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HomeMy Public PortalAboutFiling DocsFORM 1 STATEMENT OF Pleas 0 addresprinlorY name, mailing FINANCIAL INTERESTS Pleases, i t try name, and postman 1»lovn LAST NAME — FIRST NAME —MIDDLE NAME /✓l0/i �cA�/ �$CoT/ Gli�iC2f al f�dG F �ricC',y„-t. ZIP �3Yg 3 COUNTY: r3ffkll You are not limited to the s ce on the Tines an this form. Attach additional sheets, If necessary. CHECK ONLY IF CANDIDATE OR I] NEW EMPLOYEE OR APPOINTEE 2016 FOR OFFICE USE ONLY: **** BOTH PARTS OF THIS SECTION M **** DISCLOSURE PERIOD: UST BE COMPLETED THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (mu heck one): DECEMBER 31, 2016 -0 ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATAREABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further l/etgll9). CHECK THE ONE YOU ARE USING (must check one): ICY COMPARATIVE (PERCENTAGE) THRESHOLDS Q$ ❑ 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 "nla") NAME OF SOURCE OF INCOME '31s - SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY 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 "Na") NAME OFNAME OF MAJOR SOURCES ADDRESS BUSINESS ENTITY I OF BUSINESS' INCOME I OF SOURCE Al PART C — REAL PROPERTY (Land, buildings owned by the reporting person - See instructiassassa ons] (H you have nothing to report, write "none" or Wa") A&(7u,e /A. G, 407� 70A 14.1 7,0x44 y (It- IFARM I-EIeoM: Jwray 1, 7017 ICwlMuM on nvsns skal ryeraprC 0Y ialerrro r RWa 3{a 20211 L FA,C PRINCIPAL BUSINESS ACTIVITY OF SOURCE 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. PAGE 1 D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates (If you have nothing to report, write "none" or "n/a") TYPE OF INTANGIRI F r ."r?.o - PART E— LIABILITIES (Major debts -See instructions] (If you have nothing to report, write "none" or "n/a") NAME OF CREDITOR WHICH LLC ADDRESS OF CREDITOR 7-000 b (kot! &0- -*'c4 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") ] ^/11% BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 4ME OF BUSINFRS Furiry r I ADDRESS OF BUSINESS ENTIT` PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY MORE THAN A 5% INTEREST IN THE NATURE OF MY OWNERSHIP INTEREST PART G —TRAINING For elected munlci�pal�rs required to complete annual ethics training pursuant to section 112.3142, F.S. U(' I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SIGNATURE OF FILER: Signature: 641, Date Signed: WHAT TO FILE: After completing all parts of this form, Including sinning and dating It send back only the first sheet (pages 1 and 2) for riling. If you have nothing to report in a particular section, write "none' or"n/a"in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. Facslfnlles will not be accepted, j. FAL WHERE TO FILE: PLEASE CPA or ATTORNEY SIGNATURE ONLY If a carried public accountant licensed under Chapter 473, or attorney In good standing with the Florida Bar prepared this form for you, he or she must complete the following statement. I' prepared the CE Form 1 in accordance with Secdon 112.3145, Florida Statutes, and the Instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein Is true and correct. CPA/Altomey Signature. Dale Signed: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. Local officerslemployees rile with the Supervisor of Elections of the county In which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State oliicers or specified state employees file Willi the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see page 3 of instructions. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified stale employee must file wNhln 30 days of the date of his or her appointment or of the beginning of employment. Appointees Who must be confirmed by the Senate must file prior to confirmation, even If that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment Firing a CE Form 1F (Final Statement of Financial Interests) does pg( relieve the filer of filing a CE Form 1 it the filer was in his or her position on December 31, 2016. TOWN OF GULF STREAM, FLORIDA ELECTION -MARCH 14, 2017 NOTICE TO CANDIDATE The Logic and Accuracy (L&A) Test of the tabulating equipment that will be used to tabulate the ballots will be held at 10:00 A.M. on Friday, March 3, 2017 at the Supervisor of Elections Facility at 7835 Central Industrial Drive, Riviera Beach, Florida 33404. - - - - - - - - - - - - - - - - - - - - If you plan to have a poll watcher/s, the name/s must be turned in to the Gulf Stream Town Clerk's Office, 100 Sea Road, Gulf Stream, Florida 33483 no later than Tuesday, February 28, 2017 at 12:00 Noon. The deadline for receiving campaign contributions is midnight March 9, 2017. This is to acknowledge that I have received a copy of this NOTICE TO CANDIDATES. Date Si a re of andi e OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) candidate for the office of /®�✓� (� yr�vrfrrr d�e.�c ! have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Si nature of an 'date 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). ua-Uc 04 kvx i 1) CANDIDATE OATH — NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021, Flonda 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 11.,"1fS�ClNFiL le 1, / 0 r- 6i ✓Z/ 11—ItL.41-9, (office) (district#) I am a qualified elector of W 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. i ature of C tf to Telephone Number Email Address //yam .tJ 0c.'411 9/"ej 6J4Fi7w64'" /T 3 ye.? Address city State ZIP Code Candidate's Florida Vater 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): S�v7% Lu. STATE OF FLORIDA / COUNTY OF LQ (kt J3 -C I� Sworn to (or affirmed) and subscribed before me this 3-14— day of —,20 Personally Known: x or •• �� r�-. (lp of Notary OublFc Produced Identification: H8f8/ P ITA Lbilil,, TAYLOR Print. T e or Stamp Comml sioned Name of Notary Public of Florida A MY COMM.Eapifes M'ale Type of Identification Produced: .i- COmml Mat 10.5018 099915 DS -DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C. Palm Beach County SUSAN BUCHER Supervisor of Elections 240 SOUTH MILITARY TRAIL G,�PEn ISr.r - cl 1;T1(1 :t° WEST PALM BEACH, FL 3341 5 POST OFFICE BOX 22309 1017 JAN 12 AN 9: 143 WEST PALM BEACH, FL 3341 B _, , _ ... .... TELEPHONE: (561) 656-6200 FAX NUMBER: [561) 656-B2B7 WEBSITE: www.pbcelections.org PETITION SUBMITTANCE FORM NAME OF PETITION OR COMMITTEE: OFFICE TITLE, DISTRICT, GROUP, SEAT NUMBER (IF APPLICABLE): NUMBER OF PETITIONS SUBMITTED: ADDRESS: TELEPHONE: NAME OF PERSON SUBMITTING PETITION: SIGNATURE: DATE: Staff Initials: � L OSN MMUFpm Twifim SupnA Fmm REV M 01-I013 Coe 9acf�f w'^0± 9 >& >l J l! �►C7 '4/. 0e--e2�K 17 (V (STREET) -P,Jr, (CITY/ZIP) x'/2-17 ' OF Ptd` Palm Beach County m OF PP�, SUSAN BUCHER Supervisor of Elections CERTIFICATION 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 3341 6 TELEPHONE: 15611 656-6200 FAX NUMBER: 15611 B56-6287 WEBSITE: www.pboelections.org I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 5 signatures on the Petition for the office of Town Commissioner, of SCOTT W MORGAN, are registered electors in the Town of Gulf Stream, according to the registration records on file in this office. This is to further certify that SCOTT W MORGAN is a registered voter in Precinct 4072, in the Town of Gulf Stream, Florida. Signed, this the 12th, day of January, 2017. SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY (SEAL) \ } O ylt ■■ ■ r m (} 0 � � B (\ q }\ q . y �� } ( �� �� \ _ )}) { a(7 CL \ z Ll cn 0��2; LLI LLI ���{ E0 vs 3 0 $�� (|7 \) ��/ E - /})�� k ! /0 \ z \\ \ �^D \\r k\ a � e u •'v N OF GULF STREAM 100 SEA ROAD -IULF STREAM, FLORIDA 33483 n a > m o m O Dm m m C m y y m m m o I 0 oo oKn n am ozz m N! O ov mm 0 2 s: a o i �� l► v i It O y Z 69 O 5 U) Li a CAMPAIGN TREASURER'S REPORT SUMMARY OFFICE USE ONLY Name (2) //`%o /U OCi- I/ 6 & -. Address (number and street) L1,0L.- )Z 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 o2 To D Report Type: 0-6'r�iginal ❑ Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $_ / SJO. = Expenditures $ j Loans $_ • _ Transfers to Office Account $ Total Monetary $_ Total Monetary $ C) 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)s<ol I W. "4--&-14 (Type name) �5'771-1v. trio, f H� r ❑ Individual (only for IE reasurer ❑ Deputy ,,aasurer C�andidab ❑ Chairperson (only for PC and P i Y) ur electioneering comm.) Signature Signature// DS -DE 12 (Rev: Tina) – SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS ,lame _597FW- (2) I.D. Number (3) Cover Period 177 / / / through (4) Page / of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address& Ci , State, Zi Code /6017 S A JO 0 (-L, %oy:l-I+' 3 c l f 7;:L (8) Contributor T e Occu ation (9) Contribution T e _ (10) In-kind Descri tion (11) Amendment (12) Amount 'd (6) Sequence Number -- -- •- -• • •• •moi aee KtvtKbt roK INSTRUCTIONS AND CODE VALUES TOWN OF GULF STREAM 100 SEA ROAD GULF STREAM, FLORIDA 33483 r < n n 0 c m C 1 y III OOOK o 71 mma, m M Gomm n x y9< x CD �1 0 L n c0i � Z . C < 0 Zi 0 L . mm mm 0 Y myirom mmac wrmov�p y m y m 9 r mi3com �!"miaa �cjaC°x C mmsa�o n= a m 7 0 o m n < n m n o O T O mm � N 4 > 0 � O A - _ O e N r y b a m 7 0 o m n < n m n o O T O mm 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. C�IECK APPROPRIATE BOX(ES): ©/ Initial Filing of Form Re -filing to Change: [3 Treasurer/Deputy [j Depository 0 Office E] Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip A16-, W. i'% /Z�G,4n/ code) //'/d n/ OCCAN15LIVQ U[.4 1T t "n a rz 33Y43 4. Telephone 5. E-mail address (S6/ )ay3-1kiZIseosrm-rr4 7ylj,—.1,.� 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: 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 Parry candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer DeputyTreasurer 10. Name of Treasurer or Deputy Treasurer 11. Mailing Address 12. Telephone OC�:An (s6/ ) zY3-/yse 13. City�- 14. County 15. State 16. Zip Code 17. E-mail address GvtF A_ -A- Il>hM /z 73Y83 sa•i/..,v ')-,I—,d 1.,. 18.1 have designated the following bank as my Primary Depository Secondary Depository 19. Name of Bank 20. Address W=LEL FAn-cid n,4 Air_ V✓3`JL&A-Mori-7 Zfl, 21. City 22. County 23. State24. Zip Code (3=7 NT- /Sc uti G��rti fiekc� TE 33 8 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 S-7 11 26. Signature of Candidate —�,- X 27. Treasurer's Acceptance of Appointment (fill int anks and chec rc ' to block) I, S ' w' VL " "'- Al I , do hereby accept p the appointment (Please Print or Type Name) designated above as: Q__�Campaign Treasurer F1 Deputy Treasurer. I I zX — Date S' natu of Ca I mp.09-TFerasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. S