, certfficetes of deposft, �nterests in partnerships, benefidal in'terests in a trust, promissory notes owed :o you, accounts receivabie by.you, IRA's, arrd benk accounts. Such things as automobiles, houses, jewelry, end pair�tings are not intengfble property. ntangiblas reiating to the sarne business enUty should be epgregated; for �xampie, iwo certlficates af deposit and e ssvings account with the same �ank. Whare property ls owned by husband end wife as tenents by the entirety which usualry wlll be tha cese), the properLy should be velued at 100%. Ceiculetions: In order to decide whether the intengibfe property excaeds I 0°� of your totsl assets, you wtll need to totel the velue of elI of your asaets inGuding real property, intengibie property, and tengible persona! property ;uch as automobiles, jewelry, fumfture, etc.). When meking this celcuiation, lo not subtract any liebiilties (debts) that may refate to the property-�edd only he fair market value of the property. Multiply the total figure by 1�9�o to arrive it the disctosure threshold. List oniy the intanpibles that exeeed this threshold imount. Jointly owned property should be valued acc�ding to the percentage �f your jant ownership, wfth the exception of property owned by husband and rife as tenants by the entirety, which should be valued at 1'00°%. None of your efculeUons or the value of the proparty have to be discioead on the form: If ou are usine dotlar vatue threstiolds, you do not need to make eny of theae alculetlons. ' Exampies for persons using comparative (percentape) thresholds: — You own 50% of the stodc of a smen corpore8on that is worth $100,000, according to generally accepted methods of veluing small businesses. The estimated fair merket value of yaur home end other property (bank accounts, automobile, fumfture, etc.) is $20Q,000. As your total assets are worth �250,000, you mustdisdose fntangibies worth over $25,000. Since the value of the stock exceeds this threshold, you should Iist "stock" end the neme of tha corporetion. If your accourrts with e par- ticular bank exceed $25,00�, you should Ust "6enk accounts" and benk's name. — When you retired, your professfonal firm bought out your partner- ship interest by giving you a promissory note, the present value of uvhich is $100,000. You also have a certlficate of deposft from a bank worth �75,000 and en investrnent portfolio worth $30D,000, consistin8 of $100,000 of IBM bonds and a variety of other fnvestments worth between $5,000 and $50,ODD each. The fair market velue of your remaining assets (condominfum, automobile, and other personel property) is $225,ODD. Since your totsl ssseffi are worth $700,OD0, you must list each frrtan0lble worth more than $7D,DD0. Therefore, ycu would list "prornfsaory note" and the name of your former partnerehip, "certlflcate of deposit" and the name of the bank, "bonds" and "IBM,' but none of the rest of your Invest- ments. PART E - LIABILITIES jRequired by Sec. 112.3145(3)(a�t or (b�t, Fla. Sffit) In this part of the form, list the name and address of each private govemrnental creditor to whcm you were indebted at any �ime during t disclosure perfod fn an amaunt which exceeded: (1) your net worth (if you are usfng percentage threshoicis), p[ (2) $10,000 (if you are using doliar value thresholds). You are not required to liat the arnount of any indebtednBSS or your n worth. You do not heve to disciose any oi the followfng: credit card and re inatelirnent acc:ounts, taxes owed (unless reduced to a judgrtlent), indebte neas on e life Maurance policy owed to the company of fssuahce, conting liebilities, end acarued income texes on net unreal¢ed appreciation ( accounUng concept). A"corrtingent IiebUfty" is one that will become an act liability only when one or m�re future events occur or fail to ticcur, such where you are lieble only as a guararrtor, surety, or endorser oh a promiss note. If you are a"co-maker" end have sfgned as bein8 jointlyilable or join and aeverally liebie, then this is not a contingent IfabiBty; if you ere using $10,000 threshoid and the totet amount of the debt (not just tha per�entege your Ilability) exceeds $10,000, such debts should be reported. Calculations for pe�sons usinp comparafive (percentage) thresholds: order to declde whether the debt exceeds your net worth, yau will need total all of your liabili�es (inctuding promissory notes, mortgages, credit ca debts, linas of cred�, judgments against you, atc.). Subtract thi8 amount fr the value of all your assets es calculated above for Part D. This is your " worth." You must fist on the form each creditor to whom your debt exceed this amou�t unfess ft is one of the types of indebtedness listed in the pa graph above (credit card and retafl instslfinent accounts, etc.). Joint tiabi�t with others for which you are °jointly and severalfy liable," me�ning that y mey be liebie for either your part or the whole of the obligeUbn, should induded in your calculatlons based upon your percentege of IieblNty, with following exception: joint and several liab(Ilty with your spouee for a debt wh retates to properry owned by both of you as "tenents by the enllirety' (usua the caee) ahould be induded in your celcutations by valuing the asset at 100 of its value end the liabflity at '100% of the amount owed. Examples for persons using comperative (percentsge) thrs�sholds: — You owe $15,000 to e benk for student loans, $5,000 ibr aedii cs debts, end $60,000 (with your spouse) to a savings and loen for a ho mortgage. Your home (owned by you and your spouse) is wo►th $80.0 and your other property is worth $20,000. 5ince your net wotth is $20.0 ($100,000 mfnus $80,OOD), you must report only the name and addre of the sevings and foan. — You end your 50°h bueiness partner have a$100,000 busine loan from e benk, for which you both are jointly and seWeraily liab The velue of� the businass, tafdng into account the loan ae a liability the buainess, is $50,000. Your other aeaets are worth $25,000, and y owe $5,OOD on a credit csrd. Your total assets wfll be �50,OOD (hafi o business worth $50,OOD plus $25,OOD of other assets). YQUr liabi6ti for purposes of caiculeting your net worth, wfll be oniy $5,q00, becau the full emount of the business loen already was fncluded in veluing 6usineas. Therefore, your net worth is $45,000. 5ince your �0°h share the $100,000 business loen exceeds this net worth figure, you must the bank. PART F - INTERESTS IN SPECIFIE BLlSINESSES [Required by Sec. 1123145(5), Fia. 5tet.) The types of businesses covered in this disclosure are only: state a federelly charterod benks; state and federei savinps end loan Assoaetio cemetery c�mpanies; insurence companies (induding insuranc� egenae mortgege companies; credit unions; small loan companies; slcqhouc bev ape licensees; peri-mutuel wagerinp companies, utllity comperfies, en�t controlled by the Public Sendce Commission; and eMities grented a french to operete by elther e ciy or e county govammant, (CONTINUED on page 6) � You are required to disclose in this psrt of the iorm the fect that you disclosure period, an officer, director, partner, proprietor, or agenY�othertha �wned dunng the disclosure period an interest in, or held any of certain posi- a resident egent solely for aervice of process). tions wfth, particular types of businesses listed above. You are required to �f you have or held such a position or ownetahip interest in ane of thes �nake this disclosure if you own or owned (either diredly or indirectly in the �es of businesses, list (vertic:ally for each business): the name of the bus �orm of an equfteble or beneficial interest) at any time during the disclosure ness, its address and prfncipal buslness ectiviry, and the positioh held wit �eriod more than five percent (5°%) of the total assets or capital stock of one the business (if any). Also, If you own(ed) more than e 5% intsrest in th �f the types of business eritities grented a pnviiege to operate in Florida that business, as described above, you must indicate that fact and describe th are listed above. You also rnust complete this part of the form fcr each of nature of your interest. hese types of businesses for which you ere, or were at any time during the (End of Instructlons.) PENALTIES 4 failure to make any requir.ed disclosure constifutes grounds for and may be punished by one or more of the fo0owing: dis �ualifrcation from being on the ba//of, impeachment, removal or suspension from office or employment, demofion, reduction i >-alary, reprimand, or a c►vil penalty not exceeding $90,000. (Sec. 912.377, Florida StatutesJ 'n addliion, a$25 fine for each day late wll/ be imposed, up to a maximum penalty of $9,500, for fafling fo tirne/y f!/ =orm 1 on an annua! basis. [Sec. 712.3945, Florida StatutesJ ____ �THER FORMS YDU MAY NEED TO FILE IN ORD]ER TO COMPLY WITH THE ET73ICS LAWS. In addition to fifing Form 1, you mey be rsquired to file one or more of the speclal purpose forms listed below, depending on your particular position, usiness activities, or interests. As it is your duty to obtein and file any of the speaal purpose forms which may be appficabte to you, you should carefully aad the brief description of each form to determins whether it appiies. =orm 1F — Fina/ Sfaiement of Financial interests: Requirad of local officers, siete olffcers, and speci- fied state emptoyees within 60 days after leaving afFice or ernployment This fortn is uaed to report flnandal Interests between Januery 1st of the fast year of office or empfoyment and the fast day of ofFice or employ- ment (Sec. 112.3145(2)(b), Fla. Stat.] �orm 1X — Amended Sfatement of Financial Interesfs: To be used by loca! officers, state o�cers, and specb fled state emplayees to correct mistakes on previously flled Fortn 1's. [Sec. 112.3145(9), Fia. Stat.) �orm 2— Quarterly Client Disclosure: Req��rea of local ofBcers, state officers, and speciffed stete employees to disclose the narnes of clients repreaentad for compensetion by them- selves or a partner or assoclete before agencies et the seme ievel of govemment es they serve. The form shouid be flied by the end of the celendar querter (March 31, June 30, Sept. 30, Dec. 31) following the ceiendar quarter in which a reportable representation was made. [Sec. 112.3945(4), Fia. Stet] �orm 3A — Siafemenf,of lnteresf in Competitive Bid for Public Busmess: Requirod of publi� officers and pubiic employees prior to or at the time of submiseion of a bid for public business which otherwiae would violate Sec. 112.313(3) or 112.313(7), Fla. 5tat [Sac . 1'12.313(12)(b), Fla. Stet.) �orm 4A; -- Dfsclosure of Business Transaction, Re/at►onship, or Interest: Required of public officers and employees to disclose certain business trensactlons, relationships, or interests which otherwise would violate Sec. 112313(3) or 112.313(7), Fla. Stat (Sec. 112.313(12) and (h2)(e), Ffa. Stat.J �orm 8A — Memorandum of Voting Conflict for State Officers: Requfred to be filed by a state officer wlthin 15 deys after having voted on e rnsasure which inured � his or her special privste gain (or foss) or to the spedal gain (or loss) of a reletive, bu ne6s aesociete, or one by whom he or she is reteined or empibyed. Ee eppoirrted state officer who seeks to fr�fluence the dedsion on such measure prior to the meetin8 must flfe the form before undettaking th action. (Sec. 1'i2.3143, �la. Stat] Form 8B — Memorandum of Votin Conflict fo County, Municipal, and Other �oca/ Publi Q�CB!'S: Required to be flled (within 15 days of ebskendon) eech iocal officer who must sbatain from voUng on a meaBUre whi would inure to his or her speaal private gain (or loss) or the special ge (or loss) of e relative, business associate, or one by whom t�e or she retalned or empioyed. Each eppointed local offidal who seeNcs to inf ence the decision on such a measure prior to the meeting must flle t form before underteking that action. [Sec. 1'12.3143, Fia. Stat] Form 9— Quarterly Gift Disclosure: �u�►�a local olifcers, state oliicers, speclfied state employees, and sta procuremenf employees to report pffts over $100 in valua, The fo shou�d be flled by the end of the calender quarter (Meroh 31, June 3 September 30, or December 31) following the calendar quartler in whi the elft was recefved. [Sec. 11Z.3148, Fie. Stat] Form 10 — Annual Disclosure of Gifts from Governmenfa/ Enfities and Direct Suppo Organizations and Honorarium Event f�elate Expenses: Required of local oSicers, state oA�cers, speclf! state empfoyees, and siate prvcuramenf employees to teport gi over $100 in value recelved from certein agencies end direct supp organizaUons; also to be utilized by these persons to report honoreriu evant-re{eted expenses paid by certein persons and enrities.The fo should be flled by July 1 biiowing the calendar year in which the gtft honarertum event-reiated expense was received. [Sec. 11�.3148 e 1123149, Fla. StatJ AVALLABILI'TY OF FORMS; FOR 1VIORE INFORMATION �nies of these forrns ere avaliable from the Supervisor of Questions about any of these forms or the ethics laws may b :lections in your county; from the Comrnission on Ethics, Post addressed to the Commission on Ethics, Post Office Draw �ffice Drawer 15709, Taliahassee, Florida 32317-5709; teiephone 1 b709, iallahessee, Florida 32317-5709; telephone (850) 488-786 350) 488-7864 (Suncom 278-7864); and at the Commission's web (Suncom 278-7864). ite: www.ethics.state.fl.us. . FORM 1 STA'Y'�N��TT �F ��,�p so� 3��O�Z ' p�ease prini or type yourr�ame, rnailing addross, agancy name. end poeltion below: �,ST NAME — FIRST NAME — MIDDLE h HEPTINSTALL MICHP. ADDRESS : 834 BARKER ST CITY OF SEBASTIAI VAME OF OFFICE OR POSITION HELD CITY COUNCIL MEMI �'�4�.I�C�.L �I�� ' { 5�'Sc; <<��r s��:s-r�,,�,, '' FOR OFFIC�" `� F C I T Y C L� 1`� i�. USE ONLY: � '?�07 �� ►a 2 � � �l � � � 1D Code COUNTY: ID No. CoM. Code P. Req. Code 3HSCK IF � CAND(DATE �R ❑ NEW EMPLOYF.E OR APPOINTEE ""THIS SECTION MUST BE COMPLETED*` ►ISCLOSURE PERIO�: NIS STATEMENT REFLECTS YOUR FlNANCIAL INTEREST'S FOR THE PRECEDiNG TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON . FlSCAL YEAR. PLEASE STATE 9ELOW WHETHER THIS STATEMENT IS F�R THE PRECEDING TAX YEAR ENDING EITHER (check one): ❑ DECHMBER 31, 2002 Q$ � SPECiFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: 2 0 0 3 IANNER OF CALCULATING REPORTABLE INTERESTS: HE LEGfSLATURE ALLOWS FILERS THE OPTION OF�USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLL'AR'VALUES, WHICH EDUIFtE5 FEWER CALCULATIONS, OR U51NG COMPARATIVE THRESHOLDS, WHICH ARF USUALLY BASED ON P�RCfiNTAGE VALUES (se structfons for iurther detatls). PLEASE STATE BELOW WHETHER THIS STATEMENT RHFLECTS EITHER (chedc one): � COMPAftATIVE (PERCENTAGE) THRHSHOLDS Q@ � DOLLAR VALUE THRESHOLDS ART A— PRIMARY SOURCES OF INCOME [Mejor saurces of income to the reportin8 person] NAME OF SOURCE S�URCE'S DESCRIPTION OF THE SOUiRCE'S DF INCOME I ��S I PRINCIPAL BU8INESS ACTNITY vero beach chrysle � 1RT B— SECONDARV SOURCES OF INCOME [Mejor a�stomers, dients, and other eources of income to busineaees owned by the reporting pereon] NAME OF NAME �F MAIOR SOURCES ADDRESS PRINCIPAL BU5INESS n� �e��t�CR FAITIN I OF BU31NE6S' INCOME I OF SOURCP I ACTIVRY OF SOURCE �RT C— REAL PROPERTY jLend, buildings owned by the reportfng person] FORM 1- Eff. 1l20D3 (Continued on revene side) FILING IIVSTRUCTIONS isorwhe and where to flie tbis form are locai- ed at the bottom cf pape 2. INSTRUCTIONS on who muat fl�e this form and how to fill It out bepin on page 3. OTHER FORMS you may naed to fHe are tlsserfbed on pape fi. PAGE �•ppRT D— INTANGIBl.E PERSONAL PROPERTY [Stocks, bonds, cettificates of deposit, etc.J TYPE OF IIVTANGIBLE I BUSINESS ENTITY TO pqRT E— LIABILITIES jMajor debts] � NAME OF CRHDITDR ADDRE55 OF CREDITOR �ART F— INTERESTS IN SPECIFlED BUSINESSES jOwnership or posl�ons in eertein types of businesaes] S BUSINESS EM�iTY # 1 � BUSINESS ENTITY # 2 � BUSINESS ENTITY# 3 A MY ' IIJTERES'T IF ANY OF PARTS A THROUGH F ARE CONTINUED ON•A SEPARATE SHEET, PLEASE CHECK HERE ❑ IGiNATURE (required) JHAT TO FILE: fter compietlng all perts of this fortn, including gnin0 and detin8 it, sand back only the first �aet (pages 1 and 2) for fllinB. OTE: IULTIPLE FILING UNNECESSARY: enerally, e pareon wh� hes flled Form 1 for a ilender or fiscel year is not required to file e :cond Fortn 1 for the seme year. HoMrever, a �ndidate who prevfously flled Fortn 1 beceuae anofher public position must et least fl�e e copy his cr her o�igfnel Form 1 when queltfying• = FORM 1 - Efl. 112003 DA'fP SIGNED (roqu` i�� FTT,TNG IlrTSTRUCTIONS: WHERE TO FILE: If you were mailed the form by the Commiasion on Ethics or e County 3upervisor of Electlons for your ennuel diadosure fliing, retum the'form to that locerion. Loaal oflRcers/employees flle wlth ths Supenrlsor of filections of the couMy in which they perme- nently roaide. (If you do not pertnanently reside in Flodda, flle wlth the Supervisor oT the county where your apency has its heedquarters.) State o�flcora or sp�clfl�d sbte anployws flle wtth the Commiaslon on Ethics, P.O. Drawer 15709, Talleheaaee, FL 32317-5709. Candldei�s flle this form topsther with their queliiying papers. To deterrnine whet cetepory your poskion fells under, aee the "VNho Must Flle" Instructions on page 3. WHEN TO FILE: M►tially, each iocei oificarlemployee, s� offic:er, end spec�fied state employee must fi wlthln 30 deys of the dete of his or h appdntmerrt or oi the begfnning cd empio ment Appoirrtees who must be cot�irmed b ths Sennte must flle prfor to confirm�tion, eve ff that is lees than 30 days from the date their eppoirrtment. Candidai�s ior publidy-eiected local offc must flle et the seme time they flte the quallfyin8 pepers. Theroaftar, local officers/employsea, ste officers, and spedfied state empimyees e required to flle by July 1st bU�vYin� eac celendar yeer in vuhich they hold Ihelr pos tions, Finally, st the end of offlce or entpb�m�en each iccel officerlemployee, state officer, an speclfiad stete empioyee is required to fl� final disdosure iortn (Fam 1 F) wlthin B6 day of leaving oiflce or employmeM. PAGE DE 00-04 - March 23, 2000 Assessment of Fines § 106.07(8), Fla. Stat. TO: Ms. Grace Chewning, City Clerk, City of Orlando, 400 South Orange Avenue, Orlando, Florida 32801-3302 Prepared by: Division of Elections This is in response to your request for an opinion concerning assessment of fines pursuant to section 106.07(8), Florida Statutes. You are the City Clerk for the City of Orlando and pursuant to section 106.23(2), Florida Statutes, the Division of Elections has authority to issue an opinion to you. You ask the following: 1. Does a filing officer have any discrerion with regard to the amount of a fine assessed in section 106.07(8), Florida Statutes? 2. If such a fine is mandatory, what obligation does the filing officer have with respect to collection of the fine? The answer to your first question is no. Section 106.07(8)(a), Florida Statutes, provides in pertinent part: Any candidate or political committee failing to file a report on the designated due date shall be subject to a fine as provided in paragraph (b) for each late day, and, in the case of a cand�date, such fine shall be paid only from personal funds of the candidate. The fine shall be assessed by the filing officer. . . . As the fines are statutorily imposed and the language of the section is mandatory, the filing officer has no discretion regarding the assessment of a fine. The filing officer's duty is to determine whether a report is timely and assess the appropriate fine as set forth in section 106.07(8)(b), Florida Statutes. With regard to your second question, section 106.07(8)(b), Florida Statutes, provides that upon determining that a report is late, the filing officer shall immediately notify the candidate or chair of the committee as to the failure to file a report by the designated due date and that a fine is being assessed for each late day. Once a report is filed, the filing officer is required to notify the candidate or chair of the political committee of the amount of the fine due. Further, section 106.07(8)(d), Florida Sta.tutes, provides that the filing officer shall notify the Florida Elections Commission (FEC) of the repeated late filing by a candidate or political committee, the failure of a candidate or political committe� failure of a candidate or political committee to file a report after being notified, or the failure to pay the fine imposed. Once the FEC is notified that a candidate or political committee has failed to pay the fine imposed, the FEC will enter a fmal order for the amount of the fine assessed. At this point, the filing officer may file an enforcement action in circuit court to collect the fine and all cost and attorneys fees expended to collect the fine. The fine must be assessed and if collected the moneys must be deposited in the fund designated by section 106.07(8)(2), Florida Statutes. Unlike these mandatory provisions, the statute does not include a statement that the assessment be enforced. It is therefore our conclusion that the commencement of a collection action is within the discretion of the filing officer. � J►��=� � A filing officer has no discretion with regard to fines imposed pursuant to section 106.07(8), Florida Statutes. The filing officer's duty is to notify a candidate or chairman of a political committee of the failure to file a report; detemune the amount of the fine b�d upon the formula provided in section 106.07(8)(b), Florida Statutes; and notify the candidate or chairman of the political committee af the amount of the fine due. The filing officer is also required to notify the FEC if the candidate or political committee fails to pay the fine imposed. Once a final order is entered by the FEC, the filing officer ma.y then file an enforcement action in circuit court to collect the fine. DE 83-08 May 2,1983 INDEPENDENT CONTRIBUTIONS TO AN ISSUE CAMPAIGN To: Mr. Bennett MLifter, Lifter Enterprises, 17880 Northwest 2nd Avenue, Miami, Florida 33169 Prepared by: Division of Elections Pursuant to your request, this is a Division of Elections opinion under Section 106.23(2), F.S.1 on essentially the following question: May a person, either individually or through a corporation expend money in support of an iniriative campaign to amend the Florida Constitution without reporting expenditures or registering as a political committee? Specifically, you wish to spend money to support the iniriative campaign to amend the Constitution to permit gambling casinos in the State of Florida and to distribute and acquire signatures on the approved form. You do not wish to act in the name of the sponsor of the petition, nor do you wish to make contriburions to the sponsor. In essence, you desire to make independent expenditures on behalf of the issue campaign. An independent expenditure is defined as..."an expenditure to a person for the purpose of advocating the election or defeat of a candidate or the approval or rejection of an issue, which expenditure is not controlled by, coordinated with or made upon consultation with any candidate, political committee or agent of such candidate or committee." Section 106.011(5). F.S.1 The Florida Campaign Financing Law does not prohibit an independent expenditure with respect to any candidate or issue, but any person who makes such expenditure which exceeds $100.00, must report it in the same manner, at the same time and to the same public officer as the sponsor political committee. Section 106.071. F.S.2 states: (1) Each person who makes an independent expenditure with resist to any candidate or issue, which expenditure, in the aggregate, is in the amount of $100.00 or more, shall file periodic reports of such expenditures in the same manner, at the same time, and with the same officer as a political committee supporting or opposing such candidate or issue. Any polirical advertisement paid for by an independent expenditure shall prominently state "Paid political advertisement paid for by (Name of person or committee paving for the advertisement) independently of any candidate," and sha11 contain the name and address of the person paying for the polirical advertisement. (2) Any person who fails to include the disclaimer prescribed in subsection (1) in any political advertisement, which is required to contain such disclaimer, is guilty of a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. (3) No person may make a contribution in excess of $1,000.00 to any person, to be used by such other person to make an independent expendittue. A"person" may be an individual or corporarion. Secrion 106.011(8), Florida Statutes. While independent campaign expenditures are permitted in initiative campaigns, the use of the sponsor political committee as the means to report all contributions and expenditures is preferable. One campaign financial report accomplishes the public disclosure objecrives of the Act far better than multiple independent committee reports.2 An acrive corporation making expenditures in support of an issue campaign does not necessarily have to register as a political committee. A corporarion regulated by Chapters 607 and 617 is not a polirical committee if its political activities are limited to contriburions to candidates or political committees or expenditures in support or opposirion of an issue from corporate funds and if no contributions are received by such corporation. Section 106.011(1), F.S. Therefore, so long as an active corporation makes independent expenditures without accepring contributions in an issue campaign it need not register as a political committee. However, in such case, the corporation is still required to report independent expenditures in aggregate over $100.00 in the manner prescribed by secrions 106.071, and 106.07, F.S. as discussed herein. Another way to support the issue campaign is by direct contribution to the political committee sponsoring the petition. An individual or corporation may make such contribution without having to register as a political committee. Section 106.011(1), F. S. There is no limit to the amount of contribution. The $3,000.00 contriburion limitation in statewide issue campaigns (Section 106.08(1)(d). F.S.) has been held unconsritutional in Let's Help Florida v. McCrary, 453 F. Supp. 1033 (1978), affirmed 621 F. 2d 195 (1980). Of course, these contriburions are reported by the sponsor committee. In short, Florida's Campaign Finance Law requires that all campaign expenditures made on behalf of an issue campaign be reported either through the sponsor or through any person making independent expenditures so as to achieve full public disclosure of all sources of all campaign funds. � Unless otherwise indicated references aze to Florida Statutes (1981). 2 Section 106.071 was enacted by Chapter 77-175, Laws of Florida. DE 91-07 - October 21,1991 Calculation of Late Days Under Automatic Fine Provisions Sections 106.04(8) and 106.07(8), F.S. TO: Honorable Dorothy Ruggles, Supervisor of Elections, Pinellas County, 31 S Court Street, Clearwater, Florida 34616-5190 Prepared by: Division of Elections This is in response to your letter of September 10, 1991, wherein you request an opinion from the Division of Elections. You are the Pinellas County Supervisor of Elections and aze requesting an opinion concerning the Florida Election Code, the division has authority under Section 106.23(2), Florida Statutes, to issue this opinion. You ask: How are the number of late days determined under the late report automatic fine provisio�s of Chapter 106, Florida. Sta.tutes, when a campaign treasurer's report is late and a fine must be assessed? It is the opinion of the division that the calculation of late days begins on the da.y after the campaign treasurer`s report is due, including weekends and holidays, and continues and includes the day of the postmark, courier receipt, or certificate of mailing, whichever is earlier. Section 106.07(8), Florida Statutes, provides a per day fine for late reports of political committees and candida.tes. Section 106.04(8), Florida Statutes, sets forth the applicable fine provisions for late reports of committees of continuous existence. The fine provisions of these two sections are substantially the same. Section 106.07(8), Florida Statutes, provides in part: (8)(a) Any candidate or political committee failing to file a report on the designated due date shall be subject to a fine as provided in paragraph (b) for each late day.... (b) ...The filing officer shall determine the amount of the fine due based upon the earliest of the following: 1. When the report is actually received by such officer. 2. When the report is postmazked. 3. When the certificate of mailing is dated. 4. When the receipt from an established courier company is dated. Though the first day on which the fine is to begin is not s pecifically stated in the statute, the division and the Florida Elections Commission have construed the sta.tute to mean that the late days begin accruing on the day after the due date. The statute provides that the accruing of late days will continue until the earlier of when the report is actually received, when the report is postmazked, when a certificate of mailing is dated, or when the receipt from an established courier company is dated. Therefore, it is the opinion of the division that the accruing of late days continues, including ho�idays and weekends, up to and including the earlier of the above-referenced dates. For example, if a report was required to be filed on the first of the month and was received on the tenth, bearing a postmark da.ted on the fifth of the month, the late da.ys would include the second, third, fourth, and fifth days of the month. Therefore, the report is four days late. SUMMARY It is the opinion of the division that the calculation of late days begins on the day after the campaign treasurer's report is due, including weekends and holidays, and continues and includes the day of the postmark, courier receipt, or certificate of mailing, whichever is earlier. DE 91-02 - February 5,1991 Duties of a Filing Officer Sections 97.012,106.07(1),106.23(2),106.07(8)(b), and 106.07($)(c), F.S. TO: Mr. Donald W. Rhodes, Chairman, Florida Elections Commission, Post O�ce Box 887, Marco Island, Florida 33969 Prepared by: Division of Elections This is in reference to your letter of November 26, 1990, requesting information relating to the notification requirements of filing officers with regard to the filing of late campaign financing reports. The Secretary of Sta.te is the chief election officer of the state, and it is his responsibility to obtain and maintain uniformity in the application, operation, and interpretation of the election laws. Section 97.012, Fla. Sta.t. Within the Department of State, of which the Secretary of State is the head, there has been created a Division of Elecrions (Division) and the staff for the Florida Elections Commission (FEC) is housed within the Division. Both the Division and the FEC have specific powers and duties as prescribed by statute. See Fla. Jur. 2d, Elections Section 17. The Division is empowered to, inter alia, interpret the Election Code, Chapters 97-106, Florida Statutes, and issue opinions relating to the same. Section 106.23(2), Fla. Stat. The FEC was created by the legislature to investigate alleged violations of the campaign financing laws found in Chapter 106, Florida Statutes. The FEC has the authoriry to impose civil penalties in the form of fines to be deposited in the Campaign Financing Trust Fund. You are the chairman for the FEC and pursuant to Section 106.23(2), Florida Sta.tutes, the Division has authority to issue an advisory opinion to you relating to the Florida Election Code, Chapters 97- 106, Florida Statutes. You ask: 1. Do filing officers have an affirmative duty to ascertain that a required financial report is late? 2. If the above is required, is it a condition precedent that the person responsible for the report be notified that the report is late before a fine may be imposed? In answer to your questions, filing officers have an affirmative duty to ascertain that a required financial report is late. It is not, however, a condition precedent that the officer notify the person responsible for the report before a fine is imposed. Chapter 106, Florida Statutes, requires that each campaign treasurer designated by a candidate or political committee file regular reports of all contributions received, and all expenditures made, by or on behalf of such candidate or political committee. Section 106.07(1), Fla. Stat. Section 106.0?(8)(b), Florida Statutes, provides: Upon determining that a report is late, the filing officer shall immediately notify the candidate or chairman of the political committee as to the failure to file a report by the designated due date and that a fine is bein� assessed for each late day. (Emphasis added.) Thus, in reference to your first question, this statute places an affirmative duty on the filing officer to ascertain that a financial report is late and requires the filing officer to notify the candidate or chairman of the political committee as to the failure to file. In reference to your second question, the words " a fine is being assessed" indicate that the fine is an automatic fine. The fine begins to accrue the irst day after the due date of the report regardless of ether the candidate or chairman of the political committee is notified that the report has not been received. Therefore, it is not a condition precedent that the person responsible for the report be notified that the report is late before a fine is assessed against the candidate or political committee. Once the report is received, the filing officer determines the amount of the fine and must notify the candidate or chairman. The candidate or chauman has 20 days after receipt of the notice of payment due to pay the fine or make an appeal to the Florida Elections Commission. See Section 106.07(8)(b), Fla. Stat. Section 106.07(8)(c), Florida Statutes, provides in part: Any candidate or chauman of a political committee may appeal or dispute the fine, based upon unusual circumstances surrounding the failure to file on the designated due date, and may request and shall be enritled to a hearing before the Florida Elections Commission, which shall have the authority to waive the fine in whole or in part. In addition, Rule 1D-1.005, Florida Administrative Code, provides that the notice of appeal may be accompanied by any documentation or evidence supporting the claim. Therefore, when considering an appeal of the fine, the FEC must make a two step analysis. First, has the appellant sta.ted a claim of unusual circumstances and second, does the evidence submitted tend to prove or disprove the claim. The term "unusual circumstances" is defined in Rule 1D-1.005, Florida Administrative Code: Unusual circumstances means uncommon, rare or sudden events over which the actor has no control and which directly result in the failure to act in accordance with the filing requir�ments. Circumstances which allow for time in which to take those steps necessary to assure compliance with the filing requirements shall be deemed not to constitute unusual circumstances. (Emphasis added.) Over the years, the FEC has taken the position that occurrences such as the absence of a key person involved in the reporting process, medical emergencies, other emergencies, last minute filings, mailing a report at a rural mail facility which forwards its mail to the main post office for next day postmarking, and other similar excuses were sufficient to support a claim of unusual circumstances. However, pursuant to Rule 1 D-1.005, Florida. Administrative Code, before the FEC may label these occurrences as "unusual circumstances," the FEC must determine that the persons involved took all steps necessary to insure that a timely report was filed. In the presence of a fine and subsequent appeal for failing to timely file a report, there must be proof that everv effort was made to comply with the filing requirements, but because of unusual circumstances the report was not timely filed. The failure to take all steps necessary to assure timely filing cannot constitute unusual circumstances. The FEC has the ultimate authority to decide whether the proffered evidence bears out the claim of unusual circumstances. SUMMARY Section 106.07(8)(b), Florida Statutes, places an affirmative duty on the filing officer to ascertain that a financial report is late and requires the filing ofiicer to notify the candidate or chauman of the political committee as to the failure to file. The fine for failure to file a required report begins to accrue the first day after the due date of the report regardless of whether the candidate or chairman of the political committee is notified that the report has not been received. Therefore, it is not a condition precedent that the person responsible for the report be notified that the report is late before a fine is assessed against the candidate or political committee. � . • �� y /r'.�i�.�'.� i!r . . ., � �. i� _ ir ;, !�' �i • � i , . • _ - _ _ : / , � '� -1---� � / /_ � � • // � ��: � . i i � t ' �. � � . l5�rm�,�,�;i� r� �+rrY�.�'rWF �nrL'�;�..�.. ;y. .�� RETURNED YOUR CALL PLEASE CALL WILL CALL AGAIN TO �� ITS TO SEE YOU I �