OATH OF CANDIDATE (Section , Florida Statutes)

Transcription

1 CANDIDATE OATH NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) JUN 2 f 2016 I, Chris Hoffman OATH OF CANDIDATE (Section , Florida Statutes) (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 Jacksonville Beach City Council, Seat 1 (circuit #) (office). At Large (district#) ; I am a qualified elector of Duval County, Florida; (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 , Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of 6 id. X (904 ) hoffmanjaxbch@gmail.com of Candidate Telephone Number Address th Street, N Jacksonville Beach FL Address City State ZIP Code Candidate's Florida Voter Registration Number (located on your voter information card): I D '3' 0 (ps \ &~ * 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): KRIS HAWF-man STATE OF FLORIDA county of DuvC1 I 9'r- --c- Sworn to (or affirmed) and subscribed before me this ;;) I day of J V () ~ Personally Known: V or Produced Identification : IC ommissioned Name of Notary Public Type of Identification Produced: ~?-~:~~ JODIL YNN C. BYRD ~~ ~ ~ MY COMMISSION tl FF OS-DE 25 (Rev. 5/11)

2 JACI<SONVIllE BEACH City of Jacksonville Beach City Hall 11 North Third Street Jacksonville Beach FL Phone: Fax: RESIDENCY AFFIDAVIT STATE OF FLORIDA ) COUNTY OF DUVAL ) CITY OF JACKSONVILLE BEACH, FLORIDA) ss. OFFICE OF THE CITY CLERK ~ ~a...,..aj:l::~~.r;,;:.m~._ JUN Before me, the undersigned authority, au onzea m ldl\t:: vau,.,, personally appeared Christine Hoffman (Name of Candidate - Please Print) who being by me first duly sworn, deposes and says that they are a registered elector of the City of Jacksonville Beach, Florida; and have resided within the limits of the City of Jacksonville Beach, Florida, for a period of six (6) months preceding the election and have been a bona fide resident for a period of at least six (6) months prior to qualifying; and that they are otherwise qualified to vote as defined by the Constitution and Statutes of the State of Florida in the Municipal Election to be held August 30, 2016 and/or November 8, 2016, in the City of Jacksonville Beach, Florida. Address of Candidate: h Street North Jacksonville Beach. FL ndidate) STATE OF FLORIDA COUNTY OF DUVAL s;- Sworn to, and subscribed before me, this;)/ day of June, A.D J:q:yj I t11 I) (Printed Name) UBLIC /3 \frd Personally Known: or Produced Identification: Type of Identification Produced:,~ JODILYNN C. BYRD r:!*! MY COMMISSION ft. FF ~..;. EXPIRES June 02, o1i':i~153 FloridiiNoalryServtcuom

3 " dpc!_y) ~ PE.:CEIVEQJTYIOF JACKSONVILLE BEACH -v, 3 -:nt, 20bG MUNICIPAL ELECTION,. " l o.u.il NOMINATION OF CANDIDATE "We, the undets1gn~e and residents of the City of Ja (\w\<;.-\ilf'\.t- 4-\ ~ C"'- for the office of: (Candidate's Name) City of Jacksonville Beach Council Member, District# MJ..u..v-, Seat# to be voted for at the election to be held the year 2016, and we individually certify that we are qualified to vote at such election." U11 ~ 01) i I VcY: I <;u/1') --S...f-/-'"'-""~ ADDRESS: 31'-IS fv i l~" 0. ja:jl pth,r 3Z2S r, SI~N URE: :. _ ;3c~ ~ \(_~\ ~~ OCi-\ E..fL--r-1 ADDRESS: ~'2...1 ~ ~ C'-...:102.~ SIGNATU~ c;a")l~ NAMEo ("/fase~rint) SIGNATUREo ~ /302- / ~!Q~ctiD q~ ~ ~ IOO~tb_Jt ~ JO.x ge_c:~50 Nomination of Candidate - Municipal Election

4 , ~_;!3o2 ~ NAME' (Pfease prinq SIGNA~ fbc..h-\--.uv (_ fso~j( ~~ J~ -~..:_:_ l 2-~.,..oo--L-f---~---- ADDRESS : \l~~ /{ph-~ - A! "-Sa~,VJifeg~vh,;::{_ I 5..)~5'0 ~-~ NAME: {Please print) '-""- SIGNATURE: 1 3 I D /' +h~n.;, &de-. Wcd~n 0~['~ ADDRESS:,81 <t' } '51-.;s-1-, 1\J. -:;ti:~),jtrl(.~~.fl )._..., ~),. t3d4 v SIGNATURE: hao~ta-~~ 0 ~ A(;D REss: Loz3 7PL Jh ~ ~~ Jar =nuv ~ I 3D)... ~ Ql_Q_/ UUD$2r' ~ 5 ~ ADDRESS: JQ2..tp [O SIGNATURE: ~ ~ a;;\c 0'2-~ ~~~~~~~~~\Jl~~~~x~~~~~~~-- '--' - ' NAME' (Please print) SIGNATURE: 1 ~ L~~~~ ~if~~ ADDRESS: ~Ob:tl!~{'-.\ \~ 1 Z~?)D ) Nomination of Candidate - Municipal Electoon

5 t\1 13/o / -? Ch~~,-r. Co 1 cd., ADDRESS: S"' cj<' q t~ AJ-< JV. ;\cy ~ 13!/ - ~ /3/0 NAMEo (Please j!rinl) ~... SIGNATU~JJ-~ u ej!.r11l~ o----?/!a r-c- ADDRESS: NAM~~ \JMk c;t. v LCRL:v"\ c.:r- 3 -z-~'4; 6 v SIG&:tz:S ADDREss: t'!jo ~ '2-o~ t1v-l N- ~ LZSo!3!6 v NAME: (Pie~ ~ ADDRESS: -SIG_N..Jti<~"-TU-R--'E~::c.. ~-~.-!: llo 1-~ (lve<_ N ~ J'Z.Zc=S0 ~ SIGNATURE: ADDRESS: Nomination of Candidate. Municipal Election '-"'

6 ACCEPTANCE OF NOMINATION I, Ctv~b'nl..- -\4~cV"'\., HEREBY ACCEPT the nomination for the office of City of Jacksonville Beach Council Member, District#, Seat# \, and state that I am qualified to be a candidate for the office and agree to serve if elected. Date s (.E)Jb I 1 ********************************************** CERTIFICATION I, d~ of{}a}irf", HEREBY CERTIFY that the above petition was filed with me on the!);5~-' day of C)ve= d tltvld d e.g!? (Signature';;; c@assistant }, A.D JUN (City Seal) _1"'\, '-J Nomination of Candidate - Municipal Election

7 FORMl STATEMENT OF 2015 I FINANCIAL INTERESTS I Please print or type your name, mailing address, agency name, and position below: LAST NAME - FIRST NAME - MIDDLE NAME : Hoffman Christine Helen MAILING ADDRESS : th Street, North FOR OFFICE USE ONLY: CITY : ZIP: COUNTY : Jacksonville Beach Duval NAME OF AGENCY : City of Jacksonville Beach NAME OF OFFICE OR POSITION HELD OR SOUGHT : City Council You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF D CANDIDATE OR 0 NEW EMPLOYEE OR APPOINTEE JUN **** 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): ~ DECEMBER 31, 2015 OR 0 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 COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one): 0 COMPARATIVE (PERCENTAGE) THRESHOLDS OR ~ DOLLAR VALUE THRESHOLDS PART A-- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY Beaches Area Historical Society 381 Beach Boulevard, Jacksonville Beach, Museum Orion Solutions, LLC 7545 Centurion Pkwy, #403, Jacksonville, Defense Consulting Preferred Govt. Insurance Trust 615 Crescent Exec. Ct., Lake Mary, Municipal Insurance PART B -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE N /A N /A PART C --REAL PROPERTY (Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "n/a") 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 Incorporated by reference In Rule (1 ), F.A. C. (ConUnued on reverse side) PAGE 1

8 PART D - N/A INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E- LIABILITIES [Major debts -See instructions] (If you have nothing to report, write "none" or "nla") NAME OF CREDITOR ADDRESS OF CREDITOR N/A PART F - INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses -See instructions] (If you have nothing to report, write "none" or "nla") BUSINESS ENTITY# 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY NIA 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 PART G -TRAINING '" ''~''" m""'~ offi~ ~~;~7~ ;~=~ ; ~~~~~ ~~:;~;;~~,;~ 00E 1 :~~;.~ED TRAINING. IF ANY OF PARTS A :rhrough G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Signat'f9 d,_.. ;IGNATURE OF FILER: ~ I -; \\ '-/ \..) Date Signed: WHAT TO FILE: {Q fj\ l lk, After completing all parts of this form, jnclydjna signing 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: 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. Esu<!!imil~i ~ill 112t b~ ii~~~rt~d. ~~A Qr ATTQBNEY SIGNAIUBE O~I..Y 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: WHEN TO FILE: If you were mailed the form by the Commission Initially, each local officer/employee, state officer, on Ethics or a County Supervisor of Elections for and specified state employee must file within your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees who must be confirmed by the Senate must file Local officers/employees file with the prior to confirmation, even if that is less than Supervisor of Elections of the county in which they 30 days from the date of their appointment. permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the Candidates must file at the same time they file county where your agency has its headquarters.) their qualifying papers. Thereafter, file by July 1 following each calendar State officers or specified state employees year in which they hold their positions. file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL ; physical Finally, file a final disclosure form (Form 1 F) address: 325 John Knox Road, Building E, Suite within 60 days of leaving office or employment. 200, Tallahassee, FL Filing a CE Form 1 F (Final Statement of Financial Interests) does IlQ! relieve the filer of filing a CE Candidates file this form together with their Form 1 if the filer was in his or her position on qualifying papers. December 31, To determine what category your position falls under, see page 3 of instructions. D CE FORM 1 - Effective: January Incorporated by reference in Rule (1 ). FA. C. PAGE 2

9 Supervisor of Elections Duval County, Florida (Municipal Candidate) Notification of Public Logic and Accuracy Test Receipt Please complete and sign. Thank you! I, Christine Hoffman, filed/qualified candidate for the office of Jacksonville Beach City Council do hereby acknowledge that I have received written notification of the time, date and location of the Public Logic and Accuracy Tests of the automatic tabulating equipment to be used in the 2016 PRIMARY ELECTION to be held on AUGUST 30, 2016 and 2016 GE RAL ELECTION to be held on NOVEMBER 8, 2016 (Ddte) Received by: -~ JODILYNN C. BYRD l :" ;~ MY COMMISSION# FF ~.,,, ' EXPIRES June 02, 2020 ll407j'3fi.o103 I'IOrtciiNolaryhtvtoe.oam -I JUN