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Home My WebLink AboutHerlihy Completed Qualifying Docs DSDE25,Form1, FeeCANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OATH OF CANDIDATE (Section 99.021, Florida Statutes) RECEIVED AUG 2 7 2014 City of S,t, City Clerk's Office OFFICE USE ONLY I, EDWARD H. HERLIHY (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT' — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of SEBASTIAN CITY COUNCIL (office) (district #) I am a qualified elector of INDIAN RIVER County, Florida; (circuit #) (group or seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Signature of Candidate (772)388 -0665 edherlihy @bellsouth.net Telephone Number Email Address 474 SEA GRASS AVEURE SEBASTIAN, FLORIDA 32958 Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 104698962 Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): $EDWARD H.HERLIHY F-D-W- U-HP,-D 44. H- UHK-L-,-> -EF STATE OF FLO A COUNTY OF ( �) Sworn to (or affirmed) and subscribed before me this a26 day Personally Known: '/ or Produced Identification: Type of Identification Produced: 20 -0' . Signature of Nota)y Public SALLY A. MAIO - ,,; Commission # EE 0241450 ,:g Expires October pFV0. Bunt (WTWTmY Fain ln5ucanceHOQ- 38S70t5 Public DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C. FORM 1 STATEMENT OF 2013 Please print or type your name, malling FINANCIAL INTERESTS address, agency name, and position below: FOR OFFICE USE ONLY: LAST NAME — FIRST NAME — MIDDLE NAME: HERLIHY, EDWARD H. MAILING ADDRESS : 474 SEA GRASS AVENUE CITY: ZIP: COUNTY: MG SEBASTIAN, FL 32958 INDIAN RIVER Ci(yof NAME OF AGENCY: Clo C/OSebaStia CITY OF SEBASTIAN, FL ks Off NAME OF OFFICE OR POSITION HELD OR SOUGHT: SEBASTIAN CITY COUNCIL MEMBER You are not limited to the space on the lines on this form. Attach additional sheets, If necessary. CHECK ONLY IF 0 CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ** ** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): (A DECEMBER 31, 2013 DE ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING: ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS Qq RJ DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "n /a ") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY US SOCIAL SECURITY ADMINISTRATION WASHINGTON, DC RETIREMENT FUNDS HERLIHY RETIREMENT FUNDS SEBASTIAN, FL RETIREMENT FUNDS PART B — SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nla ") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE N/A PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] FILING INSTRUCTIONS for (If you have nothing to report, write "none" or "nia ") when and where to file this form are located at the bottom of page 2. 474 SEA GRASS AVENUE, SEBASTIAN, FL 32958 INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 - Effective: January 1, 2014. (Continued on reverse side) PAGE 1 Adapted by reference In Rule 34-8.202(1), F.A.C. PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "n/a") PROPERTY NIA PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "nia ") NAME OF CREDITOR ADDRESS OF CREDITOR N/A PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions In certain types of businesses - See instructions] (If you have nothing to report, write "none" or "nla ") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY N/A ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE (required): DATE SIGNED (required): Li If a certified public accountant licensed under Chapter 473, or attomey in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. Signature WHAT TO FILE: After completing all parts of this form, including signing and dating It, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, you must write "none" or 'Wa" in that sectlon(s). NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year Is not required to file a second Form 1 for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. FILING INSTRUCTIONS: WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. Local oNfcerslemployees file with the Supervisor of Elections of the county In which they permanently reside. (If you do not permanently reside In Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317 -5709; physical address: 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see the "Who Must File" Instructions on page 3. Facsimiles will not be accepted. Date WHEN TO FILE: Initially, each local officer /employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates for publicly -elected local office must file at the same time they file their qualifying papers. Thereafter, local officerstemployees, state officers, and specified state employees are required to file by July 1st following each calendar year In which they hold their positions. Finally, at the end of office or employment, each local officer /employee, state officer, and specified state employee is required to file a final disclosure form (Form IF) within 60 days of leaving office or employment However, firing a CE Form IF (Final Statement of Financial Interests) does PQl relieve the filer of filing a CE Form 1 if he or she was In their position on December 31, 2013. CE FORM 1 - Effective: January 1, 2014. PAGE 2 Adopted by reference In Rule 34. 8.202(1), F.A.C. 1 "° Total Paid �_ �Initfiials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE 4 913 RECEIPT Name ��u �� 'j�, ❑ Cash qi, Ir' Date No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501341920 CopiesBid Specs. 001501341910 LDClCode of Ordinances �y/ I � � Fees 4- 001501341930 Election Qualifying 601010 343800 Cemetery Lots LotlNiche . Block . Unit 001501343805 Cemetery Fees 3(0"% 1 "° Total Paid �_ �Initfiials White - Dept. of Origin • Yellow - Finance • Pink - Applicant