HomeMy WebLinkAboutHerrold - Assessment Fee - 6-9-262026 Qualifying Checklist for Filing Officer's Use
CANDIDATE NAME: L i SGS Herro Id DATE:
OFFICE: ❑ Mayor -Commissioner — Seat 1 ff Commissioner — Seat 4 ❑ Commissioner — Seat 5
INCUMBENT? ❑ YES LY'NO
Appointment of Campaign Treasurer (Form DS -DE 9) Filed for each treasurer/deputy treasurer
Treasurer: John FIVAn
Deputy Treasurer(s): ak C n
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o
✓1 Bank: Cor'm" hrS r
52-2.&(o
Statement of Candidate (Form DS -DE 84 (Eff. 4/2026)) Filed
Nomination Petition process met
Candidate Oath — Nonpartisan Office
Cect version of form submitted (DS -DE 302NP-E Corr. (Eff. 04/2026))
Under oath, name as it is to appear on the ballot
01/check box if you have a compound name without a hyphen (Last Name affects placement on ballot)
Check box if you have a nickname AND complete affidavit on back of oath, notarized
�/_District"
"Office" provided (Example: Mayor -Commissioner - Seat 1, Commissioner -Seat 4, etc.)
should be N/A
2 "Circuit #" should be N/A
"Group or Seat #" (1, 4, or 5 whichever relates to the office you are seeking)
County of legal residence provided (Duval)
Check applicable box swearing that "I am not" OR "I am" a citizen of another country AND if also a
itizen in another country, specify which country. _
Acknowledgement of Outstanding Fines, Fees, or Penalties, s, complete detailed statement
on page 2.
Candidate original signature provided (If you are acting as Notary, have them take an oath and
/then have them sign)
6d" Phone number, email address, and address of legal residence provided
EY Venue (county where oath taken)
4hysical presence or Online presence indicated
Vate of notarization provided
nersonally known or Produced identification is indicated
06 Identification type provided, if needed; otherwise use "N/A"
notary signature
�///Contains
Notary stamp (with notary's name) affixed below signature
® Notary commission not expired when notarized
Phonetic Spelling of Name (not required for qualifying)
O/Specify the amount owed for each entity if "I Do" was checked
Affidavit of Nickname (Only required if using nickname for the ballot) must be notarized
2026 Qualifying Checklist Pagel of 2
Name L 15 a, 14-e ria 1 d
Financia isclosure (Form 1)
2025 Form 1 submitted via electronic filing system:
❑ Receipt (incumbent)
OR
9'FoS�rm
❑ Candidate's (digital) signature provided
❑ Form is complete, including n/a when there is nothing to report on part of the form
❑ Form is complete, including attachments
Election ssessment Fee (Mayor $139.62 OR Commissioner $112.43)
able to the City of Atlantic Beach
1'C k drawn on campaign account (Official, bank, cashier's check not acceptable)
� eck drawn on bank designated on DS -DE 9
ount paid l ��
An
is not less than the qualifying fee (check written amount)
Q W 'tten and numerical numbers are both filled in and are the same
;"Check signed by ❑ treasurer,
OR
N/deputy treasurer, l^ 1 S a H e r ro l d-
❑ Processed payment through AB Cashier, obtained validated receipt to file as proof of payment
SOE Doc ents (not required to qualify)
L & A Receipt signed
NOTE: F.S. 99.061 7(C) The filing officer performs a ministerial function in reviewing qualifying papers.
In determining whether a candidate is qualified, the filing officer shall review the qualifying
papers to determine whether all items required by paragraph (a) have been properly filed and
whether each item is complete on its face, including whether items that must be verified have been
properly verified pursuant to s. 92.5250)(a). The filing officer may not determine whether the
contents of the qualifying papers are accurate.
❑ Redact address & phone number from check and documents, if protected
❑ Redact social security numbers and PINs on tax returns, if applicable
❑ Redact routing numbers on check
❑ Scan documents
❑ Add documents to LF
❑ Send Oaths to DCSOE, Cierra Fackler at CFackler@coj.net
❑ Show as qualified on website
2026 Qualifying Checklist Page 2 of 2
City of Atlantic Beach
Offsite Payment Form
► RECEIVED /
JUN u92016
n1'23 i -M,
Date prepared: 06/09/26
Deposit Date:
Prepared by: Donna Bartle
Payment Cash
GL Account or
Type Receipt
Accounts Receivable
Deposit
Code Number Description
Number
Amount
UN Assessment fee for Candidate - Lisa Harrold
001-0000-369.90-00
112.43
ATLANTIC BEACH CITY
800 SEMINOLE RD
ATLANTIC BEACH, Ft. 32233-5445
United States
Phone (904) 247-5800
COAB.US
Received From:
Date: 06/09/2026 Time: 11:23:48 Ahi
Receipt: 0000034734
Total Deposit
112.43
ITEM REFERENCE AMOUNT
Cash
UN NON-SPECIFIC
LISA HERROLD CANDIDATE FEE $112.43
ACH
_..__...__.._._..._......... ___... _.....___ _.._.__...
Checks
112.43
TOTAL $112.43
Money Orders
CHECK 101 $112.43
Total Tendered: $112.43
Total
112.43
Change: $0.00
Revised:
O:\City Clerk\INTERNAL USE\ELECTION 2026\Qualifying\[Payment Form- Lisa Herrold.xls]Form