Martinez, Julio HERTA HOLLY
`SNoR�s p� MAYOR
�t JESSE WALTERS
RC1 ami
miShorej
VICE MAYOR
Villaqe
HUNT DAMS
10050 N.E.SECOND AVENUE V COUNCILMAN
(0) 11D
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:
E-Mail Address: C'()V\C.I C4 Z.W\ O 2D GOdh
Address: L
Telephone Numbers: 7� -aG0
CANDIDATE INFORMATION REQUIRED FOR
QUALIFYING FOR VILLAGE COUNCIL ELECTION
J Notice of Candidacy and Residency
Campaign Account &Treasurer's Appointment
Form 1 Financial Disclosure
Loyalty&Candidate's Oath
Statement of Candidate
50 Signatures on Nominating Petition
Confirmed by Miami-Dade County Elections
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):
Initial Filing of Form Re-filing to Change: [3 Treasurer/Deputy C] Depository E] Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)T, �. 'X
4. Telephone 5. E-mail address /!/6J�// sDl�r�, L 33l✓�'
(7A )aq0-z��(6
6. Office
�sou ht (include circuit, group number) 7. If a candidate for a nonpartisan office, check if
997 ?AJC o`� -1) 11/L"', applicable:
/x11411 ;�//O Ae&S — 33 i ❑ My intent is to run as a Write-In candidate.
8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write-In X No Party Affiliation Party candidate.
have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
Name of,, rea urer or Deputy Tasrer
11. Mailing Address 12. Telephone _
v i�5- 94 IM!F CV ) J-9e-aS 6 J
13. City [1_4. County 15. State 16. Zip Code 17. E-mail address
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Nameol Bank 20. Address
21. ity 22. County 23. State 24. Zip Code
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING fORM FO APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT TH CTS S ATED IN 1T ARE TRUE.
25. Date 26. Signatfksand�
e
X
27. Tre urer'ssAA/ccepta ce of Appointment(fill in t, heck the appropriate block)
1, �D / dq hereby accept the appointment
(Please Prin r Type Name)
-esignated above as: Campaign Treasurer Deputy Tr su
!�!AJ_11j__ X
Date Signature of C n Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) 1 Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of codAInz" ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
Si a 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 84(05111)
CANDIDATE OATH —
NONPARTISAN OFFICE
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
/ (Section 99.021,Florida Statutes)
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT'-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of R*YI ShkEg
(office) (district#)
I am a qualified elector of 1-114AIt .5AAe5 /�i�i�� � 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, F orida Statutes; and I will support the Constitution of the United States and the Constitution of the
State of Florida.
X
SI re of Candidate Telephone Number Email Address
b rl/45=- I� /�J q1�� � �- 3--3
"Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): /a2z,�-L�1Jq
* 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):
#0
STATE OF FLORIDA
COUNTY OF SJAZF-
Sworn to (or affirmed)and subscribed before me this(7 day ofyebyywc•A , 201r.
r° . ••.�'n MYRUMALOMIA
tK 1
* * MY COMMISSION#FF 134641 Ah
Personally Known:_�or EXPIRES:June 22,2011
J'°rFafloP`O' BOedThnJ8ud0N0Wy5mkq Signature of Notary Public
Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public
Type of Identification Produced:
DS-DE 25(Rev.5111) Rule 1S-2.0001,F.A.C.
c�tloRES pi
-1932
� n
nn81
��OR1Dp`
NOTICE OF CANDIDACY AND RESIDENCY
I, w ''� hereby file this Notice of Candidacy dacy this AL day
Of 0 05--- , 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 dat of qualifying for office as required by Section 23 of the Village Charter.
SI Print Name
L&2 A)E
Address
Telephone Number
E-Mail Address .
STATE OF FLORIDA ) ccV\C(C-V\�I Z oLhd Q Cz Giv�- COMM
COUNTY OF MIAMI-DADE )
BEFORE ME personally appeared GLAtO 1 yMI1Y1('..•Z who executed this Notice of
Candidacy and Residency this( day of 2015.
Notary Public
Personally Known
Produced the following Identification Seal/Commission Expires:
BARBARA A ESTEP
MY COMMISSION M FF 073975
tiEXPIRES:March 29,2018
�i R f i,; Bonded Thru Notary Public Underwriters
♦SH'jVkC-1932
ORloss aw 51111 rM
PERES
—
60'
�t010
MIAMI SHORES VILLAGE COUNCIL
CANDIDATE INFORMATION RECEIPT
Candidate: Go In WLo.V��nez,
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 C mp 'gn Treasurer Handbook
State Statute C ter 7 6
i
Received By:
Date: