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STATEMENT OF CANDIDATE (Section 106 .023, F.S.) (Please Type) OFFICE USE ONLY 0 ILL- candidate for the office of have received ,read and understand the requirements of Chapter 106, Florida Statutes. JI loq ate 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 (Rev .03/08) " r . S T A T E O F F L O R I D A A P P O I N T M E N T O F C A M P A I G N T R E A S U R E R A N D D E S I G N A T I O N O F C A M P A I G N D E P O S I T O R Y F O R C A N D I D A T E S ( S e c t i o n 1 0 6 . 0 2 1 ( 1 ) , F . S . ) ( P L E A S E T Y P E ) C H E C K A P P R O P R I A T E B O X : O F F I C E U S E O N L Y O r i g i n a l A p p o i n t m e n t f l D e p u t y T r e a s u r e r 1 = J R e a p p o i n t m e n t o f T r e a s u r e r N a m e o f C a n d i d a t e J a m e s R . D r a y t o n 1 A d d r e s s ( i n c l u d e p o s t o f f i c e b o x o r s t r e e t , c i t y , s t a t e , z i p c o d e ) 1 8 1 5 W . C e n t r a l B l v d . O r l a n d o , F L 3 2 8 0 5 T e l e p h o n e ( o p t i o n a l ) ( 4 0 7 ) 4 2 9 - 5 4 4 0 2 . P a r t y ( P a r t i s a n c a n d i d a t e s o n l y ) D e m o c r a t i c P a r t y 3 . O f f i c e ( a d d d i s t r i c t , c i r c u i t , g r o u p n u m b e r ) C i t y C o m m i s s i o n e r D i s t r i c t 5 I h a v e a p p o i n t e d t h e f o l l o w i n g p e r s o n t o a c t a s m y C a m p a i g n T r e a s u r e r D e p u t y T r e a s u r e r 4 . N a m e o f T r e a s u r e r o r D e p u t y T r e a s u r e r J a m e s R . D r a y t o n 5 . M a i l i n g A d d r e s s ( I f p o s t o f f i c e b o x o r d r a w e r a d d s t r e e t a d d r e s s ) P . O . B O X 5 5 5 1 2 9 6 . T e l e p h o n e 4 0 7 - 4 2 9 - 5 4 4 0 7 . C i t y O r l a n d o 8 . C o u n t y O r a n g e I F L 9 . S t a t e 1 0 . Z i p C o d e 3 2 8 5 5 I h a v e d e s i g n a t e d t h e f o l l o w i n g n a m e d b a n k a s m y P r i m a r y D e p o s i t o r y S e c o n d a r y D e p o s i t o r y 1 1 . N a m e o f B a n k W a c l i o v i a B a n k 1 2 . S t r e e t A d d r e s s 2 0 N . O r a n g e A v e 1 3 . C i t y O r l a n d o 1 4 . C o u n t y O r a n e _ �� 1 5 . S t a t e F L 1 6 . Z i p C o d e 3 2 8 0 1 1 7 . S i g n s r e o f C a n a D a t e 1 0 / 0 2 / 2 0 0 9 d 1 a s l a r e r ' s A c c e p t a n c e o f A p p o i n t m e n t J a m s R . D r a y t o n , d o h e r e b y a c c e p t t h e a p p o i n t m e n t a s C a m p a i g n T r e a s u r e r I I D e p u t y ( P l e a s e P r i n t o r T y p o ) T r e a s u r e r f o r t h e c a m p a i g n o f J a m e s R . D r a y t o n w h o i s s e e k i n g n o m i n a t i o n o r e l e c t i o n a s a D e m o c r a t i c c a n d i d a t e t o t h e o f f i c e o f ( P a r t y ) C i t y C o m m i s s i o n e r D i s t r i c t 5 U N D E R P E N A L T I E S O F P E R J U R Y , I D E C L A R E T H A T I H A V E R E A D T H E F O R E G O I N G C A M P A I G N T R E A S U R E R ' S A C C E P T A N C E O F A P P O I N T M E N T A D T H A T T H E F A C T S S T A T E D A R E T E . 1 0 / 0 2 / 2 0 0 9 X D a t e ' S i g n a t u r e o f C a m p a i g n T r e a s d ' - - r o r D - " - + T r e a s u r e r D S - D E 9 ( R e v . 0 1 / 0 8 ) I STATE OF FLORIDA APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1 ), F.S.) (PLEASE TYPE) CHECK APPROPRIATE BOX: RX Original Appointment Name of Candidate James R. Drayton, III Telephone (optional) 407 ) 429-5440 14. County Orange I have appointed the following person to act as my 4. Name of Treasurer or Deputy Treasurer Margaret Wilster 2. Party (Partisan candidates only) Democrat 5. Mailing Address (If post office box or drawer add street address) 5747 Brookgreen Ave. 7. City Orlando 8. County Orange I have designated the following named bank as my 11. Name of Bank Wachovia Bank 13. City Orlando 17. Sig ture of Candida 1, I^Campaign Treasurer Mrgaret Wilster (Please Print or TWO F Deputy Treasurer for the campaign of who is seeking nomination or election as a do hereby accept the appointment as Jaynes R. Drayton, III Democratic candidate to the office of (Party) Commissioner District 5 UNDER PENALTIES OF PERJURY ,I DECLARE THAT I HAVE REATHE FOREGOING CAMPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND TIi T THE FACTS STATED ARE TRUE. July 10, 2009 0 9. state Florida Deputy Treasurer q Reappointment of Treasurer 1 1. Address (include post office box or street ,city, state ,zip code) 1815 W. Central Blvd. Orlando, FL 32805 OFFICE USE ONLY 3. Office (add district,circuit, group number) Commissioner District 5 Campaign Treasurer U Deputy TreasurerX V Primary Depository 10. Zip Code 32839 0 Secondary Depository 6. Telephone 407-345-0576 12. Street Address 20 N. Orange Avenue 15. State Florida 16. Zip Code 32801 Date r - r Campa " -Treasurer's Acceptance of Appointment Signature Campaign Treasurer or Deputy Treasurer Date T\ DS-DE 9 (Rev .01108) " r . S T A T E O F F L O R I D A A P P O I N T M E N T O F C A M P A I G N T R E A S U R E R A N D D E S I G N A T I O N O F C A M P A I G N D E P O S I T O R Y F O R C A N D I D A T E S ( S e c t i o n 1 0 6 . 0 2 1 ( 1 ) , F . S . ) ( P L E A S E T Y P E ) C H E C K A P P R O P R I A T E B O X : O F F I C E U S E O N L Y O r i g i n a l A p p o i n t m e n t f l D e p u t y T r e a s u r e r 1 = J R e a p p o i n t m e n t o f T r e a s u r e r N a m e o f C a n d i d a t e J a m e s R . D r a y t o n 1 A d d r e s s ( i n c l u d e p o s t o f f i c e b o x o r s t r e e t , c i t y , s t a t e , z i p c o d e ) 1 8 1 5 W . C e n t r a l B l v d . O r l a n d o , F L 3 2 8 0 5 T e l e p h o n e ( o p t i o n a l ) ( 4 0 7 ) 4 2 9 - 5 4 4 0 2 . P a r t y ( P a r t i s a n c a n d i d a t e s o n l y ) D e m o c r a t i c P a r t y 3 . O f f i c e ( a d d d i s t r i c t , c i r c u i t , g r o u p n u m b e r ) C i t y C o m m i s s i o n e r D i s t r i c t 5 I h a v e a p p o i n t e d t h e f o l l o w i n g p e r s o n t o a c t a s m y C a m p a i g n T r e a s u r e r D e p u t y T r e a s u r e r 4 . N a m e o f T r e a s u r e r o r D e p u t y T r e a s u r e r J a m e s R . D r a y t o n 5 . M a i l i n g A d d r e s s ( I f p o s t o f f i c e b o x o r d r a w e r a d d s t r e e t a d d r e s s ) P . O . B O X 5 5 5 1 2 9 6 . T e l e p h o n e 4 0 7 - 4 2 9 - 5 4 4 0 7 . C i t y O r l a n d o 8 . C o u n t y O r a n g e I F L 9 . S t a t e 1 0 . Z i p C o d e 3 2 8 5 5 I h a v e d e s i g n a t e d t h e f o l l o w i n g n a m e d b a n k a s m y P r i m a r y D e p o s i t o r y S e c o n d a r y D e p o s i t o r y 1 1 . N a m e o f B a n k W a c l i o v i a B a n k 1 2 . S t r e e t A d d r e s s 2 0 N . O r a n g e A v e 1 3 . C i t y O r l a n d o 1 4 . C o u n t y O r a n e _ �� 1 5 . S t a t e F L 1 6 . Z i p C o d e 3 2 8 0 1 1 7 . S i g n s r e o f C a n a D a t e 1 0 / 0 2 / 2 0 0 9 d 1 a s l a r e r ' s A c c e p t a n c e o f A p p o i n t m e n t J a m s R . D r a y t o n , d o h e r e b y a c c e p t t h e a p p o i n t m e n t a s C a m p a i g n T r e a s u r e r I I D e p u t y ( P l e a s e P r i n t o r T y p o ) T r e a s u r e r f o r t h e c a m p a i g n o f J a m e s R . D r a y t o n w h o i s s e e k i n g n o m i n a t i o n o r e l e c t i o n a s a D e m o c r a t i c c a n d i d a t e t o t h e o f f i c e o f ( P a r t y ) C i t y C o m m i s s i o n e r D i s t r i c t 5 U N D E R P E N A L T I E S O F P E R J U R Y , I D E C L A R E T H A T I H A V E R E A D T H E F O R E G O I N G C A M P A I G N T R E A S U R E R ' S A C C E P T A N C E O F A P P O I N T M E N T A D T H A T T H E F A C T S S T A T E D A R E T E . 1 0 / 0 2 / 2 0 0 9 X D a t e ' S i g n a t u r e o f C a m p a i g n T r e a s d ' - - r o r D - " - + T r e a s u r e r D S - D E 9 ( R e v . 0 1 / 0 8 ) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER 'S REPORT SUMMARY (1)^ ^^ [1 (1 ^(OFFICE USE ONLY Name ^ (2)[S J ,S Address (number and street) -01 V ,LL`s IIL 3906 City, State ,Zip C de q CHECK IF ADDRESS HAS CHANGED (3)ID Number: (4)Cheek appropriate box(es): Candidate (office sought): C Vu1 L 6S C j)L S. cLL q Political Committee q CHECK I PC HAS DISBANDED q Committee of Continuous Existence q Party Executive Committee q CHECK IF CCE HAS DISBANDED q Electioneering Communication q CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From ! l / To q Report Type Original q Amendme nt q Special Election Report q Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7)EXPENDITURES THIS REPORT Cash & Checks $ Moneta Expend ry itures $ -- ^j Loans $C Transfe rs to Office Accoun t $ T l Mt $o a onetary G Total Moneta ry $ In Ki d $G-n (8) Other Distributions (9) TOTAL Monetary Contributions To Date $-0- -0- (10) TOTAL Monetary Expenditures To Date $ - C ; --- 1 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.)I certif that I ha iyve exam ned this report and it is true- correct, and complete. (Type name )-), S }Z t-n q Individual (only for Treasurer q puty Treasurer NWA Sig}iature DS-DE 12 (Rev. 08/04) I certify that I have examined this report and it is true, correct, and complete. (Tvna nnmo)i . l^ f \ C andidate 0 Chairperson (only for C, PTY a erino common ornani7alinn1 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) James R. Drayton OFFICE USE ONLY Name (2) P.O. BOX 555129 Address (number and street) Orlando, FL 32855-5129 City, State, Zip Code FA CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): n Candidate (office sought): City Commissioner District 5 ❑ Political Committee ❑ ❑ Committee of Continuous Existence • • Party Executive Committee ❑ Electioneering Communication CHECK IF PC HAS DISBANDED CHECK IF CCE HAS DISBANDED CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 07 / 31 / 2009 To 09 / 30 / 2009 Report Type Q2 j Original • Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 100.00 (7) EXPENDITURES THIS REPORT Monetary Expenditures $ 0.00 Transfers to Office Account $ 0.00 Loans $ 1,000.00 Total Monetary $ 1,100.00 Total Monetary $ 0.00 In -Kind $ 0.00 (8) Other Distributions $ 0.00 (9) TOTAL Monetary Contributions To Date $ 1,100.00 (10) TOTAL Monetary Expenditures To Date $ 0.00 (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) James R. Drayton I certify that I have examined this report and it is true, correct, and complete. (Type name) James R. Drayton 1ldividual (only for ✓ -easurer Deputy Treasurer 0 C ndidate • .hai .-rson (only for P , PTY & • • i. e in commu . .. .. .Pion) ele commun SI ture S • ature DS-DE/12 (Rev. 08/04) 111 CAMPAIGN TREASURER'S REPORT -- ITEMIZED CONTRIBUTIONS (1) Name James R. Drayton 3) Cover Period 07 / 01 / 2009 through 09 (2) I.D. Number 30 , 2009 (4) Page 1 of 1 (6) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number 07 / 13 /2009 Mitchell, Thomas 1320 Dewey Ave. Orlando, FL 32808 1 CHE N $100.00 1 08 / 18 /2009 Drayton, James R. 1815 W. Central B1 Candida to LOA N $1,000.00 2 / / / / / / / / / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) James R. Drayton, III OFFICE USE ONLY Name (2) 1815 W. Central Blvd. Address (number and street) Orlando, FL 32805 (4) l City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED Check appropriate box(es): Candidate (office sought): City Commissioner District (3) ID Number: 5 ❑ Political Committee • CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee Electioneering Communication _,_,. CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED Cover k Original (5) REPORT IDENTIFIERS Period: From 10 / 01 / 2009 To 12 / 31 / 2009 Report Type A ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) Cash Loans Total In -Kind CONTRIBUTIONS THIS REPORT & Checks $ 0.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 1,100.00 $ 0.00 to Office $ 0.00 Monetary $ 0.00 $ 1,100.00 $ 0.00 (8) Other Distributions $ 1,100.00 (9) TOTAL Monetary Contributions To Date $ 1,100.00 (10) TOTAL Monetary Expenditures To Date $ 1,100.00 (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) James R. Drayton, III I certify that I have examined this report and it is true, correct, and complete. (Type name) James R. Drayton, III ❑ eleG ( Y• Treasurer Deputy Treasurer EG�ru�c�l.rurnrYaiur) ✓,._., idate ❑ Chairperson (on for PC, PTY & el iZreT e 1d0 DS -D 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name James R. Drayton, III (3) Cover Period 10 / 01 / 2009 through 12 / 31 /2009 (2) I.D. Number (4) Page 1 of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number 10 /02 /09 U.S. Post Master Orlando, FL 328559998 Post Office Box MON $50.00 1 11 /04 /09 James R. Drayton, III 1815 W. Central Blvd. Orlando, FL 32805 Campaign Loan Refund REF $950.00 2 01 /04 /10 Tom Mitchell 1320 Dewey Ave. Orlando, FL 32808 Campaign Contribution Refund REF $100.00 3 / / / / / / / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Amount of Contribution: Date Received: Date Returned: CONTRLBUT)ONS RETURNED (Section 106,07(4)(b), F.S.) (PLEASE TYPE) OFFICE USE ONLY report applies only to contributions received by a.11.y" candidate or committee, but returned to the contributor before being deposited nn the campaign= account. Candidate J Political Committee Full Name: 5 r [J Committee of Continuous Existenc o Fun Address: 1 � � C_' vt- . ( ik u c l t') ,cl n�► FL 3c9Kb-- Full Name and Address of Contributor: 8 s Li CeArt -&j .t3 l cad ,Sagas-- qs-ob 06 svrjrzO Full Name and Address of Contributor; Full Name and Address of Contributor v i Qwl ,e( Amount of Contribution: Date Received: 7//y/q Date Returned; L /Z0 6 39 KQ 1 i eo s ?Q Amount. of Contribution: Date Received: Date Returned: Full Name and Address of Contributor. Amount of Contribution: Date Received: Date Retuned: I CERTIFY THAT 1 HAVE EXAMINED THIS REPORT AND IT IS TRUE, CORRECT AND COMPLETE. ca ke Type or Print Nam x DS -CI LV,. Rev:`I?8Fi Candidate, Treasurer or Chairman WAIVER OF REPORT (Section 106 .07(7), F.S.) (PLEASE TYPE) Vv^^Q S < .. V- I OFFICE USE ONLY Candidate's Name (Last, Suffix, first, Middle) Identification Number (Assigned by Division OR Political Committee, CCE or Party Name of Elections) (S its ^(- 1; I -44 (4i1 Wlt SSl Ob'1`P 1S"^,Address (Number and Str tee ) O ice Sought (Include District, Circuit or Group Number) City State Zip Code Candidate 'Ej 0 Committee of Continuous Existence D Political Committee F1 Party Executive Committee Check box if address has changed since last report. Check here if PC or CCE has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION q January q 32nd day prior q 46th day prior q April q 18th day prior q 32nd day prior q 4th day prior q 18th day prior q October q 4th day prior 0 TERMINATION REPORT q SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF C . ate SIGNATURES REQUIRED FOR: dindidates Candidate, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees Chairman, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Committees of Continuous Existence Treasurer (s. 106.04(4)(c), F.S.) Party Executive Committees Treasurer or Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS-DE 87 (Rev. 08/03) Alternative Method Affidavit (Please Type) I certify that I intend to qualify by the alternative method as a candidate for the office of i_., e.,0 p i&.LP f = Ls -Er -Cc -4 j (include district, circuit, group or seat numbers) as a: Partisan Candidate, Member of the Party ix No Party Affiliation Candidate (formerly independent) Nonpartisan Candidate (includes judicial offices) Under penalties of perjury, I declare that I have read the foregoing affidavit and that the facts stated in it are true. OtikkUe,s elA 417, Print Name of Candidate yigntuTJt'eandi#Jate Residence Address (do not use post office box) v--LoA&A__t, City (L(6)) G (,-33 C[ Day Phone State 05 Zip Code Fax Number AFFIDAVIT OF UNDUE BURDEN FOR MUNICIPAL CANDIDATES ELECTION ASSESSMENT ONLY (Section 99,093, Florida Statutes) T —� CtLLU tf .l. QV1 1 iai swear (or affirm) under oath that I intend tidi qualify as a candidate for the office of Ct �V.C�VI�.1rvl,�S� L©tALO and that I am unable to pay the 1% State election assessment fee for that office without imposing an undue burden on my personal resources or on resources otherwise available to me. _._ ig tnature of a ndidat i Print Name: -••••\ STATE OF FLORIDA COUNTY OF ORANGE Sworn to and subscribed before me this 1,0 day of /U0 l je`n (Signature of Notary Public) "k,, DENISE HOLDRIDGE MY COMMISSION # D[?498930 (Prim EXPIRES: February 03, 2010, Typo or Stunp Commissioned Name of Notary Public) �`� a, i44141 A WI i•R'I ri. Notary urN nt MS.(' cam. ''',"0.04140,14 "ea Personally Known or Produced Identification„ Type of Identification Produced F t ' 5 L l C G .S