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HomeMy WebLinkAboutCandidate Packet_Bruce Prince_12/9/2019STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, X-O � V- r-10 6 -e._ candidate for the office of ViV t4l,r�ovme-%1 have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candidate to 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) Date: 1 g / 2019 Lori McWilliams, MMC Village Clerk Village of Tequesta 345 Tequesta Drive Tequesta, Florida 33469 RE: NOTICE OF CANDIDACY I Aroce . re Nc e- , a resident of the Village of Tequesta, residing at 70 JG + t.J e rlc , do hereby file as a Candidate for the two (2) year term for the Office of the Council Member, Seat No. C-- 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 • I 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, Candidate's Signature Office use only: Date filed: ! -qjj f Received by: d� Date Candidate Qualified: I a io i g Received by the Village Clerk: ✓ Loy Ity Oath / Oath of Candidate ✓ Candidate Name Pronunciation (on Oath of Candidate) Statement of Financial Interests From 1-2018 ✓ Nominating Petitions Notice of Candidacy L&A Testing Driver's License to prove residency - SOE will certify voter status) ✓ Qualifying Check CANDIDATE OATH — NONPARTISAN OFFICE RECEIVED o not use this form if a Judicial or School Board Candidate) Check DEC 2019 box only if you are seeking to qualify as a write-in candidate: VILLAGE CLERKS OFFICE ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) r I, /�rvCe �. PrinoL (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.) d� ,am a candidate for the nonpartisan office of ��¢ a t 0 � 1\C L' M- ' (Office) (District #) /V %} ; I am a qualified elector of ��} IM A? 40A C k County, Florida; (Ci uit #) (GrcWjp 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; nd 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): 113 5 11 r) 3 D 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.] l� rLA C 2 Pit lrn e ee x (so '9 F 7, "16 7 b r�r� rc • �E�'rf► M / �. c o �r. Signature of Candidate Telephone Number Email Address YJ ;ry,e6.J £', / 33 Address City State ZIP Code m - STATE OF FLORIDAy _ Signature of Notary Public COUNTY OF PIS, %t4-i Print, Type, or Stamp Commissioned Name of Notary Public below: �tiO LORI MCWILLIAMS Sworn too (or affirmed) and subscribed before me this 4 ; Commission#GG00067 day of V (per 2011 ' ry' Ewa Bober 18, 2020 yn+Troy Fain Insmr," A00, M7019 ?ersonally Known: or Produced Identification: Type of Identification Produced: DS-DE 302NP (Rev. 11/17) Rule 1S-2.0001, F.A.C. leo FORM 1 STATEMENT OF 2018 Please print or type your name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address, agency name, and position below: LAST NAME — FIRST NAME — MIDDLE N ME t rJct 4jw �I MAILING ADDRESS . RECEIVED 0 �11 i a33�6 DEC - 9 2019 Cl ZIP COUNTY: VILLAGE CLERKS OFFICE 11,1 a -e v� Te rof4 N AGic : Ce i D o n e r *4 NAME 0 FFICE 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 Q,16ANDIDATE OR d 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 EITH R must check 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 THATAREABSOLUTE 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): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR 15'0*� 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 rin ct n ZI�1C• 39 /J. C o- 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 S URCE I -C �LA v vx 39 *J, ess po .4vt r i�rc�4t» Z C 3 99 /tit Pre IS e &( Co. o A i4-t4 S.r 1 1:2Y9 eJ. rrtf £ cr• A,. Co. 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 r �s f begin on page 3. CE FORM 1 . Effective: January 1. 2019 (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 'Wa") 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 "n/a") 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 /t 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 U I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. J IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Gate Signed: /a C FfLlNiG I STRUCT17 S: 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 specif►ed 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.Q. 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 your completed form and any attachments as a pdf (do not use any other format) and send it to CEForml@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: 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. CPA/Attomey Signature: Date Signed: Candidates file this form together with their filing papers MULTIPLE FILING UNNECESSARY: A candidate who files a Forrn 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 1 F) 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, 2016. CE FORM 1 - Effective: January 1, 2019. PAGE 2 Incorporated by reference in Rule 34-8.202(1). FA.C. Village of Tequesta 345 Tequesta Drive 561-768-0700 Tequesta, FL 33469 www.tequesta.org J RECEIVED DEC - 9 2019 $v VILLAGE CLERKS OFFICE NOTICE OF LOGIC AND ACCURACY (L&A) TEST t 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 f� �r 4) 0 C ?. J- ti)1G � Candidate Name (Print) Date Vice -Mayor Kristi Johnson Mayor Abby Brennan Council Member Laurie Brandon Candidate Signature Council Member Vince Arena Council Member Kyle Store Village Manager Jeremy Allen q� OF Ft yP �F�GAtSF�9iO SUPER . wendy Sartory pink 14 2015 DEC 10 AM 9' 03 OF PAS Palm Beach County Supervisor of Elections PALM BEACH COUNTY. FL PETITION SUBMITTANCE FORM NAME OF PETITION OR COMMITTEE: l� 11k , '� � ri (\&L NUMBER OF PETITIONS SUBMITTED: (APPROX) NAME OF PERSON SUBMITTING PETITIONS: ADDRESS: n � T E � L) e, 3 t G 0' --,O- -�C �v "�3 t-Z�, ti, 3 3 y � CONTACT: (phone) 9L —) � Vg C 3 SIGNATURE L:\SHARE\OfficeForms\PetitionSubmitForm.doc (email) IE�.�'� �( tyre 0 DATE Iall/ L-)1 240 South Military Trail, West Palm Beach. FL 33415 I Post Office Box 22309, West Palm Beach. 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LL O O LU Z c� o fV J N T" t L) L m 2 14; E• a� N M RN N ..r O cC L 0 v �L O 25- .0 ca m m ai a 0 - n r� A\\ CD - L 'o O Nn Z y d 0-)0')O) m d) CD ( 3 � �3 a 0 ++ co M M M M ':M M ` M M M U= CO co M ? M 7 co' CO co•� M M M " > c� co ,Q c� co o cd co c� c� c� 3 L 0 Z N U- N N N N (A N f- ~ �— M+;� /CD \T � 7 N d a ti ILL 'c z; 0 L C �� WL 7 rl r .0 V L 2 V co 3 0' co "T M (o - — q- cM LT M 4,� coM m co co�� M W M W co V LL f6 c LL V fB LL f6 r LL U fB LL 7 (0 Q LL (0 LL (B (B [Q� LLcn LL (6 v LL (0 (D a) a) \ A a) a� a� a� \�V — a) a) � 1 N(D �(D � i i C-7 mz:z r v / e or OF F4 co �F,caAt �9'� /Pawlm endy Sartory Link °F PA�Beach County Supervisor of Elections CERTIFICATION I, Wendy Sartory Link, Supervisor of Elections, for Palm Beach County, Florida, do hereby certify that 60 signatures on the Nominating Petitions of Bruce R. Prince for the Village of Tequesta, Council Seat 5 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 Bruce Randall Prince is a registered voter in Precinct 1078, in the Village of Tequesta, Florida. Signed, this 10' day of December, 2019. Supervisor of Elections Palm Beach County (SEAL) 240 South Military Trail, West Palm Beach, FL 334151 Post Office Box 22309, West Palm Beach, FL 33416 Telephone: 561.656.6200 1 Fax Number: 561.656.6287