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2012District1Ross
OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) j/fqx/voy / $5 candidate for the office of C,7"' (c///G / AJ/uct have received, read and understand the requirements of Chapter 106, Florida Statutes. 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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (Rev. 03108) APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. 1. CHECK APPROPRIATE BOX(ES): ❑ Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy [] Depository 0 Office iA 0 PH 1:4'5 OFFICE USE ONLY ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) A4A1Py Gloss 4. Telephone ((/o;)cgO/$' f 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. 5. E-mail address 3. Address (include post office box or street, city, state, zip code) 2/ 9 Sr SvAisrefs h/ 407 /214,--).„/ Cm l Uv 1-c ,OJT/C7- 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 D Write -In C] No Party Affiliation Er • '6 C/ ' Party candidate. 9. I have appointed the following person to act as my paign Treasurer [] Deputy Treasurer 10. Name of Tr urer or Deputy Treasur, _,,,,_ (-?e 5,5- 11. Mailing Address 12. Telephone 7,q>-S(iN t21"7v' , ( Yu) )Vii-2Sz 13. City 14. County o€aJ00 18. I have designated the following bank as my 15. State 16. Zip Code 17. E-ma'I address 3zd/ Ea -/r ()a -et, -- Primary Depository ❑ Secondary Depository 19. Name of Bank a /7_, 21. City 22. County_ V/Z-Z4/00 0,47V 20. Address 23. State 24. Zip Code 3241 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 /1o/// 26. Signature of Candidate X �. 27. Treasurer's ptance of pointmg$- fill in the blanks and check the appropriate block) designated above as: liji Do 977 f ebs$ (Please Pr Type Name) Campaign Treasurer X , do hereby accept the appointment Deputy T esurer. ld Signatur�r; of Campaign Treasurer r Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S.2.0001, F.A.C. NOV Pm a Alternative Method Affidavit (Please Type) I certify that I intend to qualify by the alternative method as a can idate for the office of 6)(//‘-/C/ �- (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. Print Name of Candidate 2/9 SfAbf•JaieziAl 4V -fl Signature of Candidate Residence Address (do not use post office box) 64/.9-/viou L City (VV) vd/— Was State Zip Code (va �yiGoP Day Phone Fax Number ID PM 1.:i AFFIDAVIT OF FINANCIAL HARDSHIP "971/A0V SS , a candidate for the office of / (�C.fi�/�� 6'.1-719.,/ Zr / do hereby certify, pursuant to Section 99.093, Florida Statutes, that X am unable to pay the 1% election assessment to qualify for nomination or election to public office because paying the assessment would be an undue burden on my personal financial resources or on the financial resources available to me. UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT IT IS A TRUE AND CORRECT STATEMENT. Signa e o i didate -7/ 7 S S7/qa)J 4, Address of Candidate AFFIDAVIT OF UNDUE BURDEN (Section 99.097(4), Florida Statutes) IMPORTANT: Paying signature gatherers will preclude or invalidate the filing of an undue burden oath. Section 99.097(6), Florida Statutes, provides: (a) If any person is paid to solicit signatures on a petition, an undue burden oath may not subsequently be filed in lieu of paying the fee to have signatures verified for that petition. (b) If an undue burden oath has been filed and payment is subsequently made to any person to solicit signatures on a petition, the undue burden oath is no longer valid and a fee for all signatures previously submitted to the supervisor of elections and any submitted thereafter shall be paid by the candidate, person, or organization that submitted the undue burden oath. If contributions as defined in s. 106.011 are received, any monetary contributions must first be used to reimburse the supervisor of elections for any signature verification fees that were not paid because of the filing of the undue burden oath. [Note: The second sentence in (b) applies only when payment is made to a signature gatherer after an undue burden oath had been filed.] I certify and oath that I intend to qualify as a candidate for the office of and that I am unable to pay the fee for verification of petition signatures for that office without imposing an undue burden on my personal resources or on resources otherwise available to me. X Signatu ,of Candidate Print Candidate's Name -79 s v ``) alt-pifr Address State State of Florida County of 32-O/ Zip g/74--/I,e City / (967 ) Telephone Number Sworn to (or affirmed) and subscribed before me this by jZ ti;') y 5 Personally Known: or Produced Identification: Type of Identification Produced: _FL D IZA GIL to C 5 - /( day of /0 ,202,_ Signature of Notary Public — Stat P[arida Print, Type or Stamp Commissioned Name of Notary Public '""' , DENISE HOLDRIDGE ' /"r MY COMMISSION 8 00947618 EXPIRES: February 03.2014 1,a043% P.Y H Notary Oiacornt Aiwa. Co. FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) i311A// Y/ 5x OFFICE USE ONLY - _" iily _ . y.Gn Name S. (2) 7/ 9 SvAJoi €Le7J 4i, --e Address (number and street) d/C iPv , -1214/ City, State, lip Code • CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): .Candidate (office sought): Ci7"V Coc'/4C,L ,UJ+ZT (3) ID Number: -/ _ ❑ 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 (5) REPORT IDENTIFIERS Cover Period: From % I / I // To / Z I ,3/ I // Report Type Report ❑ Independent Expenditure Report Original ❑ Amendment 0 Special Election (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ �d 4 9, (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 175-7°:= P� Loans $ /UliP- to Office $ / Total Monetary $ $ ---- In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ //acA,_9F (10) TOTAL Monetary Expenditures To Date $ i7s_ (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) A44 PIl I certify that I have examined correct, and complete. (Type name) �� this report and it is true, , 41 ❑ Individual (only for 43Treasurer ❑ Deputy Treasurer electione ' commun.) X 6Q -4 EaCandidate X Chairperson (only for PC, PTY & commun. organization) electioneering Signature Sig ure DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (2) I.D. Number (3) Cover Period / u / / / /f through /2 / 3/ / // (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 %2 42?M ,&e,e,./ 5,20 Ai ek-.r 717 8/41'1"4' ,41, 61//, l�#Ar neD 09v. °v "7/ fie avi2e .r / q*' ✓- 3za/ / eir1�.� /`l 0 Acv -.A " / / / / /1 / / I 1 /1 DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name �R /aq 4--1- (3) Cover Period /y / / / // through (2) I.D. Number /L 17/ / // (4) Page / of (5) 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 /a , 7/ i /i I,rVa4- s r yZ elv. � o ''/ d2ZL4/� / C � /� /' f` _ Uz, 075 //o Z!// 2-44y D'cete 3f7h C k /a, pv /1, 30 / // Xfr"-s-') -) /LGa sok7AA-A1c- .w6A10_,/,_-_- .32 -Br az- C./i» 5.--. w, /2, ,30 / 1/ -fc.07-6 i40 4Wi>r$ /2-13c/ 1// Jsopl kb* 70, /1(141b J 0,e c73Z/Z1/ e (14P °y s /2 ,., 1// sr 4' , /uozi" 7477; K 3-t z y 0-1 29 dl 6,7 h141/iii J ,z/2 6//.3,,,, ' g vvk /HUNG C 01, 9 qs 1,2- ,2 ,%/ Jc/L'P 'V&A �4/ real 144Az X33s1(- ��� --171 . DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name (2) I.D. Number / through /2 / 2/ / // (4) Page .� air - 3 O Cover Period /0 / / / f (5) Date (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code /Z / Z z- 1 // e- 9 ? (6,-, 503) Ci C400/41 A'& 02f22? C/r, J C/ 49 _ at. f /zILL ,// C -T1 4 s7) giii-6-1 CT ,Uffi jog ill c�� V 0'7I CIA, ev 2r: 4 / 2/ in 0 11,-/ *. finit sYQsr dh/l-e. 3z tilt ce S 4U p1;/1// / JPi•-17I'Ps) 7z: f ilti e/ APO/ -324j cite 5 x' 443) Ill Aw, il40. y r. �r fUfi 'Z -e4- ft/joy, I 1 1 1 I I DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name XYWO , S f 3) Cover Period /U l i / C/ through /L / 3/ (2) I.D. Number // (4) Page d of (5) 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 /2 -2j /// /WOW- C�J l[ 7r P�17// pz 9C/q �i� Car s; 2 .)/ /1 4144-,6601A- r?ri 6147 Ca b,ib (/D3 C/6 Ci-le /8, G= /L,7y/// JI/fdK,w 5-0O ed,z/ t ( g- ..20G /L, 2 , // Ogee :7�44-) / r7- 577-430-9— /4-4ili Gc,0 9, C CA - --L c, 1e 1 � /a- - Z 29 IN 7PA/ 411, ,, �i'�'� 3,a r iM1 C(L Chk7 /l °' /Z , Z y , /, jdspv ✓ wvitt J e r 06, /L l z /// Pow,,k 419'27c 0 s'-- ,600.41// a - s7) iew � 337A, C/4- Cik /z, ,, ► L #4) 2.61 1 fir, 64P11 - //wt/Joile/ .F- yi/Si (G lit DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name �o / ,' / 7/ through IL 3 Cover Period (2) I.D. Number 7, ! l/ (4) Page (5) 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 7; , )7 , // PO(' 737 LZCG'GUQ 06.04/0/-- 32J ' 9 �1� a- 16' 12 , 47 , // eiv 3" hi � 7 1. ; 33/7J L 14, � LNG 7 11,27 ,f/ Luj CN4 ,oc,-- - 6y3® rJ 321•1 CI42 /e.0/1/01z /2- 9 r, // Pow/4,41-1'0k A .64a4.417-T-kti/M1-- cg,sratokto Clfr a2s ; /2- - 1Z1 , l/ o/ /6'4t /sue C401 a' //.3Z/Jf are clip ('v 9' IL , ?y ,„, ..--ifive,--,/4 cz ot- ILI 23 ,a 10 -JA -1 I U/"ia e �i/cx 2 r`, JZd C/1- O OPw c41-- .ad_ /2, ,li ,// cke /at c'/.1- fir/, 9izi c4, r C Vie._ . DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name 3) Cover Period �j (2) I.D. Number 10 / / / G'/ through /Z / S/ / /1 (4) Page Qf (5) Date (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code /l / 15 //( 0 , 4 601,t90 --<-)A, �`.,,,/; (&?z, a 040 CeV — s-,- fZ, L3 ,// Jeirtre C o (/ 12 q M¢ fwcol L2 i;-''£4z34 64- 0-1-49 �� , 23 /// A/4 A'% /Z/3 0, ov 4",4 c 3'7€ cic C/ k /2 , Z3 // Ci4 4-7 � /y /+ 7? 41M'(„SiiIJr&s f --- 0., , /a zz , l/ , 4' /. :i 11 00 yCy -lf' (/' Y ale /'L 12 z< , t/ i 'V 47 /076,y /azieu it £ -/-17-: 3112 6/6 r OP `v. li_ / 2L ,// ,N /9-z( c- 79F' 5-Arir 7i-lv,,i 3L03 ck ' C /le c1s 9' /L/ z2 //l W4../-,7 6i' O3/,'/ /c ‘,e.3, ((L OPffio,,c,. /' �v 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) Randy Ross OFFICE USE ONLY Name (2) 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code • CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): © Candidate (office sought): City of Orlando Commission, (3) ID Number: District 1 ❑ Political Committee • CHECK IF PC HAS DISBANDED E Committee of Continuous Existence • CHECK IF CCE HAS DISBANDED • Party Executive Committee n Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 1 / 1 / 12 To 2 / 10 / 12 Report Type Report ❑ Independent Expenditure Report PA Original ■ Amendment ❑ Special Election (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 620.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 1,852.72 Loans $ to Office $ Total Monetary $ $ In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ 11,666.98 (10) TOTAL Monetary Expenditures To Date $ 1,927.72 (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) /!. v'7 ` I certify that I have examined this report and it is true, correct, and complete. (Type name) / ';;4 r' , /eic -r Individual (only for ✓ Treasurer ❑ Deputy Treasurer E Candidate Chairperson (only for PC, PTY & electioneering commun. organization) 7 electioneering mun.. + Signature J Signature DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Randy ross (3) Cover Period 1 / 1 / 12 through (2) I.D. Number 2 / 10 12 (4) Page 1 of (5) 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 Brian Fenn 1 Insuranc che $100.00 1/ / 31 /12 1650 Canton Lane e sales Oviedo, FL 32765 1 Don Vandigadon Bus Attorne che 250.00 1 / 31 /12 2705 W. Fairbanks y Winter Park, FL 32789 2 Mary Lackner i Marketi che 75.00 1 / 31 1? 47 W. Division ng #263 Chicago, IL 60610 3 Don Ping I retired che $50.00 1 / 31 /12 27110 Jones Loop Road#72 Punta Gorda, Fl 4 33982 John Schooler I retired che $100.00 1 / 31 / 12 941 N. Hyer Orlando, Fl 32803 5 Kim Wren I realtor che $20.00 1 / 31 42 P.O. Box 15026 Cape Coral, FL 33915 6 1 / 31 1 r2 David Dorman 7575 Dr. Phillips Bus realtor che $25.00 P1 Orlando, FL 32819 7 / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT ITEMIZED EXPENDITURES AND DISTRIBUTION (1) Name Randy Ross (2) I.D. Number (3) Cover Period 1 / 1 / 12 through 2 / 10 / 12 (4) Page 1 of 1 0 Expenditures (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Distributions.) ElDistributions (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Expenditures.) (5) Date (7) Full Name (L, Suffix, F, M) Full Street Address City, State, Zip Code (8) Purpose (add office sought for candidate contributions) (9) Expenditure Type (10) Related Expenditures (11) Amended (12) Amount (6) Seq Num 1' 31,12 Drew Drew this Sign 737 Ellwood #4 Orlando, Fl 32804 Marketing support Mon 410.54 1 1 31/12 Michael Vicara 2005 Lake Baldwin Dr Orlando, FL 32814 Web design/support Mon 250.00 2 3/ 12 City of Orlando City Hall Orlando, FL 32801 Qualifying fee Mon 958.89 3 1/ 31/ 12 Doug Pilon 14 Michigan Brid Orlando, FL 32806 Marketing support Mon 25.00 4 1 31 12 Joe Abney 14011 Symacore Tr Dr Orlando, FL 32806 Marketing support Mon 25.00 5 1/ 1/12 Wildside's BBQ 20 N. Summerlin Orlando, FL 32801 fundraiser expense Mon $48.29 6 1/ 31 12 US Post Office Delayne Avenue Orlando, FL 32806 postage Mon 135.00 7 DS -DE 14B (Rev. 1108) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Randy Ross OFFICE USE ONLY 201E MAR 2 PM 3;,.) Name (2) 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): 17 Candidate (office sought): Orlando City Council, (3) ID Number: 1 ❑ 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 (5) REPORT IDENTIFIERS Cover Period: From 2 / 14 / 12 To 2 / 24 / 12 Report Type Report ❑ Independent Expenditure Report !I Original ❑ Amendment ❑ Special Election (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 850.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 166.50 Loans $ 300.00 to Office $ Total Monetary $ $ In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ 12,816.98 (10) TOTAL Monetary Expenditures To Date $ 2,094.22 (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. 9�� (Type name) E1� iN `i//Ub I certify that I have examined this report and it is true, correct, and complete. (Type name)%//9A 0 fi ❑Individual ( for if surer ❑ Deputy Treasurer ✓ Candidate Chairperson (only for PC, PTY & / eonsoaring organization) electioneering om un /) Signature Signatur DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name Randy Ross (2) I.D. Num�berpR 2Fr1 4' 3) Cover Period 2 / / 12 through 2 / 24 12 (4) Page 1 of 1 (5) 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 Judy Conrad I retired ck 500.00 2 / 11 /12 433Wekiva Cove Rd Longwood, FL 32779 1 Michael Pitt I busines ck 100.00 2 / 11 /12 10 Summerlin s owner Avenue Orlando, FL 32801 2 Victor Scapphio I banking ck 100.00 2 / 24 1? 233 S. Federal Highway Boca Raton, FL 3 33432 John Schooler I retired ck 100.00 2 / 24 /12 941 N. Byer Orlando, FL 32803 4 Bryan Beal I retired ck 50.00 2 / 24 / 12 1210 Berwyn Rd. Orlando, FL 32806 5 Randy Ross can candida SA/ $300 2 / 24 }2 719 S. Summerlin Avenue did ate to Orlando, FL 32801 6 / / / / DS -DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 2012 MR 2PM3 4i8 CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES 1) Name Randy Ross (2) I.D. Number 3) Cover Period 2 / 1k / 12 through 2 / 24 / 12 (4) Page 1 of 1 (5) Date (7) Full Name (8) Purpose (add office sought if contribution to a candidate) (8) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code 2 /14 /12 US Post Office Delayne Avenue Orlando, FL 32806 postage Mon $90.00 1 2 /14/12 Office Depot 2847 S. Orange Orlando, FL 32806 copies Mon $76.50 Z.- / / // / / / / / / / / -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Randy Ross (2) Name 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): © Candidate (office sought): Orlando ❑ Political Committee ❑ Committee of Continuous Existence ❑ Party Executive Committee ❑ Electioneering Communication OFFICE USE ONLY (3) ID Number: City Council 1 ❑ 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 2 / 25 / 12 To 3 / 9 / 12 Report Type 121 Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ Loans Total Monetary In -Kind $ (7) EXPENDITURES THIS REPORT Monetary Expenditures $ 927.50 Transfers to Office Account $ Total Monetary $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date $ 12,815.98 (10) TOTAL Monetary Expenditures To Date $ 3,021.72 (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) Betty Parker Ross p Individual (only for Treasurer ❑ Deputy Treasurer electioneering commun.) X Signature I certify that I have examined this report and it is true, correct, and complete. (Type name) Randy Ross E Candidate X Signature ❑ Chairperson (only for PC, PTY & one commun_ organization) DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES Randy Ross (2) I.D. Number (3) Cover Period 2 / 25 / 12 through 3 / 9 / 12 (4) Page 1 of 1 (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 (1 1) Amount (6) Sequence N Number 3 /9 /12 US Post Office Delayne Park Orlando, FL 32806 postage mon $190.00 1 3/ /9 /12 Action Mail 1904 Premier Road Orlando, FL 32809 postage mon $268.75 2 /9 /12 kit r iad'il 5:y-vJ- /?/y 41!'x"1 A-✓ s -7- oiz/-fry /-- 3Z gar" Si firs /4-1r' / �/(.k �� 3 / / / / / / / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT -- ITEMIZED CONTRIBUTIONS (1) Name Randy Ross (2) I.D. Number (3) Cover Period 2 / 25 / 12 through 3 9 / 12 (4) Page 1 of 1 (5) 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 / / none / / / / / / / / / / / / / / 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) Randy Ross OFFICE USE ONLY Name (2) 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): 17 Candidate (office sought): Orlando City Council (3) ID Number: 1 ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED • Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee n Electioneering Communication III CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 3 / 10 / 12 To 3 / 29 / 12 Report Type ❑ Original ❑ Amendment n Special Election Report Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 2,180.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 1,798.75 Loans $ 5,000.00 to Office $ Total Monetary $ $ In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ 19,996.98 (10) TOTAL Monetary Expenditures To Date $ 4,820.47 (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) Betty Parker Ross I certify that I have examined this report and it is true, correct, and complete. (Type name) Randy Ross Individual (only for ✓ Treasurer ❑ Deputy Treasurer ✓ Candidate ❑ Cha_ir arson (only for PC, PTY & , ' "-eectio ring commun. organization) electioneering commun X V7A1.51L-7 X Signature ;e_ Signature DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Randy Ross (2) I.D. Number 31 Cover Period 3 / 10 / 12 through 3 / 29 / 12 (4) Page (5) 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 3 / 20 /12 Local Union 606 IBEW 820 Virginia Drive Orlando, FL 32803 {3 ' .uAyon d P/�"C__ ck 500.00 1 3/ / 25 /12 Elena Puig 1600 E. Hillcrest Street Orlando, FL 32803 2 dentist ck 50.00 2 3/ / 29 1? Gerald Collin 7346 Cherry I designe r ck 100.00 3 Laurel Drive Orlando, FL 32835 3/ / 29 /12 Jason Leclerc 701 n lk davis dr orlando, FL 32806 1 ck 10.00 4 3 / 29 / 12 James Bott 1600 Magnolia Ave Winter Park, FL 32789 2 ck 25.00 6 3 / 29 }2 Greg Dasher 844 W Roscoe St Apt #2 Chicago, IL 60657 1 ck 100.00 7 3 / 29 12 Teresa Sapp 2801 Bluestone Drive Deltona, FL 32738 I ck 20.00 8 3 / 29 !12 Michael Wozniak 820 Duff Drive Winter Garden, FL 34787-5007 I ck 50.00 9 DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Randy Ross (2) I.D. Number (3) Cover Period 3 10 12 through 3 29 12 4) Page 2 of 3 (5) 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 3 / 27 12 IUPAT 2153 West Oak Ridge Road, Orlando, FL 32809 dam' t1144 -ea FA -C -- ck 500.00 10 3 / 27 l2 IUPAT 2153 West Oak Ridge Road, Orlando, FL 32809 pc 1+14.11.0E (�� ck 500.00 11 3 / 29 1 Randy Ross 719 S. Summerlin Ave Orlando, FL 32801 2 candida to loan 5000.00 12 3 / 29 /12 Jeremy Pullen 100 W. Grant Street # 3042 Orlando, FL 32806 1 ck 50.00 13 3 / 29 / 12 Phil Kean 229 Alexander Place Winter Park, FL 32789 I ck 25.00 14 3 / 29 }2 Andrew Dowler 1316 Long Street Lakeland, FL 33801 I ck 10.00 15 3 / 29 ,.2 Jackie Bowen 10864 Knightsbridge Lane Fishers, IN 46037 I ck 30.00 16 3 29 /12 Bette -Lou Rush 110 Commerce Streer Clinton, CT 06413 I ck 10.00 17 DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Randy Ross (2) I.D. Number 3 Cover Period 3 / 10 12 through 3 29 / 12 (4) Page of (5) 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 3 / 29 /12 David Conrad 1275 Wakiva Road Longwood, FL 32750 I ck 200.00 18 / / / / / / / / / / / / / / DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT ITEMIZED EXPENDITURES AND DISTRIBUTION (1) Name Randy Ross (3) Cover Period 3 / 10 / 12 through (2) I.D. Number 3 / 29 / 12 (4) Page 1 of El Expenditures (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Distributions.) ElDistributions (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Expenditures.) (5) Date (7) Full Name (L, Suffix, F, M) Full Street Address City, State, Zip Code (8) Purpose (add office sought for candidate contributions) (9) Expenditure Type (10) Related Expenditures (11) Amended (12) Amount (6) Seq Num Ferguson Signs Campaign Signs mon 468.75 3 2012 1314 W. Anderson / / Street Orlando, FL 1 32805 Nick Janovsky Campaign Field mon 200.00 3/ 20/12 1810 E. Palm Marketing Avenue Tampa, FL 33605 2 US Post Office postage mon 45.00 Delayne Park 3/12/ 12 Orlando, FL 32806 3 US Post Office postage mon 45.00 3/ 16/ 12 Delayne Park Orlando, FL 32806 4 US Post Office postage mon 45.00 3 20 12 / / Delayne Park Orlando, FL 32806 5 US Post Office postage mon 45.00 3/ 27/12 Delayne Park Orlando, FL 32806 6 Drew Drew This marketing/printing mon 950.00 27 12 3// / 737 Ellwood #4 Orlando, Fl 32804 DS -DE 14B (Rev. 1/08) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Randy Ross OFFICE USE ONLY -., �f kr :; Name (2) 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): © Candidate (office sought): Orlando City Council (3) ID Number: 1 ❑ 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 (5) REPORT IDENTIFIERS Cover Period: From 3 / 10 / 12 To 3 / 29 / 12 Report Type ❑ Original WiAmendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 2,180.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 1,798.75 Loans $ 5,000.00 to Office $ Total Monetary $ $ In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ 19,996.98 (10) TOTAL Monetary Expenditures To Date $ 4,820.47 (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) Betty Parker Ross I certify that I have examined this report and it is true, correct, and complete. (Type name) Randy Ross • Individual (only for 0 Treasurer II Deputy Treasurer 0 Candidate ■ Chairperson (only for PC, PTY & electioneering commun.), X? G.- - '<3lectio*ring commun. organization) X - -)‘;Z:77-3 Signature Signature DS -DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT ITEMIZES) EXPENDITURES AND DISTRIBUTION (1) Name Randy Ross (2) I.D. Number (3) Cover Period 3 / 10 / 12 through 3 / 29 / 12 (4) Page 1 of 0 Expenditures (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Distributions.) ElDistributions (Use separate sheets for Expenditures and Distributions. Do not combine sequence numbers with Expenditures.) (5) Date (7) Full Name (L, Suffix, F, M) Full Street Address City, State, Zip Code (8) Purpose (add office sought for candidate contributions) (9) Expenditure Type (10) Related Expenditures (11) Amended (12) Amount (6) Seq Num Ferguson Signs Campaign Signs mon 468.75 20/12 1314 W. Anderson Street Orlando, FL 1 32805 Nick Janovsky Campaign Field mon 200.00 3 2012 1810 E. Palm Marketing / / Avenue Tampa, FL 33605 2 US Post Office postage mon 45.00 Delayne Park 3/12/ 12 Orlando, FL 32806 3 US Post Office postage mon 45.00 3/16/ 12 Delayne Park Orlando, FL 32806 4 US Post Office postage mon 45.00 3/20/12 Delayne Park Orlando, FL 32806 5 US Post Office postage mon 45.00 3/27/12 Delayne Park Orlando, FL 32806 6 Drew Drew This marketing/printing mon 950.00 3/ 27 12 / / 737 Ellwood #4 Orlando, Fl 32804 DS -DE 14B (Rev. 1/08) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIINI N&>.. (1) Name Randy Ross (2) I.D. Number (3) Cover Period 3 / 10 / 12 through 3 29 12 4 Pane of (5) 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 3 / 20 /12 Local Union 606 IBEW 820 Virginia Drive Orlando, FL 32803 - 13 won P ck 500.00 1 3/ / 25 /12 Elena Puig 1600 E. Hillcrest Street Orlando, FL 32803 I dentist ck 50.00 2 3/ /29 1? Gerald Collin 7346 Cherry Laurel Drive Orlando, FL 32835 I designe r ck 100.00 3 3/ / 29 /12 Jason Leclerc 701 n lk davis dr orlando, FL 32806 I ck 10.00 4 3 / 29 / 12 James Bott 1600 Magnolia Ave Winter Park, FL 32789 I ck 25.00 6 3 / 29 )2 Greg Dasher 844 W Roscoe St Apt #2 Chicago, IL 60657 I ck 100.00 7 3 / 29 12 / Teresa Sapp 2801 Bluestone Drive Deltona, FL 32738 I ck 20.00 8 3 / 29 77 r2 Michael Wozniak 820 Duff Drive Winter Garden, FL 34787-5007 I ck 50.00 9 DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIAUTIONS (1) Name Randy Ross (2) I,D. Number 3 Cover Period 3 10 / 12 through 3 29 / 12 4) Page of 3 (5) 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 IUPAT Pe' u a ck 500.00 3 / 27 /12 2153 West Oak 10 Ridge Road, Orlando, FL 32809 Pic 3 / 27 /12 kL 4 (') is'e' usL QH ck 500.00 11 � ',..,g,C.1 t!?y-,d4� /€. J ad,' Randy Ross I candida loan 5000.00 3 /29 1? 719 S. Summerlin to Ave Orlando, FL 32801 12 3 / 29 /12 Jeremy Pullen 100 W. Grant I ck 50.00 Street # 3042 Orlando, FL 32806 13 Phil Kean I ck 25.00 3 / 29 / 12 229 Alexander Place Winter Park, FL 14 32789 3 / 29 42 Andrew Dowler 1316 Long Street 1 ck 10.00 Lakeland, FL 33801 15 3 29 Jackie Bowen I ck 30.00 / /1.2 10864 Knightsbridge Lane 16 Fishers, IN 46037 3 Bette -Lou Rush I ck 10.00 / 29 ?-2 110 Commerce Streer Clinton, CT 06413 17 DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS , (1) Name Randy Ross �2 ApR (2) I.D. Number (3) Cover Period / 10 / through 3 / 29 / 12 (4) Page -2) of DS -DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) 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 3 / 29 /12 David Conrad 1275 Wakiva Road Longwood, FL 32750 I ck 200.00 18 I / / / / / / / / / / / / / CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY am a candidate for the nonpartisan office of (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. OATH OF CANDIDATE (Section 99.021, Florida Statutes) 4T (PLEASE pRINT NNAE ' yot) wiSH IT T APPEAR THE BALLOT * — NAME MAY NOT BE CHANGED AFTER THE END OF CRIALIFyING) ON C 7V ; I am a qualified elector of (office) • (di5Eri,ct #) County, Florida; x (V 2) / 'fr' Telephone Number = all Address 4.1 e ture of Candidate jj;/1/41-11-6/1 Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): 94/ 02/ * 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 this form): ----a2e2v-e-y a S..f .5' .5 STATE OF FLORI A COUNTY OF Sworn to (or affirmed) and subscribed before me this ay of I4L / /, 20 -; Personally Known: Produced Identification: Type of Identification Produced: ///0,,1 p7 %ter /ti attErtgf NPtgly P♦ubjjc Pn Tygei,or,Stamp Com 9804 nr3%Public V PoA Notary, Public - State of Florida ` • = My Comm. Expires Jun 4, 2015 sy,-^s►_'/ Commission # EE 63655 ,,,, Bonded Through National Notary Assn, DS -DE 25 (Rev. 5/11) Rule 18.2.0001, F.A.C. FORM 1 STATEMENT OF 2011 Please print or type your name, mailing address, agency name, and position below: FINANCIAL INTERESTS LAST NAME -- FIRST NAME -- MIDDLE NAME : Ross Randy FOR OFFICE USE ONLY: MAILING ADDRESS : 719 S. Summerlin Avenue ID Code CITY : ZIP : COUNTY : Orlando 32801 Orange ID No. NAME OF AGENCY : City of Orlando Conf. Code NAME OF OFFICE OR POSITION HELD OR SOUGHT : P. Req. Code City Council, District 1 You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF m 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): 0 DECEMBER 31, 2011 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS 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). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (must check one): ❑ COMPARATIVE PERCENTAGE THRESHOLDS R IZI DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, you NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions must write "none" or "n/a") SOURCE'S ADDRESS p. 4] DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY CCP, Inc. 10 N. Summerlin Avenue Orlando, FL 3280 Marketing PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to report NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses , you must write "none or "n/a") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions p. 4] PRINCIPAL BUSINESS ACTIVITY OF SOURCE none seemar PART C -- REAL PROPERTY [Land buildings owned by the reporting person - See instructions p. 4] (If you have nothing to report, you must write "none" or "n/a") FILING INSTRUCTIONS IONS 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. OTHER FORMS you may need to file are described on page 6. none CE FORM 1 • Effective: January 1. 2012. Refer to Rule 34-8.202(1). F.A.C. (Continued on reverse side) PAGE 1 PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions p. 5] (If you have nothing to report, you must write "none" or "n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Life Insurance New York Life Insurance PART E -- LIABILITIES [Major debts - See instructions p. 5] (If you have nothing to report, you must write "none" or "n/a") NAME OF CREDITOR ADDRESS OF CREDITOR Carrington Mortgage P.O. Box 54285 Irvine, CA 92619-4285 PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions p. 5] (If you have nothing to report, you must write "none" or "n/a") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3 NAME OF BUSINESS ENTITY none none none 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 ❑ WHAT TO FILE: After completing all parts of this form jncluding 2in_ning 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 "n/a" 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. DATE SIGNED (required): 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 ofthe 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: 3600 Maclay Boulevard, South, Suite 201, Tallahassee, FL 32312. 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. FacsimilIs will not be accepted. 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 1F (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, 2011. CE FORM 1 - Effective. January 1, 2012. Refer to Rule 3a-8.202 (1), F.A.C. PAGE 2 FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1) Randy Ross OFFICE USE ON ,Y Name (2) 719 S. Summerlin Avenue Address (number and street) Orlando, FL 32801 City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (4) Check appropriate box(es): Fl Candidate (office sought): Orlando City Council (3) ID Number: ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED H Party Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 3 / 29 / 12 To 7 / 2 / 12 Report Type TR Report ❑ Independent Expenditure Report '!% Original ❑ Amendment ■ Special Election (6) CONTRIBUTIONS THIS REPORT Cash & Checks $ 0.00 (7) Monetary Expenditures Transfers Account Total Monetary EXPENDITURES THIS REPORT $ 19,996.98 Loans $ to Office $ Total Monetary $ $ In -Kind $ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date $ 19,996.98 (10) TOTAL Monetary Expenditures To Date $ 19,996.98 (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) Betty Parker Ross I certify that I have examined this report and it is true, correct, and complete. (Type name) Randy Ross ❑ Individual (only for 0 Treasurer ❑ Deputy Treasurer electioneering commun.//),,\ X s�+ -) _.,"> Q X Candidate Chairperson (only for PC, PTY & ctin Bering common. organization) Signature `- Signature '-'" DS -DE 12 (Rev. 08/04) (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES Randy Ross (2) I.D. Number TR (3) Cover Period 3 / 29 / 12 through 7 / 2 / 12 (4) Page 1 of 1 (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 4/ /4 /12 Randy Ross candidate 719 S. Summerlin Avenue Orlando, FL 32801 loan repayment loan repay $13,426.a 1 4 /3 /12 Nick Janovsky 1810 E. Palm Avenue Tampa, FL 33605 Campaign Field Marketing mon $800.00 2 4 /4 /12 Drew Drew This 737 Ellwood #4 Orlando, FL 32804 Marketing/Prin ting mon $950.00 3 / / / / / / / / / / DS -DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES