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Home My Public Portal AboutORTHWEIN - Filing DocsAPPOINTMENT 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 CECK APPROPRIATE BOX(ES): Y Initial Filing of Form Re- filing to Change: ❑ 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 j-0 IAN 7'�. 0 /Z TW we-/"J code) j,� rr, —'/ • 2 � Y�3 4. Telephone 5. E -mail address 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if I . _ i,f d /Gh eA - /dA*1 11*eam applicable: ❑ 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 ❑ Write -In [-] No Party Affiliation ® Party candidate. 9. 1 have appointed the following person to act as my QrCampaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer , �io/f/ 11. Mailing Address 12. Telephone (SG < ) 2V3 `d Ly3 13. C' 14. County 15. State 16. Z'p�code 17. E -mail address �t� c� 1. .Jorfbwcu�' @ .u-1 f — .lrira�.or 18. 1 have designated the following bank as my Primary Depository Secondary Depository 19. Name,9f Bank 20. 20. Address / 11��-1411 17 21. City od'o- Aacx 22. County A l,-. zatc,/ 23. State 24. Zip Code 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. Signa a ofCand� ate � X *1��/ 27. Treasurer's Acceptance of Appointment (fill in th lanks and check the appropriate block) I, �J(�/} -/1/ D�'T�� ' do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ;Abi-/ X TZ& Date Signature Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. FORM 1 STATEMENT OF 2013 Please print or type your name, mailing FINANCIAL INTERESTS address, agency name, and position below: FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME — RIDDLE NAME: U ?77{4lel-A MAILING ADDRES y �an AIA 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 a- 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): 12( DECEMBER 31, 2013 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 for 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 Ah le- ,6 c, 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. %%UAf. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 - Effective: January 1, 2014. (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 PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "n /a ") BUSINESS ENTITY TO WHICH THE PROPERTY RELATES /1R1§1Z 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 "nla ") BUSINESS ENTITY # 1 ENTITY PRINCIPAL BUSINESS NATURE OF MY OWNERSHIP INTEREST BUSINESS ENTITY # 2 IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE re u' d : DATE SIGNED (reguired): LLI., 1> / If a certified blic 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 Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. nature WHAT TO FILE: After completing all parts of this form, including signing and dating it, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, you must write "none" or "Na" in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form 1 for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. FILING INSTRUCTIONS: WHERE TO FILE: 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 officers /employees file 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 officers or specified state employees file with 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 the "Who Must File" Instructions on page 3. Facsimiles will not be accepted. Date WHEN TO FILE: Initially, each local officer /employee, state officer, and specified state employee must file within 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 for publicly - elected local office must file at the same time they file their qualifying papers. Thereafter, local officers /employees, state officers, and specified state employees are required to file by July 1st following each calendar year in which they hold their positions. Finally, at the end of office or employment, each local officer /employee, state officer, and specified state employee is required to file a final disclosure form (Form 1F) within 60 days of leaving office or employment. However, filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if he or she was in their position on December 31, 2013. UL FUKM 1 - tnective: January 1, 2U14. PAGE 2 Adopted by reference in Rule 34- 8.202(1), F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) candidate for the office of -� 6V 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) 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 -7d-" g , , (office) (district #) Q I am a qualified elector of AMn oLri 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 tatutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. X orthwQ.�n Ul�-s�Y'rrctm . orG ignature of Candidate Telephone Number Email Address Al 61111 dffaM R Address City I State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): f4/' Oa-7VZ 4 * 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): . ,reR Al )r 09771 - wiiye STATE OF FLORIDA COUNTY OF ?Aj 1A, C A Sworn to (or affirmed) and subscribed before me this �day of / lz. k , 20 . i Personally Known: 11_� or r rao Signature of Notary Publi Produced Identification: Print, Type, or Stamp Com issioned Name of Notary Public o0N, P418, ,� RITA L TAYLOR Type of Identification Produced: * MY COMMISSION # DD 949851 EXPIRES: February 21, 2014 -r" . n.�'�P Banded ThN Duo NWq kits DS -DE 25 (Rev. 5111) Rule 1S- 2.0001, F.A.C. INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CANDIDATE'S NAME FOR AUDIO BALLOT Use the PRONUNCIATION KEY below to provide pronunciations for ambiguous first names and surnames. Capitalize STRESSED syllables, use lower case for unstressed syllables. Use dashes ( -) to separate syllables. You should also add any notes such as rhyming examples, silent letters, etc. PRONUNCIATION KEY Stressed Vowel Sounds EE (FEET) feet I (FIT) fit E (BED) bed A (KAT) cat (KAD) cad AH (FAH -thur) father (PAHR) par AH (HAHT) hot (TAH- dee) todd UH (FUHJ) fudge (FLUHD) flood UH (CHUHRCH) church AW (FAWN) fawn U (FUL) full 00 (FOOD) food OU (FOUND) found O FO foe El (FEIT ) fight Al (FAIT) fate 01 FOIL) foil Y00 (FYOOR- ee -uhs) furious Unstressed Vowel Sounds uh (SO -fuh) sofa (FING- uhr) finger Certain Vowel Sounds with R AHR (PAHR) par ER (PER) pair IR (PIR) peer OR (POR) pour OOR (POOR) poor UHR (PURR) purr Samples: NAME ON BALLOT PRONOUNCED AS Mishaud mee -SHO (`d' is silent) Jahn HAHN (rhyme: fawn) Beauprez boa -PRAT (rhyme: hooray) Maniscalco man- uh- SKAL -ko Tangipahoa TAN- ji- pah -HO -uh Monte Mahn -TAI Tanya TAWN -yuh (not TAN) Consonant Sounds B (BED) bed TS (ITS) its (PITS - feeld) Pittsfield D (DET) debt TH (THE[) Thigh F (FED) fed TH (THEI) Thy G (GET) get ZH (A- zhuhr) azure (VI- zhuhn) vision H (HED) head Z (GOODZ) goods (HUH - buhz -tuhn) Hubbardston HW HWICH which J (JUHG) jug K (KAD) cad L (LAIM) lame M MAT mat N (NET) net NG SING -uhr singer P (PET) pet R RED red S (SET) set T TEN ten V (VET) vet Y YET et W (WICH) witch CH (CHUCRCH) church SH (SHEEP) sheep NOTE: t: I his page snoulU not be submitted to the filing officer. Page 2, DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C. Candidate Name Pronunciation Request OFFICE SOUGHT: l Name On Ballot Pronounced As A ��,� ll&/e, OR7-H . wIn.1,e Pronunciation Guide In the "NAME ON BALLOT" column, enter the name as it appears on your ballot (First, Middle, Last). • In the "PRONOUNCED AS" column, enter the breakdown using the PRONUNCIATION KEY below. Capitalize STRESSED syllables, use lower case for unstressed syllables. You should also add any notes such as rhyming examples, silent letters, etc. Also provide pronunciations for ambiguous place names, first names and surnames. Use dashes ( -) to separate syllables. Samples NAME ON BALLOT PRONOUNCED AS William Mishaud mee -SHO (`d' is silent) Sue Jahn HAHN (rhyme: fawn) Tim Beauprez boo -PRAT (rhyme: hooray) Robert Maniscalco man- uh- SKAL -ko Tangipahoa TAN- ji- pah -HO -uh Monte Anthony mahn TAI Tanya Smither TAWN -yuh (not TAN) DS -DE 105 07/10 PRONUNCIATION KEY Stressed Vowel Sounds EE (FEET) feet I (FIT) fit E (BED) bed A (KAT) cat (KAD) cad AH (FAH -thur) father (PAHR) par AH (HAHT) hot (TAH -dee) toddy UH (FUHJ) fudge (FLUHD) flood UH (CHUHRCH) church AW (FAWN) fawn U (FUL) full 00 (FOOD) food OU (FOUND) found 0 (FO) foe El (FEIT) fight Al (FAIT) fate 01 (FOIL) foil Y00 (FYOOR- ee -uhs) furious Unstressed Vowel Sounds uh (SO -fuh) sofa (FING -guhr) finger Certain Vowel Sounds with R AHR (PAHR) par ER (PER) pair IR (PIR) peer OR (POR) pour OOR (POOR) poor UHR (PUHR) purr Consonant Sounds B (BED) bed TS (ITS) its (PITS - feeld) Pittsfield D (DET) debt TH (THEI) Thigh F (FED) fed TH (THEI) Thy G (GET) get ZH (A- zhuhr) azure (VI- zhuhn) vision H (HED) head Z (GOODZ) goods (HUH - buhz -tuhn) Hubbardston HW (HWICH) which J (JUNG) jug K (KAD) cad L (LAIM) lame M (MAT) mat N (NET) net NG (SING -uhr) singer P (PET) pet R (RED) red S (SET) set T (TEN) ten V (VET) vet Y (YET) yet W (WICH) witch CH (CHUCRCH) church SH (SHEEP) sheep TOWN OF GULF STREAM, FLORIDA ELECTION -MARCH 11, 2014 NOTICE TO CANDIDATES The Logic and Accurace (L & A) Test of the tabulating equipment that will be used to tabulate the ballots will be held at 3:00 P.M. on Friday, February 21, 2014, 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 February 25, 2014, Tuesday, at 12:00 Noon. The deadline for receiving campaign contributions is midnight, March 6, 2014 for opposed candidates. The deadline for receiving campaign contributions is noon, February 11, 2014 for unopposed candidates. This is to acknowledge that I have received a copy of this NOTICE TO CANDIDATES. Al-4-11-1 Date Si lure of Candidate OFP AL Palm Beach County or SUSAN BUCHER Supervisor of Elections CERTIFICATION 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 33416 TELEPHONE: [5B 1 ] B5B -8200 FAX NUMBER: [5B1 ] 656-62B7 WEBSITE: www.pbcelections.org I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that Joan K. Orthwein submitted 5 petition signatures for the office of Gulf Stream Town Commissioner. I further certify that 5 of those signatures 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 Joan K. Orthwein is a registered voter in Precinct 4072, in the Town of Gulf Stream, Florida. Signed, this the 10th day of February, 2014. LuLe .SUSAN BUCHER SUPERVISOR OF ELECTIONS PALM BEACH COUNTY (SEAL) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. I, the undersigned, a registered voter (print name as if appears on your voter information card) ��rr''�� in said state and county, petition to have the name of o e�!/L• placed on the Primary/General Election Ballot as a: [check/comp t ox, as applicable] * lOnpartisan ❑ No parry affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address City CounC�x� � � State Zip Code / s Pam 3 3 Signature of Voter Date Signed (MM /DDNY) [to be completed by Voter] � 7l Rule 1S -2.04. .A. DS -DE 104 (Eff. 0911, CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. J ►�Vw V y6zD IF L i LAI I ' — (print name as it appears on yo r voter information card) in said state and county, petition to have the name of Joan K. Orthwe in placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] the undersigned, a registered voter Nonpartisan ❑ No parry affiliation ❑ Party candidate for the office of (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration �Number Address l , / r ,��,/ �(,,/ (Mm D( 0 0ean(�'g l bj a City n State Zip Code 6 (A �3 csv Signature of Rule 1S- 2.045. F Date Signed (MM /DDNY) [to be 7�0 plete d y Voter] el DS -DE 104 (Eff. 09/11 CANDIDATE PETITION Notes: -till information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. Za Ineri ne. Um Uvejn (print name as it appears on your voter iiifuiiiiation card),\ in said state and county, petition to have the name of ` T-1 I placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] [,Nonpartisan ❑ No party affiliation ❑ the undersigned, a registered voter Parry candidate for the office of iS) yY 1 \,,UO III I 1 4 )J lu I Il'r _ I T) rr J 1'( I I - (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM1DDtYY) 0/6/85 6�5 Fah City County State Zip Code C�1� S e.orn G� P�etch FL D"D LJ8 3 Signature of Voter F.A.C. Date Signed (MM/DDNY) [to b^ rirp a 6y Voter] DS-DE 104 (Eff. 0911 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 0Y )NN6n the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of fan k1n�N e► placed on the Primary/General Election Ballot as a: [checi omplete box, as applicable] 0 Nonpartisan ❑ No party affiliation ❑ n n slontf --low (insert title of office and include Party candidate for the office of circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MMIDDIYY) v s 3 2'�® 5y:� PRAM Wq City County State Zip Code C,TLxt: t- reay\,-) e FL 3 (-j C6 Signature of Voter Date Signed (MM /DDNY) [to be completed by Voter] t72 /05 2oly e 1S- 2.045, F.A.C. DS-DE 104 (Eff. 09111 CANDIDATE PETITION Notes: -,ill information on this form becomes a public record upon receipt by the Supervisor of Elections. - It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] - If all requested information on this form is not completed the form will not be valid as a Candidate Petition form. aieL^' the undersigned, a registered voter (prinYname as it appears on your voter information card) ,,1 in said state and county, petition to have the name of 4/ ^Q•4N e. to,_, —A ` placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑ No party affiliation ❑ Party candidate for the office of C7 W1; e!";rm 2ni�tttun �r (insert title of office and include district, circuit, group, seat number, if applicable) Date of Birth or Voter Registration Number Address �� (MM /DD/YY) 1"a /m &/,/ a� 11111?-17 /� AZ 37/31 �� City County State Zip Code �91,4 Zlrea on d"'� J��n� Z-'/, 'f? r - - Signature of Voter Date Signed (MM /DDNY) [to be completed by Voter] DS -DE 104 (Eff. 09/11