5 &ELI D A N C#eSx R, am a candidate for the

Transcription

1 ~ ~ NON-PARTSAN CANDDATE LOYALTY OATH NON-PARTSAN OFFCE Sections , Florlda Statutes STATE OF FLORDA LEE COUNTY PLEASE PRNT FRST NAME MDDLE NAME/NTAL LAST NAME am a citizen of the Stat0 of Florida and of the United States of America, and a candidate for publlc offlce, do hereby solemnly swear or affirm that wlll support the constitution of the United States and of the State of Florida. L OATH OF CANDDATE Section Florida Statutes PORTANT NOTCF TO ALL CANDDATFS THE WAY YOU WANT YOUR NAME TO APPEAR ON THE BALLOT AFTER THE END OF OUAL FYNG PRNT NAME BELOW AS YOU WANT T TO APPEAR ON THE BALLOTa 1, 5 &EL D A N C#eSx R, am a candidate for the PLEASE PRNT NAME AS YOU WANT T TO APPEAR ON BALLOT office of k c &. SC#VOL "6D &isr-f GROUP OFFCE DSTRCT am a qualified elector of u g CRCUT County, Florida. am 0 qualified under the Constitution and Laws of Florida to hold the office to which desire to be T nominated or elected. have qualifled 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 whlch am requlred to resign pursuant to Section , Florida Statutes.?2 c s:.c 07- /Z 66 #= Signature of Candidate Date Slgned CHESTER, SHER DAN RVER RD FORTMYERS FL dj 7) k 93 -f207 ( Daytime Telephone # Fax Telephone Number led for Lee County only DOE APPROVED a

2 T NAME - FRST NAME - Be-*< MDDLE NAME. MALNG ADDRESS: sp).-;d&h /3a3 -&4ev 7f.b / 22- rvd 337iJ- Le e/ tlty : ZP : COUNTY : T0Z.7GfJ e 3/--iEf5 CAQd/ 2&,%yo! NAME OF OFFCE OdPOSlTlON HELD OR SOUGHT : FOR OFFCE USE ONLY 5 D Code D No. Conf. Code P. Req. Code c c1-j c3 m c P 9 2 CHECK F THS S A FLNG BY A CANDDATE PART A -- NET WORTH Please enter the value of your net worth as of December 31, 2005, or a more current date. [Note: Net worth is not calculated by subtracting your reported liabilities from your reported assets, so please see th My net worth as of / /GW -3&dhJ DESCRPTON OF ASSET (specific description is required - see instructions p.4) /!/3 m0+& eamd %fer z. 3. VALUE OF ASSET /bo, 060 Bp a - / m,/# *cg LABLTES N EXCESS OF $1,000: PART C - LABLTES -- * -- * JONT AND SEVERAL LABLTES NOT REPORTED ABOVE: NAME AND ADDRESS OF CREDTOR AMOUNT OF LABLTY -0 - CE FORM 6 - Eff (Continued on reverse side) PAGE 1

3 PART D - NCOME You may ETHER (1) file a complete copy of your 2005 federal income tax return, including all attachments, OR (2) file a sworn statement identifying each separate source and amount of income which exceeds $1,000, including secondary sources of income, by completing the remainder of Part D, below. 7 elect to file a copy of my 2005 federal income tax return. [f you check this box and attach a copy of your 2005 tax return, you need not complete the remainder of Part D.] PRMARY SOURCES OF NCOME: NAME OF SOURCE OF NCOME EXCEEDNG $1,OW ADDRESS OF SOURCE OF NWME AMOUNT SECONDARY SOURCES OF NCOM nts, etc., of businesses owned by reporting person-see instructions]: PART E - NTERESTS N SPECFED BUSNESSES OWN MORE THAN A 5% NATURE OF MY F ANY OF PARTS A THROUGH E ARE CONTNUED ON A SEPARATE SHEET, PLEASE CHECK HERE OATH STATE OF FLORDA COUNTY OF, the person whose name appears at the beginning of this form, do depose on oath or affirmation and say that the information disclosed on this form and any attachments hereto is true, accurate, and complete. Sworn to (or affirmed) and subscribed before me this / 2 day of Personally Known OR Produced dentification FLNG NSTRUCTONS for when and where to file this form are located at the top of page 3. NSTRUCTONS on who must file this form and how to fill t out begin on page 3. OTHER FORMS you may need to file are described on page 6. CE FORM 6 - Eff. 1/2006 PAGE 2

4 Use the RS label. othemise, Please print or type. Home address (nunberand street). f yw haw ap.0. box, see instnztions. Aparbnent no River Road Ci. tom or post office. f you have aporpion addresr, se imbuctaris. " sm ZP& Ft. Myers EL ~ Youmustenter your SSN(s) above A Checking a box below will not change your f more than six p&5. c Dependents: (l) First name Last name mqependent's Waddlildmn moepndenrs (qgfi o n ~ ~ socia securny relattonship e& liml number to you *r#hyou... rfdldb -.d#m live* YoUhto 1 dkdlaor sapnlbn Social security Educator expenses (see instructions) Adjusted gross 17 RA deduction (see instructions) income 18 Student ioan interest deduction (see instructions) Tuition and fees deduction (see imtructiom) * Addnmrb.rr ~n#nnw d Totai number of exemptions claimed... ncome & 7 Wages, salaries, tips, etc. Attach Form@) W ,45k Attach Fwm(s) 8a Taxable interest Attach Schedule 1 if required... 8a 4& w-2 hna. w =E bfax-exempt interest Donet indude on line&... 8b c;- E&R? 9a Ordinary dividends. Attach Schedule 1 if required... 9s 4& was wittikid. b Qualified dividends (see instructions)... 9b Capital gain distributions (see instructions) a RA distributions s lbtaxabteamwnt... llb -- 12a Pensions and annuities... 12a 12bTaxabk amount... 12b 5,49%; Q 13 Unemployment compensation and Alaska 73 lfywddnot Permanent Fund dividends pet a W-2. see instnrtlons. Endase, but benefits a 14b Taxable amount... 14b donotattach, wpsymant Add tines 7 through 14b (far right column). This is your totd incoma... b 15 20, Add lines 16 through 19. These are your total adjurtments Subtract line 20 from line 15. This is yow rdj ustedqrikssiltcme... b n 19,783. BAA For Disclosum, Privacy Act, and P.pambl.k Redudon Act Notice, see imtructionr. Form lwoa (2005)

5 Form 1040A (2005) Charles E Walliama 6 Sheridan Chester P Enter the amount from line 21 (adjusted grass income) , 783. Tax, Credits, and You were born before January 2,1941, TW boxes payments if: Spouse was born before January 2,1941, checked. 23a b f you are qarried filing separately and your spouse itemizes deductions, see instructtom and check here... b 23b5 VDedUCtiMl L Enter your standard deduction (see left margin) , Subtract line 24 from line 22. f line 24 is m e than line 22, enter ,783. fw - People who checked any box on line 2% or 23b or who can be claimed as a dependent, See instructions. All others: Single or Married filing separately, 85,OOo Married filing jointly or Qualifying widow(er), $lo,ooo Head of Household, $7, f line22 is over$109,475, or you provided hausingtoa person displaced by Hwricana Kabina, see instructions. otherwise, multiply $3,200 by the total number of exemptions claim on line 6d , Subtract line 26 from line 25. f line 26 is more than line 25, enter -0-. This is your taxableincome , Tax, including any alternative minimum tax (see instructions) Credit for child and dependent care expwes. Attach Schedule Credit for the elderly or the disabled. Attach Schedule l Education credits, Attach Form Retirement savings contributions credit. Attach Form Child tax credit (see instr,uctions). Attach F m 8901 if required Adoption credit. Attach Form Add lines 29 through 34. These are your total credits Subtract line 35 from line 28. f line 35 is m e than line 28, enter Advance earned income credit payments from Fotm(s) W Addlines36and37.Thisisyowtotaitax Federal income tax withheld ftom Forms W-2 and Joint return? See imtnrctions. KeepacoW fw your records. Your signature spouse s sigmtwe. n apint return. -mustsign. Rspareh signaure Dais Date Your occupldiar cook Daybmephonenumber r % sporae ~occupatm i S El rrtird/aub.t.itntm toacho -;3 Date Qleckif ~&SSNoCFllN selfempw pmpamfs Firm s (oryourrifsaif. OWH ---_-_-- Self -Prepared _- use only zl-2?!& b... ZlPOode E# phon no.

6 Charles E William 6 Sheridan Chmter Rivor Road Ft. Myers, E% U.S. NDNDUAL TAX RESPURN SUMMARP Adjusted Gross ncome Taxable ncome Total Tax Total Payments Refwld Effeative Tax Rate 9 8 $ $ Qi Listed below are form8?and related worksheet8 for your review: - Form 1040A ndividual ncome Tox Return F YOU PLAN TO FLE ELECTRONCALLY: After you file your return alrctronioally, you will recwive inotruationrr on how to complete the electronic filing prooers. F YOU PLAN TO MAL YOUR TAX RESPURN: When you print your filing aapy of your tax return, you will reaeive inetruotions on where to mail your return. KEEP THS PAGE FOR YOUR RECORDS "2 MAL.