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HomeMy WebLinkAboutCandidate Packet_Frank D'Ambra_12/16/2019Date: 1 (; 2019 Lori McWilliams, MMC Village Clerk Village of Tequesta 345 Tequesta Drive Tequesta, Florida 33469 RE: NOTICE OF CANDIDACY a resident of the Village of Tequesta, residing at do hereby file as a Candidate for the two (2) year term for the Office of the Council Member, Seat No. I on the Tequesta Village Council to be elected by the Village electors at the Municipal Election to be held on March 17, 2020. 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 $106.40 payable to the Village of Tequesta for the required $30.00 filing fee and the Florida Department of State's $76.40 assessment fee (1 % of the annual salary of the office being sought), and a completed Statement of Financial Interests (Form 1 — 2018). Respectfully submitted, andidate's Signature Office use only: Date filed: I AlU01 19 Received Date Candidate Qualified: Received by the Village Clerk: ✓ Loyalty Oath / Oath of Candidate v" Candidate Name Pronunciation (on Oath of Candidate) Statement of Financial Interests From 1-2018 ✓ Nominating Petitions (Q ✓ Notice of Candidacy �✓ L&A Testing Driver's License (to prove residency — SOE will certify voter status) Qualifying Check CANDIDATE OATH — NONPARTISAN OFFICE )o not use this form if a Judicial or School Board Candidate) check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) � j� 1 ' 1z gloy- I (� k�jQ2 � --11 (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of V r (\ aq21 13 V= T? (Office) (District #) I am a qualified elector of ?all,, 1"�rChcH 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; ind I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): _ (,0-7 � 5 7 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] -F(_Q C 1L e Qm ram S Signature of Candidate Telephone Number Email Address � A k 3�z Address City State ZIP Code STATE OF FLORIDA Signature of Notaryublic /� COUNTY OF PC- 1� &CCA Print, Type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me this N� �•, MARYANNGRIESER day of Dr�'�"&'y 20 19 ICommissionIGG0027fit " Expires June 15, 2020 ersonally Known: or Produced Identification: ., ,,` eclodThruTmyl*IMr*nc* 3A570t9 Type of Identification Produced: va-uc ooc��r ir%ev. r it 1 r) Rule 1S-2.0001, F.A.C. Village of Tequesta 345 Tequesta Drive Tequesta, FL 33469 561-768-0700 www.tequesta.org NOTICE OF LOGIC AND ACCURACY (L&A) TEST I 5.11--' 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 17, 2020 Municipal Election, will be on TBA at the Palm Beach County Supervisor of Elections Office. I plan to attend the Logistics and Accuracy Test ' I do not plan to attend the Logistics and Accuracy Test Candidate Name (Print) ( 21►(,) v� Date C Candidate Signature Vice -Mayor Kristi Johnson Mayor Abby Brennan Council Member Vince Arena Council Member Laurie Brandon Council Member Kyle Stone Village Manager Jeremy Allen FORM 1 STATEMENT OF 2018 Please print ortypeyour name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agency name, and position below: LAST NAM((��E - FIRST NAME - MIDDLE �NAME: Rnii u- (.=- I�tZl�d\ MAILING ADDRESS DECEIVED CITY: ZIP: C NTY �c DEC 1 6 2019 NAME OF AC.,ENCY : LwA(IC Gt✓ � `'6 �" ti= S`�'{� VILLAGE CLERKS OFFICE NAME OF OFFICE OR POSITION HELD OR SOUGHT: You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF 2-'CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE t'k 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 ISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHEck one): ��DECEMBER 31, 2018 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 for further details). CHECK THE ONE YOU ARE USING (must check one): / 0 COMPARATIVE (PERCENTAGE) THRESHOLDS OR 3 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 �'1..�.. ��Cnf1l� ,'7 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 "n/a") 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 "n/a") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file N this form and how to fill it out begin on page 3. — — i - cnecme. January i. [uia (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.202(1), F.A.C. I PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "n/a") TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions], (If you have nothing to report, write "none" or 'Wa") NAME OF CREDITOR ADDRESS OF CREDITOR 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 "n/a") BUSINESS ENTITY # 1 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 BUSINESS ENTITY # 2 ❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. I IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Date Signed: FILItiG INSTRUCTIONS: 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. To determine what category your position falls under, see page 3 of instructions. Local officers/employees 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.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics, it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan lour completed form and any attachments as a pdf (do not use any other format) and send it to CEForm1@leg.state.fl.us. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY 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. CPA/Attorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. 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 must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form IF) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2018. Incorpo2;ed by reference in Rule 34-8.202(1), FA.C. PAGE 2 Of ,ft�., HIS DEC 16 PM 2: 4 s Wendy Sartory Link if 3 PALM BEACH COUNTY, FL Palm Beach County Supervisor of Elections C I l PETITION SUBMITTANCE FORM Frank D'Ambra NAME OF PETITION OR COMMITTEE: 66 NUMBER OF PETITIONS SUBMITTED: (APPROXI Lori McWilliams NAME OF PERSON SUBMITTING PETITIONS: 345 Tequesta Drive ADDRESS: Tequesta, FL 561-768-0443 CONTACT: (phone) Imcwilliams@tequesta.org (email) 12/16/19 ILL SIGNATURE DATE L:\SHARE\OfficeForms\PetitionSubrnitForm.doc 240 South Military Trail, West Palm Beach, FL 33415 ; Post Office Box 22309. West Palm Beach. FL 33416 Telephone 561 656 6200 : Fax Number 561.656 62V RECEIVED VILLAGE OF TEQUESTA DEC 1 6 2019 March 17, 2020 Nominating Signatures VI:.L4GF CLERKS OFFICE We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: DIDATE NAME: I l 2,-a �— '. I ►\ I 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 of petition) PRINT NAME S Tequesta, FL 33469 i *'t'v W'% Tequesta, FL 33469 Te`' u�esta, FL 33469 Te uesta, FL 33469 Te u-e�-seta, FL 33469 G.3 I v . �� n S cvz. . Tequesta, FL 33469 Tequj} esta, FL 3346/9 Tequesta, FL 33469 (;� o2 Teque s ta, FL (3,.346/9� Tequesta, FL 334 DATE OF 0 V / 7 U 7 U SIGNATURE PM.I VILLAGE OF TEQUESTA March 17, 2020 Nominating Signatures We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: RECEIVED DEC 1 6 2019 CANDIDATE NAME: AGE: to be a Candidate for the Tequesta Village Council, SEAT NO. - I , 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 te4Teguesta, �4 6)� --leguesta, I-) L):s f4v3q t Apf %I A FL 33469 FL 33469 won Teguesta, FL 33469 Teguesta, FL 33469 P C" Teguesta, FL 33469 C ✓ j; Ll Teguesta, FL 33469 Tequesta, FL 33469 C? Teque,9ta, FL 33469 147 Tequesta, FL 3346 Teguesta, FL 33469 RECEIVED VILLAGE OF TEQUESTA March 17, 2020 Nominating Signatures DEC 1 6 2019 We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: I CANDIDATE NAME: I L& en�*-- t) A c,�'B r-, 1� - I AGE: I ��; i to be a Candidate for the Tequesta Village Council, SEAT NO. - I , 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 oacies of petition) PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE Teguesta, FL 33469 4v,-. U4 Teguesta, FL 33469 fl Teg esta, FL 33469 Lx Tequesta, FL 33469 . ...... . WA T'equesta, FL 33469 C�''/�2.% 1 / equesta, FL 33469 I. i Teguesta, FL 33469 Teguesta, FL 33469 - Wta. lTes flo, e� q L 3 ta, �L 33469 cw(r'�' 9(,1(1 j//-) Teq!u esVa, FLf �33(419 RECEIVED VILLAGE OF TEQUESTA DE(` 1 6 2019 March 17, 2020 Nominating Signatures VILLAGE CLERKS OFFICE we, tne unaersignea auly qualified voters of the Village of Tequesta, do hereby nominate: CANDIDATE NAME: AGE: to be a Candidate for the Tequesta Village Council, SEAT NO. _I, 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 Teguesta, FL 33469 72 J .. ...... Teguesta, FL 33469 Teguesta, FL 38469 '4 0 4 Tequesta , FL 33489 Teguesta, FL 33469 "t',Ar-16<4JI'-4-Teguesta, 41, � -J FL 33469 Tequesta, FL 33469 Lek �Ar ; e 4t\ C, yr'oe*� Teguesta, FL 33469 CL d 1V %.0 'v► �C,/ Teguesta, FL 33469 L e h, �Ue- '5ry aueiy dub Dr. 11'�011�7-7 Teguesta, FL 33469 VILLAGE OF TEQUESTA rEGH V E D March 17, 2020 Nominating Signatures DEC 1 6 2019 We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: VILLAGE CLERKS OFFICE CANDIDATE NAME: -2r�,�r ��,�,,,r=a- „� AGE: G. to be a Candidate for the Tequesta Village Council, SEAT NO, t , 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 paqes of petition) PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE )VA c, x 1 �2 Te uesta, FL 33469 -- I AC'- 04ear'W- y 6' , 6 0A Te uesta, FL 33469 x �.r� �I •s- Te uesta, FL 33469 Te uesta, FL 33469 Te uesta, I FL 33469 i 2 1 Ito x 7 1 -:- I Te uesta, FL 33469/-- Te uesta, FL 33469 Ct,FFL ��2b Teq 33469 01 / i --Tequesta Lr 34 69 Te uesta, FL 33469 RECEIVED VILLAGE OF TEQUESTA OEC 1 6 2019 March 17, 2020 Nominating Signatures VILLAGE CLERKS OFFICE We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: CANDIDATE NAME: AGE: to be a Candidate for the Tequesta Village Council, SEAT NO. I , 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 oases of oetition) PRINT NAME STREET ADDRESS DATE OF BIRTH SIGNATURE -I Cis, x, Q-- Teguesta, FL 33469 z--'s. Teguesta, FL 33469 '2 - 2:1, �c, Teguesta, FL 33469 In- 1lt Tequesta, FL33469 UWC-e �e(1-2 Ll E;�> Teguesta, FL 33469 Te'Q'uLefsta, FL 33469 Teguesta, FL 33469 -retic,tA 167 ki o e-(2- 1)v 5. QA-TK/NS Teguesta, FL 33469 Tequ sta, FL 33469 �)I)W-saj (e)'j fAtVw(aJ Li to /-2-Z - Teguesta, FL 33469 VILLAGE OF TEQUESTA 9ECEIVED -X, March 17, 2020 Nominating Signatures 66-EC 1 6 2019 We, the undersigned duly qualified voters of the Village of Tequesta, do hereby nominate: I CANDIDATE NAME:-- - I —I— I AG I,.: 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 STREETADDRESSDATE OF BIRTH ,--:�GNAT-URE QIA �� L- c-._ uesta, FL 33469 t J'i Tequesta, FL 33469 -7 -'41 L':'TJC lt%u Tequesta, FL 33469 2V Tequesta, FL 33469 Teguesta, FL 33469 Teguesta, FL 33469 Tequesta, FL 33469 Teguesta, FL 33469 Tequesta, FL 33469 Teguesta, FL 33469 OF F40 A.4. Wendy Sartory Link 1'0p40V Palm Beach County Supervisor of Elections CERTIFICATION I, Wendy Sartory Link, Supervisor of Elections, for Palm Beach County, Florida, do hereby certify that 62 signatures on the Nominating Petitions of Frank D'Ambra III for the Village of Tequesta, Council Seat 1 for the Village of Tequesta are registered electors within the municipal limits of the Village of Tequesta, according to the registration records on file in this office. This is to further certify that Frank D'Ambra III is a registered voter in Precinct 1120, in the Village of Tequesta, Florida. Signed, this 17th day of December, 2019. v-,ot-C Supervisor of Elections Palm Beach County (SEAL) 240 South Military Trail, West Palm Beach, FL 33415 1 Post Office Box 22309, West Palm Beach, FL 33416 Telephone: 561.656.6200 1 Fax Number: 561.656.6287