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1 ~PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section (1 ), F.S.) (PLEASE PRINT OR TYPE) A1 0 : 38 I N NOTE: This form must be on file with the qualifying officer before openin the campai n account. Campaign Treasurer OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES):!2l. Initial 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) Cc... v,n Nor 4. Telephone 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 D No Party Affiliation D Party candidate. " I have appointed the following person to act as my D Campaign Treasurer D Deputy Treasurer,u. Name of Treasurer or Deputy Treasurer C./v, V\ /'.I ~ f2.o / {.s( ) 11. Mailing Address 12. Telephone City 14. County 5. State 16. Zip Code 17. address {fv'1 ov vd-- Do f'c,{ L--- a. /ce J:: L "?275 c.. comca. sf, n e f 18. I have designated the following bank as my D Primary Depository D Secondary Depository P.,r5 f I'/({ fjo(llc<j 13a 22. County 23. State _/ _ 24. Zip Code L& k ;: lort'ccr 32.?s 19. Name of Bank 20. Address 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 CT TED IN IT TRUE. 25. Date 11 (J. 5. address c..ro l(-sovj C~["2...) 55Z -lf Office sought (include d\strict, circuit, ~roup nu'.11b 1 r) C 1fy Cot-1t,Jc 1 /.- D,sfr( c..f 2 /Mo )! f Dora r=- l. s 27. Treasurer's Acceptance of Appointment (fill in the blanks an I, C~ a-=-/_v_,-_vl_~i\_' ~J-~&~o~/_{._;5_0_M,do hereby accept the appointment (Please Print or Type Name) 3signated above as: ~ 3. Address (include post office box or street, city, state, zip code) 8C0 IL/ 5/._;/qmes tuay /v/ounf Dora, PL 3 z.7s7 7. If a candidate for a nonpartisan office, check if applicable: D My intent is to run as a Write-In candidate. DS-DE 9 (Rev. 10/10) Rule 1S , F.A.C.

2 STATEMENT OF CANDIDATE (Section , F.S.) (Please print or type) OFFICE USE ONLY Al 0 :51 IN I, have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. &v / '6, 20 /G 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/ 11 )

3 CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section , Florida Statutes) I, Ca I Ro/(-soV) (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT* -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of C,,'fY Le':)U J1 Cl } (circuit#) ; I am a qualified elector of (group or seat#) r (office) L Cl ke 2 (district#) County, Florida; 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 , Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of F~lo!.IJ. UQ.-. ( '52.. )!:>-sz oo C.. f'o / (:.50,, Telephone Number Address ~ I 1'10{/t/'I I) O f'(? 32.7 s State ZI Code Candidate's Florida Voter Registration Number (located on your voter information card): / Ol:J. 5J / {) k, 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 FLORIDA COUNTY OF L..ctk e_ Sworn to (or affirmed) and subscribed before me this 18 day of -~td o...,... 1, :t_. Personally Known: V::: or Produced Identification: Type of Identification Produced: DS-DE 25(Rev. 5/11) Rule 1$ , F.A.C.

4 CITY OF~ Office of the City Manager 510 N. Baker St. Mount Dora, FL MOUNT Fax: DORA ELECTION ASSESSMENT (one percent) AJ0 :53 IN COUNTY: Lake CITY: Mount Dora Date: d tt- ll@ A. OFFICE C. ANNUAL SALARY: City Council Member I % Election Assessment Mayo r I % Election Assessment $6, $ $10, $ IO 1.28 Undue Burden: Yes: No: ~ (Note: If 'Yes' is checked, attach Affidavit of Undue Burden) Name flojlf S /_ Address / City M or/ 11t [) 0 {/'C( I Telephone ~ Sc- s s ,0{) gsk P- L 3 2, z.s-.z

5 FORMl Please print or type your name, mailing address, agency name, and position below: STATEMENT OF FINANCIAL INTERESTS 2015 FOR OFFICE USE ONLY: R SOUGHT: You are not limited t o the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF ~ANDIDATE OR O NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIA L INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL Y EAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): Ji.. DECEMBER 31, 2015 OR D SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIV E THRESHOLDS, WHICH ARE USUALLY BASED O N PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one): D COMPARATIVE (PERCENTAGE) THRESHOLDS OR ~ DOLLAR VALUE THRESHOLDS PART A PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person See instructions] NAME OF SOURCE OF INCOME SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY PART B SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person See instructions] NAME OF BUSINESS ENTITY NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE PART C.. REAL PROPERTY [Land, buildings owned by the reporting person. See instructions] FILING INSTRUCTIONS 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. CE FORM 1 Effective: January 1, 2016 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule (1), F.A.C.

6 PART D - INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] TYPE OF INTANGIBLE.1:~toQvc\ ro~\ Tv1,J.l)"l-tJt.ov.b TN5 f- L'VJcovn~ PART E - LIABILITIES [Major debts - See instructions] BUSINESS ENTITY TO WHICH THE PROPERTY RELATES $'r-~--l~ C '-l v,\i\ N. lzv I(-s o vi t<.e,vo C<tl-. L Truf:,t{~<JJ-~ <4--~ CJr-t- 1, NAME OF CREDITOR N 1)\/\e ADDRESS OF CREDITOR PART F - INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See Instructions] ~SINESS ENTITY# 1 BUSINESS ENTITY# 2 NAME OF BUSINESS ENTITY 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 OV)e. PART G - TRAINING For elected municipal officers required to complete annual ethics training pursuant to section , F.S. ~ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH GARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0 SI~ ~ Date Signed: A10,1 / WHAT TO FILE: SIGNATURE OF FILER: I ~ )? 0/{;, After completing all parts of this form, jncluding signing and dating jt. 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: A candidate who previously filed Form 1 because of another public position must file a copy of his or her Form 1 when qualifying. A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. Facsimiles will nq1 be accegted. - CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I,, prepared the CE Form 1 in accordance with Section , Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: 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 disdosure filing, relurn the form to that location. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL ; physical address: 325 John Knox Road, Building E, Su ite 200, Tallahassee. FL Candidates file this form together w ith their qualifying papers. To determine what category your position falls under, see page 3 of instructions. 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 must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disdosure form (Form 1 F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does!lqt relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, CE FORM 1 - Effective: January 1, PAGE 2 Incorporated by reference in Rule ( 1 ). FA C.

7 Gwen Keough-Johns, MMC City Clerk City of Mount Dora 510 North Baker Street Mount Dora FL AFFIDAVIT OF CANDIDACY & RESIDENCY RE: AFFIDAVIT OF CANDIDACY & RESIDENCY I, --~C'--a.,,~,~\- ~~~--'-(\-_ Dora City Council Member, District _S_O~V\, a candidate '2-. for City of Mount (if applicable), or at-large in the Lolk election, do hereby swear or affirm that I reside at: <z50 I Lf <5f ' ::Ja /r:11 WA/,1 K-ou vd: bov'~, FL.? Z7 <;,,"] where I have resided for ~11onths, and which I hereby swear and affirm is located in District (if applicable) in the City of Mount Dora, Florida, and that I meet the eligibility requirements as identified in Ordinance I')_ In accordance with the provisions ofthe City ofmount Dora Charter and Code ofordinances, I certify that I meet the qualifications for candidacy. I am a registered voter ofthe City of Mount Dora and reside at the above stated address within the City of Mount Dora. I 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 ofthe Armed Forces ofthe United States, or in any other defense agency recognized by the City, or in a status ofretirement from any ofthe foregoing. I acknowledge that I must subscribe to the Oath ofoffice as outlined in Part Ill, Section I 5 of the City Charter. RY, I DECLARE THAT I HAVE READ THE FOREGOING AFFIDAVIT CTS STATED IN IT ARE TRUE. Office Use Only: Signature Date filed:,(...,~ Q O...,_ ~--'/,.,. f_,_ / --ea J..., b""'--,... l~ --- Received b~ l(.~~oot, AU Received: -~ 0 -. / -....'-- V:::: Loyalty Oath / Oath of Candidate,,v:: Candidate Name Pronunciation Request ---==~'-- Statement of Financial Interests Form I,V"-- Affidavit ofcandidacy & Residency Date Candidate Qualified: - -'---~--~~_ cc: Candidate ~ - +-~w'lo