Candidate Packet_Frank D'Ambra_12/19/2017 Date: (Z ( q 2017
Lori McWilliams, MMC
Village Clerk RECEIVED
Village of Tequesta
345 Tequesta Drive DEC 19 2017
Tequesta, Florida 33469 VILLAGE CLERKS OFFICE
RE: NOTICE OF CANDIDACY
I F&A*A4- "-b AA,(—33r-- a resident of the Village of Tequesta, residing at
3 Z s 'R�e" T4.d .r��•3cti2, do hereby file as a Candidate for the two (2) year term for
the Office of the Council Member, Seat No. on the Tequesta Village Council to be
elected by the Village electors at the Municipal Election to be held on March 13, 2018.
In accordance with the provisions of the Village Charter and Code of Ordinances, I certify that I
meet the qualifications for candidacy:
• 1 am a registered voter of the incorporated Village of Tequesta
• 1 reside at the above stated address within the incorporated Village of Tequesta
• 1 do not hold any other public office in the Village (Exceptions: Notary Public,
membership in the National Guard, organized Reserve of the Armed Forces of the
United States, or in any other defense agency recognized by the Village, or in a status of
retirement from any of the foregoing)
• 1 acknowledge that I must subscribe to the Oath of Office as outlined in the Section 2.03
of the Village Charter and as required by 99.021, F.S.
Attached is a petition containing the signatures of at least fifty (50) registered voters of the
incorporated Village of Tequesta in support of my candidacy, a check for $103.44 payable to the
Village of Tequesta for the required $30.00 filing fee and the Florida Department of State's
$73.44 assessment fee (one percent (1%) of the annual salary of the office being sought), and a
completed Statement of Financial Interests (Form 1 —2016).
Respectfully submitted,
C��Pl 7�6�
Candidate's Signature
Office useff only:
Date filed: 1) 13 Received by: M of Se✓ Date Candidate Qualified: 102(1 R ! 7
Received by the Village Clerk:
IJ Loyalty Oath /Oath of Candidate
--C-ar.dodate Name
a_te)
Statement of Financial Interests From 1-2016
Nominating Petitions
Notice of Candidacy
L&A Testing
Driver's License to prove residency— SOE will certify voter status)
Qualifying Check
RECEIVED
q .
CANDIDATE OATH - : 19 2017all-
--Ykv3
NONPARTISAN OFFICE VILLAGE Ci-ERKS OFFICE
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021,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 C6vn4:-.
*�,(office) ^ (district#)
I am a qualified elector of ;aam &W-k County, Florida;
(circuit#) (group or seat#)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or
elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs
concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to
Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the
State of Florida.
X(::1e (sc� ) 676 -53t3
Signature of Candidate Telephone Number Email Address
►�-
Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): t ►I 4 6 7 6 S 7
* 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):
Raotutc 'V AtnRRR it,
STATE OF FLORIDA
COUNTY OF &M OVA&I
Sworn to(or affirmed) and subscribed before me this i day of D�UA41 bjeAl- , 20
Personally Known: or
Signature of Notary Public
Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public
Type of Identification Produced: LORI MCWILLIAMS
Commission#GG 004067
ExDires October t 0
BondedThruTmy Fain lneurenee110-3815-70119
DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C.
FORM 1 STATEMENT OF 2016
'lease print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
iddress,agency name,and position below:
BAST NAME—FIRST NAME—MIDDLE NAME:
MAILING ADDRESS: RECEIVED
�S ; ��� A �• 302 DEC 19 2017 a
CITY: ZIP: COUNTY VILLAGE CLERKS OFFICE
NAME OF AGENCY
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
You are not limited to the s ce on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF CANDIDATE OR J 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, 2016 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER
CALCULATIONS, OR USING COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES(see instructions
x further de ils). CHECK THE ONE YOU ARE USING(must check one):
COMPARATIVE(PERCENTAGE)THRESHOLDS OR ❑ 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'Wa")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
le.'e-us i(�lcd►cc,1 U.G 1b�S �i u :kyt �ctr��ttx, J ►�Ct l tr(�u(«t �e,.,tae
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"nia")
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-See instructions]
(If you have nothing to report,write"none"or"nla") FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM 1-Effective:January 1,2017 (Continued on reverse side) PAGE 1
Incorporated 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 BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
%ad.ks 19,S. " e.,Ri s
15f-he-ic- 7{a•IC;-O,s m",�a� >✓t c
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
(� -Y►�. u 5. �w t 'C'��s�cr F1.. S34(4i
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
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
PART G—TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142,F.S.
�. I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473,or attorney
Signature: 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.
Date Signed:
204'1 CPA/Attorney Signature:
Date Signed:
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, including If you were mailed the form by the Commission Initially,each local officer/employee,state officer,
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within
sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment
that location. or of the beginning of employment. Appointees
If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file
section,write"none"or"n/a"in that section(s). Supervisor of Elections of the county in which they prior to confirmation, even if that is less than
permanently reside. (If you do not permanently 30 days from the date of their appointment.
NOTE: reside in Florida, file with the Supervisor of the Candidates must file at the same time they file
MULTIPLE FILING UNNECESSARY: county where your agency has its headquarters.) their qualifying papers.
A candidate who files a Form 1 with a qualifying State officers or specified state employees Thereafter,file by July 1 following each calendar
officer is not required to file with the Commission file with the Commission on Ethics, P.O. Drawer year in which they hold their positions.
or Supervisor of Elections. 15709, Tallahassee, FL 32317-5709; physical Finally, file a final disclosure form (Porn 1 F)
address:325 John Knox Road, Building E, Suite within 60 days of leaving office or employment.
Facsimiles will not be accented. 200,Tallahassee,FL 32303. Filing a CE Form 1F(Final Statement of Financial
Interests)does not relieve the filer of filing a CE
Candidates file this form together with their Form 1 if the filer was in his or her position on
qualifying papers. December 31,2016.
To determine what category your position falls
under,see page 3 of instructions.
CE FORM 1-Effective:January 1,2017. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.
Village of Tequesta
345 Tequesta Drive 561-768-0700
Tequesta, FL 33469 www.tequesta.org
RECEIVED wk
DEC 19 2017 Q
VILLAGE CLERKS OR-i„r
NOTICE OF LOGIC AND ACCURACY (L&A) TEST
the undersigned, hereby
acknowledge that "Due Notice" has been given to me that the "Logic and Accuracy Testing of the
Computerized Tabulation Equipment," which will be used to tabulate the votes cast for the March
13, 2018 Municipal Election,will be on i'rlarc�„ Z O1$ , (if blank date is TBA).
I plan to attend the Logistics and Accuracy Test
I do not plan to attend the Logistics and Accuracy Test
Candidate Name (Print) Candidate Signature
r4 � [?-017
Date
Vice-Mayor Frank D':-lmbra :Mayor Abby Brennan Council Member Tom Paterno
Council Member Steve Okun Council N'lember Vince.-arena
Village Manager Michael R. Couzzo,Jr.
VILLAGE O, —OUESTA RECEIVED �
March 13, 2018 Nominating Signatures DEC 19 2017
We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: KS OFFICE
CANDIDATE NAME: c�,zt}tia�, �„ •�-- AGE: ram, 3
to be a Candidate for the Tequesta Village Council, SEAT NO. , Village of Tequesta, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
The above must be completed on all pages ofpetition)
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VILLAGE O, —QUES`fA RECEIVED ,
March 13, 2016 Nominating Signatures DEC 19 2017 Q
We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: ICE
CANDIDATE NAME: � � ", Mr AGE:
to be a Candidate for the Tequesta Village Council, SEAT NO. , Village of Tequesta, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all pages ofpetition)
PRINT NAME STREET ADDRESS . DATE OF BIRTH SIGNATURE
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VILLAGE O, _QUES`I"A RECEIVED
March 13, 2018 Nominating Signatures DEC 19 2017 gig
We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: IF
1(1L
CANDIDATE NAME:
to be a Candidate for the Tequesta Village Council, SEAT NO. `� , Village of Tequesta, Palm Beach County, Florida for a two (2)
year term Pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all pages of petition
PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE
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RECEIVED 41_.,-.-...
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VILLAGE O, e.,2UES`I'A ��r ,� � � I � ,
March 13, 2018 Nominating Signatures
VILLAGE CLERKS OFFICE
We, the undersigned duly qualified voters of the Village of Tequesfia, do hereby nominate:
CANDIDATE NAME: AGE;
to be a Candidate for the Tequesfia Village Council, SEAT NO. S , Village of Tequesfia, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all Pages ofpetition)
PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE
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RECEIVED ,
VILLAGE O, _,�UESTA l
March 13, 2018 Nominating Signatures ' v 1 9 2017
We, the undersigned duly qualified voters of the Village of Tequesfia, do hereby nominate: VILLAGE ci
CANDIDATE NAME:-- - �}N1� s �Cr; y;� -!� AGE;
to be a Candidate for the Tequesfia Village Council, SEAT NO. , Village of Tequesfia, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all pages ofpetition)
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VILLAGE_ O, _,�UESTA RECEIVED
March 13, 2018 Nominating Signatures DEC 19 2017
We the undersigned duly g y qualified voters of the Village of Tequesfia, do Hereby nominate:
CANDIDATE NAME: tc. AGE;
to be a Candidate for the Tequesta Village Council, SEAT NO. .5 , Village of Tequesfia, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all pages ofpetition)
PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE
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RECEIVED �:�� �.
VILLAGE O, e�UES"I"A �#*�
March 13, 2018 Nominating Signatures DEC 19 2017
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We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: CI-EERKS()Fr.IGF.
CANDIDATE NAME: i — AGE: 3
to be a Candidate for the Tequesta Village Council, SEAT NO. .S , Village of Tequesta, Palm Beach County, Florida for a two (2)
year term pursuant to the Charter and Ordinances of said Village.
(The above must be completed on all pages ofpetition)
PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE
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