D Check here if address has changed (3) ID Number:

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1 CAMPAGN TREASURER'S REPORT SUMMARY 1) Cq, { f2_o C:S. o V) OFFCE use ONL v Name (2) 8D lff sf. Ad ress (nujllber and street) Of.tt/1,-- b om. /- L S City, State, Zip Code D Check here if address has changed (3) D Number: (4) Check appropriate box(es):!8f,candidate Office Sought: D Political Committee (PC) D Electioneering Communications Org. (ECO) D Party Executive Committee (PTY) D ndependent Expenditure (E) (also covers an individual making electioneering communications) D Check here if PC or ECO has disbanded D Check here if PTY has disbanded D Check here if no other E or EC reports will be filed (5) Report dentifiers Cover Period: From ~ / _[j{ -1.fz_ To t2.. S--- G Report Type: l~ D Original ~Amendment D Special Election Report (6) Contributions This Report Cash&Checks ~/ $ /fp._,_._ Loans $ -- ' -- ' Total Monetary $ n-kind $ -- ' -- ' (9) TOTAL Monetary Contributions To Date 0~ $ [CQ/, _,_. _ (7) Expenditures This Report Monetary Expenditures $ Transfers to Office Account $ Total Monetary (o J-9-- ' -- ' $ (o {fj2: (8) Other Distributions $ 3'6~.,. (10) TOTAL Monetary Expenditures To Date $~, OD~. (11) Certification t is a first degree misdemeanor for any person to falsify a public record (ss , F.S.) certify that have examined this report and it is true, correct, and complete: (Type name) Cav { RO {(; O V) (Type name) ~ / R.o {(-s O '1 D Deputy Treasurer D Chairperson (only for PC and PTY) DS-DE 12 (Rev.11/13) SEE REVERSE FOR NSTRUCTONS

2 CAMPAGN TREASURER'S REPORT - TEMZED CONTRBUTONS (1) Name (2).D. Number (3) Cover Period ~ / _EK_ //o through k_ 2 O Jb (4) Page of (5) (7) (8) (9) (10) (1 1) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution n-kind Number Citv, State, Zio Code Type Occupation Tvoe Description Amendment Amount 0~1 /'6 J, l~l'.d l~h, Qdv1r-N '60 11-f' 5,f. -.iq11<.ej ()Jay MO<V\ f-- Dorc,, /~l,, ~1 5e / ( ~ r r <?.-.1, v( cp CH~ l'too 1-- (J..1-OrWJy OS-DE 13 (Rev. 11/13) SEE REVERSE FOR NSTRUCTONS AND CODE VALUES

3 CAMPAl~N TREASURER'S REPORT - TEMZED EXPENDTURES (1) Name Co / b;;o{ fso0 (2).D. Number (3) Cover Period (J Y i_;i..b..._ through _ /_2_! _/_/_[z_ (4) Page..._ of -----'- (5) Date (6) Sequence Number (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) (10) (11) Expenditure Type Amendment Amount D ) /'i i /b 1 /2.o ~ )V) 1 Ct~ {17 1V 1 /\/ f80 Lf- s f ~..l;:py1lm) LV q \ Mov~,t ll o VG, FL 327 sf 1= /f-~~oh /::::~ (rv1 Pee C..AN # 0/,/ 0 (2. /1 z./lb ~ ( bo/<-'v) Ctt, fv; t1 A/, 8 ~ Sf- ::t1111p.4 woy /v/othf~ bo rqi, ~ l-- 327sl ~ 1' n, hu r--sr2yt'lflj /Jei/'S OYJq r:vrid5 R /v1 B q ~?>,9 o OS-DE 14 (Rev. 11/13) SEE REVERSE FOR NSTRUCTONS AND CODE VALUES

4 CANDDATE OATH - NONPARTSAN OFFCE (Not for use by Judicial or School Board Candidates) OFFCE USE ONLY OATH OF CANDDATE (Section , Florida Statutes) 1, Ca Ro/(-soV) (PLEASE PRNT NAME AS YOU WSH T TO APPEAR ON THE BALLOT NAME MAY NOT BE CHANGED AFTER THE END OF QUALFYNG) am a candidate for the nonpartisan office of (circuit#) C,'''{y Caun Ct.) r (office) (district#) ; am a qualified elector of L Cl K(2 County, Florida; (group or seat#) am qualified under the Constitution and the Laws of Florida to hold the office to which desire to be nominated or elected; have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office seek; and have resigned from any office from which am required to resign pursuant to Section , Florida Statutes; and will support the Constitution of the United States and the Constitution of the State off~lo,/j. ~-- Telephone Number Address f>::d t State 3;:,75 ZP Code Candidate's Florida Voter Registration Number (located on your voter information card): /Ol/9J/0 7 3 * Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): STATE OF FLORDA COUNTY OF L...ct /c e Sworn to (or affirmed) and subscribed before me this 18 day of.._,_..., h:) fl ""'l \ j :t_. '""" G O ON Personally Known: V::: or /i~mv.~:;:,. WEN~O.LEN KE UGH.J H l*! 1 '.J;;.'': ~ Con:im1ss1on # EE ature of Notary Public ;~-~?! Expires June 7, Produced dentification: ',,~ ' Type of dentification Produced: ,r.,~~ BoodeHtvvTroyF111ni,m,ance o19 Print. Type, or Stamp Comm1ss1oned Name of Notary Public OS-DE 25 (Rev. 5/11) Rule 1S , F.A.C.

5 l\ppontment OF CAMPAGN TREASURER AND DESGNATON OF CAMPAGN DEPOSTORY FOR CANDDATES (Section (1), F.S.) (PLEASE PRNT OR TYPE) Al0 : 38 N NOTE: This form must be on file with the qualifying officer before openin the campai n account. OFFCE USE ONLY 1. CHECK APPROPRATE BOX(ES): a nitial Filing of Form Re-filing to Change: D Treasurer/Deputy D Depository D Office D Party 2. Name of Candidate (in this order: First, Middle, Last) C~u-. vi Vl 4. Telephone C3b7-J 55Z -Lfz..o 0 Nof' 5. address cro 1(-soVJ ;osol1 6. Office sought (include district, circuit, group numb 1 r) C, 1-y Co c.{ lrj c, /.- \) (Sf r {cf 2 /Mo v f Dora r=- l. z s 3. Address (include post office box or street, city, state, zip code) ~ L/.Sf.JC?mes tuay /v/ollnf Dora ~t=- L 3 Z-7 s7 7. f a candidate for a nonpartisan office, check if applicable: D My intent is to run as a Write-n candidate. 8. f a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a 0 Write-n O No Party Affiliation D Party candidate. " have appointed the following person to act as my 0 Campaign Treasurer D Deputy Treasurer c./ v,'y\ ~ /.. Ro / (.sco.0. Name oftreasurer or Deputy Treasurer so, 11. Mailing Address 13. City {iv') ov V f-- DO {f'c{ 14. County L-._ a.. fee 18. have designated the following bank as my 5. State,t: L. 16. Zip Code "321s D Primary Depository 12. Telephone 17. address c_ ro/f 50v; (!:!_ c om ca.sf, n e - D Secondary Depository 19. Name of Bank 20. Address P:.,rr; f '/({ f10v)q/ Ba County 23. State 24. Zip Code L-&0e F or( ckr c~o.v f DoV'Cf, 3 ~1S UNDER PENALTES OF PERJURY, DECLARE THAT HAVE READ THE FOREGONG FORM FOR APPONTMENT OF CAMPAGN TREASURER AND DESGNATON OF CAMPAGN DEPOSTORY AND THAT THE CT TED N T R TRUE. 25. Date.. / Treasurer's Acceptance of Appointment (fill in the blanks an, C=..:a.~/ c._ ll_.:_vl_...1-a! _ :!LJ_--'--'--':::...L./...:.h ~ & o _:5 _ 0_VJ (Please Print or Type Name) 3Signated abo ve as: ~, do hereby accept the appointment l{af / ~,,, ZO[b Date DS-DE 9 (Rev. 10/10) Rule , F.A.C.

6 STATEMENT OF CANDDATE (Section , F.S.) (Please print or type) OFFCE USE ONLY Al 0 :51 N, have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. bv / '6, 2-e> /C, r Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss (1 )(c), (1 ), Florida Statutes). OS-DE 84 (05/ )

FORMl STATEMENT OF 2015 Please print or type your name, mailing FNANCAL NTERESTS FOR OFFCE USE ONLY: address, agency name, and position below: R SOUGHT: You are not limited to the space on the lines

7 FORMl STATEMENT OF 2015 Please print or type your name, mailing FNANCAL NTERESTS FOR OFFCE USE ONLY: address, agency name, and position below: R SOUGHT: You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY F ~ANDDATE OR O NEW EMPLOYEE OR APPONTEE **** BOTH PARTS OF THS SECTON MUST BE COMPLETED**** DSCLOSURE PEROD: THS STATEMENT REFLECTS YOUR FNANCAL NTERESTS FOR THE PRECEDNG TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FSCAL YEAR. PLEASE STATE BELOW WHETHER THS STATEMENT S FOR THE PRECEDNG TAX YEAR ENDNG ETHER (must check one): ~ DECEMBER 31, 2015 OR D SPECFY TAX YEAR F OTHER THAN THE CALENDAR YEAR:. MANNER OF CALCULATNG REPORTABLE NTERESTS: FLERS HAVE THE OPTON OF USNG REPORTNG THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHCH REQURES FEWER CALCULATONS, OR USNG COMPARATVE THRESHOLDS, WHCH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USNG (must check one): D COMPARATVE (PERCENTAGE) THRESHOLDS OR ~ DOLLAR VALUE THRESHOLDS PART A PRMARY SOURCES OF NCOME (Major sources of income to the reporting person - See instructions] (f you have nothing to report, write "none" or "n/a") NAME OF SOURCE SOURCE'S DESCRPTON OF THE SOURCE'S OF NCOME ADDRESS PRNCPAL BUSNESS ACTVTY PART B SECONDARY SOURCES OF NCOME [Maj or customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (f you have nothing to report, write "none" or "n/a") NAME O F NAME OF MAJOR SOURCES ADDRESS PRNCPAL BUSNESS BUSNESS ENTTY OF BUSNESS' NCOME OF SOURCE ACTVTY OF SO URCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (f you have nothing to report, write "none" or "n/a") FLNG NSTRUCTONS for when and where to file this form are located at the bottom of page 2. NSTRUCTONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 - Effective: January 1, 2016 (Continued on reverse side) PAGE 1 ncorporated by reference in Rule (1 ), F.A C

8 CTY OFN Office of the City Manager 510 N. Baker St. Mount Dora, FL MOUNT Fax: DORA ELECTON ASSESSMENT (one percent) A10 :53 N COUNTY: Lake CTY: Mount Dora Date: s5- t- He A. OFFCE C. ANNUAL SALARY: City Council Member $6, % Election Assessment $ Submitted by: Name Mayor $ 10, % Election Assessment $ O 1.28 Undue Burden: Yes: No: '... (Note: f 'Yes' is checked, attach Affidavit of Undue Burden) /) _ Ca 1ao /h,oh 80 Jlf S / Jq111e s W o. v Address / City Telephone gsk DC) {"q ~ S7_- 5 SL ,0t) p::- L '3 L zs.z

9 Gwen Keough-Johns, MMC City Clerk City of Mount Dora 510 North Baker Street Mount Dora FL AFFDAVT OF CANDDACY & RESDENCY RE: AFFDAVT OF CANDDACY & RESDENCY, = C:... _ 0.,,=..,,.,_\_... Ko--=--"-(.:.._\-_-S O~V\, a candidate for City of Mount Dora City Council Member, District t2._ (if applicable), or at-large in the L Olk election, do hereby swear or affirm that reside at: ~o L/ 5f,.Ja ta1 WA j 1 Nrou vd-- bov'~, EL ~ Z,7 <;;] where have resided for ~11onths, and which hereby swear and affirm is located in District (if applicable) in the City of Mount Dora, Florida, and that meet the eligibility requirements as identified in Ordinance '2- n accordance with the provisions ofthe City ofmount Dora Charter and Code ofordinances, certify that meet the qualifications for candidacy. am a registered voter ofthe City ofmount Dora and reside at the above stated address within the City of Mount Dora. do not hold any other public office in the City, with the following exceptions: that ofnota,y Public, or membership in the National Guard, or the organized Reserve of the Armed Forces ofthe United States, or in any other defense agency recognized by the City, or in a status ofretirement from any ofthe foregoing. acknowledge that must subscribe to the Oath ofoffice as outlined in Part 11, Section 15 of the City Charter. Office Use Only: Date filed: _ Received: RY, DECLARE THAT HAVE READ THE FOREGONG AFFDAVT CTSSTATEDNTARETRU~.._r~- Q t..,... lf...,, V 1,_..., J'"""'.,...l._.l""".{1-- b Received b,e;;;zfo it~ffw - ~ -V::: Loyalty Oath Oath ofcandidate - ~ v- Candidate Name Pronunciation Request -~v-- - Statement of Financial nterests Form - ~ V~ Affidavit of Candidacy & Residency Date Candidate Qualified: _,._c..,, ~ ~...~...- ~~_ \ la cc: Candidate _ Date l

8C0 IL/ 5/._;/qmes tuay

8C0 IL/ 5/._;/qmes tuay ~PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021 (1 ), F.S.) (PLEASE PRINT OR TYPE) 05-18- 16 A1 0 : 38 I N NOTE: This form must be on file with