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Zelkowitz, Steve w HERTA HOLLY ANC.1932StloREs G,` MAYOR JESSEWALTERS s,,, �- "„�� �a'^`A VICE MAYOR `+�• HUNT DAMS Lei.= C�e 10050 N.E.SECOND AVENUE V COUNCILMAN �LOR 0 MIAMI SHORES, FLORIDA 33 138-238 2 JIM McCoy TELEPHONE(305)795-2207 COUNCILMAN FAX(305)756-8972 IVONNE LEDESMA COUNCILWOMAN TOM BENTON VILLAGE MANAGER BARBARA ESTEP, MMC February 26, 2015 VILLAGE CLERK RICHARD SARAFAN VILLAGE ATTORNEY Steven Zelkowitz 420 N.E. 95th Street Miami Shores, FL 33138 Dear Steve: 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. Steven Zelkowitz 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 RECEIPT OF QUALIFYING LETTER I, 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. Candidate Signature Date HERTA HOLLY SNORES G,. MAYOR 11SC-193 1 // JESSE WALTERS G!i wi hol ejVilla a VICE MAYOR loll11111111111" HUNT DAVIS I�� pmt 10050 N.E.SECOND AVENUE COUNCILMAN �Ri 0 MIAMI SHORES,FLORIDA 33 138-2382 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 March 3, 2015 VILLAGE ATTORNEY Mr.Steven Zelkowitz 420 N.E. 95`h Street Miami Shores, FL 33138 Dear Steve: Congratulations on qualifying to run for office as part of the Miami Shores Village Council. While you are on the campaign trail in the upcoming weeks,you will no doubt be bombarded by many questions and comments concerning the operation of our Village government. As Village Manager, I would like to extend an invitation to you to meet with me to discuss current issues facing our community and answer any questions you may have regarding the operation of our Village government. Please contact me at 305-795-2207, extension 2,and I will be happy to set up a time at your convenience to discuss these issues. Best of luck with your campaign and I look forward to meeting with you in the near future. Sincere) Tom Benton Village Manager TB: Mgr-2431 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 February 26, 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 Steven Zelkowitz, a candidate for Council in the Miami Shores Village. A total of 56 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. Sincerely, h sti a White Chief Deputy Supervisor of Elections Enclosure (1) Elections 2700 NW 87th Avenue M IAM 1•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, Christina White, Chief Deputy Supervisor of Elections of Miami-Dade County, Florida, do hereby certify that 50 signatures submitted by Steven Zelkowitz 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 26th DAY OF FEBRUARY, 2015 f Christina White Chief Deputy Supervisor of Elections CANDIDA�Tt: PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate`_- 7-At 6L,4-%4'7— for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature Signed 0/o4/41 374;rA 0 ( �•- I!y1� gmi� rl-33135( 2•tS• - 06# � X16 101 33(;6 7010a6 •r �� a'h'I`f.� � ��'h s� 2 X5`6 ►�,►v� �� ate,, ��3 vim► z 585"' l m 2 l5 YWISAL&W- 11 13357 OV&97�3- lj'I�c i .SJR 1310- _ Z �s CIS;s A ig �o 15 A qs 3-Ar fa&Ak,&S - ��' �� era S,77 , i , S;�V3 33��' -ls- 0 NO 2 � �30� �,�.� � �1� Z SKS kW-( 5tbOts FL 5zs l 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: _41.4 Nt'C 957 ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDAA,''r.�� rETITION We,the undersigned electors of Miami Shores Village,do hereby nominate°"7�1y4GV1 7&(kOti44+Z for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code ature Si ned Lwo — � - rco w-se S 1 w G. I�asln tt- oe.32 1lr8�i NE �o� J�I:.M W6 �S r it 0/6y X3(01 1PE1 tL)ffg r77.4y C-)1 4 F5�A9;z' '(�te b *9- 110,6Y, �� QSIISI ' � l�- � uV X13 lU� �(X�'�' �F 11/liQi'ytJ �il�f �' �• �' 01`1 � -- The undersigned is the circulator of the foregoing paper containing lL signatures. Each appended thereto was made in my presence and is the genuine signature of the personwhose ame 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 for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature atly& ,,p Signed / C CA led L'Y �25�2. to eZ q 1313 +v�1Oy1k w &1A+'� S�orYS� �1�a�+�dw.l�/3313� get 1.��15�/ Coo V4 mac. '4 115.2 N-e./4'nom, Af hAt1& hoees � �� ��-iLc,�r��✓ a- -a s- �- Age 04 ► 5 a LoSo - 4 A10 130KA)CJDY5� dtqm� 6,r At" U)Wut 71 13as JUE to S Ialo Ate /� awry 3L, 2� 1Zu0«Aft, 0603 --71 u'tiW &0Q-- Lf AW- ru,cOVW; SU.ove� '021- t. r 145 -. The and ' igned is the circulator of the foregoing paper containing L signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose ame it purports to be. t _ ' • ,/ Signature of Circulator: Address: SIAO /yE Jl � yv`%,w•: S�fe � �', 3 138 ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDAT.. ,ETITION We,the undersigned electors of Miami Shores Village,do hereby nominate LGV � for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature Signed qA0 5-44,s4-. �,► slums FL 'aL33 13 10 /,A� 1 )_ 402 IV&XraMi la f/ , �U M�i�.e� ��j • 3 31��'g x S-1 7y l 9 WL" 4!j s? i / s 6a �3� 7- 41"4i" lits. 33(5s 1 10 11-;'44 rc ,mac s 33r.30 z DMI5 aila LIS cAkN 01W4 W" 10 C4 q14 N3>?Dfv *m;<,-�haleen 331Y s v Ac&- �• f I'1AV1 -IWrs9uOy tAF- 3 Ail'C ffil Il .S60res X138 • 8• l /Va�l�f� � •�i� �4•�o?•�►S 3�OG�d(a,�ery /�1%aw,% S��w 3Si��' o?�•/� 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: _*;O /J.E aJ3L,fiy,� /�iA.r+; s'rlo�3� �. VIM M Ga.s:•f"2 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 740 VZA4 for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature Signed CAak Au Mme- i � � ►cam. `i" ��a1 Q�-� �,1 �kr.�-A l S ,rterbl <<�• � 13533� 8 SSS CyL[ Ylec e(3 S� %- yu� :S 3 g Z G� L . 3 l 0 os'3? `BGG o AF_5:kW- t-1 &o . . tl► IPm/L�2 dn%lc�, i2-23-`� 'Zte 4 06 °M S4; N i A.U .` SLtar•e s L-4�0' PeAgz� `1`'� ` /0d si*�- A&At �'S'Gni 32� IrlMAA (3 f 4U -u/- 1 2,54 13.� U to a 7I��� �k37/33 C � � s8'2 -1 s(-5— Q el . CC The undersigned is the circulat of the foregoing paper containing signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose me it purports to be. Signature of Circulator. Address: 7aRO ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDID, ETITION ,I We,the undersigned electors of Miami Shores Village,do hereby nominate 456NI N �e�0UJ47 for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Si tur Signed s5e ell -11fTJX 3 'd (jfi e A : 3F Lq o h I��No2 -� �� a� N ► c �A. ►m rem s af— 'S2z o � Pam- �wtv 1 14 l N*- s7 M S k b q1 j, P-0,S r j &A LV "j'nC-a4% (Z ►3 �3 lo�{� Nc��(o M�c�,,� CS g tS Le (I&OVs4. 00%, Vl�U QQ-1k4t;A6 8 ��7lJ� 95 S'f As*4 ai 7�v�es�13� �• 8 • /� 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 who me it purports to be. Signature of Circulator: Address: Tao pi E, ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. /110% Signature of Candidate: CANDIDATt PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate!s4t a 7&040t.J:'FZ for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Si nat (n� Siened ow,J 3'2 y ' S `� f 0115 T�S ,✓E � /��,9m� S1,a r�g 33�3� �cJ .2- - 1 Irl S �ZC�ir>� 1 � t 7BO S S i�.�.g"7 69r f9) '�tahnnaflyrn I� 3� 14�h a�•E. tort` d✓l�.r»: Cln�res 314 711110 1/31 sok IV` d�2ia,,•a' �a/�a � i � JO h a ellow I' 6�6vc Z - V-S7 Ail 4� V Gl 7/ Y �� 14 40 �� /a/ f Zai$ 1V 1 a3 o 5i#t ime iao,4*x, IaM�J�'1A'IcJ it 1$ �S -tet Sj Rq 0MAM" 510M> YM el_ oo�r{ ca--tQ��f if31 W g7``�sf— I�lcu s The undersigned is the circulator of the foregoing paper containing JQL signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose name it purports t e. Signature of Circulator: Address: AU tjE a15'r%19S+1n4A40 / N\�rw•: 4V-o%GS� 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 46)0~ 244�C/t�a• Z for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Reg.# Address City/County/Zip Code nature Signed _74-211 erg [�`lcWO�(0Oq 3M 13C- ( ter134�r38 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 me it purports to be. Signature of Circulator: Address: 026 aE a'S4` est" �4- /t�:p.,,. ; ��►0nG.5� pl. 33 t ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: HERTA HOLLY `t1ORES MAYOR 114C.193= JESSE WALTERS 1111 1 /V/V S40rej„Imi Vtllaqe VICE MAYOR wi�_ 11111 „.�•y HUNT DAVIS 1 0050 N.E.SECOND AVENUE COUNCILMAN L'�FN7' 114 MIAMI SHORES,FLORIDA 33138-2382 JIM McCoy 0RIDA 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 23, 2015 Ms. Michelle McClain Miami-Dade County Elections Department P 2700 N.W. 87th Avenue Miami, FL 33172 Dear Ms. McClain: Enclosed please find Petition Forms (6) from Steven Zelkowitz, in reference to the Miami Shores Village April 14, 2015 Council Election. Mr. Zelkowitz opened his 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 CANDIDATUPETITION We,the undersigned electors of Miami Shores Village,do hereby nominate for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code SDienature DSianed hrr.c•SL 3 3 13 �1Q ��P��..J ! .S /I/..�.r�r�.L,�PE-s.�.<, � i i.P•� ��lild' - .3/ •� ,` /� 402 �v�'ys'.sem CG �GIa f/ r[U 91211; MirZ E• 3 ! g S / y S'r ✓ SI (r bG X31 �e c(�( _ s X54 to 1 IZD a On (, au I 19mr �'Lb4- (�� �r ► �'lo>Pc� ,31 IS Ac+6r 4ffirw Jy _t� 3 Aire 1 YI dam I' Shapes13� ANN • 8. 5 N��l�{Aa� •fOi�t// /�•�?•bs' 3ZO66.% �a+�a,v /�1%ate% S� 3S�s� �•/�' The undersigned is the circulator of the foregoing paper containing__C_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: od /J.E Oi3'N' ,� /t�iA.,•,: �lj�y,, j ?i���$ ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. 1 Signature of Candidate: CANDIDATt PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate g:Sk� IC A3.%* Z for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Signature Signed �e�,r-ce1a► P.�ae 't/°�/6? 37Gl��lo ( �- r�nS GMi, ��- 135( Z'(S' (S A-le 1ci1 33M 2. s- ,s- a�l`u .Zai Y\n z Ml -ml s 3 l3 2 l5 l5 ro S l sty. 1' t3 357 ALG 97�5�� M1c * Z l r 0kr i s i$ 10 o /qr b d 5( 0( -3313 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 za f'� g5"A ' .'w,,,; shr�Gs� Pt ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDAL-t-PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate Z..1�GAw�� for a position on the Miami Shores Village Council. Printed Birth Date or Name Voter Ree.# Address City/County/Zip Code Signature Date Signed kI/ -LA( OILA( — -0 � a ,3j� 3 1351 tiC tD 9' 1,4, 3 3 8 l I S i c,lC 1,1,-1 •SSCL14VL er S �` 33 3 a L __ its awe' Z.. 'A 06 alb S+: i ayM% Ska, s r- -2,11 V1 Ur MAA �����6-j lod s,� f �1'1�awc [3 K MVA T .N4- vft�q e /0 7 INL —/�6fj Vhc 37/33ell S Aa- The undersigned is the circulat of the foregoing paper containingAL signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose me it purports to be. Signature of Circulator. Address: 'qJ5 ^4- S be 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 nominate5;Own 24(140Wfor a position on the Miami Shores Village Council. Printed Birth Date or Name Voter Ree.# Address City/County/Zip Date Code Signature Signed C ( VY C'es iC2 eZ T 3 q3 ry�l oytk Sl' ' oyY ,k-V33/ &Wt js lS CA RacylVi fVl�r�r+� S� S1 �1�arM; 3 C/!D V'4 " ,a AM= ley..�• All'4ti _A311va J �• >�iLc,�rl4/✓ a-�"a �� 3 2,A/&/O! s7-- 04 /ON s 14 V-k 'F02-2 A)e B& 11— 7— tuts iugh'ST M -�L 2�/S 2-- 'u, :S f a- ' 1� - 1 �F o c� s� Y a r3� ���o3"�S� h�nme► o ► Ski ��xs z /S�iS S r Loyl-ldnr lC�/O LIE PIA, Ar cv iM. 4-4o�c.p�L o 6 o 3 -?j �i O � Ll�e M"W, Shovel 2, l t•. 1 s' ly4Cw1: SLt 0,1 �/ ��•�.� The and 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 personwhose ame it purports to be. Signature of Circulator: Address: Alo4 NE 455%/ %i►.r.: S/1e 's� �, 3 3138 ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDATE=PETITION We,the undersigned electors of Miami Shores Village,do hereby nominate ' g y ���►��W�� for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address ll City/County/Zip Code ature Signed e,n I k - (0 23 &ran d — M.i��uln r 33l 3� 2-9- Go rCo tN"9e G. �1- $.32 1lrS�; NIG �o� I .:.M:• ���..y+sr�,�3b C,1 A#(a. 0?-7 If III A M4 - FIA1:q;r944/sbz, �s door q AV1MA-1 ( uSt ' S ix 11,L, q13 AX- 10D fA p klrahtj �irlyrd �- �• �' - 2i O � . u-- The undersigned is the circulator of the foregoing paper containing 1 I signatures. Each appended thereto was made in my presence and is the genuine signature of the person whose ame it purports to be. Signature of Circulator: - Address: T;O ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: CANDIDA--r)ETITION We,the undersigned electors of Miami Shores Village,do hereby nominate � for a position on the Miami Shores Village Council. Printed Birth Date or Date Name Voter Ree.# Address City/County/Zip Code Si tur Signed sye ell r� 3&,QIY" an e 1112X25 qS�" c�" ► 2 : aq N o ► 6q&A a I a s �,-- _WJ ,p Y90A11 /o 1sZ ,jij- ��� nAN�0 &ALV Iv Z A /0q1 E "Ar "DGK T"jKDA �Z 3 (3 l oc4I9/A art f YIX611 CU PAC 95-7 n1O g5 5' 14,-.4A,' <Agre5 3r3Y r � 8 • /�" 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 who me it purports to be. Signature of Circulator: Address: 41;0 IJ E. '44VV440 /Vt:006.; 44uv s'I h TT,As ACCEPTANCE OF NOMINATION I hereby accept the nomination for the Village Council and agree to serve if elected. Signature of Candidate: HERTA HOLLY `yNoRB,s A"C*113,1yMAYO)YlR JESSE WALTERS iap iShorej VICE MAYOR �+�✓ Villaqe HUNT DAMS 10050 N.E.SECOND AVENUE L/ COUNCILMAN �LORl�� MIAMI SHORES,FLORIDA 33138-2382 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: Mels_ E-Mail Address: 4e- 1 VOW t Z@QV_QA +FAkASC)A. Cp Address: y,ID UE R5* S k Telephone Numbers: WS-so L-SS33 CANDIDATE INFORMATION REQUIRED FOR QUALIFYING FOR VILLAGE COUNCIL ELECTION Notice of Candidacy and Residency y Campaign Account&Treasurer's Appointment Form 1 Financial Disclosure V Loyalty& Candidate's Oath Statement of Candidate 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) candidate for the office of a;A4,i.'' ��hore S KIIA11— 6w� ) have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X 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 84(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: MAST NAME--FIRST NAME--MIDDLE NAME : 446vetA MAILING ADDRESS: CITY: ZIP: COUNTY: 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 0,CANDIDATE OR 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): ❑ 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 `pr further details). CHECK THE ONE YOU ARE USING: COMPARATIVE (PERCENTAGE)THRESHOLDS OR 0 DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY LOA 1 ra�c�s 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 /A- PART C--REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] (If you have nothing to report,write"none"or'Wa") FILING INSTRUCTIONS for when and where to file this form are N 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) Adopted by reference in Rule 34-8.202(1),F.A.C. PAGE 1 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 L}01 K P ice; �✓� /� ��,,,�Tr���t- , , 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"nia") 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. 1 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, sianing and datina 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 1st 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 specified 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 Facsimiles will not be accepted the filer of filing a CE Form 1 if he or she was in their position on December 31,2014. CE FORM 1-Effective:January 1,2015. Adopted by reference in Rule 34-8.202(1),F.A.C. PAGE 2 DECLARATION FOR CANDIDATES NOT AUTOMATICALLY COVERED by the Mandatory Provisions of the Miami-Dade Ethical Campaign Practices Ordinance Miami-Dade County Code at 2-11.1.1(C) (1) The Mandatory Fair Campaign Practices Ordinance at Sec. 2-11.1.1(C) of the Miami-Dade County Code extends to— • Candidates,and their respective campaign staffs,for Miami-Dade Co. Commissioners or Mayor; • Candidates, and their respective campaign staffs,for Miami-Dade Co. Community Councils; • Candidates, and their respective campaign staffs,for any municipal elective office within Miami- Dade County; • Candidates, and their respective campaign staffs,for the Co. Property Appraiser. Other candidates for elective office with a constituency in whole or in part in Miami-Dade Co. who are not required to comply with the Mandatory Fair Campaign Practices Ordinance may at any time declare that they agree to abide by the Mandatory Fair Campaign Practices Ordinance. The Mandatory Fair Campaign Practices Ordinance states that a candidate 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 that exposes the person to hatred,contempt, or ridicule or causes the person to be shunned or avoided or injured in his or her business or occupation; (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 that exposes the person to hatred, contempt, or ridicule or causes the person to be shunned or avoided or injured in his or her business or occupation; (c) Willfully injure, 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; (d) Knowingly obtain, or cause to be obtained, the campaign property of another candidate with the intent to temporarily or permanently deprive the candidate of a right to the property or its benefit; or (e) Knowingly file with the Ethics Commission a groundless or frivolous complaint against another candidate. If you are not automatically covered by the Mandatory Fair Campaign Practices Ordinance,but you have a constituency in whole or in part in Miami-Dade County and you would like to abide by the Mandatory Fair Campaign Practices Ordinance,please sign and date below. Once signed,the Declaration is deemed irrevocable for the duration of the campaign. I, Nevi 2lut ';-fez , a candidate for the office of please print your name / r pM10/1tiS Y i�lQi�,( l�D t.(�1 G� l in elective office sought county,municipality,or other jurisdiction understand that I am not automatically bound by the Mandatory Fair Campaign Practices Ordinance of Miami-Dade Co. Nevertheless, I choose to abide by the Mandatory Fair Campaign Practices Ordinance and recognize the compulsory jurisdiction of the Ethics Commission and its authority to decide whether I have violated the ordinance at Sec. 2-11.1.1(C) of the County Code. I further understand that if a violation is found,the Ethics Commission has the authority to impose the appropriate penalty, if any. JC /5- Signature Date COE,revised 4/2010 5t1oC.REs Gil Eggs �ZORIP MIAMI SHORES VILLAGE COUNCIL CANDIDATE INFORMATION RECEIPT Candidate: �-! W , -0Lno 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: r. SNORES Dr �t l..■ o.n� OiR1Dp NOTICE OF CANDIDACY AND RESIDENCY hereby file this Notice of Candidacy this2Fday of �, 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. 111s, Vj. Signature Print Name 42o oe Address ' 7095' Telephone Number 4)WB0 E-Mail Address STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) BEFORE ME personally,appeared Q Z.Q. 6 ,who executed this Notice of Candidacy and Residency this �V day of 2015. Notary Public Personally Known Produced the following Identification Seal/Commission Expires: 1 = BARBARA A.ESTEP MY COMMISSION Y FF 073975 a:, a EXPIRES:March 29,2018 Bonded Thru Notary Public Underwriters CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Florida Statutes) <, +eVerq Ze.1kow4z (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 AAM.. S/,t✓t'�5 V,/1AsJ,G 6W C%1 , , (office) I (district#) I am a qualified elector of AA,-Vll'. ►/AA 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. y �'I Signature of Candidate Telephone Number Email Address _pfd o Nc q?, Sof F Address fCity State ZIP Code Candidate's Florida Voter Registration Number(located On your voter information card): * 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): ee-yev-\ zelkow -�� STATE OF FLORIDA COUNTY OF 0&�W� 8aL -� Sworn to(or affirmed) and subscribed before me this 9i!day of_fi'Uf 20t:S . Personally Known: or ,;ti'p"%vim, BARBARA A.ESTEP .: MY COMMISSION#FF 073975 , EXPIRES:March 29,2018 Signature of Notary Public Produced Identification: 4,W(, Bonded ThruNotiyPublic Underwriters Print,Type,or Stamp Commissioned Name of Notary Public Type of Identification Produced: DS-DE 25(Rev.5/11) 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): Initial Filing of Form Re-filing to Change: [3 Treasurer/Deputy ® Depository Office Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip �v�✓► �J11����(�✓1�1 ��� � coder ISI✓ a 7� ��1'�'`� 4. Telephone 5. E-mail address `-.C' ^ 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if applicable: 1_ �4V V1 Gi 1 "4eN" �.Qt E] 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 E] Write-In [:] No Party Affiliation Party candidate. have appointed the following person to act as my Campaign Treasurer Deputy Treasurer Name of Treasurer or Deputy Treasurer 11. Mailing Address 12. Telephone 13. City 14. County 15. State 16. Zip Code 17. E-mailddres P2"11- 18. 1 have designated the following bank as my Primary Depository Secondary Depository 19. Name of Bank 20. Address AV%Wi 5V4 44,,,A- + Oe 2�1 A 21. City `� 22. County � 23. State 24. Zip Code 0+ 1 V►f ► rlM 1,19 j' 4 i aj?; 1 UNDER PENALTIES OF PERJURY,I DECLARE THAT I 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 Candidate 2- ; V X 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) �L I, `" i '� ALV'3 tZ , do hereby accept the appointment (Please Print or Type Name) Designated above as: Rf Campaign Treasurer Deputy Treasurer. � X Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. //'� CAMPAIGN TREASURER'S REPORT SUMMARY (1) `'�Vewe 1 ?_e.A4.ovj•6+Z. OFFICE USE ONLY Name (2) q?, V3. Address (number and street) T City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): 9Candidate Office Sought: iAw+'. 4V%ont<, V' A!S& coV%C' � ❑ 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 / / S To Report Type: Ef Original ❑Amendment ❑ Special Election Report r(6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , 2 • 70 Expenditures $ $ , 02 Loans $ 100 Transfers to Office Account $ Total Monetary $ 221 10 Total Monetary $ • In-Kind $ , , 0 (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ . 10 $ 02 (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) zG�ey/►'� lGt) (Type name) IGeDa. ❑ Individual(only for IE M Treasurer ❑ Deputy Treasurer ["Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) X 04X Signature Signature DS-DE 12(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name �� �Govy �-Z (2) I.D. Number (3) Cover Period a / / +C> through %5 (4) Page t 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 .1asO^ t9'NAX.,r' '�cl�aln�•cu L��- � 1�Ctt1a/►u'S fiN'c �2SD•� 32 ,+2 It1701 I urns aw x.00 tel•`""' ' ���i2� QAJw.o.Ar tv451i W'36r- toil''"`t . f2oaw 11000'00 3�t3� -700 0E "10" s+. 1017 r G J'+,oco.co mw. sly ,eL r<�V iSw.At. 3Qoo f;fM c4if t�oco,00 PA Nor AAA 14;.-,.. b l DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name `�u.� —acvw'.�2 (2) I.D. Number (3) Cover Period �_ / 1 / 1.4; through (4) Page _f of S (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 �L�;& lsonh.�-d I /11; V?115f r:"YLalccpt �i24�3o 1 . � �� �'l(br'Irw� Gtr 4 (00.fb Or t .;�'L501 eve, 42-W.co 2 / t c / 1'S ►2'r�a� �A x ���i 5E 2 �v►�c FIL foo br:dzelk{Cwt 4 (00-00 :,,N•; GL �1 CAC 41pw-oo V1 A 2/ �Gl / � 613 I N�a'lx►�,r S�.I DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name 4" r_�Low; � (2) I.D. Number (3) Cover Period 2 / 1 / IS through / / 1S (4) Page of S (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 LA11dA-CAdKcc, lft-. f,,,,:ro+,�� l Qq0 / S I?_;;-7o NE 'k"/ '�v�l�tncws 4 1 ocn.CX� %AL(of a / go / IS Qr* tie S a ►J�. : SIn S,f v1, yh-k I,ate.ori Po SO ►-%c- O 4. Afai sF 64-W 425D.co t te"17 Ne- Wi r`Gdl G�G DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name �.U��GvW,'�"2 (2) LD-Number (3) Cover Period 12 / 1 / IS through / / 115 (4) Page Lk of 5 (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 I TVpe Description Amendment I Amount too SEV'19'4- 4,1;4 ^'19'4.4,1;.l.c *�155D 1 AAarr^1 Gti4 c �svv.«� a bmAr A • Cass al a o ,w VA ;w.co ��3� Ls,.c-off•. +2o.u� �,Gt�,l So.co -too-oa '77'71 I?i'j 20o. co %A: FL Alw P. �hl�A 200 1 qvt 4200.CD DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name (*7 (2) I.D. Number (3) Cover Period 2 / / lS through �_ / / �� (4) Page 5 of S (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 SSW ctfe S 2i �wN+Nj 2500 1 I'��►l �/l 2 .C� ft mill toD'CO Gam,•.je- A00 ,N Lj 4'k 1 o DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES (1) Name eS�d� —W 1C,0-,',+-7- (2) I.D. Number (3) Cover Period 115(5 through_D/L✓ / (4) Page of ) (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 a r- �� 04A,-,. 9�o len i0 oc- 2`^,C 1� Ugh , I^-. a-;.A;v Work �U0 fir. �e 1,t1 e Aii•1 i�A; `,,,..; C- L 19) Ujj',4�A-Ak7 CA-r3 ^, 1?L .77e5,So W CA- 6A otor Jk 1o70 re �v� s cis A 00 �kk r'--. 'Sti0^e41 DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN LOANS REPORT ITEMIZED Page of (PLEASE TYPE) FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER: 7,(A44,,J:-�-z 4f�"�e� Qn ?2ljs16 Yti 41'nc" T�- :33\-ig OCCUPATION: /'✓yv/ OCCUPATION: AMOUNT OF LOAN:il.op, oo AMOUNT OF LOAN: oa�_oo DATE RECEIVED: `Z� t S DATE RECEIVED: a FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER: OCCUPATION: OCCUPATION: AMOUNT OF LOAN: AMOUNT OF LOAN: DATE RECEIVED: DATE RECEIVED: FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER: OCCUPATION: OCCUPATION: AMOUNT OF LOAN: AMOUNT OF LOAN: DATE RECEIVED: DATE RECEIVED: DS-DE 73A(Rev.08/03) CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Name Address (number and street) 9 44AA0^e"e' City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): mcandidate Office Sought: i A.w^; 46U.e., ❑ 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 / / To / / Report Type: Q Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ j , '1 pp 00 Expenditures $ Loans $ , , Transfers to Office Account $ . Total Monetary $ ZOQ QQ Total Monetary $ p�$ , In-Kind $ , (8) Other Distributions $ . (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ D . l0 $ • � (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) -ulGpf�, (Ty name) �•-C/�IGI�N, ❑Individual(only for IE EfTreasurer ❑ Deputy Treasurer Ef Candidate ❑Chairperson(only for PC and PTY) orelectioneer' comm.) X X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name �G�w. '� (2) I.D. Number (3) Cover Period / / through � / / k55 (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 I Amount (Mary a+. GNMnns A. Aw:Jce k1 rioo AICA.ca � �r:sa'inc �i•r"torplts Vrrc. barbNa �oe2r:��-t I '' , 1 202o N-3 14 -51f- V;'. kV;sIfi�sirvl�C. 'V662 aE 2.,*'A,4,Ax Yt�o� 4Grv',u— Ni�i 410000. 00 2,31 r, N6 VA 6p.,r+ DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name �� �y.y;k2 (2) I.D. Number (3) Cover Period '_27 / �`� / through 2j / — / 115- (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 Occupation Type Description Amendment Amount ��SCli1K �^��•wl N , Fl, �uot 6v11;, ,AN6w-c. 4100.00 VL ?i?il;g) 22 ✓ chi, to c. Imo:thgk�, UL X22 "S b 122 64e too.Cc �c,kFr�l;�Sc DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name (2) I.D. Number (3) Cover Period / / (� through -27 / / (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 1�>J !6l� uL / / 1051� t t+ u�(•�• , f-- �►gyp GcrAtVKJ F,2 WaAPIMA 110w-C>0 U ;t;4 LCI Qf: ate dh ,fL o tz a l k n Ton-), OPP.?? ��►S� f r �" DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 4 AMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name zGK w +-z (2) I.D. Number (3) Cover Period 11;- through_ '1 /2.7 / li (4) Page 1 of (5) (7) (8) (9) (10) (11) Date Full Name Purpose (6) (Last,Suffix, First,Middle) (add office sought if Ex enditure Sequence Street Address& contribution to a p Number City,State,Zip Code candidate) Type Amendment Amount �✓- 1� 'P D. fio�c 3�oSL!P �P�^"��ur � �G� �q 4�5'.00 Tyr 1�J ?f.�0"� �' . IJ�:,,,,... {��Kivw�, C��v►Pa:`6,.� L'A1�1 DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY �1) ZS�� JtaA),+Z OFFICE USE ONLY Name (2) �Zo N� Address (number and street) J94 acs . rL. City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Candidate Office Sought: tA i A�. 6 A V', a ❑ 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 -L / l / To 2j / 2� / Report Type: ❑ Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , a'10 . q1D Expenditures $ Loans $ Transfers to Office Account $ • Total Monetary $ �j , q"70 • q� Total Monetary $ In-Kind $ 00 (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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) 7t�A6wAT_ (Type name) ❑ Individual(only for IE Treasurer ❑Deputy Treasurer RrCandidate ❑Chairperson(only for PC and PTY) or election eerin comm.) X X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name (2) I.D. Number (3) Cover Period / / l5 through '2j / 115 / X"? (4) Page I 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 Type Occupation Type Description Amendment Amount �o1nv� fiti�.11¢�nat- t✓1:,,,►�.Ste, �(. l �po� (�� a��i.�� ,,,,;.k ;T w A 4" !iN j Cao.o0 , fl7Jt5 I 1,x.1 ao. 3+01 l6h"1 low klk"` Dec I so GN' 1,Oz.00 -.,: , V1- �i�125 w:4(tc t4tcolM Y-i r4(k%412+w+ MI6 %SCI QaceL 2,26122 l l 1 04-510 CA c.jrcS frock La�d�r d�►4 fit- t ��L� kp_k G�3�16 FCS-' VAC-40 p� ��k�1 ►•"� 101�'��. 1 �1 k� fit-1'E ';i 7�77�b ClLr 4A �Inorev? ';17X1i� DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name Z�� UGn w;A-Z (2) I.D. Number (3) Cover Period -4— / 1 / 16 through / l'i (4) Page L 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 Type I Occupation Type Description Amendment Amount -' 1AAeJAAd- �anc5 �- l cb,cac VII:�:ti v3or� wt:�:. , f7 (,owe jAAj �rA .r (nol�Itn ISA ?.v cL Sr. ?A �avn;/?\A Wh L �jrvl ct1' i Jo1�h �iln�1l,(,Nor 12 h14wt,., CtCA 'Qom LL � �;,w•; ��itC1.. �lriv� DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name lJCVw,-k-z (2) I.D. Number (3) Cover Period _Z7 / I / `c). through 2• / / ��j (4) Page -3 of 3 (5) (7) (S) (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 1 Amount r..r. LL L o..• 10 K Food- 230.00 IM;�►��I N�tkw�:�t 171) I �3�7? 1 / DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES G (1) Name fuse t 2J�.-I'L_ (2)I.D. Number (3)Cover Period 11� through 27 (4) Page ) of I (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 t5 K� -6kewow ,dt�'1 V:Lt�yl s ivoo'[OA4s;04li4r^Se- 101 LVA A60(4co tS «i N.�. 14+4 Fite CAS �co.c� V- lJrb�.• �,.:-t;..a-;,►cam, � 1730-'�'� tivi iA A:�� SGL (o,CnD.Gn CAA DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Na e (2) ty2lo ocl AF31," G Y-" Address (number and street) City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): Vcandidate Office Sought: 0.— 0^e'0> A ❑ 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 S To LA / IS Report Type: ❑ Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ q'(. 00 Expenditures $ 00,0 Loans $ , Transfers to Total Monetary $ 0z Total Monetary $ 000 00 In-Kind $ . (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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) {IV(/b� � `Gtf��. (Type name) �j ❑ Individual(only for IE reasurer ❑Deputy Treasurer Ercandidate ❑Chairperson(only for PC and PTY) or electioneering comm.) I X X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name -�GlLo�.,, (2) I.D. Number (3) Cover Period through A (4) Page �_ of 2 (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 (� -,co_4or��I-b4fb 2to N„a lcl FL33t2�r I Seth w� fiNrc 4 2-65.oo o 1'5 ,,�kEa Cv ly ter Sk + 6,,ns.� `�+ �'I£ I oa, ae I Li 1,500.gvz � � u- / v A. Lw.. 77-7 117f:daA Ate►--t, J." /7,)-.k 400 Sb4Mc`xCA.*:-h FL ZOO,00 h6*41 O+C t;o,o DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name 4Y'N �AAtco,". k2. (2) I.D. Number (3) Cover Period 27 / / `� through (4) Page of 2 (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 I's uc Incl 411 cool ��,�►.�IS4R 1EjC.a.M,f(, �►�18a aolG 1� � 2.015.E;s6*-ix-c IA 1(7 IAA- A: o,--. ('-, i'5%2 1 Xj 11.04 AO f q.S NE Ab ,C -. CPO P 5D 4.,.IC C A"�7 Moo.00 DS-DE 13(Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES AMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name (2)I.D. Number (3)Cover Period ?7 / 24S through�/ / �� (4) Page of 1 (5) (7) (8) (9) (10) (11) Date Full Name Purpose (6) (Last,Suffix, First,Middle) (add office sought if Street Address& contribution to a Expenditure Sequence Type Number City,State,Zip Code candidate) Amendment Amount ��gig rJ� l�0�1"^mak . H: 4A OZ.00 DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Name (2) qU tZe Address (number and street) � / . City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): [Candidate Office Sought: ❑ 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 2j / 1A / kS To 2, / 2-7 / I7 Report Type: ❑ Original KAmendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , too oa Expenditures $ ,S50 o 0 Loans $ Transfers to Office Account $ • Total Monetary $ too E, Total Monetary $ 0-0 In-Kind $ (8) Other Distributions $ . (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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: I (Type name) �ja-( f/v► �l&oW.AL (Type name) ❑ Individual(only for IE [Treasurer ❑ Deputy Treasurer ❑Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) X X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS (1) Name 4k,&y,, —2 (/U&w• `rz (2) I.D. Number (3) Cover Period / / kC� through 1? / �21 (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 Descri tion Amendment Amount 4.- IGoM�,li6Y� U04�in JW$to A Q9 4 l o0 oo i w.. IFL ;' ob 1 i DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES (1) Name "��t (2) I.D. Number (3) Cover Period '27 through 'Z, /21 (4) Page ( of (5) (7) (8) (9) (1 U) (11) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought if Ex enditure Sequence Street Address& contribution to a p Number City,State,Zip Code candidate) Type Amendment Amount 2'"� ,K �o e,AJ AOS DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) '640W� ���,,pu p'�� "L, OFFICE USE ONLY Name (2) qU Pe A95*` AA.,.&A Address (number and street) M:wv%-. jGti't City, State, Zip Code ❑ Check.here if address has changed (3) ID Number: (4) Check appropriate box(es) (Candidate Office Sought: V:tio, ('06m, ❑ Political Committee (PC) ❑ Electioneering Communications Org. (EGO) ❑ 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) (6) Report Identifiers Cover Period: From 1+ / tO / ji; To -7 / t,3� / %4* Report Type: ❑ Original ❑Amendment ❑ Special Election Report (6) Contributions This.Report (7) Expenditures This Report Monetary Cash &Checks $ ,(per pp Expenditures $ Loans $ Transfers to Office Account $ , Total Monetary $ 00 Total Monetary $ L4 ")21 . In-Kind $ (8) Other Distributions $ , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , ) 'ion t o $ 6 , 106 • 10 (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) iM K/*tr.Ot.•'� �-'"Z (Type name) 410~ � 1La�•+:k2 [:1 Individual(only for IE Treasurer El Deputy Treasurer Candidate [I Chairperson(only for PC and PTY) or electio ring comm.) X X Signature Signature DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name 2 J cows "'z (2) I.D. Number (3) Cover Period %4 / _o / IS through "7 / lei / 14� (4) Page i 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 VNtL UJ@ �r 41)3 5c- 2 Ate. 1s.i'le 1;U0 ! A" tole 150.00 �. +�s� •ti 1 Harr C4E 5a®.CID MAI r / DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name (2) I.D. Number (3) Cover Period / / through / / (4) Page of (5) (7) ($) (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 LA hi lS 19" Air)r;s. VVI S NW St", *gore.% r-L 22 We-'r,4 fir 14.00 �'G^ '�aadL Gb�+�t�►«nvl �� a� 21,544;-10 �k La��•�r�atc, �%t- .fir �c�c�,r� l�vrApr k. lam:�lar1�, ��iw•► o� �Nl'.w•: , Vit.. '�i3 t'7r � �c�'.K.e� • t�h is n,t, Zoo y_ #i:SCAVVn. F '100•Lia o Cd Auto" �- IW7 t'1 .bpi DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT SUMMARY (1) 9Sj4eoo/ 72� A-z- OFFICE USE ONLY Name (2) 41* PP ASS 4*v. A Address (number and street) City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): `I [Candidate Office Sought: �:pr.: �j�naY,g V;��a f,c, 60yV'Ci, 1 ❑ 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 L+ / 10 / To -"7 / l3 / %0;" Report Type: ❑ Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ '(060 00 Expenditures $ Loans $ Transfers to Office Account $ Total Monetary $ (Pqo 00 Total Monetary $ N X21 In-Kind $ (8) Other Distributions $ , (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date (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) '4` _ �Z„�/1�(Ay�.�2 (Type name) �7401~ 'ZACy.-4--kZ ❑ Individual(only for IE Treasurer ❑Deputy Treasurer 16Candidate ❑Chairperson(only for PC and PTY) or electio ring comm.) , X X Signature Signature DS-DE 12(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS (1) Name �V�/y1 —4A1C0VV:+-z (2) I.D. Number (3) Cover Period p / IS through '7 (4) Page 1 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 lAsw1c use;,%%& ec 3�3 '%, 2 AA0. jS,,:.t.e ,Zoo 1 A" 1950.00 /24 /�-� I�lo�r la I�Gt.lw.►�. C4ft �v ae (,W%1:At SAB. µ;W%ft;t VL DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES (1) Name (2) I.D. Number (3) Cover Period / / through / / (4) Page of (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 NA�65 AA"r k►•s; 8 'IS Nw �o'Y'''Tuta►.�.c Ttc. SH:r�lz, (c CG S�So.co A77/1 S �:.�►; r-�In.�,a�, V:I6 V Ml: wr-: 5�^s�G�s� ��- �i31�1� 1G�t/�e�•n 1�.� fril'Ln '`rooms Go•�� '�� � 1404 L&.' 0%0►S �Sk JL� Lark �.aadl,�lr��, �1.. •�'dr �%�G�hiw� Z�ii�15.30 OL �- �o 4. 1;0D CO Q..aAI'5 1201'6 � �i t��F tom• g:jec 64#*AA cu#z" 020w, fir'6'0' &*.A k, frk. 1 4440t tic trl- 02 A%36 Akzo oe 09t*_ Sk. Law. rig}.e� 11�� Ski; fL DS-DE 14(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES