HomeMy WebLinkAboutGilliams final qualifying & feeCR OF
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HOME OF PELICAN ISLAND
ELIGIBILITY TO HOLD OFFICE
OF COUNCILMEMBER
Charter Section 2.02 - ELIGIBILITY
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"No person shall be eligible to hold the office of council member
unless he or she is a qualified elector* in said city and actually
continually resided in said city for a period of one ('9) year
immediately preceding the final date for qualification as a
candidate for said office."
I, IDA "'`` -` C-_A ` t ` ' "` & , candidate for the office
of Council Member, meet the eligibility qualifications to hold office as
required in Sectio .02 of the City of Sebastian Charter, above.
Signature o andidate
Sworn to and subscribed before me this day of ,
2014.
Notary Public
State of Florida ,.. '' �E1w rEWLUAMS
_ 1 r= commission # EE 038067
= Expires Febrwry 28, 2015
SEAL ..,., ' e,,, w wn Tmy FWn warm W0385 -70$9
*166.032 Electors.- -Any person who is a resident of a municipality, who has qualified as an elector of this
state, and who registers in the manner prescribed by general law and ordinance of'the municipality shall be a
qualified elector of the municipality.
Ms- word/electiontcharter eligibility
DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.G.
CANDIDATE OATH -
NONPARTISAN OFFICE
01'x1' of �Qf
(Not for use by Judicial or
Cr S
Cl erk8 o e
School Board Candidates)
OFFICE USE Otsli_Y
OATH OF CANDIDATE
(Section 99.421, Florida Statutes)
'
{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 X C. t ' ` -,Lj CLW J j e ` L I +
(office) (district #)
I am a qualified elector of.h z° t►a+. I ��� -�,>` 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 1 seek; and I have resigned from any office from which I am required to resign pursuant to
Section 99.012, Florida S tutes; and I will support the Constitution of the United States and the Constitution of the
State of Florida.
SE�t �
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,. CoVw,CtA<T,vfr
Signature coandidate `telephone Number Email Address
5�13AfT1W -J '3 2-'i
Address city State ZIP Code
Candidate's Florida Voter registration Number (located on your voter information card)= j 0 q 3 /
* 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):
D- i "\ -+ 1 - +y'V} Y L U '— ('_ � � is- � � ' 'C' 1_. _ ' F`� � Wt -- S
STATE OF FLORIDA
COUNTY OF End i Cxtn ki v "tr
Sworn to (or affirmed) and subscribed before me this frd day of 'Septt` +fin h Cr , 20 .
f
Personally Known: _a or
4rint,
ture of Notary Public
Produced Identification: Ty pe, or Stamp Commissioned Name of Notary Public
+ +a
Type of Identification Produced: ,9,0 JEANETTE WILLIAMS
` Commission # EE 033067
Expires February 28, 2015
Banded %u T F* Wvanw M 741
DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.G.
INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO
BALLOT
Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames.
Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes ( -) to separate syllables.
You should also add any notes such as rhyming examples, silent letters, etc.
PRONUNCIATION KEY
Stressed Vowel Sounds
EE
FEE feet
I
FIT fit
E
BED bed
A
(KAT) cat (KAD) cad
AH
(FAH -thur) father
PAHR par
AH
(HAHT) hot (TAH-
dee ) Todd
UH
(FUHJ) fudge
FLUHD flood
UH
CHUHRCH church
AW
FAWN fawn
U
(FUL) full
00
FOOD food
OU
FOUND found
O
FO foe
El
FEI fi ht
Al
(FAIT) fate
01
FOIL foil
Y00
(FYOOR- ee -uhs)
furious
Unstressed Vowel Sounds
uh (SO -fuh) sofa (FING-
uhr ) finger
Certain Vowel Sounds with R
AHR
PAHR par
ER
PER air
IR
PIR peer
OR
(POR) pour
OOR
POOR poor
UHR
I (PUHR) purr
Samples:
NAME ON BALLOT
PRONOUNCED AS
Mishaud
mee -SHO ('d' is silent)
Jahn
HAHN (rhyme: fawn)
Beauprez
boo-PRAI (rhyme: hooray)
Maniscalco
man- uh- SKAL -ko
Tangipahoa
TAN- ji- pah -HO -uh
Monte
Mahn -TAI
Tanya
TAWN -yuh (not TAN)
Consonant
Sounds
B
BED bed
TS
ITS its PITS -feeld Pittsfield
D
DE debt
TH
(T El) Thigh
F
FED fed
TH
(T El) Thy
G
GE et
ZH
A -zhuhr azure I -zhuhn vision
H
(HED) head
Z
(GOODZ) goods (HUH - buhz -tuhn) Hubbardston
HW
HWICH) which
J
(JUNG) jug
K
(KAD) cad
L
(LAIM) lame
M
MA mat
N
NE net
NG
SING -uhr singer
P
PE t
R
RED red
S
SE set
T
TEN ten
V
(VET) vet
Y
YE.. t =.
W
ICH 'witch
CH
CHUCRCH church''
SH
SHEEP -sheep
NOTE: This page.sbould not -be- submitted to the filing officer.
Page 2, DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.C.
FORM I STATEMENT OF 2013
Please print or type your name, mailing FINANCIAL INTERESTS
address, agency name, and position below: FOR OFFICE USE ONLY:
T NAME -- FIRST NAME -- MIDDLE NAME:
MAILING ADDRESS:
-3-2-
CITY: ZIP : COUNTY :
Sep
tc- s T t Wn 1 C,
NAME OF AGENCY : �, 0b.e�V�
� �
NAME OF OFFICE OR HELD OR SOUGHT:
/PO4ITION
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 (�t check one):
DECEMBER 31, 2013 QR 13 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:
a' COMPARATIVE (PERCENTAGE) THRESHOLDS OR Q 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
O11 F INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
OAc q ..vr, Ct� ! tA-L C5' -rt4Tr
16-Z-3 V� Uw t }tG'v�ST r #rte L
1-c . L sue; + ]
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'Wa ")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C —REAL PROPERTY (Land, buildings owned by the reporting person - S �instructions]
(If you have nothing to report, write "none" or "n!a ") '7/ 3 l �� ?1,1? 7 C (li p5.7jdr�
FILING INSTRUCTIONS for
when and where to file this
form are located at the bottom
of page 2.
INSTRUCTIONS or who must
II"
SC . 7zr�fl J(f 3 VS ,y, f � r� {%ix1`r " 14 (,
IA
!,.r JG,.V 1 1,2y71C %tl/Sires. f
' 10 id 14uv- / fir`s14f7 ►a
4c"-s' el,, c12 j/Z �f�lys'Tih'rJi L4:7 F +� f<c >rrurteD /�{ GtrJ t'2_F (%r*r�.
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
Adopted 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 "nla ")
TYPE OF INTANGIBLE
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "nla ")
NAME OF CREDITOR I ADDRESS OF CREDITOR
�' l�'f t /jj�✓ C �,?v c LG[ I A r27 IV Z Yr t s `A L, z c— �r �°C I.a'= 5�r0 7 -2--
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'Wa ")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2
NAME OF BUSINESS ENTITY - /1' 0 + � t= -- l) ^ ff .-;f f b ors A,;2 , Q
ADDRESS OF BUSINESS ENTITY /CVO it ;r i 'r?5Th V "Fr h4111- f 5-f64f7#4,,' 1"�- 14-23 V� ! SF yas; rkrr✓ �=c jT� "
PRINCIPAL BUSINESS ACTIWITYP+t-1- L 7ffl{ mar p •f VY trV -e �CrYI _ x.
POSITION HELD WITH ENTITY �'
I OWN MORE THAN A 5% INTEREST IN THE 6USINESS t is /� S I
NATURE OF MY OWNERSHIP INTERESTS' `L' _ �rJz+� -L � 1Lt�
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Ll
DATE SIGNED (required):
C:�-3 / 4-
If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or
she must complete the following statement:
1, , 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
sinning 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 "nla" in that
section(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.
CE FORM i - EHeave. January 1. 2014,
Adoped by reference in Rule 34- 8.202(1), F.A.C.
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 officerslemployees 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 Fite " 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 officers /employees, 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 oificerlemployee, state officer, and specified
state employee is required to file a final disclosure
form (Form 1 F) within 60 days of leaving office or
employment. However, filing a CE Form 1F (Final
Statement of Financial Interests) does not relieve
the filer of filing a CE Form 1 if he or she was in their
position on December3l, 2013.
PAGE 2
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.423, F.S.) CC��1'of 2(j
(Please print or type) t; -? ost'.
0
candidate for the office of
9
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x s % Lt
/A 5ignat of Candidate Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS -DE 84 (05111)
CITY OF SEBASTIAN
CIT Y CLERK'S OFFICE
RECEIPT
4910
Date
No.
001001 208001
001501 322900
001501 341920
001501 341910
001501 341930
601010 343800
001501 343905
F*t eck OL-) I
Amount Paid
Sales Tax
Garage Sales
Copies/Bid Specs.
LDC/Code of Ordinances
Election Qualifying Fees =
Cemetery Lots
LoYNiche , Block , Unit
Cemetery Fees
VJ
0
— Total Paid
Initials
ito 0ept. of Origin • Yellow — Finance s Pink • Applicant