Rosen Gonzalez Qualifying Documents CANDIDATE OATH -
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NONPARTISAN OFFICE
2D 1 SEP -9 gill 3_. 16
( y CITY' ti�L_I_I ii a -
Not for use b Judicial or _� F IL
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021,Florida Statutes)
Kristen Rosen Gonzalez
I,
' (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT*— NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
Miami Beach Commissioner N/A
am a candidate for the nonpartisan office of
(office) (district#)
N/A 4 ; I am a qualified elector of Miami Dade County, Florida;
(circuit#) (group or seat#)
I am a qualified elector of the City of Miami Be ch,FI rid , siding tin the City at least one year before qualifying for City of Miami Beach
elected office,with my legal residence being: jl pnvn / ,Miami Beach,Florida. I am qualified under the ordinances
and Charter of said City and 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 y�.face from which I am required to resign pursuant to Section 99.012, Florida Statutes;.and I will support the Constitution of
the United St land the Constitution of the State of Florida.
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'g t é Ca idate Telephone Number E �uar�ss
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Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): I t 0,2Q"(,.
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*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):
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STATE OF FLORIDA
COUNTY OF Cokittmez- /ALL)
Sworn to(or affirmed)and subscribed before me this q-46 day of , 20 /:J .
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Personally Known: !�����71i
or ,.•��:�P L MM R.HATFIELD e,. , ice..: if ri.✓..
Ali; MY COMMISSION#EE 844865 .ture of Notary Pu c
Produced Identification: J'- EXPIRES:February 18,2017 � nt Type,or Stamp Commissioned Name of Notary Public
. c Banded Thru Notary Public Underwrites' S E P 9 2015
Type of Identification Produced: .
DS-DE 25(Rev.Sift) Rule 1S-2.0001,F.A.C.
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CITY OF MIAMI BEACH OATH/AFFIRMATION
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Befoi e, a officer authorized to administer oaths, personally appeared
n k) rwux -e l- to me well known who, being
sworn, says that he/she is a candidate for the office of Mayor or City Commissioner, Group No.
, for the City of Miami Beach, Florida; that he/she is a qualified elector of said City
residing within the City at least one year before qualifying or City o Miami Beach elected office; that
his/her legal residence is: 461 ?� -P) \+-0 n a ,
Miami Beach, Miami-Dade County, Florida; that he/she is qualified under the ordinances (including
Miami Beach City Code Chapter 38 governing "Elections")and Charter of said City to hold such office;
and that he/she has paid the required qualification fee or filed with the City Clerk a petition approving
his/her candidacy signed by sufficient qualified and registered voters to constitute not less than two
percent (2°°) of this number of such voters as the same shall be on the date sixty (60) days prior to
the first •. if qualifying as a candidate for office.
Signatur- ididate•
Sworn to (or affirmed)and subscribed before me this day of , 2015, by
0-15//tn --b's ► 61)136i!tr.?? .
‘VMPIMA SEP .9 2015
Signature of Notary P':lic-State of Florida (NOTARY SEAL)
/, s.�"': WAM R.HATFIELD
I,+: ��� MY COMMISSION#EE 6,t••55
'.�,'•.-,,.:;a7 EXPIRES:February 16, i.; I,'
Name of Notary Typed', Printed or Stamped .-;8f„ , Bonded Thru Notary Public Underii er
Personally Known • OR Produced Identification
Type of Identification Produced
FORM .1 STATEMENT OF 2014
Please print or type your name,mailing FINANCIAL INTERESTS I FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME--FIRST NAME--MIDDLE NAME :
Rosen Gonzalez, Kristen
MAILING ADDRESS:
4618 Alton Road
C) to
CITY: ZIP: COUNTY:
Miami Beach 33140 Miami Dade
NAME OF AGENCY: c--) Ill -I)
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n. E w .-
NAME OF OFFICE OR POSITION HELD OR SOUGHT: LO `
Miami Beach Commissioner, Group IV (_
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. '_ -`i
r, C,,J
CHECK ONLY IF Eil 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):
XDECEMBER 31, 2014 OR ❑ 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:
❑ 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
Miami Dade College 11011 SW 104th St., Miami, FL 33176 College Professor
Kristen Rosen Gonzalez 4618 Alton Road, Miami Beach, FL 33140 Real Estate
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 PRINCIPAL BUSINESS
BUS NESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
' 10 1 -A-
1
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. •
1319 71st Street, Miami Beach, FL 33141 INSTRUCTIONS on who must file
4618 Alton Road, Miami Beach, FL 33140 this form and how to fill it out
begin on page 3.
1501 71st Street, Miami Beach, FL 33140
CE FORM 1•Effective:January 1,2015 (Continued on reverse side) PAGE 1
Adopted by reference in Rule 34-8.202(1),F.A.C.
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R F C F
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CiTY OFFICE
PART D—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
Trust Account David Rosen Trust FBO Kristen Rosen - Suntrust
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
Home Lending Services 5901 Golden Hills Drive, #600, Golden Valley, MN 55416
Richard B. Carme 12555 Biscayne Blvd., #800, North Miami, FL 33181
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to rep rt,write"none"or"n/a")
BUSINESS 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
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
SIGN TIME O F FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or
Signature: attorney in good standing with the Florida Bar prepared this
form for you, he or she must complete the following statement:
prepared
_AA"
the CE Form 1 in accordance with Section 112.3145, Florida
•
• Statutes, and the instructions to the form. Upon my reasonable
knowledge and belief, the disclosure herein is true and correct.
Date Signed:
CPA/Attorney Signature:5-
l Date Signed:
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, including If you were mailed the form by the Commission Initially,each local officer/employee,state officer,
signing and dating it,send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within
sheet(pages 1 and 2)for filing. 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
If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file
section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they Prior to confirmation, even if that is less than
section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment.
reside in Florida, file with the Supervisor of the Candidates for publicly-elected local office must
NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying
MULTIPLE FILING UNNECESSARY: papers.
State officers or specified state employees Thereafter, local officers/employees,A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer p oyees, state
of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are
of his or her original Form 1 when qualifying. A address: 325 John Knox Road, Building E, Suite required to file by July 1st following each calendar
candidate who files a Form 1 with a qualifying 200,Tallahassee, FL 32303. year in which they hold their positions.
officer is not required to file with the Commission Finally,at the end of office or employment,each
or Supervisor of Elections. Candidates file this form together with their local officer/employee,state officer,and specified
qualifying papers. state employee is required to file a final disdosure
• To determine what category your position falls form(Form 1F)within 60 days of leaving office or
under, see the "Who Must File" Instructions on employment.However,filing a CE Form 1F(Final
page 3. Statement of Financial Interests)does not relieve
the filer of filing a CE Form 1 if he or she was in
Facsimiles will not be accepted. their position on December 31,2014.
CE FORM 1-Effective:January 1,2015. PAGE 2
Adopted by reference in Rule 34-8.202(1),F.A.C.
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY:
Rosen Gonzalez, Kristen
MAILING ADDRESS: OFFICE OR POSITION HELD:
4618 Alton Road Miami Beach Commissioner, Froup IV
CITY: ZIP: COUNTY: FOR QUARTS ENDING(CHECK ONE): YEAR
❑MARCH UNE ❑SEPTEMBER ❑DECEMBER 2015
Miami Beach 33140 Miami Dade County
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is
being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the
date(s)the gift was received.If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
\II/H
- p ,
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
r_
PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy of thatreceiptgto this
form.You may attach an explanation of any differences between the information disclosed on this form and the information oh the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA
COUNTY OF'Yyu, ,,
depose on oath or affirmation and say that the information disclosed Sworn to or affirmed)and sub 'bed ore a this
M- day of ,20
herein and on any attachments made by me constitutes a true accurate, by K e;S/e'1 k o sei>h 611>1 ykvis
and total listing•f all gifts required to be reported by Section 112.3148,
% � Oral....1
Florida .to.•s. ',
. t '., LItJAM R.HATFIELD '` (Signature of Notary Public- :te of Florida)
_ :
:.: �� :r_ MY COMMISSION#:E 844865
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I
• �'•.���;off: EXPIRES:February 18,2017
,,qf„ •' Bonded Thru Notary Publ°, Y or Stamp Co9missioned Name of Notary Public)
SIGNA.ra17�o ING OFFICIAL - ownOR Produced Identification
Type of Identification Produced
PART D—FILING INSTRUCTIONS
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi-
cal address:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.The form must be filed no later than the last day of the calendar
quarter that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.)
CE FORM 9-EFF.1/2007(Refer to Rule 34-7.010(1 Xg),F.A.C.)(Rev.9/2013) (See reverse side for instructions)(53'
MIAMI BEACH
NOTICE OF TESTING OF THE TABULATING EQUIPMENT
(LOGIC AND ACCURACY TEST)
AND CANVASSING BOARD SCHEDULE
FOR THE CITY OF MIAMI BEACH RUN-OFF ELECTION (IF NECESSARY)
NOVEMBER 17, 2015
Pursuant to Florida Statute §101.5612, notice is hereby given of the time and location of the public
preelection test of the automatic tabulating equipment (Logic and Accuracy Test) for the November
17, 2015 Miami Beach Run-Off Election (if necessary).
Pursuant to Florida Statute §102.141, notice is hereby given of the time and place during which the
City of Miami Beach Canvassing Board for the November 17, 2015 Miami Beach Run-Off Election
(if necessary) will meet to canvass the absentee electors' ballots and provisional ballots.
The City of Miami Beach Canvassing Board will convene at the Office of the Supervisor of
Elections, 2700 NW 87 Avenue, Miami, Florida. The Canvassing Board is convening on these dates
in preparation to conduct the Miami Beach Run-Off Election to be held on November 17, 2015 (if
necessary).
DATE/TIME ACTIVITY ATTENDANCE
Thursday, 11/12/15 1. Logic and Accuracy Test of the touch All Canvassing Board
10:00 a.m. screen and optical scan voting systems to Members or
be used for absentee, early voting, and one designated
precinct ballots Canvassing Board Member
Friday, 11/13/15 1. Pre-count Logic and Accuracy Test of the All Canvassing Board
10:00 a.m. through optical scan system used for absentee and Members or
Tuesday, 11/17/15 provisional ballots one designated
2. Absentee ballot opening and processing Canvassing Board Member
(as needed)
3. Duplication of ballots (as needed)
Tuesday, 11/17/15 1. Absentee ballot opening and processing All Canvassing Board
(as needed) Members
2. Duplication of ballots (as needed)
Canvassing: 3. Canvassing of presumed invalid absentee
5:00 p.m. to completion ballots and provisional ballots
4. Tabulation of results
5. Unofficial Results provided by the
Supervisor of Elections
Friday, 11/20/15 1. Canvassing of provisional ballots All Canvassing Board
11:30 a.m. to completion (if needed) Members
2. Certification of Official Results, including
provisionals, by the Supervisor of Elections
3. Post-count Logic and Accuracy Test of the
optical scan system used for absentee and
provisional ballots
4. Race and precinct(s) selection for manual
post-election audit
5. Audit process starts to completion Majority of the Canvassing
Board Members or
designees
6
Gk,
All proceedings will be open to the public. To request this material in alternate format, sign
language interpreter (five-day notice required), information on access for persons with disabilities,
and/or any accommodation to review any document or participate in any City-sponsored
proceedings, call 305.604.2489 and select 1 for English or 2 for Spanish, then option 6; TTY users
may call via 711 (Florida Relay Service).
In accordance with Florida Statute §286.0105, a person who appeals any decision by the
Canvassing Board with respect to any matter considered at a meeting, he or she will need a record
of the proceedings and therefore will need to ensure that a verbatim record of the proceedings is
made.
Please note that the Canvassing Board Schedule is subject to change, if needed. Please
contact the Office of the City Clerk at 305.673.7411 if you have any questions.
The County Canvassing Board Members are TBD - County Judge, Chairperson; Rafael E.
Granado, Cit y Clerk;Clerk and TBD — Miami Beach Resident.
M AM AC H
NOTICE OF TESTING OF THE TABULATING EQUIPMENT
(LOGIC AND ACCURACY TEST)
AND CANVASSING BOARD SCHEDULE
FOR THE CITY OF MIAMI BEACH GENERAL AND SPECIAL ELECTIONS
NOVEMBER 3, 2015
Pursuant to Florida Statute §101.5612, notice is hereby given of the time and location of the public
preelection test of the automatic tabulating equipment (Logic and Accuracy Test) for the November
3, 2015 Miami Beach General and Special Elections.
Pursuant to Florida Statute §102.141, notice is hereby given of the time and place during which the
City of Miami Beach Canvassing Board for the November 3, 2015 Miami Beach General and
Special Elections will meet to canvass the absentee electors' ballots and provisional ballots.
The City of Miami Beach Canvassing Board will convene at the Office of the Supervisor of
Elections, 2700 NW 87 Avenue, Miami, Florida. The Canvassing Board is convening on these dates
in preparation to conduct the Miami Beach General and Special Elections to be held on November
3, 2015.
DATE/TIME ACTIVITY ATTENDANCE
Thursday, 10/15/15 1. Logic and Accuracy Test of the touch All Canvassing Board
10:00 a.m. screen and optical scan voting systems to Members or
be used for absentee, early voting, and one designated
precinct ballots Canvassing Board Member
Friday, 10/30/15 1. Pre-count Logic and Accuracy Test of the All Canvassing Board
1:00 p.m. through optical scan system used for absentee and Members or
Tuesday, 11/3/15 provisional ballots one designated
2. Absentee ballot opening and processing Canvassing Board Member
(as needed)
3. Duplication of ballots (as needed)
Tuesday, 11/3/15 1. Absentee ballot opening and processing All Canvassing Board
(as needed) Members
2. Duplication of ballots (as needed)
Canvassing: 3. Canvassing of presumed invalid absentee
5:00 p.m. to completion ballots and provisional ballots
4. Tabulation of results
5. Unofficial Results provided by the
Supervisor of Elections
Friday, 11/6/15 1. Canvassing of provisional ballots All Canvassing Board
1:30 p.m. to completion (if needed) Members
2. Certification of Official Results including
provisionals, by the Supervisor of Elections
3. Post-count Logic and Accuracy Test of the
optical scan system used for absentee and
provisional ballots
4. Race and precinct(s) selection for manual
post-election audit
5. Audit process starts to completion Majority of the Canvassing
Board Members or
designees
\ 0,\
All proceedings will be open to the public. To request this material in alternate format, sign
language interpreter (five-day notice required), information on access for persons with disabilities,
and/or any accommodation to review any document or participate in any City-sponsored
proceedings, call 305.604.2489 and select 1 for English or 2 for Spanish, then option 6; TTY users
may call via 711 (Florida Relay Service).
In accordance with Florida Statute §286.0105, a person who appeals any decision by the
Canvassing Board with respect to any matter considered at a meeting, he or she will need a record
of the proceedings and therefore will need to ensure that a verbatim record of the proceedings is
made.
Please note that the Canvassing Board Schedule is subject to change, if needed. Please
contact the Office of the City Clerk at 305.673.7411 if you have any questions.
Judge, Chairperson; Rafael E.
The County Canvassing Board Members are TBD County g p ,
Y 9
Granado, City Clerk; and TBD— Miami Beach Resident.