RESOLUTION 2017-03

A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE AVE MARIA STEWARDSHIP COMMUNITY DISTRICT ADOPTING SPECIAL ELECTION POLICIES AND PROCEDURES; AND PROVIDING FOR SEVERABILITY AND EFFECTIVE DATE.

WHEREAS, the Ave Maria Stewardship Community District (“District”) is a local unit of special purpose government created and existing pursuant to Chapter 2004-461, Laws of Florida, ( the “Act”) being situated in Collier County, Florida; and

WHEREAS, in accordance with the provisions of the Act, on June 27, 2016, the qualified electors, as defined in same, approved a referendum on the question of should certain members of the Board of Supervisors of the Ave Maria Stewardship Community District be elected by qualified electors, as defined in the Act as any person at least 18 years of age who is a citizen of the United States, a legal resident of Florida and of the District and who registers to vote with the Supervisor of Elections in Collier County; and

WHEREAS, the Act required the Board of Supervisors of the District (“Board”) to direct District staff to prepare maps of the District describing the extent and location of all urban areas within the District (the “Urban Area Maps”); and

WHEREAS, the Act defines “urban area” as “a developed and inhabited urban area within the District within a minimum acreage resident population density of at least 1.5 persons per acre as defined by the latest official census, special census, or population estimate, a minimum density of one single-family home per 2.5 acres with access to improved roads, or a minimum density of one single-family home per 5 acres within a recorded plat subdivision”; and

WHEREAS, on August 2, 2016, the District Engineer presented the Urban Area Maps to the Board at a duly noticed public meeting and after discussion the Board requested certain revisions be made to the Urban Area Maps; and

WHEREAS, on September 9, 2016, the District Engineer presented the revised Urban Area Maps to the Board at a duly noticed public meeting and after discussion the Board requested certain additional revisions be made to the Urban Area Maps; and

WHEREAS, on October 4, 2016, the District Engineer presented the further revised Urban Area Maps to the Board at a duly noticed public meeting; and

WHEREAS, pursuant to the Act, upon presentation of the Urban Area Maps, any District landowner or elector had the ability to contest the accuracy of the Urban Area Maps within 30 days of submission to the Board; and

WHEREAS, the District did not receive any notice of objections to the Urban Area Maps; and

WHEREAS, on December 6, 2016, the Board adopted the Urban Area Maps as the

official maps of the District; and

WHEREAS, pursuant to the Act, any District landowner or qualified elector may contest the accuracy of the official maps in accordance with the provision for judicial review as provided in the Florida Administrative Procedure Act; and

WHEREAS, no contest was filed prior to the January 5, 2016, deadline for filing any contest pursuant to the Florida Administrative Procedure Act; and

WHEREAS, in accordance with the Act and section 189.04, Florida Statutes, the Board set the qualifying period for Seat 3 of the Board from noon March 24, 2017 through noon March 31, 2017, and the special election for April 25 , 2017 from noon to 7 p.m.; and

WHEREAS, the District has provided a report to the Collier County Supervisor of Elections stating the purpose, date, authorization and procedures of the special election as required pursuant to the Act and section 189.04, Florida Statutes, attached hereto as Exhibit A; and

WHEREAS, the Board accordingly finds that it is in the best interest of the District to establish by resolution the policies and procedures attached hereto as Exhibit B (the “Special Election Policies and Procedures) to govern the District’s actions related to the special election and qualifying period.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF SUPERVISORS OF THE AVE MARIA STEWARDSHIP COMMUNITY DISTRICT:

SECTION 1. The Special Election Policies and Procedures attached hereto as Exhibit B are hereby adopted pursuant to this resolution as necessary for the conduct of the special election and qualifying period. The Special Election Policies and Procedures shall remain in full force and effect through swearing-in of a qualified elector elected by qualified electors to Seat 3 of the Board.

SECTION 2. If any provision of this resolution is held to be illegal or invalid, the other provisions shall remain in full force and effect.

SECTION 3. This resolution shall become effective upon its passage and shall remain in effect unless rescinded or repealed.

PASSED AND ADOPTED this 7th day of March, 2017.

ATTEST:	AVE MARIA STEWARDSHIP COMMUNITY DISTRICT

ASSISTANT SECRETARY	CHAIRMAN

Exhibit A:	Report to Collier County Supervisor of Elections
Exhibit B:	Special Election Policies and Procedures

Exhibit A

The AMSCD will timely report to your office the results of the special election.  Pleasecontact meimmedai tely i f this letterdoes not accurately reflect our previousdiscussoi ns or If youhave any cone.ems regarding the special election,

Sinc.erely,
1/1),
Todd Wodraksa Disbict Manager

Cc:	Jonathan,T Johnson, DistrictCounsel

Exhibit B

Special Election Policies and Procedures

District Publishes Notice of Qualifying Period. Two publications, first publication no later than March 14, 2017.
Section 100.141, Florida Statutes, requires two publications, first publication at least 10 days prior to qualifying period for special election to fill any vacancy in office.
Form of Notice of Qualifying Period is attached as Exhibit A.
District Publishes Notice of Election- First publication no later than March 24, 2017, second publication no later than April 7, 2017.
Section 100.342, Florida Statutes, requires at least 30 days’ notice of the election by publication. The notice shall be made at least twice, once in the fifth week and once in the third week prior to the week in which the election is to be held.
Form of Notice of Election is attached as Exhibit B.
Qualifying Period. Commencing at noon on March 24, closing at noon March 31, 2017.
By end of qualifying period, Candidates to provide:1
Loyalty Oath for Non-Partisan Office attached hereto as Exhibit C;
Form 1 Disclosure of Financial Interests attached hereto as Exhibit D2;
District Affidavit of Intent attached hereto as Exhibit E;
$25.000 cash or check OR petitions, in the form attached hereto as Exhibit F, containing 25 signatures of qualified electors within the District.
At conclusion of qualifying period, District Manager, or its designee, to check the signatures on the petitions to verify their status as qualified electors within the District and certify the number of valid signatures. District Manager, or its designee, shall notify the candidate as to whether the required number of signatures was obtained.
The District Manager, or its designee, shall receive and review candidates’ items during the qualifying period. Review of qualifying papers is a ministerial function.
In determining whether a candidate is qualified, the District Manager, or its designee, shall review the qualifying papers to determine whether all items required have been properly filed and whether each item is complete on its face. The District Manager may not determine whether the contents of the qualifying papers are accurate.
Publication and Provision of Ballot Form.
Provide two sample ballots to the polling place. The sample ballots shall be in the form of the official ballot as it will appear at the polling place on election day. Sample ballots shall be open to inspection by all qualified electors.
Publish a sample ballot in a newspaper of general circulation in the county, before the day of election.

1 If the District Manager, or its designee, receives qualifying papers during the qualifying period which do not include all items as required prior to the last day of qualifying, the District Manager shall make a reasonable effort to notify the candidate of the missing or incomplete items and shall inform the candidate that all required items must be received by the close of qualifying. A candidate’s name as it is to appear on the ballot may not be changed after the end of qualifying.
2 A public officer who has filed the full and public disclosure or statement of financial interests with the Commission on Ethics or the supervisor of elections prior to qualifying for office may file a copy of that disclosure at the time of qualifying.

Resignation of Office. Supervisor Carletta provides notice of resignation, effective upon qualified elector election of a qualified elector to Seat 3 by a majority of those voting.
Supervisor Carletta was elected at the November 2016 landowner’s election to Board Seat 3 which expires in November 2018. Pursuant to Resolution No. 2016-05,  Seat 3 of the Board was designated as the seat to be converted to election by qualified electors. Therefore, Supervisor Carletta should provide a notice of resignation of Board Seat 3 effective upon qualified elector election of a qualified elector by a majority of those voting.
Special Election. April 25, 2017, 12 p.m. to 7 p.m.
Pursuant to Chapter 2004-306, Laws of Florida, only a qualified elector defined as any person at least 18 years of age who is a citizen of the United States, a legal resident of Florida and of the District and who registers to vote with the Supervisor of Elections in Collier County may vote.
Qualified electors shall be required to provide current and valid picture identification3 prior to voting along with their voter’s registration card or other evidence of voter’s registration.
Winner of the election must be by a majority of those voting.
With the exception of elections of special district governing body members conducted on a one-acre/one-vote basis, in any election conducted in a special district the decision made by a majority of those voting shall prevail, except as otherwise specified by law.4
The District Manager shall keep a list of those voting.
Assumption of Office.
Neither the Act nor section 189.04, Florida Statutes, establishes when a newly- elected supervisor shall take office. As stated above, the supervisor shall be deemed elected upon receipt of a majority of votes cast by those voting. The newly-elected supervisor shall take office upon the Board’s certification of the election results at the next meeting of the Board and administration of the oath of office.
Other Issues.
Vote-By-Mail.
The District may elect to allow vote-by-mail ballots but is not obligated to do so. If the Board elects to allow vote-by-mail ballots, the following policies and procedures regarding provision and collection of vote-by-mail ballots shall apply.
The District Manager, or its designee, shall accept a request for a vote-by-mail ballot from a qualified elector in person or in writing. The District Manager, or its designee, may accept a written or telephonic request for a vote-by-mail ballot. Family members may also make the request in in person. A request for a vote-by-mail ballot to be mailed to a voter must be received no later than 5 p.m. on the sixth day before the election by the District Manager. The

3 Valid forms of picture identification are a Florida driver license, Florida identification card issued by the Department of Highway Safety and Motor Vehicles, United States passport, debit or credit card, military identification, student identification, retirement center identification, neighborhood association identification, public assistance identification, veteran health identification card issued by the United States Department of Veterans Affairs, a license to carry a concealed weapon or firearm issued pursuant to section 790.06, Florida Statutes, or employee identification card issued by any branch, department, agency, or entity of the Federal Government, the state, a county, or a municipality.
4 Section 189.04(4), Florida Statutes.

District Manager shall mail vote-by-mail ballots to voters requesting ballots by such deadline no later than four days before the election. The District Manager shall mail vote-by-mail ballots within two business days after receiving a request for such a ballot.
The District Manager shall include instructions, voter’s certificate and a vote-by-mail affidavit similar in form to those required by sections 101.64, 101.65, and 101.68, Florida Statutes.
Absentee ballots to be counted must be received by the District Manager by 7 p.m. the day of the special election.
Early Voting.
The District may provide early voting in any District election not held in conjunction with county or state elections.5 If the District provides early voting, it may designate as many sites as necessary. Such early voting sites must be geographically located so as to provide all voters in that area with an equal opportunity to cast a ballot, insofar as it is practicable. If the Board elects to allow early voting the following policies and procedures shall apply.
If the early voting is to be offered, the District shall designate the site and hours that early voting will occur at least 30 days prior to the election.6
Any person in line at the closing of an early voting site shall be allowed to vote.7
The qualified elector must provide identification and complete an early voting certificate in the form required by section 101.657, Florida Statutes, prior to early voting.

5 Section 101.657(1)(f), Florida Statutes. 6 Section 101.657(1)(b), Florida Statutes. 7 Section 101.657(1)(c), Florida Statutes.

Exhibit A

NOTICE OF QUALIFYING PERIOD FOR CANDIDATES FOR THE BOARD OF SUPERVISORS OF THE
AVE MARIA STEWARDSHIP COMMUNITY DISTRICT

In accordance with Chapter 2004-461, Laws of Florida, (the “Act”) and Section 189.04, Florida Statutes, notice is hereby given that the qualifying period for candidates for the Seat No. 3 qualified elector office of Supervisor of the Ave Maria Stewardship Community District will commence at noon on March 24, 2017, and close at noon on March 31, 2017. Candidates must qualify for this office of Supervisor with the offices of the District, located at Ave Maria Master Association located at 5076 Annunciation Circle, Suite 103, Ave Maria, Florida 34142, telephone number 239-867-4322. All candidates shall qualify in accordance with the Act by (1) paying a filing fee of $25 or qualifying by petition process pursuant to section 99.095, Florida Statutes, (2) filing a Form 1 Disclosure of Financial Interests, (3) a Loyalty Oath for Non-Partisan Office (DS-DE 25), (4) Affidavit of Intent Special District Candidate and must also be a qualified elector of the District. A qualified elector, as defined in the Act, is an individual who is: at least 18 years of age who is a citizen of the United States, a legal resident of Florida and of the Ave Maria Stewardship Community District and who registers to vote with the Supervisor of Elections in Collier County. Candidates may contact the District Manager for the required qualification documents. All required qualification materials must be received by at the offices of the District Manager on or before the conclusion of the qualifying period.

The Ave Maria Stewardship Community District has one (1) Seat up for election this year, specifically Seat No. 3. Seat No. 3 carries a four-year term of office. The election is nonpartisan and is set for April 25, 2017, from noon until 7:00 p.m. (EST) at the Ave Maria Master Association located at 5076 Annunciation Circle, Suite 103, Ave Maria, Florida 34142.

AVE MARIA STEWARDSHIP COMMUNITY DISTRICT
www.avemariastewardshipcd.org
PUBLISH:  NAPLES DAILY NEWS	 	
[Publish two times, first publication no later than March 14, 2017]

Exhibit B

NOTICE OF SPECIAL ELECTION FOR SEAT 3 OF THE
BOARD OF SUPERVISORS OF THE
AVE MARIA STEWARDSHIP COMMUNITY DISTRICT

In accordance with Chapter 2004-461, Laws of Florida, (the “Act”) and Section 189.04, Florida Statutes, notice is hereby given that the Ave Maria Stewardship Community District will hold a special election at which qualified electors may vote for the purpose of electing a qualified elector to Seat No. 3 of the Board of Supervisor of the Ave Maria Stewardship Community District. The special election will be held on April 25, 2017, from noon until  7:00 p.m. (EST) at the Ave Maria Master Association located at 5076 Annunciation Circle, Suite 103, Ave Maria, Florida 34142. A qualified elector, as defined in the  Act,  is an individual who is: at least 18 years of age who is a citizen of the United States, a legal resident of Florida and of the Ave Maria Stewardship Community District and who registers to vote with the Supervisor of Elections in Collier County.

Voters shall be required to present current and valid picture identification and voter’s registration card or other evidence of voter registration prior to voting. In accordance with the provisions of the Americans with Disabilities Act, any person requiring special accommodations or an interpreter to participate at the special election should contact the District Manager at 561- 630-4922 and/or toll free at 1-577-737-4922.

AVE MARIA STEWARDSHIP COMMUNITY DISTRICT
www.avemariastewardshipcd.org
PUBLISH:  NAPLES DAILY NEWS	 	
[Publish two times, first publication no later than March 24, 2017, second publication no later than April 7, 2017.]

Exhibit C

Loyalty Oath for Non-Partisan Office

INSTRUCTIONS: INSERTING PHONETIC SPELLING OF CAllDIDATE'S NAME FOR AUDIO BALLOT
Use the PRON UNCIATION KEY below to p to'l.lid e p ron un ci ation .s fot am big uou s firs:; nam es and suma mes.
C api;a lize STRESSED syllab les. use lower case for unstressed syllables. Use dashes(-) to separate syUables. You should also add any no:es such as rhyming examples, silent letters. etc.
Samptes:

PROHUNCfA110N KE Y
atni GVowel • o unc11,	
EE	( FEE T ) ft	
'	( Fn'}t.l	
E	{SEO)tiH	
A	ltATI( 4':fltA0 l ( ,1(1	
AH	(FM-l•OlulJ'  raotff
( PAH R) O¥	
AH	(HAHT} (TAH-
Cle-el toclct•	
UH	( FU-1.f) 'O)e
(FtU.  HO) tlCIOd	
UH	( C HU HRCH ) c n"1'tfl	
"'	( FAWN) r,1wn	
u	f'U.l I	
00	F OOO' fOOCI	
OU	F O UNt)l	
0	FO' fc>e	
A"	( FS T) t,'gn t	
O	( F AI T) t .:t.e	
"'	( F OIL) fOI	
YOO	( FYOOR- 1.1 )
:.t1011	

 
HA.ME OH BALLOT	PR ONOUHCEO Al	
Ml :,'-"'	mlt-CHO('Il'l       k   nl)	
» M	HAHN(rl1)'et : t, ""1)	
8 e,11.1i:--u	DOG-PRAJ (rTl e: l'I	
M .1/ll Qi' C,O	ffl ¥,- l,ln-s,(M.-1.0	
T :!o!'!ll l).)1'0,1	TA"'"'" ;iil'!•	n	
MO	M,1110-TAI	
T:!of!Y,1	TA'liN-:,Ufl     ! TAN)	

(80 -fUl'I) '!:cf .J (FING ·

 "	

11:uut     ll nc e r	

C•rtaln Vowel • o unac:w ith R		
AHR	(PAHRJ ¥		
ER	(PERl o.W		
OR	( P I R J Ot ef'		
°oo"•	.<P.O.R.>.oour
,<P OOR		
UH R			
C onsonantSounds	
	BED	oea	TS	rr ,s I ts PITS- fee l Oil Pl t%Sllei0i	
•D	OET
FED	r
".'".	a
n,	rl E l 1 T /1
rl E l 1 TffY	
G
H	GET
HEO	l	"z "	A - znu lV' 1 a u e 1V1-z nunn1 v1s on
G OO D Z l Q0OCI.Sltl U H • DUtlZ•: lll n) HUDCWGS:Ofl	
HW	H \V IC H \ w1l1Ch	
J	( JUH G) j\lg	
K	KAO	'"m'	
L	!A I M	r., e	
M	WAl	ma;	
N
N G	N	ne-;-	
	sm	nn s111o er	
••	PET
RED te<I	
s	SET		
T	EN	ten	
V
y	YET	vt--1
W-1	
VI	'VICH ) wt.en	
CH	CHUCR CJil  GIUrCI)	
SH	SH EEPl s/lreec	

...,
.

"'

NOTE: Tnl8 page enou1e1no t De euDm.11:t&CI t o tne n n og o mcer.

Exhibit D

Form 1 Disclosure of Financial Interests

PART O -    INTANOJBL.E PERI  ONAL  PROPER TY I	$, DOnCI$, C	$ o1 Cl	I.  ll'IC. • Stt   !rk:lt'Ud:lon$I
Cit  f <' "' "'•"    no  tnt n o  to r.oort.wr!h..no,..,..or "rlr."1
TYPE OF INTAHGISLE	8U$'.N!  E 33  ENTITY TOWHJCH THE PROPERTYRe.ATES

PARTE -  L IA8a.lTIEa  lt.1     Cld:e• 3tt   tn  l!\ICOOl'I$)
(11'yo u 1111v, no tll l D O to r. pori,wrlbl"non..- or - ,

Nt\ME OFCREOITOR	AOORE33 OFCREOITOR

PART F-    arrutu n  .. aPEC IFIEOeo aM. H  U      (OW"""   IIIP or oor.1111n	i:)'PKo r  tiuci,_.    ,     • *" lndruotlonq
(If )"OU II-   nofl'll'llO to re-])Ol't. _. 	,"no 	ot " nt.")
8U3N E$3 ENTITY# 1	8U31NE$SENTITY# 2
NAME OF 8U31NE33  ENTITY

ORE 33  OF  8U3 1NE 33 ENTITY
PRINCIPAL	,.c:mrrrv
P03mONHELOWITHENTITY

I C,/iN MOi.£ THAN'A $'!loINTS.f\E3T IN THE 8U31 .:33 NATUREOF MY O\\ 'N5'  SH?  INTS.:SS. T
PART G - TRAINlMO
For , i.,ot  o,n un101""-1o	U!rt<Ib   oomplt !t  ;)r!D;ul eeiiu  lt.)'.niftDour:.r.utt 1,   $t <.'UOl'l 11 2..3142, F.3 .
D	I CERTIFY THAT I HAVE COMPLETED THE REQUIR ED TRAltllll G.
F ANY OF PARTS ATHROUGHGARE CONTINUED ON ASEPARATE SHEET. PLEASE CHECK HERE   D
SIGNATUREOF FILER:	CeA 2c AIIQBUEY SIGHAIUBEQHI Y

Si gnatu re :

I   1i1c en,,te,o PUtlliC X  OOUl'l!lll'III	uncle!'Cl'IH"ber4 73, ot lilC:Omt )' tn Oo«I::':..llrnll     ·.m,	FIOIICl:t 8111r		ltll$torl!'Itor you.rteor
$lie,1'!'.!;elc oml)l t beO t l'oliOW)'.Q ::'.:.ll:e.ment:

'

Pl'ti::itre<I ll'lt   CE
,Fon-,) I  tn xoorc,oce	3«-UOft 112.314$. FIOIICl:t &r.k-    $,:tnCIe,e    tn l!\ldlOJ'I$ 'lO ll'lt l'otm. Uoont:rl'f ne111 n111 t knOW!t<IOt lill'.ICIoet tl' , e.e
<1::d.   0$-    t>eretnI$ 11\re:, no oorrect.

Date Signed:

'	,,'	'

CPA•At1,:irr  ,  S1on111tt.  rt  : O :t ! t 3 eo:
, pr  / S:

WHAT TO FILE:	WHERE TO FILE:	WHEN TO FILE:

...

Alter  OOfflOlett\lil/il! p:,tt,:;Of Oil$ fOl'l!'I, IDDIU(ll np	If )'OU•tre    l t<I ll'lt fl)r/!'I DY ll'lt C0mf!li:;$10n     Wdll.lry. t lilttllOC4i«"l ur ,	. ,:;t.:,,e Olket
ston'DP :WI 11fftn9Ji :.encl  tl:tCl  ON)' ll'lt fh'.!  on Eeilu ot IIICOul'.tf S	::..01'"ot 8tc!l)ntor 111nC1	::.':Ille t m PIO'Jtt mu ::t nie vrltNt!

,. .,

,.

$1'1t"  I  CPlll(lt    t	2)  l'or tl iftD,	your 1ilMU1ill 4J:  ure fa'.Q.	fl)r/!'I b	30 dfp   ot	(I.Y.e Ofl'I    ot  lie!"1ill)l)Olrllmert

If )"Ou ·.-. no t111no to n- pott tn :, l»l1!CIJ'1.11r

111111

on.
otrltJw,/- N

or  «	t,t,,gl'l nirQ  «   tmOIO'Jfflenl.  APPOJ'bl e"
o , 11,t»m.,,.::  toe oon!rm DY	3en :,,e	tie

$t C'UOI'\.	'ri ot-"' " or  ·nr.·1n 11111:,:  «oon(S).   3-« ltCl!On$ot ll'ltcounty1n·•111tt1   y      prlOr 10	rmlilllM,, e-.-en I   ¢11111 1$    lt:Z 11'1,n
:,r,entt,re::ioe.  (If  you oo 1'.10(     ..«ny3041il)'1 3',:im e,e    Cllliil" d	r     :t:c,ointment
NOTE:	re!iklt lfl Flor!Cll,il ! le -.111'1	::..01'"«   ll'lt		=  1 t ie 111t	=	t le M UL TIPLE  Fil.I NG UJ,iN EC EU   ARY:	 OOUl'lf)'-.rtere',out:,penq    rt/il  !ta	. )	l'  QU1iJl t/tl'lQ' Olill)el'."-'.

Iii	Iii	StlrllJ offlofn or ,,-c."'-1 •tlrllJ ..,,.p,to)'fft'

A U  fldkl 1i!l<=' Wl'IO! I t $   FOl'l!'I t W:t l'I Qu:t ff;thll	ThoN'wf'IW, n t  01 Jut,t IOtltllliln ttl c	r U !  l$ DCII tttf;.ll"t<IIOme    l     COmmi:., bJ'I      nie .. 11'1ll'lt   COmml   $IO!Ion  e.    . P.O. O!'/il11,     :,tt lil'h   Wl'llCl'lll'lt.'t l'IOklt\elr i:«,	.
or 3 u	::.or«  Eie-coon .	1 $709 .   'TlJIIS-".3<:. t t , FL  3.2317-S7C'il:	le/ill RIN N)'. Soe III tn 111 o io=.ure torm {Form IF)
lilCIOrt :z :  l-'$JOl'ln l(l'.IOlf ROM ,  eu 1e1ng   E , 3 1,lil t	11,ffl'IJI 6 0  Cl/ii'.,'$«ie1il'Nl!il of!oten,p}O'Jment
Facsimil es will not be acce2ted.	200, n, 11111111 ::.e-e. FL  32303,	Fll no  1i1C E FOffll IF (Fri/illStlibementd   Fri 111n e1111
1noen, t:;)  00t    .m:1re	ll'lt! lel'O:t.lq:tCE
c.ncoct.tN  ! It   11'1     l'otm  l,:,O<='Cl'ter ' .-trl  ll'ltl'      Form I  I:	l'l tr	lfl   l'i$'  0t  lle"00'$1!01) 0l'.l
Q    ll"ft,   <Q p :,	.	o« emt:er 31, 2016 .
o(I 4 t !tfl'!Wlt 11,tt111: O lle OOf'/ your PO$J:Otl !':I, $ 1.F!Cltr, $<='t i,:111 3 of r.:lr!XOOl'I$.

1:CKIINl •l -	,1 ;ll;I T
-	n -      -.    :imt1i. r Ac

"OUC:f
Annual Stat ements of Financi al Interests are due July 1. If the ann ual  form is not file<! or  postmarked  by September 1. an automat ic fine of S2Sfor eachday late will be impo se<I, u p to a maximum penalty of$1,.SOO. Failure to fil e also can res ult in remova l frompublic office or employment (s. 11 2.3145. F.S.)

In additi on. failure to make llff'/required discl osure constitutes grounds for andmay be puni shedby one or moreof the fo ll owing : disqua lifica t ion from being on the ballot impeachment removal or suspens,on from office or employment demotion. red uc tion in s alary. reprimand, or a civil penalty not exceeding $10.000. (8. 112.317. F.S.J	
WlIO l\U JST FILE FO&\111:	
Be<tec:I p.ai:ct:.cs.unot 6EM'IQ1n a pon:cr wxr.uicnd :ne  ChCbYd a ro..rcy. ITU'!    ")'. or o,s  por.cr 9JXIM61on;:	oc s;..n a-.,      penai   rr.ec, to1W a  vac:ric,tn$UCll Ol'!ce,  t.l'lle:SS     ITU'lq:>a a:r.omey. cner ccuny rsrrur,cipa cu:iatig 1nr,pec:or. C01t1ty nqsrec, tonieu asa06ttt cnFenn6.	Of l'l'l.NClp.ll \der le60I.IW$ cooran,nr. CCU'lty IYl'l'LnCtp.¥ pcikll!Cl'I
lfflOhle(I menYJer6 01 eZOl DO.TO. corrmwon. au:nom:y, or  ccraoi	<X»P.f orlllnelp.ll	con:oldreaot:COlt1ty
CCU'ICIIUIM'lg&aewaeJIIIS(li:::tx>n, axld'lgmen1:1et&orw«y ucry or	v,m pcM1:filCISJ3'lloroen.ya la'l(Ioei.'ei0p1'le!'ll OCX1e$. CU!lrw.:ut  :l'lg,-,ICUIn::mnn,gc:orm1Wonm.ntieA;Oree.en    perrm;cnerorpa•    n  cner.tl'IJl"«:lpa ctert:			a      6(:fO)I or arq..se flOl'lCO. SOllPS FiOr'Cll Fu'd'lg OCrp:r.C1crt.    Clrea"  Q.4)81T.e CCITl'11.l1ty cocege jnQ"aefl:	11'£<1Cl exa:rfl'lEf'; SOI.rteFkWICS,J; an::,tl'8'11:la'$orb C0.ndlen1'leSOCl3'Stn6d BbCI pu'INElrg agern (rag.w'=" d IJtle} M1ng amv:rtl'J' IO 11'1'«.e atty Men a'tlieoy&;  Execu:"ROlrecur,Gcwen'lln.:ll(IEe'll::II' or	putna6eax::eecing $20.CCOt,r   IOCi1		ln'I.
0!2en6Proper;)'hSI.B'ICeOCrpcratlcrl;	a,o	8 ) OTlc:eA an:,en1)IC1)Ee$d en:De6 f.eM'igasCfllefa::t'l1ru::sal!\E
d Fbrlc1l V.tll'tm' C0!Tpe'16atlc:r JOl'l1 ng	tlOa'Cl c0cert1 apr.er at>Cr'oUl0f\.
01ire	Ra. Regional Tr.ln$pOl"'.:cen COM1s$1Cr1;	9 ) Men'Cla$d g:,vemng 00a'ISd cn.r-s$ChXI& opaa:=<1Dy a
d h tlOa'Cl 0: Tl:IJ'1lfl QJf C00Q, ll'IC.merttle!50:ire 00.T(I ct:yorotlalllllCertl2!).'
d   flCr'ICbI& Fo,  ve!a.n.In:.; ¥!ClmerTCla$d h      OIOgy>c.uay    wo10a}-efl1'Jf"Jff6"  "   CfflQed   l'leGoJemcl'a d   acaanetrrarcer 0:1.nc11...mnt'leNJi!rCtt:r Str.e1'kln:ll0g/.	exenixrrornire cnerSM1Qe S)'&tem. ax::t,c,rig i,ec,em.t,
1'heCCln'T1:.Wc:r'Jerd   EOJca:cn	d tre s-..11eeo.wor Cle!IC,J,' ¥!Cl"111lrp:l6d!Cl'I&.
EC1C3ttln. ire Boorad  Go.'ffl'ICl'S.a"'!<I1'leIOC::.l fOa'06d  Tn..6U>e6¥!Cl	11) Th! l>law'rg postlon&" eai::fl &tat.e Clep,nT8ll. OO!Tl'l1S&ICl'I
PrE'6IOel'll5d ae U1'18Y.e&..	oo.w. or COI.R:lt secrei:ary, AWsl:a'l1 a 0epl.ty secretar),' .
Per$On6 elSCte<l 10 oace n :,iy partt:a WXIM&lon (&u::n as	orec.or. AWstatt or Dep.ry	oweaor. m a'l)tnerwrgN m.r1Cp,llr.:e6,,COl.f!De6..nl  &peCl:J	, .nl Ylfpet501'1<W(ff'te<I iv:) l)CM1:f ronutycc:nrarealCXl'Ia.enperson&.,eg,.nle66d lltle. 11aVaearoJ in acn CfflQ!.lf'lleateqUrea10n:e f oon6..		12} Th! a 10Mng p:l6ltlCrl$ n eacn &tat.e oep.nrert or Cf\l..&ICl'I:
AppXn:eCI  m:-trCEn  0: ire t,[c,.t1ng	CCU'ICil6, orec.or. AsGst:trt or oep.r.,, anau O'fet AWQ3nl &noo c:c:rm1S$IOl"I a.an"tJe&.. or 00'8"IX([e,;d CCU'lt),' 11'U'fq)alty,	ave(,m :,iy Pel'6CW'I rwrg IX'-'EI'norm.-try cc:nrarea l4IOl"I w:tl (l&Q"..d, ln:Jepe!'IClel'I special ds:nc.i or C0'8 pon!C3! atl<t.11&1on: h		reg.:.,:tsdtr.e..
g:,,E111ng t100f t1 ire acct\l..&ICl'I: CCITt1'U1l)' c:o:ieg.or ptor()Cjiege		13} AsE'Slatt State A::t:me'J5. AW5IYt PUtt Cleren:JeA. Cttl11nal (l&Q".ctooa,sor	to.Ti:16  1ng:Jiepow!'f"IOerrrcroeIOC.1' cooe    o::rtllC:t an:,O'A regcnJ'CCIJl'l6Ef.. an:,a&S"Sla"'ll arrf\3'cc:rnlCI ¥!ClcM ua,ns;  toa!ISd     a::1 o::mru,r,y lel»Yeq::rrett	tes,:,na CCU'l&el, PUtt CCl.nsel, tJ MlrrE S131!	w.1ng as pl3'1 orzs:w1ng 000COS l'la'A'lg ire   pc,.o,er toieccrrrnena. c:re.u. or      ro.n&e1or a&S"st:trtCXU'l6EI10a ae	»mlS!r.CRtlW
n-.xtry 131'(1paytrg or Zl::dlg wtt1n a l)lr.:cr WXf•1SCW'I. emp ta	""'"""'9""'""
Cttzen:OUl:lyo::nrrt".?-e&.l8::fV1C3coon:tnllngc:onmrtee6.¥!Cl$1rrf3'	rt.enaenta Olrecttto:a ae rrattinezci Nlt.!t.c:
9'0I.PS wroony M-e     l)CMEt' torri¥e  01'1$to	t J'al :ll(lfKSCl'lrl htraUl'l&.11TlffelCl.or:,ry"'-'"or or zoning DOa'06.a'lCI	rcr	d   a mlltaf')'11'151.11.ilon    .s.t.3.'.,e.ln.,!o,ll)nL.ena  ra:::tny El6t.Xi161'8:1toro::mdlon6. n  raig. tre:cl'M!'l't.or ac:rgentl6\¥I'or.t i m1r.ary11'6131:aa01'16 vm1n N jl.RdttcnPEf'lSlon
or rec:rem:nt tl03'06 E'f11)CMae(I 10 ll'IIESI pen&100 or te:rem!'l'll l\l'dS		15) S-.x: ;qfr:, Eusrls  Ma"laget5.  Rf'8'1Cle artl ACO:UT.ng or oe,:ern1ne encr.:ement ill a .rn::u11d pe!'l6lons or coa rearem:nt			Pfflemelor:.cm.Gr.rltCOOrdln.T.M;, ¥!Cl pucl'l.16lngagerrl5 """""-	( reg.TIJS d tt.ie) Ydlhp:,.o,er10 rrok!ap.irtfl.lSe	S3l.00l.
ru.ec, rrarca o:a 1oca g:wennent 00.TIJ wo 1&	16} Th!  l'alCMl'lg poemn in	cr.n:::n agencie&: eai::fl
rec,toniea SIX9T8lldl'la'Cblrt.er5:$0)'ire'4)POtt"rgal.ftlr.l)'  emp10yee(ONf Ila'\true oyean	. cen::ai. i,ec,em.t,
er:neenorigies,si.cion. orall\YICe,orie60lr.cnaetre 003'l1	orQTl131"po6t..on&an<legl&lar:tw      O)'tneprKIClng
Per$On6 nc:fdlng ¥ty  d   trae p:l6ltlCl'I$ n kX:a1	omoer or m:r l'IOuSe}: <l'ltl eacn eff'90lff or tr-= COn'l11Wen on
rna,or. rorqorct:y nnnaga:ctfel'a::t11	ornl'Q"!Ce    E INC6.	
I NST R UCTI ONS FOR COM PLETIN G FOR M 1:	
INTRODUCTORY INFORMATION (Top of   Form):  If   yot.r
n.:tme. m.,ilni gaddress. pt.tllic agency. andpositionarealready
printed on thefionn donotneed toprovide th&infom\ltion
unlessit should be     anged. Tochangeanyd  this informatoi n,	PUBLIC  RECORD:  The  disclosure  fonn and  ewrything attached to itis iJiJ:Jlic record. Ynur Sorfal Sm,
ims unJott.oXyoirued  a     Y2!:! should redact it from	listed
areanacweorformercrlioeror	
\Oaffle the correct inlionrotion on the fonri.  and contact you:	on 119.071. F.S•.  whose home .:tdctessis exef11:l( fro m
3gea	fia.%-  1'rii dsdi:isutf C!:!!.!afmtl::!   You can f:ndlf:. disdostn. the Cornmssion	m.,inbin that confidefliafity a"	
coordinatoron the Commissionon Ethi:swebsite: wmu     ic-s.     YPU'idlhOJit iJMittffite:QHf'il
st.lte.fl.m.	DISCLOSUREPERIOD:  The tax  ye..1r for most individu.is NAME  OF  AGENCY:  The narre of   the gow,rrwnental unit    is the   calendar ye;s(J.n.ory1 h	Oecentler31). If that youserwor served, bywhichyouareor wereemployed. is the case for you. then your fnancill iniEf'eSts should be
or forwhichyouarea candidate.	reported forthe calencbr ye..1r 2016:check that box. tf you file
OFFICE OR POSm ON HELO OR SOUGHT:  The til e of   yot.rIRStlX ren.mbased ona taxye;sthat is not thecalendar
the cdice or position )'ClU hold, are seekins, orheld dlri, lhe   -ye;x, you shoud specify the dates of your tax	in this
disclosure	fYffiirfYPIIbale:siooe ffij¢fl1Q9Sifgn, I you  on	of the formand check the api:ropiate box. This 6 the	
area candidatefor cdice or area newemliOYee orappointee.
check the approi:ri-te box.	d sclosureperiocr' for your report.	
ct l'Ol!Wt •	......,,.,    . -,.-.    -	n-    -.:,ar1o.c	P AG  E   )

      L;\ NNER OF CALCIJ"LATING REPORTABLE Il' fIT REST
Filers have  the option of reportni g b.lsed on f:lbetlhresholds that  are comparative (usually, based on percentage values) m thresholdsthatarebased on absolute dol.:tr v.altes. The instructions on the fiolowing p.,sspecificaly descrbethe different threshold.sCheck lhe  box that reflectslhe choiceyouhave m.1de. YmI mt,s 11se!he rvre qt ttu::sbstd yg I ba,reGb9sfo fix MOO NIT  nfJbe fuan Inother words. if you choose10reportbased on absol.rle dol.:tr value thresholds. youcannot use a percent.lge thresholdon any partd the fonn.
IF YOU HAVE CHOSEN DOLLU VALUE THRESHOLDS	
THE	FOLLO\VING	INSTRUCTIONS	APPLY	

PART A - PRIMARY SOURCES Of INCOME
(RecpJredby &. 11 2.3 14S(3Xb)1. F.S.)

1nc:cmeo.,nng!he Cf:scl09Jre penoo.'ltlt.lao notn..we kl cl:scto6e11e

cs   PartAl&l'r.enoedIO  th=<BCfOISl.ffOf,CU nclpall601.ftff

il	enlny (il	. ll C, l!i1e-apJnnersrip,
:r	elOnNp, ion  ved:ln.trust.rnn . ete..<IOJ',JouuneS& ri FIOrlclilX

pel'OCI tomltlalDl.$IMES enl3Jt .

a{2,)  Yooreoel'iedmore	$5.000 ot 'JOIS grosi11	o-.n,gcne

m:, ,,mm91'  rorneCf9":b'ftl aoawunm nmmn  mcp;rntem m:rn  , ,ps 1nte"e61$anagrcubXlmee	INw  INKI\Ck1!i, !NO    ror ll'!at

cffs:MOQ	Jp	Wffiyour

IDte QQffflM(ftU"!1K'llCf:9lltffiYPII meVlf§	T 1nc:.cme
filXIU&e nee<:l no! DeCf:sc:to6elt ro.twec.If Nre 115pm1nc:.cme

tullE$5enmy your.-xi&t1st emy    S011Ce or  nomo  e to ltle01.1m e,  i  en

kl you a,a ,cu &pour.etom propaty youc,,tnprn,y (6UCII as rn«Kt  v.Nctl mffele-a ttl'lloo:uie ousries.s entt"/$ gu., r.icome (compuli<I on
a	trorna D.3'& acc:otr1l or QOCkS}. you fil'IOIJCI Ol6d06e t'le   o. '"6  ¥ ot1M OUfnl eESenln)'$ tn06I reee-..:ly OO'!lple!e-a n.cr )?Jr). cne

$0Urted :flatlnCcm!If ne:icceeoeatt O'rle&nole.l
Rease tot 1nn, Plr1or!he rorm w nane. aoare6$.¥IGpr1nc1pa1 OJ6rle65actMl'j01each$Oll'Oe   d    yourin:::.ttrewNCfl	$2.500 csgossU'ICCll'rMe	oy )OU 1n yoisov.n ,ane or oy ;Jtr.Y Oll1Ef pmon roryour U6ecs oerd.

,n:::cm.

"Q'oss 1nc:cme· meYI$ !he same a& n ct1es 11:lr riccrne tax jXll'J)06K. e\'erlIf theIncome 16 no! actu.11y taxal:>le, 6UCha6 rn«Kl Cl'I  W--tfff 00l'IClS.  e6	hef\JOe: c:orrp.ns.r.on ror &M1CK.

Ex-

lfM'I OU6rle6$,  g.¥1'1& ttm   p,opefty Clellng6. rr.aest. rent&.
dV!ctena6, pension&, IRA.<IS:l'IDU:on&.60C1a1	.  (ls:!101.r.W snare
CS p	9'066 rK:Orre, a'ICla:1m::iny, NnctCh]CIQl)pCWt.

-   If  you were empl0IJe<l oy a COl'll)a'l.y tl\11 m.vnJt3clt.tK
CCl'll)lieA aia  teOeL'V8' m:n  Nn  S2.SOO, IQ  :rie name or Ole
CCl'll)a'TY. , 115aacreo&.a'ICl11$ pr.ncip,.110u&1nessactMly(COfTl)lt,Ef
ffi3'11ta  C, .IMng ),.

$01.tenilCICl!@ES, ancicne&01.ten pTq?,31OU'11e,io.tJ.
EXamplei:
-  You.n IN SOie pn:ipnexr« a crya u nrg 01.1s:neES, trom WtUCn
)'OCI recenomen too  $5,000. i: onryoneCUSIOme.r a Ltlto mi f'en:JI
y.   po¥lteCI	111an 1 o,r,or yorx«y cte.wngouuneS&, YoU
m  ust  I);!   tieotUte Ufll'Orr.'I rmll	11$ aoclreQ..andts
pMttpal	(urtrorrnrernn
- You a x,,r,pJnner n a pannersril) lfla!<JNOS asl'lqlP}"gmat aria yoLt	1100- .e ei:eee-aeo 111e aoo,,,e IJlr'KnolS . Ustexn leflal'IIOllMm al		l'XIC'l!Oll'I 10'1/ootlhepJnnenti:p'$gro6,$
l'IOmO  e aoa111e  terianrs ilCICl!@ESancipinousries.sad:l\tty.
PART C - REALPROPERTY
(ReqlJl'E<IDy&.112.31     3)CD)3,  f.S  ]
1n       pan.1st IN beatl)ner<1esa,ptonor a11re.JI propeny1n FIOrl4a
II ritUCflyouov.nea	(1( lnClnt!:!'y a:any ome 41.Rlg IN OISCb61.n

-    It you'Awea pamer1na ra• llrmanaycu  <1161J'1:>1.G\E snare  pen:,o n e:rees,or 51'  or  l!'le	,   'alui> nr, n omwumro11<1

dpannfflJlll gO&SJnCCm!ex	S2.S00. 1161- me nareor1J1e 

o.n,

trm.r.sact::fe66, anan, prtnctp,.11Dua"neaactr.tty(Pr.t::.':ceor13"1)',1.

P ffll"nre, :nm,m:,ons anx\' YJ1'9'1 r.z::u If w:1rer:e lm!KIIe

-    If  )OU'Awetre  &Oleproptletor01area-

gmDua"nea anaycu

1ne1rect<Mf!ersfll) lb::b:I=& stttonirittere)OJ area oecie-1e1aryo:a

«

Nt   tu:	1M propeny, asw    el as s t-.&r.ioni Wl\ffi>)'OCl<MT1n-aell'!an

g'065riccrne trommeousrtK5	$2.500. 1151:me,aned
tieCXJ&r1es&. lt6 aoare6S. aia , n pnnq,ai tiu51rte6S actM'/ (l"E".31 51' Ola partnen;fll)	lllat<Mfli1M property. The Ya:!Je OllM

5.¥e&).
- It yourecel\ECI hCCl'ne ttm Jm'e&:mem, In 6tock5art100l'ICI&.
"' f:illD msr.Mtd mn;wny trtm'AttCh you OEmEa men run

pq:iet1y m'iff oe e1eterr	X1e-a r,,ttTce m:ii&t rtt.eG,Y ilS-$eS$eCI va-R 1bf w
p;rpJEes. 11ee aDSenceOlamcn onent	u .
TheIOC¥Jon «	or IN  propet't/$hOUX10o?s Uff'.clet"--tto enatie
e'Ch:I kl0t5a:tieb'm10kteNlf)'b prq:,,;tty. Asin el aClttffi5flOCICI

S2,SOO. Dono1 aggregar.e a lld your rr-.e	income.

Co?ose<,I,

al &S.

If morellanS2,SOOor}CU"9n:u hCOme'Aa&g.1"nttwn rie saie d    p-oper;y{not        h       i,et1ngpnce). IQ  a&a $CU'Ce,dtnci::m!IJle '	,ane., aoare&S aria pmcip,31 0u&1ness aaMty. If Ole
5	kJefltl!)' 15 tl'lkrtONn. w::f\ a&'A	6e0.11De5 116:-e<I onaa excnange are$Okitrr0l.ql a 0fOkaage trrn me $OtfO!ed hCOme 5l'ICIJICl oenmaa&"$a':e ot (nameoro::mP31Y) 5t0<:•l. ror exam .
It mn run S2.SOOd your 9ro6$U'ICClm< wa& 1n :Jierorm rS
rita'Kttromone  part1::U1ar fnlnelaln6!0JJ::'1n (	rn«Kt

PART 0 -   INTANGBJ LEP£RSONAL PROPERTY
(Req:.lred oys. 112.3l4! (3)(b)3, F.S.)

,toes,.

oe,atoe ¥Yf ntangbe p,;tlCNi propEJty M :,. any tr-"-'-e<11.fVlg cne OW061.1te oenoa. •'a& ri'Ol'VI more Ulan $10,000 ar.iJ SGte re ousrnes.s EC.:'f)' to 'Cflx:n IN propet'T)' relnO. 11tlngbe l)fflOllaJ propen)'
nig  i sucnas casnenrunc.i	oona&. eafflc.D=& ot<1.pos,l	Cle
ie	. r::.a-ests n tu	. oenettui it.	ts 11 trusts.	o.'tO
you,   anoRel18"-"-H-'< ap:on Progm'3   l'OROP) a,:xou"lts, 111e kr!4a

fl'Orn3 1CD'&, a,::xxu'115, etc., at NI:lnQT.WOf')l, Iii   Ile minedIJle
11$actn65, a'l(l11$p'lnq,al eu&rne6$actMl)'.
PART 8 - SECONDARYSOURCESOFINCOME
(Reqllreaby&.112.31'5( 3XD)2.fS.   ]

Pfep,iO COilege Plan. ;n, o.r.J acoouits. intr.g:Ole p,;tl(Ni prq,etty" a:$0 llellele, lrleW----El'lt onxtJCt:s fie))IIIRAs, IJn)	-:s. ano oe l'tm3COl e 11\'KlmMI Pln    NOi! ltlat1M p,ooutt COl'lllIn
aIJn)	IRA ocb     fl::lrl(la COl»ge ln'ifflJ'nent  Plan15'JOIS
asr.K-oo:oe a:::oocrt oc p1ar1 Tr#lgi a e alJIOmOl)l ei ano
you a.n . ie-• er y. a"JO pam::ng, :n not r0ng11:,i. properrJ. lfltn1

Thli part1&ntenoeo10reovreIN   a,	0m1  .f:rcw.«"'---ffl..e11er-,:s,
a"'IO	sonie, ot inoome toIXISl'.ff5E6 II • tllttl  you OllTl an lt'lfflil

rm:ing tohe sre   OUS:neESax::ty may oeant9n-a;t1f°eU'!'tple. cos
ar.iJ sa·,Yigi acooc.rits wll'I IN s.rie oartk.PTopet't)' (111,fled tenants r1f

!lIf om!'lXreoomng1 nm::::  ro  ,..ws rm That lf>CI« 11	ll'OJCI   b      M tf'K/   (1( ai pmlenM!I$Wlbn:,corsi.r.tYOrSNpSflOUlJCo? Y&!Je,O at

Ile reporii-011'1 PanA "Prtmaryso-.rt:ie, 011noome·. r t meetsee rep,:ro:ng
ttv'Kholl. Your.11 r..o:naven j11'1l"..gtoreponl.lf11eSE,i <1i.rv:g ee  01Sei:16ure
pe,tOC:I
(1) YOOOllned (e.tnefO rectrJCfWIClredf)'WIUte b'moranequtatlle Of
ClaJ lfWeS() more IIWI 51'  otUte total  etsocCJfllb l s:ock ot

1 Ct:/%.  Theva.:teotai.ase-avent1er,1r1eYENCI.'$p-e5emvatRr.'#lui cne
ieaseresitruill(a numt>erto.r'ICI onoe 1u seOOCmtJ em

PAGE£

IEMor 001tar va1ue Tnr• noias ris tructlonaJ.

rea to cermy on

m rorrn uutyouMVe mensucn1ra1nrng.

es. fJJly companlei, a-nn., cooro1e-o  ti,   trie PuNc   d   E"11C6 10t'Pl.l>IICOlloer6 ¥1(1EmplO'/E'K.  anot'le pltl lC recoos

sa-1.ceCOmmlWOn; anCIEC.:'!le$gr,:eoahXIU5e to operall>r,,etll'IEra   aoaopen met-:-ngs iawsd  the &tate..'1'01.1 are

oty a aC(U'ltygoyenr

compar,IK; Cfed!Z you are reqllreo to comp1e-ie rour l'IOIA of e-'JllC6 tra1n1ng wN<:ll

inon,s:m  a1loan ccmpaniei: alOOI\Ole oe.lkenr.ef:f P<fW!luDJeJ   aacnsse, AIUcle11. s ec: on 8 orme F10r..oaCOl'l5tl!IJ':on.the  coae

wagen-.g

r.-:tet'al)'  enaieieo oanu : stall> aro  erai U'Mg& a10 10an a.60Cir.01'16-:   WVIOe t1eg3n bel'Ore Marcil 31 or ine yell't>r "'111Cfl you are ffJt)g.

cemetery oorrp.ri es.: 11s1.R1ce companie:i

11you .ft  a COn&lltU:onai or eiectea m.t!IC(p.1	wl'IO&e

Re <,Pe, <t DuSne e,«wen-a ., 1211, aiseb6i.n ltleu:»: stal'a-.o

PARTG - lRANl<GCERTR:ATKlN
(Req!JreCIOf&.112..314.2, f,S .J

PARTF- tfTERESTS If SPECIFED BUSIESSES
(R.eq;.lreoO'/6. 112.314.5{S), F.S

-co-mala""¥'$Jare p:noym  e«	ano&e\'a'al)'lutle.11tet11 1&nix  a   oescrtie tie r..r.n oryos ntecKt

(Cl'ldnge!lflaDlt'J.

. ISi Ute nma  e OfUte ousries.s, ts  aixrm a10

at(Mf),' andIre poS!ttln rit!CwI  .tnIre  ousaneS&(II'a'Y1). i:

. snry, ora-«tSE<enaP'l)m1™:ify note. nyouarea yoo<Mn[eCI)tl'lOle too a51' 111eresi:h VieOU6J'le&s.. nalCateox Dtrl ia

"CO'Xlngentldty, "1  oneIIU!•   0e0:)me an	la0Uf/ {X'j'f wttenooe Ule5e tYPf:6«

Ot menMl.rte E'ter!IS OChSOt l'all to oc«r, $UCI\ asWf!ffi; 'JOOare latl?e pmcl)Ji

on'Jasa g

ir you ria.-e or ritiCI,ueri a pow:in a O'N merest n one a

11,inneepolcy(Jft(ItolltE!r:.tr.f)¥'Jf otIS&Uilflt:e.Oto::inangem l at!Jte s..A

t cw ano /"EQI llv.alt"'....at anytrc' .E!l.fVlgfie CliS::ao&Rpet;OC,I ill Olkef, <lreelOCpamer, proprlelot or

aoooums..taxe,o.-eo(lrie,, f'e-3:iceo10a1uogment).1nC1et11!:'0l'leS&ooar e   agl'!l foUlerinan afff k!et't t	soierytcr seMce otproce6S).

ieasepaymer,ns '1XIarena1re<p-e010 ISi IN r.o;tt oririefcirr.'Iroreaeri« cnesetype,otouuneE&e,t:lfritutn'JOO:n . a wa-e a:

orll'ff oect 'l'bu<10 no1riM to 01Seb6 e

unp:,o

ll'leCD>i::to&repa».,n-ae Ulin 5% OflM totala.	orcapbiv.oct;d,

Oflrie	or	, enlb:>, 1-.:te-a:lhle.YC,-Jaom    ust	ell> N&p,yt

ust1M nma  e a-.oao.:lrff& Oleaencre<ltor to ,.non,)'OCIOll'E'O more  IIOl!ed:IY n N>1bffllora,   eq1Jtab1J?oroene!kli 111eie6t) at ¥1J b"'--e<li.rT..g

$ 1 0.COO:,. any trne ai.rtng trie<11S::io8n penoa. The amoum«b

laNtf Ol a Ye01a:e1ease"  I,N mu   orll1f  pa.t 1),3)1"--K'.:6 ana al

llter'KI h. lYl\@l¥'1f otceit.anpostonw, :tnttTcE! typeSOl16

aD0\'1.: Younu! maMlfl <l'.SC508nll )1)1.1OMlOtOllneG{etMr<Ired!'/or

Olse506o? ft lfllS p.J't the l'aclIn.al)'OUOlltieO<lln9Ute OISC:b61M pet1)0all

PARTE - UA8I.JTlES
(R.eq;.lreo0-, , . 112.314.5(3}(1))4. F.S.)

PARTA -   PRIMARYSOURCES OF INCOME
(Reqllre<:IDys. 112.314S{3Xa)1. F.S.]

1nves:m:n1tnc::ome.

moreinaos,;,d yors ssricome. Donot

ea11oryour

SOl.lteSorlnc::ome CM!ng !he ([SC1061.ff pef10CI.. You<IOnot IU'o'e IO

Pan A 16 lntel"IOeel to reqllre me (1$CICl6lff d 'PJI pr!ncfp.31

- II'moretr8'Is,;,of your gO&Sricomewa& 9Jr'Ittm tnes.¥e

r:fttlfeme'1tDA!irn 2i ,oppme we:YM '1na xo11oe=::SJ nor1w m,r

o;' propeft)'{no!f.lJ61,  :fie6Eihl   9  pnce), ISla&aSOl.ro=d  1nc:.ome.

the

name.

a'ICI

OU&lrte&S acuwy.

ssm1tP   liMY resetvea ttnro fifMlm4     me QQflPQ011\ w,:,m M   llrffi

116: ea on ai   en:tunge are soia tl'V'0u1' a  crourage :rm. me

t1 tne pm:Mser& ICIMffly16 t.n.nown.. &uCI\ a&  Yofta'e &eeultt!K

eaicuacrng your gro&Sln<:.Cl!Tetor me<1:sc.1061.ffpe1100. The inoome01

you to n1e in1& 1Xm. CIUl tN6 arrol.l'll Shol.lCI be lncfUCleCI Yof'len

YOU'spouse neeanot be Cll&o®6eltIICIWe'IW, If lhefe16IOlntlnc::omeIO

60UC'Ce o:incomeSfW:l!.IICI oe 115ted a& "$.lieor(rL3/Tle o:compaiy)
6!0CS.." 1t)re.xatll)le.

ricomewnencaron:-ngyour 9f'06SlnCOme ana<1SCl06e :rie S01.ro= o;­

<MGMO:Sttomao..vi1aocounl or s»c1&). you 6hOuCI1nc1uae •d m.11

youanayOU'spouse trornpropertyyou o-""'JOlntly (sucfia& rnerutor

ln;.ereQ :torn one p,aUCIJ'a fha'ICl3! ln&l:ftUt!on ( aggreg_1tlng

- II'm:n :riai 5%d your gro&S tnoorne W.:t6 1n me t>rm d

tt'lltincomerrnexceeaec, meO'rle $Nlld

Mme d :rie ln6 n.ltS
"""1\y.

interest rrom • ccrs. acccuns. etc. at f'lat rt5tr.t.aon w me

ana ltS prtncfp,31 OU&lne&S

PCe:tse11&1ri ms p.3r1orine rormmename. aa

d megro&Sricome	oYyou in )'01.1'CMnnameor oy any Olher

Du&fness adM!)'ore3Cfl S01.1te oryW' 1n<:.01TMe wNcnexceeoea 5'%

pe1500ror )Oll' oenefttorU&edi.ringtne<1:sct061.n penoo.

_,

anopr!ncfp.31

PARTB - SECONDARY SOURCES Of INCOME
(Reqlrleooy s. 112.3145(3Xa)2.F.S.J

puJ)06K. e1,-en rrine 1nOOme16not adU3I)'1a:xa01e. sucn a& rneres1 Clents, anaoua 60Uroes orrK:Orne to CIJ6r!EUK ri v.f1ICllyou CMn

"Gr'o6$ hCOme' tneY1S me "3tne a& n aoeis ror 1n<:.01TMe tax

TI1Span16 rnencte<lIOreqllreIle Cll6oef06l.ffd orcus:omer&.

ricome:torn Du&fness, gain&:rom proper;y Cleli'.rig&. ll'ltafft rents. d ricome 9\0IJCIbe reponea In Pat A. "Pl1may SCU'cK d Income..•

on

CIOl'I06. Exa 111)1K tK:kJCle: COf11)en&aaon ror &eMCeS. aoln:ereol n I§ npri'P£recorrng nppme ttrm,emngm Thal11na

<IVIGMO:S.  pen&JOn&,   IRA Cl6: 110Utlon.S. SOClal  securtty,  <lstrllu:'le   ir nmeetsthe  reportr)g trw'Kf'Od YouWII /!Ollm'eatytnlngIOraport
Sl\nd	grossricome. ana  1mony. CIUlnotcr111a S'-l)pCWt.   Uflles5 Cllfl'lg N   Cll&CI061.ff palO(!:
(1) You ov.nea ( e!ther <Slrec':)' or lnClftCIJy 1n the rorm o;- ao

-  rr you wae em

oy a corrpany 11\11 IT\YIUl'ad:Ures

eqtAt¥lle orcienencw	men 1'lan5%d Ile 10tal asse':6or

the  company, ISl the  rwned   Olecompany. , r.& ao:n&$. ana r.&
p nru:1p.310u&fness	(compu:fr maooracturtng).

c:.ompulel$aid recEM<Imo,eNn5%o;")OI.I'!J06$lnc::ome trorn

1mnea pamaaiip.

C"4)IUI6tOCIora CIJ6r!EQ entl!y(a corporation. p,.-¥tnerffip. LLC.

CIOr)gOU&lne. ssri Ror1cU;}; ana.

p. JOhl \Enture. rust. nrm. etc..

ofpannffffip gO&S1nc:cme exceeo.,a 5%orycu gross1nc:.om.e.

- rr youwerea par.netri a &.rM trm ana your <1&ll'l:ll.(!WSl\n

bu&ril:Q enmy:and ,

t2l )00 recel\ECImore Nn 10%d YOU'906'!nCOme l'IOm llat

then 1151 Ile Mme Of Che nrm. 115 ao:n&$. aid !IS pr!ncfp.31

OU61ne&Sac:uvey (PractlCe Of law).
- rr you wge the SOie: propn_a:, r d a retailQllt CIJ6rll:$$ ¥1(1 your9"06Sinoomerromthe bu&lnessexteeaed5%01your total 9ro6SIncome. ISl me rwneor:rieDu&fne&&.It&act:nu. aidl-:& p Mnclp.310u&fne6S	( 19 U K ).

( 3 )    You reoet.'eCI m:n  in:.,$1,500 In 9"06S!nOOl'Te rrom llat
CIJ6rll:$$ enmy.
I f your ln:eCKIS ana gro6Sln<:.CIITMe exceeoea inese thre611010:S. then

ror rut CIJ6rll:$$ enmy youmust IQ e'lovtr'/ SOll'Ced rK:Orne tome

0u&ff'le$$ !:IT.tty YoftlCl'l

10% 01the CIJ6r!EQ enmy,9"'"

- rr you reoer.-ea 1nc:.ome. ttm 1n ves,n.entsIn 6IOCl.6 ¥1(1

oona&.  1161 f-ll7l IMMOl@I m:nmnv tom    •ttc:h  you oenvea

completed l6cal )'ear). tne 60Un::.·e,
DuS"ness adM!).'

hCOme(compu- on tneDaSrsor:rieOU&lrte&S en::tty's mootrec:«lt7)'

ana the S01.ro='$

IF YOU HAVE CHOSEN COMPARATIVE (PERCENTAGE) THRESHOLDS THE FOLLOWING INSTRUCTIONS APPLY
Ct l'Ol!Wt  • 	,., .     1. -,.-o  -	ft-      -.:C, :rlo.C

Ex'""""

)00 .n 111e $Ole: p,opneior ora ary cteairigD.Qless, 1t0m YoflCh you tecEM<I mcwe trWI 10% d ycu 9'06& ln:xms---an atn0tl'l!N W-36mn 11\3'1S 1,SOO. lt 0tf'/onecus:omer. a trttonn rental COf11)at'I),' prcMOe(I more Olan 10% CS )'<U <Yy C"eYllng Du&nl e&$. youmust11s., tne  naTEortne tnronnta'llal c::orrpan.y, r.saoarea. anaIt& pnnc:1pa11businessaclMl'f {IXll::>rmmr! al&).
)00  area 20% par..n«in a P	Nt OWKl6 a &rq)plng nu1anoycu partnerffipincome exce-eoea tne1Jn61101Cl6 lloleO aDCM:-. YouQ'l0IJO ll&t eacnoenamd N> m3I 'flatprovlGE<Imore tr8'I 10% or 111e pann.EAN·p, 9'066 ric:orne. ana 111e ia\31'1t's
al3are&4 anClp,rq,alClu6r'IEU ac'!Wy.
PART C - REALPROPERTY
(Requh<l o, y . 112.3 14S(3Xa)3. f..S.J

, u,

nomes rr)2uoenveincomerrommem.

1n uu pat,11s., tne iocar:ron oroesoip:onora111'!31proper;y in Fionaa1n •twlyou o-.viea <1recay orrur iecuy at atiy timeouting tne al&CfOISUre pef10(I ri exoea d 5% d N> proper;f&V¥ue. l:m.l areoat® fMm wm ,r revoecrCfft Y9!t@ M i1'lY va;mpn

PART E - LIABll mES
(Req!Jreatl'j&..112..314S(JXDJ4. F.S .]

•ment

uu tr1enaTE<1'1(1aoareaO(eacncrecnortowrM:myoucr.'te<l¥r.Y amotn1:flat. al aiy M'M.cu,ng!he Ol&Ci061.ff per!OCI, exceeoea yW' ne:wom.You arenot  reqllre(IIOI151 l'leam0U'll01any<JeO'!or yW' ne1 wortrLYouoonot na-1eto Ol&CiO&e:cnanc.3'tlano
a0XU'l!5,  taxesowea( Lri l:$$	to a Jl.llgment).h  aeritdll:$$
on a I.:-e riairanc:.e pooc:y owea to me o::mpaiy or 16WY!Ce, or CCl'tlff'IQa'llnaoo111e&. A ·-con::rnga-n naoolt)"' 1& one 11\l! v,111 oecome an acfu3I t.al:>llty Otfy	one or more l'Ubn	occur or tai l
to oca.r.WClla&'Aftefe youarenaixeonry a&a	. surety. or enacwser on a pron1&5Cr)' no.-c. II'youae a "-CC>-m.1le.f <1'1(1are JOlntCy ta1:11e or J« n'Jy ana 'Y I1301e, ti 15 no! a contrngent 1a1:111t1,
carci.ta:on&;: T0 oetermri e •ne1r1er IN <JeO'! exoee05 yW' ne! t.w0ftrl, total al or )'OIi" 11.Glltii?& ( lnd ldng prom&$Ot)' no:es, mortgage&, crec1t eara oeot5. f.UOSJnen:& ag.¥n&1 you. e.le.). The
atn0U'lfd   meaaD"rn:y d   a vffide1ease15 eN> wrn  or anypast4Je
pa)Tnetll5  ano a1I   u,pa:c,	lease p.3ym:,n1&.. S\rJtract

eaicwateaaDCweror Pat o. Thl515ycu -net•'Orth.·

eacncretltOI'

tne arn total oryour 1a1:11m es trorn tne vaiue or  °y''our asset& as

1na1rect  owne1$Np lnr:i\lCleS S1!U3!Jon& wnere yo u are a
oenenaary ora tn.1$'! tt'l3t CM1'l6 !he  propeny, aswella, 6l!lJ3tlOn&

to•nomyW'oe.01exceeoea IN&amotn1trt.e&Sn15oneor!he typK
d  ln(leD:eene&& l&te<lh    thealXwt'(creclt eatt1<1'1(1 	I

wnere youownmore tnan S%or a partn.EANp or corpora-JOn :riat

ment acccu'll5, e:e.\.JOlnt tal:llllle& •ttn ocner&b WNMyou
n "JOhUY ana 'Y	bol e.· mearmg1nat you nuy tie 11aoie ror

011"16 theproperty. The Yau!d U'lepropeft'f 11\1)'DeoetennrteODy tne ITl06t recentty		v».ieror tax ptl'p06e$,, 1nme a0ISel'ICe ora more CUTa'll	-
The IOC3t!Onor oescrtp-JOnortnepropeft)'&hOtila De61.t':.Clentto e nat>le an,orteYoflOIOOk&at Ile tirmto	meproper;y. A streel at>::l'ff&Ul0l.t<Ioeuseo.11'oneexl6.:&.
PART0 - NTAHGIBlEPERSONALPROPERTY
(Re<pe,a Dy&. 112 .3 1 45(3J(a)3, f ..S.J
DeiClloe atiy 1n;.ang::t>1e  Pffl(ll'lal proper;y U'l3I. at   any  mi.e a1.11ngme<l6CI06tn pa100.W36 wortnmore tnan10%d  ycu1or.a1 aS&efs. <l'ltlsr.a:e!he 0u6fnes& en:ry10 Y"1ll:ll tnepropeny reia:eo.. 1nta1g101e per&Onaiproper;y lnCfUOK tr.095 wena& ca&non l\3'IO. 6t0Ck$.  DOnCI&. oerfflCa:es or oeposrt, venir:::e lease&. rtta'Kt51n
ou:srnEUe&. oene!clai1merests1n tru5<&, money oweo you.oererreo

me

Re-:remern Optron Progr.rn (DR.O?} acc:011'115, the Fioncsa Prepare, COiegePl¥\, <1'1(1DY!k account&..lnl angll:>le Pff$0flalpropeft)' a&O ln,CllJOKJnYestment proclJC'l5ne«lIn IRM, Drok.erageacccu'll5, ¥1(1 theAorlOaCOiegehv e&lml:f'llP131'l Note11\l!    proclJC'Icc,;ca.\neO'
1na orokaage aocotl'll, L"lA.or1'lefiOr1G.lCOiiege lnveotmentPlan 1, your a&Se:-no( meaccountorplan n&elf. Thng& IlleatllDm:IOOe& ano l'IOu6e& you own. Jewelry, ana p,Yrr.hg& ae not rQ'lg!Dle
pn:,pef!)'. htalgltlle& refa".W)g 10h   &.1me Du&rll:$$ entity may De

!Wier your part ormewMleor 1r1e oo:lg.rt!On. UICK.f(I De hCkJClea ri
yW'c.3lCtll3t!On5at100% or 1r1e atn::IUl'l1. 0WEO.
EXatll)le: You owes1s.oooto a 0a11 1l)r s:ll»nt10.V!&,, ss .ooo ror Clalt eara CleDt$,, ana seo.ooo (wt.n fil)Ollse) to a anoI03l'Irora ronel'l10l'Tglge.. Your nome( owne. a oyyou ana your gpcllJse) 15 wortn sso.oooana yW' OCha" proper;y1, wom
$20.000. Since your net worm 15 S2.0,00 D (S100,000 ntnu&
$80.000}. you n1.15'! tepo,t «r, !he naTE <1'1(1 aacn&&d !he
&a\{ng& <1'1(1IOan..
PART F- MERESTS _. SPECFEO BUSt.lESSES
(ReQtJreaoys..112..3145. f..S.J
The t)pe& orDu&rle6Se& co'ME'CIIn w, <f&CtOQR!nCfllCle: u.e
ana teoeral)' ctmerea 0a1u: 0<ate ano rec&K.1 &l'llng, ano 10,3'1
a&SOC:la:ons; oem=.ay compa,ie&: ln&l.r.l'ICe COl'll)at1e&: mongage COl'l1)anie&: cretlt  lri"On&; 511\311ioa n compa,ie&: alCOl'IOIICDevaaQe ICEn&ee&:	wagMngcompa,ie&, u::nycompa,ie&. entnfK COf'IJo:lea ti'/ tt'le PllllCseMce C0mrt1&&10n;; ano enlfflK pte<Ia trancrise cooper.moye1INf a Cit)'oraCOlt'IT)' govanment
Dl5clo&e In  tN& part h	l'act: trill )'OU OWK!eCI <Ulng IN
<15CI06tnpenoa an rtr«Ktri , orhe{(!anyd  cena1n po&l!!On5YM:l'I,
me <)PKd 0u W!e6Se&l&teaaDOYe. You arereqtArea tomJke tnJ&

......

: ror exatll)le. CO'& ana&.3Vhg:Sacccuns•ttnme&.Yl'le

<16CI06tn If you <M1l or own.ea (ellher <1re<:Gy or 1n<1recay in IN
rorm os.ri ec,J'.Utlle or oenetlcl3I Interest) al aiy tme cu,ng IN

C31c::t.13t!on5: To oer.ermri e •nemer tne rQ'lg!Dle property e.lCOeEO& 1 0% or yois iOlal a:5$E'l5, total 1r1e taar nurtet va:ued a1 or  vcu   .-el5 (lncfld  ng reai proper?).'  tntang11Ie orooem-. ano t.Ylg:Dle Pff&Of\31 property WC11 as ,e weiry. un rare.: etc.).. V"1en making tN5   c&CIJ'a"JOn. oo not   arinct ¥LY I1301l ': e& (ctern&)  :flat may rel3te to	propaty. Mll!lpty eN> total ngi.noy 10%10 amw

accoraing

a t me <16CI06tn tnre&l'Mld Lm onry :rie 11'1".anQl>le& trille.xceec, thl51Jn61101Cl at1'lCUII. The vakleor a le3&eO venlci:e15!he veNC!e'& pre&ent \'alUe mnu& me lease tKIOUal (a nurcer wNcn ca, tie rOU'ICl on :Jie lease o:xument). Pf'Ol)M'f :!l\l115 onry JOlnlJy 01wIe<1
Pn,pe.ft)' SIOUICl oe Value.<l	to ti e  peroefllaged  your )Olnt
O"Mlatil\lp. Property OWK!E<I a& 1&	oy me err:rei:y or as )Olnt te.nan&wnnns,nOf&tNvor&Np &l'nllClDe V"auec:Iat 1 00%..NOned li:: aon&or i:N>vaiueotme proper;ynave100ect&Ct06EOon

EXonl)le:You<M1l 50% d 1l1e 5r.oc& d a $11\¥1corporar:ron :flat 15wortns100.ooo. mee&o:IT\3tea r.nnurtetva1ue dY<Urw:me ana OCha" proper?)'(DYii  ac:cour.s.. auxm1 o011e. rumbJre. e:c.) 15S200,000. A4your tot.al asse:,a.-ev.orthS250,000, youmu&t Ci5elO&e rQ'lglDIKwomova"S2S .OOO.  snoe meva:ueor  me
6l0Ck exceecl5 m 1l'lf'e6hOICI, you 51'10ti10 115; "QOCI.'" ana me
naned tne corpora-JOn. lf )'OII"account:&lW:l'Ia p,at10J1¥0ar& en:eea $25,000, you $1101.((1 llot 't>ar& arx::ou'li&" <1'1(1 0.Ylk'& oane.

<16CI06tnpalOCI more N n S'%orme10t.a1a&&ee& or    • s:OCII
d ooeor the type& or OU&lneS& entmK l&teaaDOYe. You a1&0 l1IJ5t

tcoormplete tN5	d   !he  t,rmrore:tend  !he$e	d 0u&fne&&K

part
Y,f\lCIIyou n . or "we al anyune CM!ng me<16C:1061n per!OCI,
an Office(. <lreclO(. panner,propnetol.oragem(otnertnanaffflaent
agern&01e1y t>r &aV10e or p-ooe,$$}.
I you1'13\E orflel(I5UCl'la po51UOna cr.1nermpimereotri oneor the$e PK orDu&r!EQK. l&l N> naned tne0u&fne&&. lt5 aenKS anapmcp,31OU&lne&$acs:Mty,   <1'1(1lhe    po&1aonneiawthtne0u6rll:$$
nhrc"lc':aYl:ie•IJ'l3vlo'3uc°l:."ri"d'"oelwmtDeent.h.=..r,o•uSnd%)'"O"Ii""ln"t.•ere"&'t  """'"'·
PARTG - 'IRANl<GCERTR:ATDN
(ReQtJreaoys..112..314.2. f ..S.J
11you .ft  a OOn5l!tU:Ol'lal or eiec:-.ea mldelp.¥	'Atl06e
&eNOet>eglnDel'OreMaronJ1 dtr1eYNrror•fld'lyoun  n1rig.you
;n	10CCll'll)le!efOU"l'IOtW$d  etr'lle& trainingY"1ll:llilOare&&K
Ar.lCi:e i t secuon s or the Rorl03 COn5tt.u::ron. me cooe or Ema; fOt'PllllCOl'ltCEA ana fnl)loyees. ano eN> pu011erecoro& anoopen meeang,13"11&or 1r1estr .c. YouarereqiJreo,o c:.Eftll'/on uu rormtrill
you"-1\-e tak:nw::nn r11ng.
(End of PercentageThreshok:ls Instructions.)

PAGE 6

State of Florida County of Collier

Exhibit E District Affidavit of Intent

Ave Maria Stewardship Community District Candidate

I, 	(print name), a candidate for the special district office of: Ave Maria Stewardship Community Development District Board of Supervisors, Seat 3, in the Special Election understand that my only campaign expense, from personal funds, shall be the $25 candidate-qualifying-fee.

I will not be required to: appoint a campaign treasurer, designate a campaign treasurer, designate a campaign depository or file periodic campaign treasurer’s reports as required by Florida statutes
99.061 or 106.07 and, therefore I am prohibited from collecting, soliciting, or accepting any money or contribution(s) in-kind, in connection with my campaign. I am also prohibited from making any expenditures on behalf of my candidacy.

In the event I later decide to collect, solicit, or accept any money or contribution(s) in-kind, or make any expenditure on behalf of my candidacy, I understand that I will be required to file Form DS-DE 9 (Appointment of Campaign Treasurer/Designation of Campaign Depository) with the District Manager prior to such action. Upon filing form DS-DE 9 my campaign will then be subject to all provisions of Chapter 106, Florida Statutes, including the requirement to file periodic campaign treasurer’s reports.

Signature of Candidate				Date		
Address				Phone		
City		Zip Code		Email Address		

Exhibit F
Form of Candidate Petition

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 it appears on your voter information card)	
in said state and county, petition to have the name of	 		
placed on the Special Election Ballot as a: [check/complete box, as applicable]

 Nonpartisan	No party affiliation	 	Party candidate for the office of

    Ave Maria Stewardship Community District Board of Supervisors, Seat 3		
(insert title of office and include district, circuit, group, seat number, if applicable)	
Date of Birth	or (MM/DD/YY)	Voter Registration Number		Address				
							
City	County		State			Zip Code	
							
Signature of Voter		Date Signed (MM/DD/YY)
[to be completed by Voter]	
Rule 1S-2.045, F.A.C.	DS-DE 104 (Eff. 09/11)