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Shockey, Donald On April 14th, Elect DONALD SHOCKEY A Progressive Now Voice for Miami Shores Village Council New Ideas New Opportunities Vote 7 a.m. to 7:00 p.m. this Tuesday April 14 at the Village Community Center, 96th Street west of the railroad tracks. On April 14th, Let's Unite for Positive Change in Miami Shores! Miami Shores Village is a great place to live.. but there are many opportunities to make it even better. As a member of the Village Council, my priorities will include: • Using funding for services and programs more efficiently and finding new funding. " Supporting both our local schools, Doctors Charter and Miami Shores Elementary. * Encouraging participation by all members of our diverse community. • Making the Village greener and more sustainable. • Making NE 2nd Ave. a place where we can enjoy stores and cafes right here at home • Responding to your issues and concerns. I have the experience, mind set, and commitment needed to achieve these goals and much more. Let's not miss this opportunity for another two years! Vote for Donald Shockley for Village Council on April 14th! Endorsed by: 74- SAVE DADE ACTION PAC Miami Beach Mayor Matti Herrera [lower Political Advertisement Paid for and Approved by Donald Shockey for Miami Shores Village Council. Elections 2700 NW 87th Avenue MIAMI Miami, Florida 33172 T 305-499-VOTE F 305-499-8547 TTY: 305-499-8480 miamidade.gov CERTIFICATION STATE OF FLORIDA) COUNTY OF MIAMI-DADE) I, Tara C. Smith, Chief Deputy Supervisor of Elections of Miami-Dade County, Florida, do hereby certify that 64 signatures submitted by Donald Shockey for the office of Village Council in Miami Shores Village matched the signatures on the voter files. WITNESS MY HAND AND OFFICIAL SEAL, AT MIAMI, MIAMI-DADE COUNTY, FLORIDA, ON THIS 17th DAY OF JAuL, MARCH 2009 Tara C. Sn4th Chief Deputy Supervisor of Elections Miami-Dade County Please submit a checkfor$5."00 to offce payable.t�o'�the Board of Co inl v Commissioners for the cost of verifying these signatures. j Lester Sola Date 3/16/2009 Supervisor of Elections Miami-Dade County,FL 'rime 05:37 PM Petition Status Report Petition Petition Short Description District Date Petition Number Opened 108 Donald Shockey CYD 28 16-March-2009 Signatures Sigs Unchecked Signatures Valid Rejected Duplicate Claimed checked Signatures Required Sigs Sigs Sigs including Duplicates Batch 1 68 68 0 50 64 4 0 68 68 0 50 64 4 0 1 Lester Sola Date 3/16/2009 Supervisor of Elections Miami-Dade County,FL Time 05:37 PM Petition Status Report Petition Petition Short Description District Date Petition Number Opened 108 Donald Shockey CYD 28 16-March-2009 Grand Total 68 68 0 50 64 4 0 Congressional District Batch 17 20 Total Number 1 61 3 64 Total 61 3 64 2 PETITION II lJ We, the undersigned electors of Miami Shores Village, hereby nominate �ptM.G for a position on the Village Council. PRINT NAME ADDRESS S GNATURE . DATE /AI n r+�, 06 � c a-" ` 6SO rv� ,5-4-v pj. 1 LDQ U(AYS 0&0 tv � I ►�C �i5 � � �.� 3o N e r �60 le-" - � gwtje 92.ASf- 3 S peKt4 is -nN5AA, I66 t�E gAgi), sT 3 s The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my pre ce and is the gen ' ign e of the person whose name it purports to be. Signature of Circula Address Acceptance of Nominationaim' I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Can"e44Vf /�� .��!;./ � ®2� �.�\� � 2�§\�>` � \ [/ %_ \\ f > / � � . L C'T m tvll 14 PETITION We the Undersigned electors of Miami Shores Village,hereby nominate �( for a position on the Village Council. PRINT NAME ADDRESS tTUATE::09� D JZ Mdc _: &'t'rV tY7 (V4"r- 1�94- 45-IMMUK�e- 'z14 t Q, h1rW- qv-zm 61- .4 A-Al'%- .cev� 73 / 67 41 31r d v 1 The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name it purports to Signature of Circulato Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candid(L4"-.�.I- '�e4 PETITION We, the undersigned electors of Miami Shores Village, hereby nominate g for a position on the Village Council. T NAME ADDRESS SIGNATITRE DATE 2 CA/ AW, il :1 ck�,4, 2 L-T, 0 The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is th genuine signature of the person whose name it purports to be. ( ��J ��15 ddresJSignature of Circulator � A s Acceptance ofNomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate - 2069 M.?,F" I S P 5: 01-1 E9 Etl RC1 s LJi P f T j`,'E N'T PETITION (l We, the undersigned electors of Miami Shores Village, herebynominate kldl miµ , for a position on the Village Council. PRINT NAME ADDRESS SIGNATURE DATE c r 60 93o ( ion C'absS 430 , ly� �� a� 311 s/0� K-� i)Ljl� � b�/� //3g fj -C� 79 �l ' 3 15, IJ ��C'3� �kc —�T �jr 1z The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine ignature of the person whose name, it purports to be. Signature of Circula Address t�?Jo Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candida e A ilk CIO Voc. PETITION We, the undersigned electors of Miami Shores Village, hereby nominatep0 for a position on the Village Council. "ICY, PRINT NAME ADDRESS G DATE CV-0 Oec-n 163D� Alv-- 3// d fog L� Ww'-z Leg-, 1�41 w- 103 6 . o� &oae,ti L 36 RE R-)"-Sr 3 tzlo4;/ I �k- F "Fr 2�0 �11A�►A �r�Cv�9n�L �3 G� �4 A , V—K&\)sc 2-77 o c<<z--A-N A ca r3C�OUIL4t C� . A09 0 611a I e _ r4C �a The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the gen ' sign tore of the person whose name it purports to be. Signature of Circula Address _� !X �T• r Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candid �4 c ,_ o� cG s , � t IN31,41A"d3(l S?VMIC"-- 0' W d 91 ENvl oclaz PETITION We, the undersigned electors of Miami Shores Village, hereby nomin for a position on the Village Council. PRINT NAME ADDRESS . .SIGNAup --qw DATE f �'V A r--)C5fA-�AA41 ry re 2 Ai i/tIA( Q-W 4 Pell , ti�sv, �a s 3��t°�✓ i '� �s UES-- A , S CZ � N - /7/0 The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the gen . e signature of the person whose name it purports to be. Signature of Circula o Address Acceptance of Nomination anti+ I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate 3". "'e Sym 2809 PHAR 16 PIM 04 S lic 19 Grp a 9 e 4a�m QAOR W ool�1 � 44 VC . �L0 11D -/0050 OWW. , coy 'mas March 16, 2009 Hs.-Iyy Miami-Dade County Elections Department 2700 N.W. 87th Avenue Miami, FL 33172 Dear Ivy: Enclosed please find Petition Forms (6) from Donald Shockey, in reference to the Miami Shores Village April 14, 2009 Council Election. Per our Charter, prospective candidates must obtain fifty (50) signatures of qualified electors in order to qualify for our election. Please verify the signatures on the attached petitions at your earliest convenience. If you have any questions, please do not hesitate to contact me directly at 305-762- 4851. Sincerely, Barbara A. Estep, MMC Village Clerk �liane. (305)795-2207 ('305,)76-6-897.2 �'p J�i�cul. ea�(�U miamia/eax�y `.com Elections 2700 NW 87th Avenue MIAMI•DADE Miami, Florida 33172 T 305-499-VOTE F 305-499-8547 TTY: 305-499-8480 miamidade.gov March 17, 2009 Barbara Estep, Village Clerk Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 Dear Ms. Estep: The Miami-Dade County Elections Department has completed the verification of the petitions for Donald Shockey, a candidate for Village Council. A total of 68 petitions were submitted and all were reviewed for verification. Of the total 68 petitions, 64 were certified. There will be no charge for the additional petitions that were verified. The Miami-Dade County Charter requires this process to include the following. For purposes of signature verification, however my office does not review this information, and encourages the municipality to ensure compliance with municipal charter or code requirements. • Title not being in English, Spanish, and Creole • Circulator was not a registered voter in Miami-Dade County • Notary did not comply with F.S. 117.05 • Notary was the same person as the circulator • Signatures of the circulator and the notary were dated earlier than any of the dates on which the electors signed the petition As such, please find the certification for the petition enclosed. Should you have any questions or concerns, please feel free to contact me or Michelle Giles, Acting Deputy Supervisor of Elections for Voter Services at 305-499-8302. Sincerely, Tara C. Smtih Chief Deputy Supervisor of Elections Miami-Dade Elections Department Enclosure . 050h 2.OE2 TOOO OT92 Wtt!r ■ Complete,items 1,'2,and 3.Also complete'item 4 if Restricted Delivery is desired.■ Print your name and address on the reverse so that we can return the card to you. eceiv y ed Nam) C. at of&Y ry ■ Attach this cans to the back of the mailpiece, f or on the front if space permits. L1 D. Is delivery address different m item 1? 11 Yes 1. Article Addressed to: If YES,enter delivery add re below: ❑No 3,M N93vr) �1-. 3. Service Type ►1�rn, tnA r Vr J Cl..s IXCertified Mail O Express Mail ❑Registered ❑Retum Receipt for Merchandise 1 C�O ❑Insured Mail p C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number .7O f �R-1� ' 3O� ��O (Transfer from service label) (�V �.J�J PS Form 381.11,Fe6ruary,2004 I I 'Domestic Return Receipt 102595-02-M-1540 t 't4 ft! tt UNITED STATES PqWAtt3gWj6 t tilt 11' 11111f t First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • MIAMI SHORES VILLAGE I 10050 N. E. 2nd Avenue Miami Shores Village, FL 33138 4 /• / • • .• Ul arv, OFFICIAL M Postage $ UU*4,� ti Certified Fee r=i M Retum Rece(pt FeeO (Endorsement Required) Q O Restricted Delivery Fee O (Endorsement Required) O r-R cp Total Postage&Fees $ S rtj Sent To ro M ..... - --- ----- Sweet.Apt or PO Box No. ---•-----------------------------------•-------- -`^ ••--- City,State,ZIP+4 Certified Mail Provides: ■ A mailing receipt ■ A unique Identifier for your mallplece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mails or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For-an additional fee,a Retum Rece/ t may be requested to provide proof of delivery.To obtain Return Receipt serve,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested'.To receive a fee waiver for' a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted Delivery'. ■ If a postmark on the Certified Mail receipt is desired;please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt Is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present It when making an inquiry. PS Forth 3800,August 2006(Reverse)PSN 7530-02.000-9047 SItic.URES wklylc iii uiiM LG�O LdRi"vA' X005'0 PO e P_Aa44u 0" Coy. 313138 March 16, 2009 Mr. Donald Shockey 321 N.E 93rd Street Miami Shores; F( 33.138 Dear-Hunt:, Congratulations on becoming an announced candidate for Miami Shores Village! Please be advised'that:as a candidate for the Village'Council-, you'are required to file Campaign .Treasurer's Reports.on the dates shown.below: Due Date Period Ending First Treasurer's"Report 03/25/09 03/20/09 Second Treasurer's Report , 04/10/09 04/09/09 Within ninety (90) days after having been elected,,eliminated;or withdrawing your candidacy, you must dispose of your campaign fund`.account and file a final report. Final Treasurer's Report Due 07/13/09 Reports shall be filed no later than 5:00 PM'on the designated day, however; any report Postmarked by,the U..& Postal Service no later than,midnight on the designated day shall be deemed to have been filed in a timely manner: (305)795-220y f 'aa �305�756-892 �'P-C .eet� [�mia�iva�ioxe :com Mr. Donald Shockey March 17, 2009 Page Two At 10:00 AM on April 9, 2009, in'accordance with Section 101.5612,Florida Statutes, a logic and accuracy test will be conducted on the'automatic tabulating equipment to be used.in the Miami.Shores Village Council election. The test will be held at the County's Division of Elections office, located at'2700 N.W."87th Avenue; Doral, Florida. If I can be of any assistance during your campaign, please do not hesitate to contact me. look forward to working with you in the coming weeks. Sincerely, Barbara A. Estep, MMC Village Clerk 'Certified Mail — Return Receipt Requested Candidate qualifying letter r . i 51 RES Q&amf, P9" orlaz�w �Lo iivA -/0050 PA/w. 211W March 16, '2009 Ms: Ivy Korman Miami Dade County Elections Department . 2700 KW: 87't' Avenue Miami,FL., 33172 Dear Ivy: Enclosed please find Petition Forms (6) from Donald Shockey, in reference to the Miami Shores Village April 14, 2009 CouncilElection. Per our Charter, prospective candidates must obtain fifty (50)-signatures of qualified electors in order.to qualify for our election. Please verify the signatures on the attached petitions at your earliest convenience. If you have any questions,.please do not hesitate to contact me directly at 305=762- 4851. Sincerely, Barbara A. Estep, MMC Village Clerk /one: (305)795-2207 ''aa (305)756-8972 �'p- eat��(@nuaniialio eavt�a�e:ixim PETITION }� We, the undersigned electors of Miami Shores Village, hereby nominate-1Jo1 ,�J _ for a position on the Village Council. PRINT NAMEADDRESS G DATE 1031)% �,�°w ;�1�►�- 3/i n 0 f,�, CA) 7' Uhh oae('jL Ia E Q }Sr 3 al q W, Ohs 1 k' AN �,J�� .��Mr�or✓ �� l'lA�n ��C_vJ11� � � _ �3 G'1 C,(z-A N f The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the gen ' sign ture of the person whose name it purports to be. Signature of Circu1 Address Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candida. PETITION We, the undersigned electors of Miami Shores Village, hereby nomin for a position on the Village Council. l PRINT NAME ADDRESS SIGNA DATE zo o C 'PAA -- 0 : Q 0") C E:�iN-1U* Oki 2-- ,�- �T `3.oA' Ck Q (sm, P � -�6111U � : q2) s - i�41a lC�uE� Sc c9wZCz C' A-'E F�<� a! - . 757-0, 4 I es #31 �J - � q�,Q:rG 3 i ;y The undersigned is the circulator of the foregoing paper containingsignatures. Each appended thereto -41 was made in my presence and is thegen ' e signature of the person whose name it purports to be. Signature of Circula oRAddress 7y►I Acceptance of.Nomination � \a-rvv �Ye,� 1�8 I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate PETITION We, the undersigned electors of Miami Shores Village, hereby nominate UCG for a position on the Village Council. PRINT NAME ADDRESS S GNATURE . DATE 3-15 ,01 (z' -ro k t ICY 6kw� s-15.0 04 1 C- -1� 41 Vx he cb�4 (b LIE il JI�Lb' Ccl Y'Y1 , 1.1 16SO tUUL- �TT s s ��_� PI . l � r1� } 3��6 J4±S� � l os 30 Nil �. kee)4- Bcme I(ObNE�Zncks' - D&Kra is TIW!5AA, 161 t�E- 120, The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my pre ce and is the gen ' ign a of the person whose name it purports to be. Signature of Circula Address IC I3Jal� r - -1 ar Acceptance of Nomination ' '< I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Cal a e PETITION We the Undersigned electors of Miami Shores Village, hereby nominate for a position on the Village Council. PRINT NAME ADDRESS DATE S_�s �9 J7 Wt xt) 73N� ' S - 3j 15 vy .ee , 73 Nc I9 _ r The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name it purports to Signature of Circulato Address: bl Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candie :. r PETITION `7 We, the undersigned electors of Miami Shores Village, hereby nominate 1 6 for a position on the Village Council. PRINT NAME ADDRESS SIGNATURE DATE 12 y Aik4 -3 V—T 0 The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is th genuine signature of the person whose name it purports to be. IJ,�15 ,� Signature of Circulator . Address Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate jw-.I PETITION (l We, the undersigned electors of Miami Shores Village, hereby nominate�� ovA�.�► Y , for a position on the Village Council. PRINT NAME ADDRESS SIGNATURE... DATE ai �3or 311 s/b� 0-7 UI L11 115 g .0 C C) n n' 'c 142 P LL30a�l The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine ignature of the person whose name it purports to be. Signature of Circula Address 3OxlU 9 Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candida e �s -Ta- 81b6 SNORES G �Oadam OW Wpak�6, C?#(Q/ffWp orla Z�W (e4 WZ OUR QAa~ aoww Orl aye �L0R1DA -/0050 QA11 . 2, QAame, 6", COY 33788 IF YOU WOULD LIKE TO BECOME A CANDIDATE FOR THE MIAMI SHORES VILLAGE COUNCIL 1) Read the information enclosed in the package. The information provides links that will explain the laws regulating a campaign. You are responsible for knowing and obeying the laws relating to campaigns and elections. You are also responsible for observing all requirements relating to campaign financing before accepting any contributions or making any expenditures. i 2) Appoint a campaign treasurer who is a registered voter of the State of Florida. You may serve as your own campaign treasurer or deputy treasurer. 3) Within ten (10) days of appointing a campaign treasurer, you must complete the "Statement of Candidate"form and return the form to my office. 4) A formal campaign account must be opened at a bank authorized to do business in Florida. A) The account must be separate from any existing personal or business account. B) The bank will provide deposit slips and checks. Statements should be sent to your campaign treasurer. C) You may use "counter" checks as long as you type or print your name and "Campaign Account". D) Allcampaign expenses MUST be paid from the campaign account unless specifically exempted (see Chapter 106 of the Florida Statutes as enclosed). E) Personal use of campaign funds for salary or to defray normal living expenses is permitted if you file a statement indicating the intent. This statement must be filed with the papers appointing the treasurer and the bank designation. 5) Complete the "Appointment of Campaign Treasurer" and the "Designation of Campaign Depository"forms and return them to my office. /one: (805)7S5-2207 C0.7 (305)756-8972 g'p-c/uacl eat%G@mi�mic�iorebvcllaSe.cam 6) Prior to obtaining any signatures on the "Petition", complete the top portion of each form. Other individuals may assist you in circulating the Petition, as long as they complete and sign the bottom of each Petition as indicated. Petitions must be signed in ink, with the signer printing their name and address as well as providing their signature. Fifty (50) signatures of QUALIFIED MIAMI SHORES ELECTORS are required to become a candidate for the Village Council election. Because the Village's Charter states that "... no elector shall sign more than three (3) such petitions, and should an elector do so, his signature shall be voided except as to the petition first filed. . ", please ensure that individuals signing the petition have not previously signed three (3) other candidate's petitions. 7) The following forms/papers should be completed and returned to my office: A) Loyalty and Candidate's Oath B) Financial Disclosure (Form 1) C) Petition Forms bearing at least fifty (50) signatures of Qualified Miami Shores Electors. D) Statement of Candidate 8) You will receive confirmation upon becoming a Qualified Candidate from my office subsequent to the Miami-Dade County Department of Elections verifying fifty (50) qualified elector's signatures. The last day for a candidate to qualify for the April 14, 2009 election is Monday, March 16, 2009. As the Village depends upon the County's Department of Elections to verify signatures, please ensure that your petitions are submitted in a timely manner. 9) The Village Council Election will be held in the Auditorium of the C. Lawton McCall Community Center, located at 9617 Park Drive. The Election date is Tuesday, April 14, 2009, with polls opening at 7:00 AM and closing at 7:00 PM. All precincts will vote at this one location. 10) Three individuals will be elected to serve on the Village Council, with official swearing-in ceremonies to take place on Tuesday, April 21st. If you have any questions regarding any of the information,contained within the enclosed package, please do not hesitate to contact me at (305) 795-2207 or e-mail me at estepb@miamishoresvillage.com. In addition, the Miami-Dade County Elections Department has an internet site with additional information. Their site also provides a link to the State's Division of Elections. The applicable web site addresses are: http://elections.miamidade.gov/ for the Miami-Dade County site and http://election.dos.stateftus for the State Division of Elections site. Barbara A. Estep, MMC Village Clerk PETITION We, the undersigned electors of Miami Shores Village, hereby nominate for a position on the Village Council. PRINT NAME ADDRESS SIGNATURE DATE The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name it purports to be. Signature of Circulator Address Acceptance of Nomination I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate ORDINANCE NO. 608-99 An Ordinance Miami Shores Village, Florida, amending Section 270 of the Code of Ordinances by adding a Section to be numbered 504.2 addressing Temporary Political Signs and providing for an effective date. BE IT ORDAINED BY THE COUNCIL OF MIAMI SHORES,VILLAGE,FLORIDA: Section 1. That the Code of Ordinances, Miami Shores Village,Florida,is hereby amended by adding a section to be numbered 504.2,which said section reads as follows: 504.2 Temporary Political Signs No temporary political signs shall be placed on public rights-of-way or on property owned or used by the Village, on any unimproved lot without the written consent of the property owner filed with the Village Clerk prior to posting of the sign,or upon any public utility pole or equipment, traffic control device or structure, bridge,guardrail or public traffic or location sign. Each candidate shall,prior to the installation or construction of signs in accordance with this article, post or cause to be posted with the Village, a refundable cash bond in the amount of $250.00 to ensure compliance with the conditions of this section. Any candidate who has qualified for a Miami Shores Village municipal election shall be exempt from the requirement of posting the cash bond. Temporary political signs shall be permitted in all zoning districts,provided that no temporary political sign shall be permitted to remain longer than seven(7)days after the election which is the subject matter of such sign. Any candidate who fails or causes to fail in the removal of all temporary political signs within the stated timeframe,shall forfeit the cash bond. Each parcel of property shall be permitted one sign per candidate or ballot issue. The maximum size of any individual temporary political sign shall not exceed 4.5 square feet in area. The total signable area for temporary political signs located on any single property shall not exceed 27 square feet(6 signs). No temporary political sign shall be placed within five feet of any easement of the property upon which the sign is located. No temporary political sign shall be located within ten feet of the edge of the pavement. Temporary political signs shall be located solely on the property side of the sidewalk if there is a sidewalk. No temporary political signs shall be located on property in such a manner as to interfere with or present a hazard to the flow of traffic along the streets adjacent to the property upon which the temporary political sign is located. All temporary political signs placed on vehicles(except bumper stickers)shall not exceed 4.5 square feet and shall be securely fastened to the vehicle in order to ensure that the vehicle is capable of being operated in a safe manner. No free-standing, sandwich-beard, or portable political signs, other than those securely fastened to vehicles shall be allowed. Any individual or entity who posts or causes to be posted a bond pursuant to this article, and the owner and tenant of the property where a temporary political sign is located,shall be responsible for any hazard to the general public which is caused by, or created by reason of,the installation or maintenance of temporary political signs. The candidate shall also be responsible for the prompt.removal of such signs. No political signs shall be installed more than forty-five(45)days prior to the date of the election which is the subject matter of such sign nor more than thirty(45) days prior to a primary election scheduled prior to a regular election. Any temporary political sign not posted in accordance with the provisions set forth, and any such sign which exists in violation of this article, shall be deemed to be a public nuisance and shall be subject to removal by the candidate, the property owner or the Village. If the Village removes the sign as a last resort,the Village Manager or his designee shall deduct the cost and expense of the removal from the posted cash bond, but nothing contained herein shall limit the liability to the Village of any candidate, property owner or tenant, to only the amount of such bond, and the Village may recover its actual costs without limitation. Notwithstanding the above regulations,the Village Manager may cause the immediate removal of any sign that constitutes a nuisance or poses an immediate danger to the health, safety or welfare of the community. Village personnel may enter onto premises, with or without the property owner's consent,for emergency removal. This article shall be subject to enforcement under the Florida Statutes, Ch. 162. The Village Clerk shall make a copy of this Ordinance available to all qualifying Village Council candidates, who shall sign and date an acknowledgment of receiving the document. S=ion 2 This Ordinance shall take effect immediately upon adoption. APPROVED on first reading this 1_day of ,lan,�v 1999. PASSED AND ADOPTED on second reading this 2nd day of February 1999. Mary Rosd Agosta,Mayor ATTEST: Barbara A.Fugazzi, C C, illage Clerk APPROVED AS TO FORM: Richard Sarafan, Village Atto ey 2 QUALIFYING FORMS TO BE COMPLETED AND RETURNED TO THE VILLAGE CLERK STATE OF FLORIDA OFFICE USE ONLY APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE TYPE) CHECK APPROPRIATE BOX: ®`: Original Appointment El Deputy Treasurer Reappointment of Treasurer Name of Candidate 1.Address(include post ffice box or street,city,state,zip code) e� � 8" es �� Telephone(optional) Party(Partisan candidates only) 3.Office(add district, circuit,group number) ( > -% 2. I have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 4. Name f TreasurerVeputyTreasurer 5. Mailing Address(If post o ice box or dra er add street address) 6.Telephone L 7. ity ounty 9. Stat 10.Zip Code I(A V-Y\,, AM 9.1 h YVN" AP L I have designated the following named bank as my 91 Primary Depository Secondary Depository 11. Name of Bank 12. Street Address dLV 0 0liTA City l 14 County 15.State 16.Zip Code 17. Sign ndid Date X � � Ca paign Tre urer's Acceptance of Appointment 1, o C do hereby accept the appointment as (Please Print or Tf e) EjCampaign Treasurer Deputy Treasurer for the campaign of who is seeking nomination or election as a candidate to the office of (Party) UNDER PENALTIES OF PERJU ,I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND THAT THE FACT T D A TRUE. 3/ lo Date Signature of Campaign Treasurer Deputy Treasurer DS-DE 9(Rev.01/08) OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) candidate for the office of v ; have received, read and understand the requirements of Chapter 106, Florida Statutes. So Signatur o Candidat 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(Rev.03/08) LOYALTY OATH OFFICE USE ONLY CANDIDATES WITH NO PARTY AFFILIATION (Sections 876.05-876.10,Florida Statutes) STATE OFF ORIDA COUNTY First Name fiddle Name/Initial Last Ime a citizen of the State of Florida and of the United States of America. . . . and a candidate for public office . . . do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. OATH OF CANDIDATE ( ection 99.021,Florida Statutes) I, b (PLEAS 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 office of h1left Q W , office) (district) (circuit) I am a qualified elector of t County, Florida. I am qualified (group) under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected. 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. 0 Signature of CandIdEVe Telephone Number Email Address Addr sN-C City , , (I_ State ZIP Code Sworn to(or affirmed)and subscribed before me this / day of)�-A4 200 0 Personally Known: or Produced Identification: Type of Identification Produced: WnatofPublic—St a FI rida Print,Type or Stamp Commissio ed a of Notary Public RAM"PEREZ StIft paft J2012 �m S ConmisbeI D,0T MSI DS-DE 24B(Rev.05/08) DECLARATION FOR CANDIDATES NOT AUTOMATICALLY COVERED BY THE MIAMI-DADE ETHICAL CAMPAIGN PRACTICES ORDINANCE The Ethical Campaign Practices Ordinance may apply to any candidate, and his or her campaign staff, for elective office with a constituency in whole or in part in Miami-Dade County who agree to abide by the mandatory and/or voluntary fair campaign practices. I, , a candidate for the office of ree to abide by the mandatory fair campaign practices as provided in Section 2-11.1.1(C)(1)of the Code of Miami-Dade County and recognize as compulsory the jurisdiction of the Ethics Commission. I further agree that the Ethics Commission will have the authority to decide whether said candidate has violated the mandatory campaign practices and, if a violation is found,the Ethics Commission has the authority to impose the appropriate penalty,if any. . By signing this declaration, I acknowledge that I will follow the mandatory campaign practices and shall not: a) with actual malice make or cause to be made any untrue oral statement about another candidate or a member of his or her family or staff which exposes said person to hatred, contempt,or ridicule,or causes said person to be shunned or avoided,or injured in his or her business or occupation; or b) with actual malice publish or cause to be published by writing printing,picture, effigy,sign or otherwise than by mere speech any untrue statement about another candidate or a member of his or her family or staff which exposes said person to be shunned or avoided,or injured in his or her business or occupation;or c) willfully injury,deface or damage or cause to be injured, defaced or damaged by any means any campaign poster, sign, leaflet,handbill, literature or other campaign material of another candidate; or d) knowingly obtain, or cause to be obtained campaign property of another candidate with the intent to,temporarily or permanently,deprive the candidate of a right to the property or a benefit therefrom; or e) knowingly file with the Ethics Commission a groundless or frivolous complaint against another candidate; or f) knowingly fail to remove a campaign sign within thirty(30)days of the last election in which the candidate was on the ballot;or g) knowingly erect or cause to be erected a campaign sign within the right-of-way limits of any County-maintained road in Miami-Dade County. Once the declaration is signed it is deemed irrevocable for the duration of the campaign. G ---- --- -- -- ------------ ------- ------ t- - - -q------ Signature Date In addition to abiding by the Mandatory Campaign Practices, I agree to follow the voluntary Statement of Fair Campaign Practices enumerated in Section 2-11.1(D): 1. I shall not make my race, religion, national origin, gender, physical disability or sexual orientation an issue in my campaign. 2. I shall not make my opponents' race,religion, national origin,gender,physical disability or sexual orientation an issue in my campaign. 3. I will condemn any appeal to prejudice based on race,creed,national origin, religion,gender,physical disability or sexual orientation. 4. I shall not without just cause attack or question my opponent's patriotism. 5. I shall not publish,display or circulate any anonymous campaign literature or political advertisement. 6. I shall not tolerate my supporters engaging in these activities which I condemn nor shall I accept their continued support if they engage in such activities. I will not permit any member of my campaign organization to engage in these activities and will immediately and publicly repudiate the support of any other individual or group,which resorts to the methods and tactics I condemn. 7. 1 shall run a positive campaign emphasizing my qualifications for office and positions on issues of public concern. 8. I will limit my attacks on an opponent to legitimate challenges to that person's record,qualifications,and positions. 9. I will neither use nor permit the use of malicious untruths or innuendoes about an opponent's personal life,nor will I make or condone unfounded accusations discrediting that person's credibility. 10. I will take personal responsibility for approving or disavowing the substance of attacks on my opponent that may come from third parties supporting my candidacy. 11. 1 will not use or permit the use of campaign material that falsifies,distorts, or misrepresents facts. I o1, ei a candidate for the office of r I 0 ' , ag e to abide by the Statement of Fair Campaign Practices mandatory fair campaign practices as provided in Section 2-11.1.1(C)(1)of the Code of Miami-Dade County and described on the previous page and recognize as compulsory the jurisdiction of the Ethics Commission. I further agree that the Ethics Commission will have the authority to decide whether said candidate has violated the Statement of Fair Statement Campaign Practices and, if a violation is found,the Ethics Commission has the authority to impose the appropriate penalty, if any. Once the declaration is signed it is deemed irrevocable for the duration of the campaign. -- --------I-------- -d-151-0--------- Signature Date PLEASE FILE FORM(S) WITH THE MIAMI-DADE COMMISSION ON ETHICS AND PUBLIC TRUST AND THE MIAMI-DADE SUPERVISOR OF ELECTIONS. Miami-Dade Commission on Ethics Miami-Dade Supervisor of Elections 19 West Flagler Street 2700 N.W. 87th Avenue Suite 220 Doral,Florida 33172 Miami,FL 33130 . t DECLARATION FOR CANDIDATES COVERED BY THE MANDATORY PROVISION OF THE ETHICAL CAMPAIGN PRACTICES ORDINANCE The mandatory practices of Ethical Campaign Practices Ordinance automatically extend to candidates and their respective campaign staffs for the Miami-Dade County Commission or Mayor; candidates and their respective campaign staffs for the Miami-Dade County and Rescue Service District Board; candidates and their respective campaign staffs for Miami-Dade Community Councils and candidates and their respective campaign staffs for any elective municipal elective office in Miami-Dade County. Furthermore,any candidate for public office in Miami-Dade County as described in the preceding sentence may at any time declare that he or she agree to abide b the Statement of Fair Campaign Practices. I, A0 jAf v , a candidate for the office of agree to abide by the voluntary fair campaign practices as 1 provided in Section 2-11.1.1(D)(1),of the Code of Miami-Dade County and recognize as compulsory the jurisdiction of the Ethics Commission. I further agree that the Ethics Commission will have the authority to decide whether I have violated the statement of fair campaign practices and, if a violation is found,the Ethics Commission has the authority to impose the appropriate penalty, if any. The Statement of Fair Campaign Practices is enumerated below: 1. I shall not make my race, religion,national origin,gender,physical disability or sexual orientation an issue in my.campaign. 2. I shall not make my opponents' race,religion,national origin,gender,physical disability or sexual orientation an issue in my.campaign. 3. I will condemn any appeal to prejudice based on race,creed,national origin, religion,gender,physical disability or sexual orientation. 4. 1 shall not without just cause attack or question my opponent's patriotism. 5. 1 shall not publish,display or circulate any anonymous campaign literature or political advertisement. 6. 1 shall not tolerate my supporters engaging in these activities which I condemn nor shall I accept their continued support if they engage in such activities. I will not permit any member of my campaign organization to engage in these activities and will immediately and publicly repudiate the support of any other individual or group,which resorts to the methods and tactics I condemn. 7. I shall run a positive campaign emphasizing my qualifications for office and position on issues of public concern. 8. I will limit my attacks on an opponent to legitimate challenges to that person's record, qualifications,and positions. 9. I will neither use nor permit the use of malicious untruths or innuendoes about an opponent's personal life,nor will I make or condone unfounded accusations discrediting that person's credibility. 10. I will take personal responsibility for approving or disavowing the substance of attacks on my opponent that may come from third parties supporting my candidacy. 11. I will not use or permit the use of campaign material that falsifies, distorts, or misrepresents facts. Once the declaration is signed it is deemed irrevocable for the duration of the campaign. _3 --16_/_Oy------ Signature Date PLEASE FILE A COPY OF THIS FORM WITH THE MIAMI-DADE COMMISSION ON ETHICS AND PUBLIC TRUST AND THE MIAMI-DADE SUPERVISOR OF ELECTIONS. Miami-Dade Commission on Ethics Miami-Dade Supervisor of Elections 19 West Flagler Street 2700 N.W. 87th Avenue Suite 220 Doral,Florida 33172 Miami,FL 33130 INSTRUCTIONS FOR COMPLETING FORM 1 STATEMENT OF FINANCIAL INTERESTS WHO MUST FILE FORM 1: All persons who fall within the categories of"state officers,""local officers/employees,""specified state employees,"as well as candidates for elective local office, are required to file Form 1.Positions within these categories are listed below.Persons required to file full financial disclosure(Form 6)and officers of the judicial branch do not file Form 1 (see Form 6 for a list of persons who must file that form). STATE OFFICERS include the following positions for state officials: 4) Persons holding any of these positions in local government: Mayor; 1) Elected public officials not serving in a political subdivision of the state county or city manager;chief administrative employee of a county,municipal- and any person appointed to fill a vacancy in such office,unless required to ity,or other political subdivision;county or municipal attorney;chief county or file full disclosure on Form 6. municipal building inspector;county or municipal water resources coordinator; 2) Appointed members of each board,commission,authority,or council county or municipal pollution control director;county or municipal environmen- having statewide jurisdiction, excluding members of sole advisory bodies; tal control director; county or municipal administrator with power to grant or but including judicial nominating commission members; Directors of the deny a land development permit; chief of police; fire chief; municipal clerk; Florida Black Business Investment Board,Enterprise Florida,Scripps Florida appointed district school superintendent;community college president;district Funding Corporation,Workforce Florida,and Space Florida; Members of the medical examiner; purchasing agent(regardless of title)having the authority Florida Commission on Tourism,Florida Substance Abuse and Mental Health to make any purchase exceeding$15,000 for the local governmental unit. Corporation,and the Council on the Social Status of Black Men and Boys;and SPECIFIED STATE EMPLOYEES include the following positions Governors and senior managers of Citizens Property Insurance Corporation for state employees: and Automobile Joint Underwriting Association. 1) Employees in the office of the Governor or of a Cabinet member who 3) The Commissioner of Education, members of the State Board of are exempt from the Career Service System, excluding secretarial, clerical, Education, the Board of Governors, and the local Boards of Trustees and and similar positions. Presidents of state universities. 2) The following positions in each state department,commission,board, LOCAL OFFICERS/EMPLOYEES include the following positions or council: Secretary, Assistant or Deputy Secretary, Executive Director, for officers and employees of local government: Assistant or Deputy Executive Director, and anyone having the power nor- 1) Persons elected to office in any political subdivision(such as munici- mally conferred upon such persons,regardless of title. palities, counties, and special districts) and any person appointed to fill a 3) The following positions in each state department or division:Director, vacancy in such office,unless required to file full disclosure on Form 6. Assistant or Deputy Director,Bureau Chief,Assistant Bureau Chief, and any 2) Appointed members of the following boards,councils,commissions, person having the power normally conferred upon such persons, regardless authorities, or other bodies of any county, municipality, school district, inde- of title. pendent special district,or other political subdivision: the governing body of 4) Assistant State Attorneys, Assistant Public Defenders, Public the subdivision; an expressway authority or transportation authority estab- Counsel,full-time state employees serving as counsel or assistant counsel to lished by general law;a community college or junior college district board of a state agency,administrative law judges,and hearing officers. trustees;a board having the power to enforce local code provisions;a board 5) The Superintendent or Director of a state mental health institute estab- of adjustment;a planning or zoning board having the power to recommend, lished for training and research in the mental health field,or any major state create, or modify land planning or zoning within the political subdivision, institution or facility established for corrections,training,treatment,or rehabili- except for citizen advisory committees, technical coordinating committees, tation. and similar groups who only have the power to make recommendations to 6) State agency Business Managers,Finance and Accounting Directors, planning or zoning boards;a pension board or retirement board empowered Personnel Officers,Grant Coordinators,and purchasing agents(regardless of to invest pension or retirement funds or to determine entitlement to or amount title)with power to make a purchase exceeding$15,000. of a pension or other retirement benefit. 7) The following positions in legislative branch agencies:each employ- 3) Any other appointed member of a local government board who is ee(other than those employed in maintenance,clerical,secretarial,or similar required to file a statement of financial interests by the appointing authority or positions and legislative assistants exempted by the presiding officer of their the enabling legislation,ordinance,or resolution creating the board. house);and each employee of the Commission on Ethics. INSTRUCTIONS FOR COMPLETING FORM 1: INTRODUCTORY INFORMATION(At Top of Form): listed in Section 119.071(4)(d),F.S.,are encouraged to provide an address other than their home address. If your name, mailing address, public agency, and position are already printed on the form,you do not need to provide this informa- DISCLOSURE PERIOD:The tax year for most individuals is the calendar tion unless it should be changed. To change any of this Information, year(January 1 through December 31). If that is the case for you, then write the correct information on the form,then contact your agency's your financial interests should be reported for the calendar year 2008;just financial disclosure coordinator. Your coordinator Is identified In the check the box and you do not need to add any information in this part of financial disclosure portal on the Commission on Ethics website: the form.However,if you file your IRS tax return based on a tax year that is www.ethics.state.fl.us. not the calendar year,you should specify the dates of your tax year in this portion of the form and check the appropriate box.This is the time frame NAME OF AGENCY.This should be the name of the governmental unit or"disclosure period"for your report. which you serve or served, by which you are or were employed, or for which you are a candidate. For example, "City of Tallahassee," "Leon MANNER OF CALCULATING REPORTABLE INTERESTS:As noted in County,"or"Department of Transportation." this portion of the form,the Legislature has given filers the option of report- ing based on either thresholds that are comparative (usually, based on OFFICE OR POSITION HELD OR SOUGHT. Use the title of the office percentage values)or thresholds that are based on absolute dollar values. or position you hold,are seeking, or held during the disclosure period(in The instructions on the following pages specifically describe the different some cases you may not hold that position now, but you still would be thresholds.Simply check the box that reflects the choice you have made. required to file to disclose your interests during the last year you held that You must use the type of threshold you have chosen for each part of the position). For example, "City Council Member," "County Administrator," form. In other words, if you choose to report based on absolute dollar "Purchasing Agent,"or"Bureau Chief." If you are a candidate for office or value thresholds, you cannot use a percentage threshold on any part of are a new employee or appointee,check the appropriate box. the form. MAILING ADDRESS: If your home address appears on the form but you prefer another.address be shown,change the address as described above If you are an active or former officer or employee listed in Section 119.071(4)(d), F.S., whose home address is exempt from disclosure, the Commission is required to maintain the confidentiality of your home (CONTINUED on page 4) address if you submit a written request for conffdentiaiity. Persons CE FORM 1 -Eff.112009 PAGE 3 PART A — PRIMARY SOURCES OF INCOME (a) If you are reporting based on percentage thresholds: [Required by Sec. 112.3145(3)(a)l or(b)1, Fla.Stat.] (1) You owned (either directly or indirectly in the form of an equitable or beneficial interest) during the disclosure period more Part A is intended to require the disclosure of your principal sources of than five percent (5%) of the total assets or capital stock of a income during the disclosure period.You do not have to disclose the amount business entity (a corporation, partnership, limited partnership, of income received. The sources should be listed in descending order, proprietorship, joint venture, trust, firm, etc., doing business in with the largest source first. Please list in this part of the form the name, Florida);and address,and principal business activity of each source of your income which (2) You received more than ten percent(10%)of your gross income (depending on whether you have chosen to report based on percentage during the disclosure period from that business entity;and thresholds or on dollar value thresholds)either: exceeded five percent (5%) of the gross income received by you in (3) You received more than $1,500 in gross income from that your own name or by any other person for your benefit or use during the business entity during the period. disclosure period,or (b) If you are reporting based on dollar value thresholds: exceeded $2,500.00 (of gross income received during the disclosure (1) You owned (either directly or indirectly in the form of an period by you in your own name or by any other person for your use or equitable or beneficial interest)during the disclosure period more benefit). than five percent (5%) of the total assets or capital stock of a You need not list our public salary received from serving in the business entity (a corporation, partnership, limited partnership, Y P rY 9 proprietorship, joint venture, trust, firm, etc., doing business in position(s) which requires you to file this form, but this amount should be Florida);and included when calculating your gross income for the disclosure period.The (2) You received more than $5,000 of your gross income during income of your spouse need not be disclosed.However,if you are reporting based on percentage thresholds and if there is joint income to you and your the disclosure period from that business entity. spouse from property held by the entireties (such as interest or dividends If your interests and gross income exceeded the appropriate thresholds listed from a bank account or stocks held by the entireties),you should include all above,then for that business entity you must list every source of income to of that income when calculating your gross income and disclose the source the business entity which exceeded ten percent(10%)of the business entity's of that income if it exceeded the 5%threshold. gross income(computed on the basis of the business entity's most recently "Gross income" means the same as it does for income tax purposes, completed fiscal year), the source's address, and the source's principal including all income from whatever source derived,such as compensation for business activity. services,gross income from business,gains from property dealings,interest, Examples: rents, dividends, pensions, social security, distributive share of partnership — You are the sole proprietor of a dry cleaning business,from which gross income,and alimony,but not child support. you received more than 10%of your gross income(an amount that was Examples: more than$1,500)(or,alternatively,more than$5,000,if you are using — If you were employed by a company that manufactures computers dollar value thresholds)..If only one customer,a uniform rental company, and received more than 5%of your gross income(salary,commissions, Provided more than 10% of your dry leaning business,you must list etc.)from the company(or, alternatively, $2,500), then you should list the name of the uniform rental company, its address, and its principal the name of the company,its address,and its principal business activity business activity(uniform rentals). (computer manufacturing). — You are a 20%partner in a partnership that owns a shopping mall — If you were a partner in a law firm and your distributive share of and your partnership income exceeded the thresholds listed above.You partnership gross income exceeded 5% of your gross income (or, should list each tenant of the mall that provided more than 10%of the alternatively, $2,500), then you should list the name of the firm, its Partnership's gross income,the tenant's address and principal business address,and its principal business activity(practice of law). activity. — If you were the sole proprietor of a retail gift business and your gross — You own an orange grove and sell all your oranges to one marketing income from the business exceeded 5%of your total gross income(or, cooperative.You should list the cooperative,its address,and its principal alternatively,$2,500),then you should list the name of the business,its business activity if your income met the thresholds. address,and its principal business activity(retail gift sales). — If you received income from investments in stocks and bonds,you PART C — REAL PROPERTY are required to list only each individual company from which you derived [Required by Sec. 112.3145(3)(a)3 or(b)3,Fla.Stat.] more than 5% of your gross income (or, alternatively, $2,500), rather In this part,please list the location or description of all real property(land than aggregating all of your investment income. and buildings)in Florida in which you owned directly or indirectly at any time — If more than 5% of your gross income (or, alternatively, $2,500) during the previous tax year in excess of five percent(5%)of the property's was gain from the sale of property (not just the selling price), then value. This threshold is the same, whether you are using percentage you should list as a source of income the name of the purchaser, the thresholds or dollar thresholds.You are not required to list your residences purchaser's address, and the purchaser's principal business activity. If and vacation homes; nor are you required to state the value of the property the purchaser's identity is unknown,such as where securities listed on on the form. an exchange are sold through a brokerage firm,the source of income Indirect ownership includes situations where you are a beneficiary of should be listed simply as "sale of (name of company) stock," for a trust that owns the property, as well as situations where you are more example. than a 5%partner in a partnership or stockholder in a corporation that owns — If more than 5% of your gross income (or, alternatively, $2,500) the property. The value of the property may be determined by the most was in the form of interest from one particular financial institution recently assessed value for tax purposes, in the absence of a more current (aggregating interest from all CD's, accounts, etc., at that institution), appraisal. list the name of the institution, its address, and its principal business The location or description of the property should be sufficient to activity. enable anyone who looks at the form to identify the property.Although a legal description of the property will do, such a lengthy description is not PART B—SECONDARY SOURCES OF INCOME required. Using simpler descriptions, such as"duplex, 115 Terrace Avenue, Tallahassee"or 40 acres located at the intersection of Hwy.60 and 1-95,Lake (Required by Sec.112.3145(3)(a)2 or(b)2,Fla.Stat.] County"is sufficient.In some cases,the property tax identification number of This part is intended to require the disclosure of major customers, the property will help in identifying it:"120 acre ranch on Hwy.902,Hendry clients, and other sources.of income to.businesses in which you.own an County,Tax ID#131-45863." interest.You will not have anything to report unless (CONTINUED on page 5) cOF- CE.FORM 1 -Eff. 1/2009 PAGE 4 Examples: PART E — LIABILITIES — You own 1/3 of a partnership or small corporation that owns both a [Required by Sec. 112.3145(3)(a)4 or(b)4,Fla.Stat.] vacant lot and a 12%interest in an office building. You should disclose the lot,but are not required to disclose the office building(because your In this part of the form, list the name and address of each private or 1/3 of the 12% interest—which equals 4%—does not exceed the 5% governmental creditor to whom you were indebted at any time during the threshold). disclosure period in an amount which exceeded: — If you are a beneficiary of a trust that owns real property and your (1) your net worth(if you are using percentage thresholds),or interest depends on the duration of an individual's life,the value of your (2) $10,000(if you are using dollar value thresholds). interest should be determined by applying the appropriate actuarial table to the value of the property itself, regardless of the actual yield of the You are not required to list the amount of any indebtedness or your net property. worth.You do not have to disclose any of the following:credit card and retail installment accounts,taxes owed (unless reduced to a judgment),indebted- ness on a life insurance policy owed to the company of issuance,contingent liabilities, and accrued income taxes on net unrealized appreciation (an [Required by Sec. 112.3145(3)(a)3 or(b)3,Fla.Stat.] accounting concept).A"contingent liability"is one that will become an actual liability only when one or more future events occur or fail to occur, such as Provide a general description of any intangible personal property that,at where you are liable only as a guarantor,surety,or endorser on a promissory any time during the disclosure period,was worth more than: note. If you are a"co-maker"and have signed as being jointly liable or jointly (1)ten percent(10%) of your total assets(if you are using percentage and severally liable,then this is not a contingent liability;if you are using the thresholds),or $10,000 threshold and the total amount of the debt(not just the percentage (2)$10,000(if you are using dollar value thresholds), of your liability)exceeds$10,000,such debts should be reported. Calculations for persons using comparative(percentage)thresholds: In and state the business entity to which the property related. Intangible per- order to decide whether the debt exceeds your net worth, you will need to sonal property includes such things as money, stocks, bonds,certificates of total all of your liabilities(including promissory notes, mortgages,credit card deposit, interests in partnerships, beneficial interests in a trust, promissory debts,lines of credit,judgments against you,etc.).Subtract this amount from notes owed to you, accounts receivable by you, IRA's, and bank accounts. the value of all your assets as calculated above for Part D.This is your"net Such things as automobiles, houses, jewelry, and paintings are not intan- worth."You must list on the form each creditor to whom your debt exceeded gible property. Intangibles relating to the same business entity should be this amount unless it is one of the types of indebtedness listed in the para- aggregated; for example, two certificates of deposit and a savings account graph above(credit card and retail installment accounts,etc.).Joint liabilities with the same bank.Where property is owned by husband and wife as ten- with others for which you are"jointly and severally liable,"meaning that you ants by the entirety(which usually will be the case),the property should be may be liable for either your part or the whole of the obligation, should be valued at 100%. included in your calculations based upon your percentage of liability, with Calculations:In order to decide whether the intangible property exceeds the following exception:joint and several liability with your spouse for a debt 10%of your total assets,you will need to total the value of all of your assets which relates to property owned by both of you as"tenants by the entirety" (including real property, intangible property, and tangible personal property (usually the case)should be included in your calculations by valuing the asset such as automobiles,jewelry,furniture,etc.).When making this calculation, at 100%of its value and the liability at 100%of the amount owed. do not subtract any liabilities (debts) that may relate to the property—add Examples for persons using comparative(percentage)thresholds: only the fair market value of the property. Multiply the total figure by 10%to arrive at the disclosure threshold. List only the intangibles that exceed this — You owe $15,000 to a bank for student loans, $5,000 for credit threshold amount.Jointly owned property should be valued according to the card debts,and$60,000(with your spouse)to a savings and loan for a percentage of your joint ownership,with the exception of property owned by home mortgage.Your home(owned by you and your spouse)is worth husband and wife as tenants by the entirety,which should be valued at 100%. $80,000 and your other property is worth$20,000.Since your net worth None of your calculations or the value of the property have to be disclosed on is $20,000 ($100,000 minus$80,000),you must report only the name the form. If you are using dollar value thresholds,you do not need to make and address of the savings and loan. any of these calculations. — You and your 50%business partner have a$100,000 business loan Examples for persons using comparative(percentage)thresholds: from a bank, for which you both are jointly and severally liable. The — You own 50% of the stock of a small corporation that is worth value of the business,taking into account the loan as a liability of the $100,000, according to generally accepted methods of valuing small business, is $50,000. Your other assets are worth $25,000, and you businesses. The estimated fair market value of your home and other owe $5,000 on a credit card. Your total assets will be$50,000(half of property (bank accounts, automobile, furniture, etc.) is $200,000. As a business worth$50,000 plus$25,000 of other assets).Your liabilities, your total assets are worth $250,000, you must disclose intangibles for purposes of calculating your net worth,will be only$5,000,because worth over$25,000.Since the value of the stock exceeds this threshold, the full amount of the business loan already was included in valuing the you should list"stock"and the name of the corporation.If your accounts business.Therefore, your net worth is$45,000. Since your 50%share with a particular bank exceed$25,000,you should list"bank accounts" of the$100,000 business loan exceeds this net worth figure,you must and bank's name. list the bank. — When you retired, your professional firm bought out your partner- PART F — INTERESTS IN SPECIFIED ship interest by giving you a promissory note, the present value of which is $100,000.You also have a certificate of deposit from a bank BUSINESSES worth $75,000 and an investment portfolio worth$300,000, consisting [Required by Sec. 112.3145(5),Fla.Stat.] of$100,000 of IBM bonds and a variety of other investments worth between $5,000 and $50;000 each. The fair market value of your The types of businesses covered in this disclosure are only: state and remaining assets(condominium, automobile, and other personal prop- federally chartered banks; state and federal savings and loan associations; erty)is$225,000.Since your total assets are worth$700,000,you must cemetery companies; insurance companies (including insurance agencies); list each intangible worth more than$70,000.Therefore,you would list mortgage companies;credit unions;small loan companies; alcoholic bever- "promissory note"and the name of your former partnership,"certificate age licensees; pari-mutuel wagering companies, utility companies, entities of deposit"and the name of the bank,"bonds"and"IBM,"but none of controlled by the Public Service Commission;and entities granted a franchise the rest of your investments. to operate by either a city or a county government. (CONTINUED on page 6) (�Zr- CE FORM 1 -Eff.1/2009 PAGE 5 You are required to disclose in this part of the form the fact that you disclosure period,an officer,director,partner,proprietor,or agent(other than owned during the disclosure period an interest in,or held any of certain posi- a resident agent solely for service of process). tions with, particular types of businesses listed above. You are required to If you have or held such a position or ownership interest in one of these make this disclosure if you own or owned(either directly or indirectly in the types of businesses,list(vertically for each business):the name of the busi- form of an equitable or beneficial interest) at any time during the disclosure ness, its address and principal business activity, and the position held with period more than five percent(5%)of the total assets or capital stock of one the business (if any).Also, if you own(ed) more than a 5% interest in the of the types of business entities granted a privilege to operate in Florida that business, as described above,you must indicate that fact and describe the are listed above. You also must complete this part of the form for each of nature of your interest. these types of businesses,for which you are,or were at any time during the (End of Instructions.) PENALTIES A failure to make any required disclosure constitutes grounds for and may be punished by one or more of the following: dis- qualification from being on the ballot, impeachment, removal or suspension from office or employment, demotion, reduction in salary, reprimand, or a civil penalty not exceeding $10,000. [Sec. 112.317, Florida Statutes] Also, if the annual form is not filed by September 1st,a fine of$25 for each day late will be imposed, up to a maximum penalty of$1,500.[Section 112.3145, F.S.]. OTHER FORMS YOU MAY NEED TO FILE IN ORDER TO COMPLY WITH THE ETHICS LAWS In addition to filing Form 1,you may be required to file one or more of the special purpose forms listed below,depending on your particular position, business activities,or interests.As it is your duty to obtain and file any of the special purpose forms which may be applicable to you,you should carefully read the brief description of each form to determine whether it applies. Form 1 F — Final Statement of Financial private gain (or loss)or to the special gain (or loss)of a relative, busi- In terests: Required of local officers, state officers, and speci- ness associate,or one by whom he or she is retained or employed.Each fied state employees within 60 days after leaving office or employment. appointed state officer who seeks to influence the decision on such a This form is used to report financial interests between January 1 st of the measure prior to the meeting must file the form before undertaking that last year of office or employment and the last.day of office or employ- action.[Sec.112.3143,Fla.Stat.] ment.[Sec. 112.3145(2)(b),Fla.Stat.] Form 8B — Memorandum of Voting Conflict for Form 1X — Amended Statement of Financial County, Municipal, and Other local Public Interests:To be used by local officers,state officers,and speci- Officers: Required to be filed (within 15 days of abstention) by fied state employees to correct mistakes on previously filed Form 1's. each local officer who must abstain from voting on a measure which [Sec. 112.3145(9),Fla.Stat.] would inure to his or her special private gain(or loss)or the special gain (or loss)of a relative,business associate,or one by whom he or she is Form 2 — Quarterly Client Disclosure: Required retained or employed. Each appointed local official who seeks to ihflu- of local officers, state officers, and specified state employees to ence the decision on such a measure prior to the meeting must file the disclose the names of clients represented for compensation by them- form before undertaking that action.[Sec. 112.3143,Fla.Stat.] selves or a partner or associate before agencies at the same level of government as they serve.The form should be filed by the end of the Form 9 — Quarterly Gift Disclosure: Required of calendar quarter(March 31, June 30, Sept. 30, Dec. 31)following the local officers, state officers, specified state employees, and state calendar quarter in which a reportable representation was made.[Sec. procurement employees to report gifts over$100 in value. The form 112.3145(4),Fla.Stat.] should be filed by the end of the calendar quarter(March 31,June 30, Form 3A— Statement of Interest in Competitive September 30,or December 31)following the calendar quarter in which /� the gift was received.[Sec. 112.3148,Fla.Stat.] Bid for Public Business:Required of public officers and Form 10 — Annual Disclosure of Gifts from public employees prior to or at the time of submission a bid for public Governmental Entities and Direct Support business which otherwise would violate Sec. 112.313(33) or 112.313(7), Organizations and Honorarium Event Related Fla.Stat.[Sec.112.313(12)(b),Fla.Stat.] g Expenses: Required of local officers,state officers,specified Form 4A— Disclosure of Business Transaction, state employees, and state procurement employees to report gifts Relationship, or Interest:Required of public officers and over$100 in value received from certain agencies and direct support employees to disclose certain business transactions, relationships, or organizations;also to be utilized by these persons to report honorarium" interests which otherwise would violate Sec. 112.313(3) or 112.313(7), event-related expenses paid by certain persons and entities.The form Fla.Stat.[Sec. 112.313(12)and(12)(e),Fla.Stat.] should be filed by July 1 following the calendar year in which the gift or Form 8A — Memorandum of Voting Conflict for honorarium event-related expense was received. [Sec. 112.3148 and State Officers:Required to be filed by a state officer within 15 112.3149,Fla.Stat.] days after having voted on a measure which inured to his or her special AVAILABILITY OF FORMS; FOR MORE INFORMATION Conies of these forms are available from the Supervisor of Questions about any of these forms or the ethics laws may be Elections in your county; from the Commission on Ethics, Post addressed to the Commission on Ethics, Post Office Drawer Office Drawer 15709, Tallahassee, Florida 32317-5709; telephone 15709, Tallahassee, Florida 32317-5709; telephone (850)4884864 (850)488-7864 (Suncom 278-7864); and at the Commission's web (Suncom 278-7864). site: www.ethics.state.fl.us. CE FORM 1-Eff.1/2009 PAGE 6 Miami-Dade Miami-Dade Supervisor of Elections .� 111 NW 1 Street, Suite 1910 C!W: Miami, FL 33128-1962 (305) 375-5553 RECEIPT Candidate: VL'A � P, at( e First Name Middle Name Last Name Office: <S�6ye4� �� This is to acknowledge my receipt of the following documents: Uf Qualifying Handbook for Municipal Cabdidates Received by: Candidate Sig ature Date: l� TAPackets\2002 PacketMew Municipalitylmunipal qualifying Wamation.doc Miami-Dade Supervisor of Elections MIAMI-EADE 2700 NW 87th Avenue Miami, FL 33172 (305) 499-8400 RECEIPT OF HANDBOOKS AND THE ELECTION LAW BOOK Candidate: v�G E First Name Middle Name Las Name 14lAves G\)V)CfiOffice: This is to acknowledge my receipt of the following documents: �] The Election Laws of the State of Florida Auqust 2006 UJ 2006 Candidate and Campaign Treasurer Handbook 2008 Miami-Dade County Qualifying Handbook Received by: C _K64 9)��c Candidate Signat re Date: 3/ u lo Phone No 36 J 77✓--" ' 0 Fax No.: E-mail address: MD-ED 2 (Rev.03/07) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Donald P. Shockey OFFICE USE ONLY Name (2) 321 NE 93rd Street Address (number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: 84 (4) Check appropriate box(es): © Candidate (office sought): Miami Shores village Council ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 03 / 25 / 09 To 04 / 09 / 09 Report Type G4 ❑ Original © Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ 1, 500 . 00 Expenditures $ Loans $ Transfers to Office Account $ Total Monetary $ Total Monetary $ In-Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 2, 075 . 00 $ (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss.839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) Donald P. Shockey (Type name) Donald P. Shockey Individual (only for ❑✓ a urer ❑Deputy Treasurer ✓ Candidate QChairperson (only for PC,PTY& ele tioneerin commun e e tione 'ng commun.organization) Signature Signature DS-DE 12(Rev.08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 03 / 25 / 09 through 04 / 09 / 09 (4) Page 1 of 1 (5) (7) (8) (9) (1 0) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address& Contributor Contribution In-kind Number City,State,Zip Code Tvpe Occupation Type Description Amendment Amount Donald Shockey I urban CHE ADD 1,500.00 03 / 27 /09 (candidate) planner 321 NE 93rd St. Miami Shores, FL 9 33138 DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Donald P. Shockey OFFICE USE ONLY Name (2) 321 NE 93rd Street Address (number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: 84 (4) Check appropriate box(es): © Candidate (office sought): Miami Shores Village Council ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 04 / 09 / 09 To 07 / 13 / 09 Report Type TR © Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ 2 , 500 . 00 Expenditures $ 1, 560 . 50 Loans $ Transfers to Office Account $ Total Monetary $ 2 , 500 . 00 Total Monetary $ 1, 560 . 50 In-Kind $ 200 . 00 (8) Other Distributions $ 1, 922 . 55 (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 4 , 575 . 00 $ 4 , 575 . 00 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss.839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) Donald P. Shockey (Type name) Donald P. Shockey Individuald(onlyl.or Treas rer ❑Deputy Treasurer ✓ Candidate airperson (only for PC,PTY& nee ring ti neeri commun.or iZation) X Signature Signature DS-DE 12(Rev.08/04) CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 1 of 3 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address& Contributor Contribution In-kind Number CitV, State,Zip Code Tvpe Occupation TVpe Description Amendment Amount Robert Gerrard I CHE 100.00 04 / 06 /O9 Miami Shores, FL 33138 1 Miryam Rojas I CHE 25.00 04 / 06 / O9 54 NW 106th St. Miami Shores, FL 33150 2 04 06 09 I CHE 100.00 / / Scott Perwin, Amy McClellan 800 NE 95th St. 3 Miami Shores 33138 Tim Crutchfield I CHE 75.00 04 / 06 /09 69 NE 99th Miami Shores, FL 33138 4 Ed Sunshine, Ann I CHE 25.00 04 / 06 / 09 Connor 290 NE 91st MS 33138 5 Robert Flint, I CHE 75.00 04 / 08 / O9 Kevin Burns 2065 Alamanda Dr. North Miami,FL 33181 6 JerryBell I CHE 50.00 04 / 09 / O9 1019 NE 104 St. Miami Shores,FL 33138 7 Glenn Amoruso I CHE 50.00 04 / 09 / 09 52 NE 98th St. Miami Shores, FL 33138 8 DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 2 of 3 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last,Suffix, First, Middle) Sequence Street Address& Contributor Contribution In-kind Number City, State,Zip Code TVpe Occupation Type Description Amendment Amount Robert Gerrard I CHE 100.00 04 / 09 /09 (address requested) 9 Jesse Walters I CHE 50.00 04 / 09 / 09 440 NE 91st St. Miami Shores,33138 10 Joseph Kohl I CHE 100.00 04 / 09 / 09 80 NE 97th St. Miami Shores, FL 33138 11 Aileen I CHE 100.00 04 / 09 / 09 Brousseau, 7717 Byron Ave. Miami Beach, FL 33141 12 04 / 09 / 09 Kevin Brousseau I CHE 100.00 8425 Biscayne Blvd. Miami, FL 13 33138 I teacher CHE 200.00 04 / 09 / 09 Pamela Jarvis 489 NE 101st St. Miami Shores, FL 14 33138 04 09 09 Lynn Bernstein,430 I CHE 50.00 " W.30th St. Miami Beach, FL 33140 15 I CHE 50.00 04 / 09 / 09 Ney Collazos 60 NE 99th Miami Shores, FL 33138 16 DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 3 of 3 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address& Contributor Contribution In-kind Number City,State,Zip Code T e Occu ation Type Description Amendment Amount Ari Sklar I CHE 50.00 04 / 09 /09 2310 Hollywood Blvd. , Hollywood, FL 33020 17 I real CHE 250.00 04 / 09 / O9 Michael Maxwell estate 170 NE 96th St. develop Miami Shores FL er 18 33138 Ray Perez, Village I restau- INK Hosting 200.00 04 / 09 / 09 Cafe,9540 NE 2nd rant of Ave. MS FL 33138 owner campaign event 19 04 / 13 /09 Donald Shockey I candi- LOA 1, 000.00date 321 NE 93rd St. Miami Shores, FL 20 33138 DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 1 of 2 (5) (7) (8) (9) (10) (11) Date Full Name Purpose (6) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address& contribution to a Expenditure Number City,State,Zip Code candidate) Type Amendment Amount Florida Wireless Group Distribution MON $385.20 04 08 09 www.erexorhome.com of flyers info@erexorhome.com 1 PK Graphics Printing of MON $160.50 04 /09 /09 420 Lincoln Road Suite #390 flyers Miami Beach, FL 33139 2 Little River Post Office Postage for MON $168.00 04 10 09 Miami, FL 33138 flyer mailing 3 Erik Erzah(contacted for Flyer MON $42.00 04 10 09 address, not provided by distribution report date 4 Sofia Saenz (contacted for Flyer MON $42.00 04 /10 /09 address, not provided by distribution report date 5 Iron Sushi Lunch for MON $59.92 04 11 09 9432 NE 2nd Ave. workers Miami Shores, FL 33138 distributing flyers 6 Chris Dorto(contacted for Flyer MON $117.00 04 Al 09 address, not provided by distribution report date 7 Kastroit Rexhepi (contacted Flyer MON $117.00 04 11 09 for address, not provided by distribution report date 8 DS-DE 14(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 2 of 2 (5) (7) (8) (9) (1 0) (1 1) Date Full Name Purpose (6) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address& contribution to a Expenditure Number City,State,Zip Code candidate) Type Amendment Amount Flyer MON $117.00 04 11 09 Michael Worley (contacted distribution for address, not provided by 9 report date) Samuel Ratbord(contacted for Flyer MON $75.00 04 /11/09 address, not provided by distribution report date 10 Eli Magari (contacted for Flyer MON $75.00 04 11 09 address, not provided by distribution report date 11 Syed Humayoan Hameed Jilani Flyer MON $75.00 04 11 09 (contacted for address, not distribution provided by report date 12 Jamie Sloane(contacted for Flyer MON $75.00 04 /11 /09 address, not provided by distribution report date 13 Andiamo Brick Oven Pizza Food for phone MON $34.88 04 13 09 5600 Biscayne Blvd. bank Miami, FL 33138 volunteers 14 Bank of America Checking MON $17.00 06 0 09 NE 2nd Ave. account Miami Shores, FL 33138 maintenance fee 15 DS-DE 14(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT ITEMIZED CONTRIBUTIONS AND FUND TRANSFERS (1) Name Donald P. Shockey (2) I.D. Number 84 (3) Cover Period 04 / 10 / 09 through 07 / 13 / 09 (4) Page 1 of 1 rj Contributions (use separate sheets for Contributions and Fund Transfers.Do not combine sequence numbers with Fund Transfers) MR Fund Transfers (use separate sheets for Contributions and Fund Transfers. Do not combine sequence numbers with Contributions) (5) (7) (8) (9) (10) (11) (12) Date (g) Contributor Full Name(L, Suffix, F, M) Contribution In-kind Descrip Seq Num Full Street Address& Type Occupation or Transfer or City,State,Zip Code Type Nature of Acct. Amended Amount 04 13 09 Donald Shockey S F checking 1, 000.00 321 NE 93rd St. to Bank of America campaign personal checking account 1 000104591530 Donald Shockey S T campaign 1,500.00 06 / 01 /09 Bank of America account campaign account to 229015323032 checking 2 Donald Shockey S T campaign 422.55 07 / 13 / 09 Bank of America account campaign account to 229015323032 checking 3 DS-DE 13A(Rev.02/08) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Name (2) Y (, ddress (nu ber and stre t) e L 3 City, State,Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): VILOpe- Candidate (office sought): AP ❑ Political Committee ❑ CHECK IFP AS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 3 / / To ( / y' / Report Type V Original ❑ Amendment ❑ Special Election—Report—/— ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT 7Monetary Cash & Checks $ O o Expenditures $ n �5 Ij Loans $ Transfers to Office tAccount $ Total Monetary $ 75, 00 Total Monetary $ In-Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL onetary xpenditures To Date 5,n('-) $ o l N •n, (11) CERTIFICATION .--� It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) ertify that I have examined this report and it is true, I certify that I have examined this report and it is true, drrect, and complete. correct, and ctVete. C=—�g1� CO(Type name) DOV\All 5�13! (Type name) ❑Individual(only for Trea r ❑Depu Treasurer Candidate ❑Chair e on(only for P ,PTY& q;dErio-nsp,ring mun. el ne g commu organization) Signature Signature DS-DE 12(Rev.08/04) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Namenaa0C (2) I.D. Number (3) Cover Period / / through / / (4) Page of (5) (7) (8) (9) (10) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address& Contributor Contribution In-kind Number City, State,Zip Code Type Occu ation Type Description Amendment Amount / G , 0f :r A*'VY CHG 00,00 or �Y%Ve 13 00 Y Ii�An.s S�0ve'; rL &over co U -7S 0� S6.es3 30 /0Y cyeavy. / 3b l WE lc�a,,�l�s-� C�-} IDO. o LV vrriAQ T / /0 • NQa I 0-,r\j- C� t Iw,00 17114 W !Tt'E 10viAz_ 0,0 �w nt 6* 31 /d �b�e '}�OS �-}-, j0OCA 4w 7 7 µ'pa i SNV'esY* —2z-�3 K 3 /30 l b Am,J `5� 5a�� 7 N5g3VS+- . C h4x%'Avejl�� V 3� DS-DE 13(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE,VALUES CAMP.AI N TREASURER'S REPORT — ITEMIZED EXPENDITURES (1) Name �o o (2) I.D. Number (3) Cover Period / / through 01 (4) Page of (5) (7) (8) (9) (10) (11) Date Full Name Purpose (Last,Suffix, First,Middle) (add office sought if (6) Street Address& contribution to a Expenditure Sequence City,State,Zip Code candidate) Type Amendment Amount Number 311PAVVCoS / ��a�ml C CI�� i °� to v U D S 0',Ar it X'140�5 H146(YY\'j cK s i � r4�GCtvk "h,� r &2�yz e.�C� 5 a3. .. t DS-DE 14(Rev.08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES {�i r t f� ,' s�. s i i -. 1 � ti i ,. r 4 ' r / � ;•. F � i t ., r � • f �� S w x-• C � fi ,'!�• � +•�' ` '�� ; � t _ � � � I �� WAIVER OF REPORT OFFICE USE ONLY (Section 106.07(7), F.S.) (PLEASE TYPE) voy\aIll �.(,S�Ocve\/ - 8,,_J-`, Candidate's Name (Last, Suffix, Fi(st, Middle) Identification Number(Assigned by Division OR Political Committee, CCE or Party Name of Elections) 2A24-6iva-4- i Aye's Address (Number and Street) Office Sought(Include Dist ' t, Circuit or Group Number) Kayn', O%Y6 El, -53t3 City State Zip Code VCandidate ❑ Committee of Continuous ElCheck box if address has changed since last Existence report. Political Committee F Party Executive Committee ❑ Check here if PC or CCE has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION .GENERAL ELECTION ❑ January ❑ 32nd day prior ❑ 46th day prior ❑ April ❑ 18th day prior ❑ 32nd day prior ❑ TERMINATION REPORT ❑ July ❑ 4th day prior ✓1 18th day prior ❑ El October El 4th day prior SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT /FOR IITHE RE PORTING PERIOD OF V617 0 through w1 ao 03 *5 0 Signature0 Date SIGNATURES REQUIRED FOR: Candidates Candidate,Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.) Political Committees Chairman,Campaign Treasurer or Deputy Treasurer(s. 106.07(5), F.S.) Committees of Continuous Existence Treasurer (s. 106.04(4)(c), F.S.) Party Executive Committees Treasurer or Chairman(s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account(no funds expended or received)the filing of the required report is waived. However, the filing officer must be notified in writing'on the prescribed reporting date that no report is being filed: DS-DE 87(Rev.08/03)