The URL can be used to link to this page

Burch, Alice RECEIPT OF QUALIFYING LETTER I ht(e Ouv-& ► candidate for Miami Shores Village Council, hereby acknowledge receipt of the Candidate Qualifying Letter which among other items includes information regarding the Treasurer Report due dates and the date for the Logic & Accuracy Test to be conducted by Miami-Dade County Elections Department. I C &&'vL Candidate Signature 02 Date MONDAY TO FRIDAY �r OFFICE 9:00 A.M.-4:00 P.M. BROWARD:(954)457-8560 L OUTSIDE BROWARD:(888)840-8560 FAX:(954)458-1369 DRS. BURCH & BURCH P.O. BOX 218 HALLANDALE, FLORIDA 33008 burchdvm@bel Isouth.net ALICE BURCH OFFICE MANAGER (305)318-9578 �y HERTA HOLLY w ` QR�s �'� • • 11illa MAYOR JESSE WALTERS 1," "„ � /�/y/� ^ VICE MAYOR vr{/ C///J /C// HUNT DAVI5 10050 N.E.SECOND AVENUE (/ COUNCILMAN �NTEs(N$ MIAMI SHORES,FLORIDA 33138-238 2 JIM McCoy �ORiDA TELEPHONE(305)795-2207 COUNCILMAN FAX(305)756-8972 IVONNE LEDESMA COUNCILWOMAN TOM BENTON VILLAGE MANAGER BARBARA E5TEP, MMC February 26, 2015 VILLAGE CLERK RICHARD SARAFAN VILLAGE ATTORNEY Alice Burch 1440 N.E. 1015` Street Miami Shores, FL 33138 Dear Alice: Congratulations on becoming a qualified candidate for the upcoming Miami Shores Village Council election! 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: Reporting Period Due Date January 1 —January 31, 2015 February 10, 2015 (Not applicable) February 1 —February 28, 2015 March 10, 2015 March 1 — March 13, 2015 March 20, 2015 March 14—March 27, 2015 April 3, 2015 March 28 —April 9, 2015 April 10, 2015 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 July 13, 2015 Reports shall be filed no'later than 5:00 PM on the designated day, however, any report postmarked by the U.S. Postal Service prior to midnight on the designated day shall be deemed to have been filed in a timely manner. Alice Burch February 26, 2015 Page Two 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 is scheduled for 10:00 AM on Thursday, April 9th and 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. I look forward to working with you in the coming weeks. Sincerely, Barbara A. Estep, MMC Village Clerk Candidate qualifying letter Elections 2700 NW 87th Avenue M I AM I•DADE Miami, Florida 33172 T 305-499-8683 F 305-499-8547 TTY 305-499-8480 miamidade.gov CERTIFICATION Batch # 1 STATE OF FLORIDA) COUNTY OF MIAMI-DADE) I, Penelope Townsley, Supervisor of Elections of Miami-Dade County, Florida, do hereby certify that 50 signatures submitted by Alice Burch for the office of Council in the 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 FEBRUARY, 2015 Pen op Townsley Sup isor of Elections Elections 2700 NW 87th Avenue MIAMI•DADE Miami, Florida 33172 T 305-499-8683 F 305-499-8547 TTY 305-499-8480 miamidade.gov February 17, 2015 Barbara A. Estep, MMC Village Clerk Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 Dear Ms. Estep: The Miami-Dade Elections Department has completed the verification of Batch # 1 of the petitions for Alice Burch, a candidate for Council in the Miami Shores Village. A total of 52 petitions were reviewed for verification; of which 50 were certified. For purposes of signature verification, my office follows the directives given by the municipality. You are encouraged to ensure compliance with municipal charter or code requirements. Please find the certification for the petition enclosed. Should you have any questions or concerns, please feel free to contact me or Rosy Pastrana, Deputy Supervisor of Elections for Voter Services at 305-499-8548. Sincer , Penel a ownsley Sup isor of Elections Enclosure (1) CANDIDAL c PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate Mice 0>ti�� . for a position on the Miami Shores Village Council. 6N 64 INK- 3 oK �y Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code ure S tSigned 5--7S"• Ssfkyec-� �c� i (e Cn I -0s ,`e Sou r)— 6 - � �? ��i �'►'c u� c�i,�,u ; tnu�� C 3� ' � ° /�f� ,�f J,S_ ?30 r C _ � /17, �0 4-/ e r0; F77— ar ��0 658 ( a 6 / 15 to a to --�4 3;'7 -7 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: f ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: 11l CANDIDATt PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate I ( C� �y�6,11 for a position on the Miami Shores Village Council. sl 6N l N 1,� � 3 0"' �y Printed Birth Date or -� Date Name Voter Ree.# Address City/County/Zip Code Si nature Signed U.1093033}�` IJ�Aq'C'-t— �4�^'�1 SKc _F( C1 ' Ln t ro. H 161fdI 9 gSaC rlVV 2"1�fl Ile ,aw-S-J rl Uq � Iasrsc /S V1, G 1 w, a2`►� N Q S IU��aw<i ��1c1�Cs .Tl x(38 L �Zo21�32,E cJ��2 emin ie 17 /19 Z7) NE ��t.h s � l�l�im� ShOrPS+ � E ��3� �T Ar wh' IiZV4 ciao D.s 2s ? �326/Yu1.2ND- ✓£- o , l a� 09f 2AA VAf / �� 3.z to .�,9� /f ,cs,- 3�� 'j-1 -7 1J.t-J 1 2S A C>1 331 /ogt5 3 /1 1 ( 3 0�//G/ 2 ilfl,1��Gtl- The undersigned is the circulator of the foregoing paper containing-Lj--signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name i purports be. SignatureyofCirculator: Address: Z `� IV((;,/ a nd i f,Gi11. F� l5 G ACCEPTANCE OF NOMINATION 2)3 I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: `t CANDIDAr- r-ETITION We,the undersigned electors of Miami Shores Village,do hereby,nominate_ ` I C e �J r for a position on the Miami Shores V�Ilage Council. Printed Birth Date or Date Name r � OG(850z Voter Ree.# Address City/County/Zip Code Signature Signed �Jil . 4n W �i /ll-lg 7® y�fgs 3 ✓ 2 1 Sl3 I YY 3313 ✓ log 352 1-42 6f 33 t3 Y l 08,`18�Y 1 l� 1 xamfiey 7//7/97 1/ ✓E 57 3313 �3" 60d VIII 5 9 �- /7 /Y y f 16/16 /1 K3 AJE 5'� Sf 3 3 r 3e c4i `7n 16 1 The undersigned is the circulator of the foregoing paper containing I 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 1 hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDATt PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate 41(CC �v�� for a position on the Miami Shores Village Council. Printed Birth Date or �51 6 N I N G I JV—' 3 0" Ly Date Name 3435 Voter Ree.# Address City/County/Zip Code Si n ture Signed PAI�� 9 4� S°l 64;*-j1J �,,,c, �'li A S A514 33C'3,9 (oqo� I(,- 114,55 I6 �a�-�1� Qj�n�,�. 12130 � 5�► � 1Q� St- ti1��> Ste, 3�3� � b 1S I oo�ao�-8� ovE (oto-" sl. Vi4I,(im,50i(e► , 33/3P a ioeq a8e3 _ A/ Zj4v,e-r Vi /08951 z aov-�ee,?,, �LA 6VA"� W 2- -6 o%7-6 6 S14.4uN C/� , 421 (940e 65 .z-� ✓^ � 1 aely 7381 H toRl Y��3 � w Cd l (� l /�l /020 Q� lc-), ; sAq, �&il' 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 1 hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: &A/- , CANDIDATtP,E(TITION /� We,the undersigned electors of Miami Shores Village,do hereby nominate l"� � I C e, 6 w -c,� for a position on the Miami Shores Village Council. Printed Birth Date or SIGN 1 N I N k-- 3 ON L-J Date Name IU�5l2l1� Voter Rea.# Address City/County/Zip Code Signature Shined f 0 2a40`-f Kknw-,<,VxN�s 8 24(P NNE ku�3W )c 01 rT- / as . --� Mia" 35(-31 o2�d06 � a�"- 1101815oq.5 L/ 7e,�, 3.58 0c /63� t I OoaR$ 051- 5V Z- to 931n-ciq n-ceGov-)" r N tD-z5 331-S�l lU 4G65 % 3 � too oy o2b / _, M_ -- -�306663 / 37 -1379 AE �Pfc — 3 (Rpax ��f � L l by y y 112 S �� e�t q ST 3 f The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my r ence 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: (Z�% HERTA HOLLY `yNoREs MAYOR JESSE JESSE WALTERS 1.1 1 �- ,,,, Yiami JOre / 11ifla(/��,eVICE MAYOR aHUNT DAVIS l� a 4' 10050 N.E.SECOND AVENUE COUNCILMAN O s MIAMI SHORES, FLORIDA 33 1 38-2382 JIM McCoy TELEPHONE(305)795-2207 COUNCILMAN FAX(305)756-8972 IVONNE LEDESMA COUNCILWOMAN TOM BENTON VILLAGE MANAGER BARBARA ESTEP, MMC VILLAGE CLERK RICHARD SARAFAN 2015 VILLAGE ATTORNEY Candidate Name: _ Al IC2. t► )UI^tfYl E-Mail Address: COLI C e,6)ycC,)-CIO L cc Address: 14 4 0 n C tot�' • Telephone Numbers: J` C)S— 3 � �` - q,5 CANDIDATE INFORMATION REQUIRED FOR QUALIFYING FOR VILLAGE COUNCIL ELECTION Notice of Candidacy and Residency ✓ Campaign Account &Treasurer's Appointment J Form 1 Financial Disclosure ✓ Loyalty&Candidate's Oath J Statement of Candidate v 50 Signatures on Nominating Petition Confirmed by Miami-Dade County Elections OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, A candidate for the office of �l a n CA 5e-O,+ have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X z - 5 - J-s Signature of Candidate Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS-DE 94(05111) FORM 1 STATEMENT OF 2014 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: AST NAME--FIRST NAME--MIDDLE NAM OtAPcA AAI C6 Vp.CMC-Li 6 MAILING ADDRESS: W40 9 E 10 1 5T M141L4 5 kjl/Ll sFL- 351 --51' IvL(AMI CITY: ZIP: COUNTY: P- NAME OF AGENCY: NAME OF OFFICE OR POSITION HELD OR SOUGHT: You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF (X CANDIDATE OR J NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER(must check one): 0 DECEMBER 31, 2014 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions r further details). CHECK THE ONE YOU ARE USING: ❑ COMPARATIVE (PERCENTAGE)THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY Po Box 2- 19 it, 1 WLE fi, v N cin/ PART B-- SECONDARY SOURCES OF INCOME [Major customers,clients, and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2015 (Continued on reverse side) PAGE 1 Adopted by reference in Rule 34-8.202(1),F.A.C. PART D—INTANGIBLE PERSONAL PROPERTY[Stocks, bonds,certificates of deposit,etc.-See instructions] (If you have nothing to report,write"none"or"n/a") TYPE OF INTANGIBLE 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 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5%INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET PLEASE CHECK HERE ❑ SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or Signature: attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: Prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable Date Signed: knowledge and belief, the disclosure herein is true and correct. 2 CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, including If you were mailed the form by the Commission Initially,each local officer/employee,state officer, signing and dating it. send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they prior to confirmation, even if that is less than section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment. reside in Florida, file with the Supervisor of the Candidates for publicly-elected local office must NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY, State officers or specified state employees papers. A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer Thereafter, local officers/employees, state of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are of his or her original Form 1 when qualifying.A address: 325 John Knox Road, Building E, Suite required to file by July 1 st following each calendar candidate who files a Form 1 with a qualifying 200,Tallahassee,FL 32303. year in which they hold their positions. officer is not required to file with the Commission Finally, at the end of office or employment,each r Supervisor of Elections. Candidates file this form together with their local officer/employee,state officer,and specked qualifying papers. state employee is required to file a final disclosure To determine what category your position falls form(Form 1 F)within 60 days of leaving office or under, see the "Who Must File" Instructions on employment.However,filing a CE Form 1 F(Final page 3. Statement of Financial Interests)does not relieve the filer of filing a CE Form 1 if he or she was in Facsimiles will not be accepted. their position on December 31,2014. CE FORM 1-Effective:January 1,2015. PAGE 2 Adopted by reference in Rule 34-8.202(1),F.A.C. i HERTA HOLLY `yNoREs MAYOR JESSE WALTERS Ila eVICE MAYOR -rear• HUNT DAVIS 10050 N.E.SECOND AVENUE COUNCILMAN FNTgg(N$ MIAM:SHORES, FLORIDA 33138-238 2 JIM McCoy �LORIV TELEPHONE(305)795-2207 COUNCILMAN FAX(305)756-8972 IVONNE LEDESMA COUNCILWOMAN TOM BENTON VILLAGE MANAGER BARBARA ESTEP, MMC VILLAGE CLERK RICHARD SARAFAN VILLAGE ATTORNEY February 9, 2015 Ms. Michelle McClain Miami-Dade County Elections Department 2700 N.W. 87"' Avenue Miami, FL 33172 Dear Ms. McClain: Enclosed please find Petition Forms (5) from Alice Burch, in reference to the Miami Shores Village April 14, 2015 Council Election. Ms. Burch opened her campaign account on February 3, 2015. 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 CAN DI DAT t/(PEfTITI ON We,the undersigned electors of Miami Shores Village,do hereby nominate— �-Y I ( C,� 6V"� for a position on the Miami Shores Village Council. Printed Birth Date or >I 1 A] I N 3 0,� L 7 Date Name` Vater Ree.# Address City/Countv/Zia Code Signature Signed U. U u ra Cla hCi rcl Cisx IV V1/U?",-/I vc- i ; S !r�s, r 1 -� �si5t+ V111 �b e2'►� NI%�� 5� �(�'au�� Y�rJ,�cs.,�=1c3g /s IA,�m; Si Or-es 0 l � 3v � � Z� FIs =--�I.�.�.+tic L A 2 � ��L �] "fh �l tC- 4— f-mo�Aw- P.- � - Al -IL- . 1AA L 'e 711-3 A-7 X4"4)'/ The undersigned is the circulator of the foregoing paper containingJj T signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name i purportbe. Signature of Circulator: Address: Q326 N(,/ 7 nd �s J ACCEPTANCE OF NOMINATION 33150 I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDA7EPETITION iC� We,the undersigned electors of Miami Shores Village,do hereby nominate �1�(;r N I for a position on the Miami Shores V'llage Council. Printed Birth Date or Name Voter Ree.# Address Date G' , City/County/Zip Code Signature q Signed 0't-4 114( -71 S A.).f- 91/7# 6+ _ 33 t 3 Y MeV- r 7 0?3 A✓� TIF 5T 3313 16 AeA fieifrm c5VI/z 1135- AV lQ7,9' C2 cc /0114 4,601 f rill, vg� 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 1 hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDAL r- PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate-- Alice &tcck for a position on the Miami Shores Village Council. Printed Birth Date or i G N f ri IN K' 0 Date Name Voter Rea.# Address City/County/Zip Code Mg" re Signed z4_ � � (��( �u�S"f�r i'� %u� j��l t r��4� S fkrr_e_,. J��-.�3s 3�• �� \ � 5 ,�� 7? 3 i �v ��tdy�,�, Svc� a T c � �P � � ?nom 3( 2 � gG7 Its EZL2e15 j(0a x% CANDIDATt PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate "I ( CQ �y r6'�-) for a position on the Miami Shores Village Council. Printed Birth Date or S1 (ON 0 N 6 lJ Date Name Voter Ree.# Address City/County/Zip Code Si nature Shined P14144 1,1' Y2PI 5-c>' C,1 H1,4- 5 As%f 3 3(3,9 66�17- A 21/-,b/Y2 &<z;r\1C 7ST NIA Pry�10� �e,�;�, . 121�o � ��► t� �Q l� S�- ti��; 5�,�, `��' ��Yx��.�� ' -_ � � �S f w►A 5V N S(. IM mw SU 3 313 A- V 3 - SJ %�� y /y:ts t— NSI i Vgof i'sdolc°-S ��- �i�fic�k-'cy r� Z�-4• 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: CANDIDATt PETITION We, the undersigned electors of Miami Shores Village,do hereby nominate Af I c e, for a position on the Miami Shores Village Council. Printed Birth Date or 51 G N /Af //V k ON LV / Date Name Voter Rea.# Address Citv/County/Zip Code Signature Signed 24(0 WE ku�3 s-- 14 X2005 l a 61 �5'N4f-- 0a Y 3'�13e 131 hc� �OuJi.� Al\srl-T'k Nt loz 5 3W VE- g L53! -0-na�41, A- �Lwakd�7 IJ6 q '-1 �7- r The undersigned is the circulator of the foregoing paper containing signatures. Each appended thereto was made in my �re/nce 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: CANDIDA._ . ETITION We,the undersigned electors of Miami Shores Village,do hereby nominate Ace &UrJ\ for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree:# Address City/County/Zip Code Signature Signed 1:4 y< lyaSt-'- 'tw�,r�3�3E Ca�,,2 co � (Lot V, N"u-�f S� 3 g' l Z010 KEF I 0.3 5r ,f�l td'm t S Plore'S -7 �P�'d '7 Sc� �ZZS `�- loll+ST I� AIX ZJ35 L18 o s 1 12)f T X38' NF Ia5yt �60 tJt �Z _ 11y) 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: CANDIDA /nETITION We,the undersigned electors of Miami Shores Village,do hereby nominate A l I Ce 6 to r&1'1 for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature Signed M��p�� 6�� [ �3\[ IVB 10-3 St. �rtw.► s[t�Rfs rz— � ✓ y �5— �Jr,,9- !Qr4 no- 00,000 u de (4%ki ;oto rN rC - �— g341 AhF 7/ _rUk, NI .4 ! FL 2 NIr5- CJdbqL L C I � 13 O Sa Z iJ� !O Si r -F �Ar San i D 2-k (oz ` 10 VVI 07SC ryl(am I 12176 yl -& 03 ) 06 ql"_4 Ric S�Ntwa,, ah K — The under igned 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 1 hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: Au� �� CANDIDA/_-_,_ ETITIO N / We,the undersigned electors of Miami Shores Village,do hereby nominate_ � �� 6 0,,I for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address Citv/County/Zitode Si natu Ij Signed ,30s��o�v1r�P��-f&73T30 l�ay�� °�St t�i�'Y►'1r S��f3�,� � - = 10121 " ! s �r�s 1-7- /q5-1 /o/ 5t �I i r! Shu Nies Z v �`�'h � �►� tom— r E Fc)C.�� --�- ' �z x i 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: CANDIDATt eE(TITION We,the undersigned electors of Miami Shores Village,do hereby nominate Y�I (�C� &y r6�1 for a position on the Miami Shores Village Council.. SI 6 N ► N d f (-' Printed Birth Date or Date Name Voter Rea.# Address City/County/Zip Code Si re Si n Yd ' r✓/ 33 /� 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: q' 4 t"m �Y4 3315 0 ACCEPTANCE OF NOMINATION 1 hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: ♦StIORFs j1 nu ® umI FLORIDA MIAMI SHORES VILLAGE COUNCIL CANDIDATE INFORMATION RECEIPT Candidate. I � C�° � rc '1 This is to acknowledge receipt of the following documents relating to the 2015 Miami Shores Village Council Election to be held on Tuesday, April 14, 2015. Informational Letter from the Village Clerk Petition Forms Village Ordinances relating to Village Election Qualifying Forms Treasurer Report Forms Items and Documents available from Miami-Dade County Absentee Ballot Information Poll Watcher Information Candidate and Campaign Treasurer Handbook State Statute Chapters 97— 106 Received By: Date: C 2 Feb 0515 11;54a Burch&Burch DVM 305-758-2733 p.1 STATEMENT OF OFFICE USE ONLY CANDIDATE (Section 406.023, F.S.) (Please print or type) A u r(,� } candidate for the office of VAI H aQ a U n Gi i Sea+ J have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candidate Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of Statutes). up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida D&-DE 94 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE C (Section 99.021,Florida Statutes) (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of V!UA 6G Oud cq L , (office) (district#) ; I am a qualified elector oflh n r"u l . Tr- County, Florida; (circuit#) (group or seat#) I am qualified under the Constitution and the Laws of Florida to hold the office to which i desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Signature of Candidate Telephone Number Email Address qo gt Aan*-� f-b- Address Icity State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): 6�q��5% "Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities(see instructions on page 2 of this form): A - liyy u r �l� STATE OF FLORIDA 0 COUNTY OF (°,16(rd Sworn to(or affirmed)and subscribed before me this day of �C �Gi� , 20 r Personally Known: or. Signature of Notary Public Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public Type of Identification Produced: ��P�°Ya'. RENEE C.ARMAS =.r .: Commission#FF 067393 Expires October 30,2017 Bonded Thru Troy Fain Insurance 900-3857019 DS-DE 25(Rev.5111) Rule 1S-2.0001,F.A.C. APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with.the qualifying officer before opening the campaign account. OFFICE USE ONLY 1.CHECK APPROPRIATE BOX(ES): ED Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository 0 Office ❑ Party 2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state,zip AL[ jUP,CAA code) V-1 �L0 Ni 101 15f 4. Telephone 5. E-mail address M �� GYP 3 13 6. Oflfcef sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if V C l p y� Co U/1 � ' S applicable: l O ❑ My intent is to run as a Write-In candidate. 8. If a candidate for a partisan office,check block and fill in name of party as applicable: My intent is to run as a 1 ❑ Write-In ❑ No Party Affiliation ❑ Party candidate. --*---,Il have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer J. Name f Treasurer or Deputy Treasurer 0 tae. +F k/4 f I s o n 'Tr' 11. Mailing Address 12. Telephone 1235 'c- a(4 S Y�&�� ( Z OS ) (005. Qo 13. City 14. County 15. State 16. Zip Code 17. E-mail ddress 61 ICA, 1A.12 q4 jS MI n r—,_ J?- 3 t3 rb6i+ ,>ithaWS01®yv►-►cif-Cal 18. 1 have designated the following bank as my ® Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address T D BAS 21. City 22. County 23. State 24. Zip Code UNDER PENALTIES OF PERJURY,1 DECLARE THAT 1 HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 25. Date [ 26. Signature of Candidto , X slxx 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) I, ?06,V-[ r—: . 7�- , do hereby accept the appointment (Please Print or Type Name) designated above as: Ej Campaign Treasurer Deputy Trea urer. F*--g3, 20t'5�- Date Signature of Cam n easurer or Deputy Treasurer DS-DE 9(Rev. 10110) Rule 1S-2.0001, F.A.C. SNORES1114C-1932 D logo MINES 61 ��ORiDp` NOTICE OF CANDIDACY AND RESIDENCY 1, I( C 1-&� -----, hereby file this Notice of Candidacythis 27 day of Ut 2015, for the Village Council election of Miami Shores Village to be held on April, 14, 2015. 1 affirm that I have resided in Miami Shores Village for at least six (6) months prior to the date of qualifying for office as required by Section 23 of the Village Charter. -Ati/ .4 11 ct, 6u." Signature Print Name 1446 Address Telephone Number a ice bit r-A (@ ao I. c oYr, E-Mail Address STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) BEFORE ME personally appeared It ce -tL2�ck _who executed this Notice of Candidacy and Residency this day of Qav\S)rAyjj,2015. Notary Public Personally Known Produced the following Identification Seal/Commission Expires: BARBARA ESTEP MY COMMISSION#FF 073975 a'•. :,T EXPIRES:March 29,2018 "Re' f,fid' Bonded Thru Notary Public underwriters CAMPAIGN TREASURER'S REPORT SUMMARY (1) Alice Burch. , OFFICE USE'ONLY Name (2) 1440 NE 101 Street Address (number and street) Miami Shores, F\.33138. City, State, Zip Cod ❑ Check here if addre s has changed (3) ID Number: (4), Check appropriate box( ): ❑✓ Candidate office sou ht: Miami Shores Village Council ❑ Political Committee(PC) ❑ Electioneering Communi ns Org.(ECO) ❑Check here if PC or ECO has disbanded ❑ Party Executive Committee( TY) ❑Check here if PTY has disbanded ❑ Independent Expenditure(IE) Iso covers an ❑Check here if no other IE or EC reports will be filed -individual making electioneering co munications) (5) Report Identifiers Cover Period: From 2/1/2015 i To /2&/2015 i Report Type: ❑� Original ❑Amendment ❑S cial Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash &Checks $ 4, 770 0 Expenditures $ 4 , 269 . 51 Loans $ , Transfers to Office Account $ 0 , Total Monetary $ , 4 , 77 . 00 taI Monetary $ 4 , 269- 51 In-Kind $ • 00 (8) Other Distributions $ 0 - (9) TOTAL Monetary Contribu ons To Date (10) T TAIL Monetary Expenditures To Date $ 4, 77 00 $ 4- , 269 . 51 (11)Certification It is a first degree isdemeanor for any person to falsify a \Ali record(ss.839.13, F.S.) I certify that I havte�examin this report and it is true,correct,and comple (Type name) Robert illiamson (Type namea Burch ❑Individual(only for IE Treasurer ❑Deputy Treasurer El Candidate ❑Chairperson(only for PC and PTY) & I or elec 'ng mm.) X .4 LAW I I OLI Al�j Signature �fzz/ Signature/ DS-DE 12(Rev.11/13) VSEE"RSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 1 4 (3) Cover Period / / through / / (4) Page of (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 Type I Occupation Type Description Amendment Amount 2 9 2015 Burch, Alice 1440 NE 101 Street Miami Shores, FL 33138 1 S Business Won CHE 1000.00 Holly; John H a 2 / 9 /2015 9660 NE 5th Ave Rd Miami Shores, FL 33138 2 I Businessman CHE 250.00 r Williamson, Robert 2 10 2015 1235 NE 96th Street Miami Shores, FL 33138 3 I Entrepreneux CHE 250.00 Cocchi, Patricia A. 2 / 14 /2015 1089 NE 104th Street Miami Shores, FL 33138 4 I Retired CHE 100.00 Morris, Chester H, MD 2 17 2015 734 NE 119th Street Biscayne Park, FL 5 33151 I Doctor CHE 100.00 2 17 2015 Rollason, Frances 686 NE 74th Street Miami, FL 33138 6 I Retired CHE 100.00 1 Clifford, Deborah.A. 2 22 2015 1490 NE 103rd Street Miami Shores, FL 33138 7 I Real Estate CHE 1000.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 2 4 (3) Cover Period / / through / / (4) Page of (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 Type I Occupation Type Description Amendment Amount Davies, Roxane S. 2 21 2015 1041 NE 94th Street / Miami Shores, FL 33138 8 I Teacher CHE 100.00 Howell, William 2 / 21 /2015 1441 NE 102 Street Miami Shores, FL 33138 9 I Government CHE 200.00 Quinton III, Albert E 2 22 2015 467-NE 95th Street Miami Shores, FL 33138 10 I CAE 75.00 Roy, William R 2 / 21 /2015 1280 NE 101 Street Miami Shores, FL 33138 11 I Businessman CHE 250.00 Rluck, Georgette 2 21 2015 70 NE 90th Street Miami, FL 33138 12 I Real Estate CHE 250.00 N . 2 22 2015 Newman, Mary / / 140 NE 95 Street Miami Shores, FL 33138 13 I CHE 15.00 Witherington, George 2 20 2015 1381 NE 103rd Street Miami Shores, FL 33138 14 I CHE 25.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 3 4 (3) Cover Period / / _ through / / (4) Page of (5) (7) (8) (9) (10) (11) (12) Date Full Name e (6) (Last,Suffix,First,Middle) Sequence Street Address& Contributor Contribution In-kind Number City,State,Zip Code Type Occu ation.. Type Description Amendment Amount Witherington, Thomas 2 20 2015 L. 1381 NE 103rd Street 15 Miami Shores, FL 33138 I CHE 50.00 Piper, Sheryl r 2 / 22 /2015 201 Alhambra Circle Suite 703 16 Coral Gables, FL 33134 I CHE 50.00 Dombrowskp, Susan B. 2 / 22 /2015 1('[L• t t4 e (02 17 I CHE 50.00 ( Calhoun, Cheryl C. 2 / 22 /2015 10610 NE 10th Place Miami Shores, FL 33138 18 I CHE 50.00 Harnage, Frances S. 2 22 2015 257 NE 91 Street Miami Shores, FL 33138 19 1 Retired CHE 100.00 2 22 2015 Gispert, Patricia A. / 246 NE 100 Street Miami Shores, FL 33138 20 I CHE 50.00 2 22 2015 Martha Collins 525 NE 101 Street Miami Shores, FL 33138 Y1 I CHE 50.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 4 4 (3) Cover Period / / through / / (4) Page of k (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 Type I Occupation Type Description Amendment Amount CASH: Various donors 2 22 2015 22 CAS 130.00 Levasser, Phil 2 / 22 /2015 1218 NE 95th Street Miami Shores, FL 33138 23` I Retired CHE 100.00 Christopher Kelley PA 225 2015 11098 Biscayne Blvd / / Miami, FL 33161 24 B CHE 50.00 Burch, Alice 2 / 25 /2015 1440 NE 101 Street Miami Shores, FL 25 S Business CHE 100.00 Williamson, Jeffrey B 2 28 2015 2210 Overbrook / / Miami, FL 33133 26 I Businessman CHE 200.00 Huff, Colleen Fix' 2 28 2015 1290 NE 103rd Street Miami Shores, FL 33138 27 I CHE 75.00 f DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1)Name Alice Burch (2)I.D. Number (3)Cover Period 2 / 1 / 2015 through 2 / 28 / 2015 (4)Page 1 of 1 (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 Sean Saladino Design Studio 2 14 AO15 7251 NE 2nd Ave, Suite 201 Miami, FL 33138 CAN $450.00 1 2 17 015 Biscayne Media, LLC PO Box 370566 Miami, FL 33137 CAN $445.00 2 Serigraphic Screen Printing 2 25015 13982 NW 58 CT Miami Lakes, FL 33014 CAN 3374.51 , 3 t DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES • i a CAMPAIGN TREASURER'S REPORT SUMMARY (1) Ake Burch OFFICE USE ONLY Name (2) 1440 NE 101 Street Address(number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: ,(4) Check appropriate box(es): R1 Candidate Office Sought: Miami Shores Village Council ❑ Political Committee(PC) ❑ Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded ❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded ❑ Independent Expenditure(IE)(also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From 2/1/2015 / To 2/2&/2015/ Report Type: ❑✓ Original ❑Amendment ❑Special Election Report (6) Contributions This Report (7) Expenditures This Report r Monetary Cash &Checks $ 4, 770 00 Expenditures $ 4 , 269 . 51 Loans $ , , Transfers to Office Account $ 0 , Total Monetary $ 4 , 770 - 00 Total Monetary $ 4 , 269 . 51 In-Kind $ ' _ 1 _ . 00 (8) Other Distributions $ 0 , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 4, 770 . 00 $ 4 , 269 . 51 (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,correct,and complete: (Type name) Robert Williamson (Type name)Alice BUrCh ❑Individual(only for IE El Treasurer ❑Deputy Treasurer s❑Candidate ❑Chairperson(only for PC and PTY) or elec' Bering comm.) X Signature Signature DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 1 4 (3) Cover Period / / through / / (4) Page of (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 Type Occupation Type Description Amendment Amount Burch, Alice 2 9 2015 1440 NE 101 Street Miami Shores, FL 33138 1 LOA Med Off Mgr CHE 1000.00 Holly, John H 2 / 9 /2015 9660 NE 5th Ave Rd Miami Shores, FL 33138 2 I RE Support CHE 250.00 Williamson, Robert 2 / 10 2015 1235 NE 96th Street Miami Shores, FL 33138 3 I Entrepreneur CHE 250.00 Cocchi, Patricia A. 2 14 2015 1089 NE 104th Street Miami Shores, FL 33138 4 I Retired CHE 100.00 Morris, Chester H, MD 2 17 2015 734 NE 119th Street Biscayne Park, FL 5 33151 I Retired CHE 100.00 Rollason, Frances 2 17 2015 686 NE 74th Street Miami, FL 33138 6 I Retired CHE 100.00 Clifford, Deborah A. 2 22 2015 1490 NE 103rd Street Miami Shores, FL 33138 7 I RE Sales CHE 1000.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 2 4 (3) Cover Period / / through / / (4) Page of (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 Type I Occupation Type Description Amendment Amount Davies, Roxane S. 2 21 2015 1041 NE 94th Street Miami Shores, FL 33138 8 I Teacher CHE 100.00 Howell, William 2 / 21 /2015 1441 NE 102 Street Miami Shores, FL 33138 9 I Govt. Employ CHE 200.00 Quinton III, Albert E 2 / 22 /2015 467 NE 95th Street Miami Shores, FL 33138 10 I CHE 75.00 Roy, William R 2 / 21 /2015 1280 NE 101 Street Miami Shores, FL 33138 11 I Gallery Owne CHE 250.00 Kluck, Georgette 2 21 2015 70 NE 90th Street / / Miami, FL 33138 12 I RE Sales CHE 250.00 Newman, Mary 2 22 2015 140 NE 95 Street Miami Shores, FL 33138 13 I CHE 15.00 Witherington, George 2 20 2015 1381 NE 103rd Street Miami Shores, FL 33138 14 I CHE 25.00 DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 3 4 (3) Cover Period / / through / / (4) Page of (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 Type Occupation Type Description Amendment Amount Witherington, Thomas 2 20 2015 L. 1381 NE 103rd Street 15 Miami Shores, FL 33138 I CHE 50.00 Piper, Sheryl 2 22 2015 201 Alhambra Circle / Suite 703 16 Coral Gables, FL 33134 1 CHE 50.00 Dombrowsky, Susan B. 2 / 22 /2015 17 I CHE 50.00 Calhoun, Cheryl C. 2 22 2015 10610 NE 10th Place / Miami Shores, FL 33138 18 I CHE 50.00 2 22 2015 Harnage, Frances S. / / 257 NE 91 Street Miami Shores, FL 33138 19 1 Retired CHE 100.00 Gispert, Patricia A. 2 22 2015 246 NE 100 Street Miami Shores, FL 33138 20 I CHE 50.00 Martha Collins 2 22 2015 525 NE 101 Street Miami Shores, FL 33138 21 Z CHE 50.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 2 1 2015 2 28 2015 4 4 (3) Cover Period / / through / / (4) Page of (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 Type I Occupation Type Description Amendment Amount CASH: Various donors 2 22 2015 22 CAS 100.00 Levasser, Phil 2 22 2015 1218 NE 95th Street / / Miami Shores, FL 33138 23 I Retired CHE 100.00 Christopher Kelley PA 2 / 25 /2015 11098 Biscayne Blvd Miami, FL 33161 24 B CHE 50.00 Burch, Alice 2 / 25 2015 1440 NE 101 Street Miami Shores, FL 25 LOA Med Off Mgr CHE 100.00 Williamson, Jeffrey B 2 28 2015 2210 Overbrook / / Miami, FL 33133 26 I RE Developer CHE 200.00 Huff, Colleen Fix 2 28 2015 1290 NE 103rd Street Miami Shores, FL 33138 27 I CHE 75.00 Ackley, Susan D. 2 22 2015 1119 NE 99 Street Miami Shores, FL 33138 28 CAS 30.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 1 CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name Alice Burch (2)I.D. Number (3)Cover Period 2 / 1 / 2015 through 2 / 28 / 2015 (4)Page 1 of 1 (5) (7) (8) (9) (1 0) (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 Sean Saladino Design Studio Postcard printing 2 14 A015 7251 NE 2nd Ave, Suite 201 Miami, FL 33138 MON $450.00 1 2 17 015 Biscayne Media, LLC Advertisement in PO Box 370566 Biscayne times Miami, FL 33137 MON $445.00 2 Serigraphic Screen Printing Buttons, banners, 2 25 015 13982 NW 58 CT yard signs, etc. Miami Lakes, FL 33014 MON 3374.51 3 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Alice Burch OFFICE USE ONLY Name (2) 1440 NE 101 Street Address (number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑✓ Candidate Office Sought: Miami Shores Village Council ❑ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded ❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded ❑ Independent Expenditure(IE) (also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From 3/1/2015 / To 3/13t/2015/ Report Type: ✓❑ Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash &Checks $ 1 , 525 00 Expenditures $ 2 , 980 . 00 Loans $ 1, 750. 00 Transfers to Office Account $ Q Total Monetary $ 3, 275 00 Total Monetary $ 2 980 . QQ In-Kind $ , 261 . 33 (8) Other Distributions $ 0 , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 8, 045 . 00 $ 7 , 249 . 51 (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, correct, and complete: (Type name) Robert Williamson (Type name)Alice Burch ❑indivi mA10 Treasurer ElDeputy Treasurer 0Candidate ElChairperson(only for PC and PTY) or el ioneeri ) X Signature Signature DS-DE 12(Rev.11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 3/1/2105 3/13/2015 1 2 (3) Cover Period / / through / / (4) Page of (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 I Occupation Type Description Amendment Amount Smith, Patricia G. 3 3 2015 359 NE 101 Street Miami Shores, FL 33138 1 I County Emplc CHE 100.00 Leonard, Rebekkah H. 3 3 2015 9300 NE 4th Ave. Miami Shores, FL 33138 2 I Teacher CHE 100.00 Michaels, R. Samuel 3 / 3 /2015 1070 NE 92nd Street Miami Shores, FL 3 I Retired CHE 100.00 Benson, Eric 3 4 2015 361 NE 102 Street Miami Shores, FL 33138 4 I Accountant CHE 100.00 3 Salt, Abbie R. / 4 2015/ 1468 NE 104 Street Miami Shores, FL 33138 5 1 Title Co. RCT/Paypal 100.00 Quiroga, Manuel 3 4 2015 9431 NE 9th Ave Miami Shores, FL 33138 6 I Retired RCT/Paypal 100.00 Del Vecchio, Charles 3 5 2015 F. 1350 NE 103rd Street 7 Miami Shores, FL 33138 1 AC Co. Owner CHE 200.00 DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 3/1/2105 3/13/2015 2 2 (3) Cover Period / / through / / (4) Page of (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 Type I Occupation Type Description Amendment Amount Heffernan, William J. 3 6 2015 5012 NE Quayside Terr. Miami, FL 33138 8 I Consultant CHE 250.00 McClellan, Amy 3 6 2015 800 NE 95th Street Miami Shores, FL 33138 9 I Consultant CHE 100.00 Bolton, Jennifer 3 / 5 /2015 7205 Corp Ctr Dr Miami, FL 33126 10 I Marketing D' INK 261.33 Burch, Alice 3 / 7 /2015 1440 NE 101 Street Miami Shores, FL 33138 11 S Biz Office M LOA 1750.00 3 2 2015 Perez, Maritza 1450 NE 101 Street Miami, FL 33138 12 I Retired CHE 100.00 Godrey, Karen D. 2 21 2015 1481 NE 102 Street Miami Shores, FL 33138 13 1 Che 75.00 Clum, Lucille M. 3 13 2015 1430 NE 102 Street Miami Shores, FL 33138 14 1 Retired CHE 200.00 DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1) Name Alice Burch (2)I.D. Number (3)Cover Period 3 / 1 /2015 0 through 3 / 13 / 2015 (4) Page 1 of 1 (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 Greater Miami Shores CofC Egret insert 3 3 0159701 NE 2nd Ave Miami Shores, FL 33138 MON 415.00 1 3 4 015 Miami-Dade County Election lists 101 NE 1st Ave Miami, FL 33131 MON 40.00 2 Bolton, Jennifer Food campaign party 3 5 015 7205 Corp Ctr Dr Miami, FL 33126 INK 261.33 3 Biscayne Times Campaign 3 6 201 PO Box 370566 advertising Miami, FL 33137 MON 665.00 4 Paypal Bank fees 3 6 015 2065 Hamilton Ave. San Jose, CA 95125 MON 10.00 5 Gagliardi, Laura Campaign Intern 3 7 201 9326 NW 2nd Ave. Miami Shores, FL 33150 MON 1750.00 6 Gerber, Sarah Campaign Website 3 11 201 7775 SW 86th Street Maintenance Miami, FL 33143 MON 100.00 7 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Alice Burch OFFICE USE ONLY Name (2) 1440 NE 101 Street Address(number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): El Candidate Office Sought: Miami-Shores Village Council ❑Political Committee(PC) ❑Electioneering Communications Org.(ECO) ❑Check here if PC or ECO has disbanded ❑Party Executive Committee(PTY) ❑Check here if PTY has disbanded ❑Independent Expenditure(IE)(also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From 3//14/2015 To 3/27/20/15 Report Type: ❑✓ Original ❑Amendment El Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash 8 Checks $ 2, 850. 00 Expenditures $ 2 ,338 . 19 Loans $ 1 , 562. 54 Transfers to Office Account $ , Total Monetary $ 4 , 412. 54 Total Monetary $ 2, 338 - 19 In-Kind $0 (8) Other Distributions $ , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 12, 457 54 $ 9 , 587 . 70 (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,correct,and complete: (Type name) Robert Williamson (Type name)Alice Burch , ❑Individual(only for IE El Treasurer ❑Deputy Treasurer Candidate ❑Chairperson(only for PC and PTY) or electio ring comm. XAii � Signature Signature DS-DE 12(Rev.11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 3/14/2105 3/27/2015 1 (3) Cover Period / / through / / (4) Page of �. (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 Type Occupation Type pescription Amendment Amount 3 15 2015 Maggie Manrara 511 Sevilla Ave. Coral Gables 1 I CHE 50.00 Craig Swanson 3 24 2015 1426 NE 105 Street Miami Shores, FL 33138 2 I Biz Printer CHE 100.00 Joan Lutton 3 20 2015 167 NW 109 Street Maim Shores, FL 33168 3 I Retired RCT 100.00 C. M. Mennes 3 , 20 /2015 317 NE 104 Street Miami Shores, FL 33138 4 I Retired RCT 100.00 3 25 2015 Jason Alderman, PA f 9999 NE 2nd Ave Miami Shores, FL 33138 5 B Attorney CHE 500.00 Stellar Health 3 25 2015 Properties, LLC 1301 NE 104 Street 6 Miami Shores, FL 33138 B Healthcare CHE 1000.00 Cathy S Sena 3 25 2015 / 1301 ME 104 Street Miami Shores, FL 7 I Nursing Hm 14 CHE 1000.00 DS-0E 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 3/14/2105 3/27/20152 ,(3) Cover Period / / through / / (4) Page 12, of (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 Type Occupation Type Description Amend—A Amount 3 27 2015 Burch, Alice 1440 NE 1440 Street Miami Shores, FL 33138 8 S Med Office F LOA 1562.54 IS DS-0E 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES t CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1)Name Alice Burch (2)I.D. Number (3)Cover Period 3 / 14 /2011 through 3 / 27 / 2015 (4)Page 1 of 1 (5) (7) (8) (9) (10) (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 N Saladin Design Studios Flyer printing 3 19A015 7251 NE 2nd Ave. Miami, FL 33138 MON 450.00 1 3 19 201 Serigraphic Screen Printing Yard signs and 13982 NW 58th Ct. banners Miami Lakes, FL 33014 MON 315.65 2 Paypal Bank fees 3 23 015 2065 Hamilton Ave. San Jose, CA 95125 MON 10.00 Burch, Alice Food, printing, web 3 27 201 1440 NE 101 Street support, and Miami Shores, FL 33138 supplies MON 1562.54 DS-0E 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES y CAMPAIGN TREASURER'S REPORT SUMMARY (1) Alice Burch OFFICE USE ONLY Name (2) 1440 NE 101 Street Address (number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑✓ Candidate Office Sought: Miami Shores Village Council ❑ Political Committee(PC) ❑ Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded ❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded ❑ Independent Expenditure(IE) (also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From 3/28/2015 To 4/9/2015 Report Type: ❑✓ Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash &Checks $ , 900 . 00 Expenditures $ 2 , 747 .02 Loans $ Transfers to Office Account $ Total Monetary $ , , 900.00 Total Monetary $ 2, 747 . 02 In-Kind $ 594. 00 (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 13, 357 . 54 $ 12, 334 . 72 (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, correct, and complete: (Type name) Robert Williamson (Type name)Alice Burch ❑Individual(only for IE El Treasurer ❑Deputy Treasurer El Candidate ❑Chairperson(only for PC and PTY) or eleloCeeedng comm.) x ( MAx Signature Signat e DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS Alice Burch (1) Name (2) I.D. Number 3/28/2015 4/9/2015 1 1 (3) Cover Period / / through / / (4) Page of (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 Type Occupation Type Description Amendment Amount Bockner, David 3/30/2015 1199 NE 99th Street Miami Shores, FL 33138 1 I Retired CHE 400.00 Hornbuckle, John 3/30/2015 950 NE 117th Street Biscayne Park,FL 33161 2 I RCT 75.00 Campbell, Kendra 3/3/2015 / 415 NE 102 Street Miami Shores, FL 33138 3 I RCT 75.00 Challenor, John 3/0/2015 / 595 NW 91 Street Miami, FL 33150 4 I Salesman CHE 250.00 Smith, Patrice 4 7 2015 Gillespie 385 NE 101 Street 5 Miami Shores, FL 33138 1 M-D County E INK Food 294.00 Garces, Anamarie 4 7 2015 4779 Collins #2903 Miami Beach, FL 33140 6 I Health Mgr INK Bike Rental 300.00 4 8 2015 Blasberg, Larrie S. / / 720 71 Street Miami Beach, FL 33141 7 I Retired CHE 100.00 DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES (1)Name Alice Burch (2)I.D. Number (3)Cover Period 3 / 28 /2015 through 4 / 9 / 2015 (4) Page 1 of 1 (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 Serigraphic Screen Printing Additional worker 3 30 201 13982 NW 58 Ct. shirts Miami Lakes, FL 33014 MON $169.00 1 4 2 201 Miami Herald Media Company Weekend ads PO Box 3028 Livonia, MI 48151 MON 1351.00 2 Aquarius Press Absentee letters 4 5 015 13795 NW 19th Ave and envelopes Opa-Locka, FL 33136 MON 485.78 3 Paypal Bank fee 4 5 2015 2065 Hamilton Ave. San Jose, CA 95125 MON 10.00 4 Miami-Dade Elections Dept. Absentee ballot 4 5 015 2700 NW 87 Ave - #100 information Doral FL 33172 MON 60.00 5 Zip Mailer Absentee mailer 4 8 201 5137 SW 8th Street Miami, FL 33134 MON 515.06 6 Burch, Alice Giveaways for 4 9 201 1440 NE 101 Street marshmallow drop, Miami Shores, FL 33138 food, postage MON 156.18 7 DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) Alice Burch OFFICE USE ONLY Name (2) 1440 NE 101 Street Address(number and street) Miami Shores, FL 33138 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): ❑Candidate Office Sought: Miami Shores Village Council ❑ Political Committee(PC) ❑ Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded ❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded ❑ Independent Expenditure(IE)(also covers an ❑Check here if no other IE or EC reports will be filed individual making electioneering communications) (5) Report Identifiers Cover Period: From 4 / 10 /2015 To 511/31/20+15 Report Type: FINAL ❑✓ Original ❑Amendment ❑Special Election Report (6) Contributions This Report '(7) Expenditures This Report Monetary Cash & Checks $ 00 Expenditures $ 1 , 022 . 82 Loans $ , , Transfers to Office Account $ , Total Monetary $ , , 00 Total Monetary $ 1 , 022 . 82 In-Kind $ , . 00 (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 13, 357 . 54 $ 13, 357 54 (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, correct,and complete: (Type name) Robert Williamson (Type name)Alice Burch ❑Individual(only for IE g Treasurer Deputy Treasurer Candidate ❑Chairperson(only for PC and PTY) orrn X X Signature Signatqo DS-DE 12(Rev.11/13) f SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name Alice Burch (2)I.D:Number (3)Cover Period 4/ 10 / 2015 through 5 / 31 / 2015 (4) Page 1 Of 1 (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 Greater MSCC. delivery of flyers 4 14 P 015 9701 NE 2nd Ave. Miami Shores, FL 33138 HON $415.00 1 4/25 015 Gagliardi, Laura campaign manager 9326 NW 2nd Ave Miami Shores, F1 33130 MON 500.00 2 Burch, Alice printing 4 26 015 1440 NE 101 Street Miami Shores, FL 33138 MON 64.07 3 TD Bank bank fees 5 31 2015 9051 Biscayne Blvd Miami Shores, FL 33138 MON 24.00 4 Burch, Alice misc campaign party 5 30 015 1440 NE 101 Street Miami Shores, FL 33138 MON 19.75 5 t DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES