Check Request for submitting Assessment Fee 9-2-22 CHECK REQUEST
O r �,
DATE 09/02/22 r)
VENDOR NO. 99
PAYEE Elections Commission Trust Fund
ADDRESS 107 West Gaines Street
Collins Building, Suite 224
CITY Tallahassee
STATE FL
ZIP CODE 32399-1050
ACCOUNT DESCRIPTION ACCOUNT NUMBER PROJECT NO. AMOUNT
Other Misc. Revenues 001-0000-369.90-00 $579.96
Subtotal from Page 2
TOTAL $579.96
DESCRIPTION OF ITEM OR SERVICE:
Remittance of the 1% Election Assessments collected from Atlantic Beach candidates during qualifying for the 2022
Election.
SPECIAL INSTRUCTIONS:
Please give check to Donna Bartle.
To expedite processing, please attach adequate documentation to support payment.
ADDITIONAL APPROVALS ONLY REQUIRED
9/212,2 1/2/Z WHEN CHECK REQUEST IS OVER $500
,20,-,,,,y,„„r/SIA.,, (70,
REQUESTED BY/ DATE DEPT HEAD / DATE FINANCE DIR / DATE CITY MGR / DATE
Effective: 5/10/04
Revised: 5/19/04
Print Form
ELECTION ASSESSMENT (One Percent)
County Duval City(Atlantic Beach Election Date (November 8,2022 Qualifying End Date ISeptember 2,2022
A. Office B. Candidate C. Party
Mayor 15? Curtis R Ford
(Name) !— Democrat (— Republican
✓ City Clerk (Address)1536 Beach Avenue r Minor Party f No Party Affiliation
I— City Commissioner I a Nonpartisan r Write In
✓ Other (City,ST 'Atlantic Beach,FL 32233
D. Annual Salary $ 110,672.08 1 %Assessment $ '106.72 Undue Burden r Yes Q No
A. Office B. Candidate C. Party
f>ZMa yOr ) 'Sean Keane r Democrat r Republican
(Name
F City Clerk (Address)1395 Saturiba Drive r Minor Party r No Party Affiliation
I— City Commissioner I GZ Nonpartisan (— Write In
f Other (City,ST) 'Atlantic Beach,FL 32233
D. Annual Salary $ 110,672.08 1 %Assessment $ 1106.72 Undue Burden r Yes Q No
A. Office B. Candidate C.Party
Q Mayor (Name) 'Brittany Norris r Democrat r Republican
r City Clerk (Address) 11 83 Violet Street p Minor Party r No Party Affiliation
✓ City Commissioner 1 Q Nonpartisan r Write In
✓ Other (City,ST) 'Atlantic Beach,FL 32233
D. Annual Salary $ '10,672.08 1 % Assessment $ '106.72 Undue Burden r Yes Q No
A. Office B. Candidate C.Party
I— Mayor (Name) (Candace Kelly (— Democrat r Republican
✓ City Clerk (Address) 1142 Sylvan Drive r Minor Party r No Party Affiliation
FEZ City Commissioner I a Nonpartisan r Write In
r Other (City,ST) 'Atlantic Beach,FL 32233
D. Annual Salary $ 16,495.36 1 % Assessment$ 164.95 Undue Burden r Yes rX No
A. Office B. Candidate C. Party
I— Mayor (Name) ''Jennifer Deery Lagner r Democrat r Republican
I— City Clerk (Address) 1`78 Semiinole Road r Minor Party r No Party Affiliation
Q City Commissioner �I Q Nonpartisan r Write In
I— Other (City,ST) (Atlantic Beach,FL 32233
D. Annual Salary $ 16,495.36 1 % Assessment $ 164.95 Undue Burden r Yes Q No
Submitted By: Name 'Donna L.Bartle,City Clerk Phone Number 1(904)247-5809
Address '800 Seminole Road City 'Atlantic Beach Zip '32233
Remit to: Florida Elections Commission, 107 West Gaines Street, Suite 224, Tallahassee, Florida 32399
Print Form
ELECTION ASSESSMENT (One Percent)
County (Duval City'Atlantic Beach Election Date 1November8,2022 Qualifying End Date 15eptember2,2022
A. Office B. Candidate C. Party
I— Mayor (Name) Kevin Nottingham P Democrat I— Republican
✓ City Clerk (Address)11295 Main Street r Minor Party I— No Party Affiliation
15Z City Commissioner (I Ix Nonpartisan r Write In
(— Other (City,ST 'Atlantic Beach,FL 32233
D. Annual Salary $ 16,495.36 1 %Assessment $ 164.95 Undue Burden r Yes Ix No
A. Office B. Candidate C. Party l
✓ Mayor (Name) 'Jessica Ring I— Democrat P Republican
I— City Clerk (Address)11002 Begonia Street I— Minor Party I— No Party Affiliation
15Z City Commissioner 1 iTc Nonpartisan r Write In
I— Other (City,ST) 'Atlantic Beach,FL 32233
D. Annual Salary $ 16,495.36
1 %Assessment $ 164.95 Undue Burden r Yes Ix No
A. Office B. Candidate C.Party
I— Mayor (Name) I I— Democrat I— Republican
I— City Clerk (Address) I r Minor Party I— No Party Affiliation
F City Commissioner I r Nonpartisan I— Write In
I— Other (City,5T>
D. Annual Salary $ 1 %Assessment $ I Undue Burden r Yes r No
A. Office B. Candidate C.Party
✓ Mayor (Name) I I— Democrat p Republican
✓ City Clerk (Address) I r Minor Party r No Party Affiliation
I— City Commissioner I r Nonpartisan I Write In
✓ Other (City,ST) I
D. Annual Salary $ I 1 %Assessment $ I Undue Burden r Yes r No
A. Office B. Candidate C. Party
F Mayor (Name) I I— Democrat I— Republican
F City Clerk (Address) I r Minor Party r No Party Affiliation
I— City Commissioner I 1— Nonpartisan I— Write In .
I— Other (City,ST) I
D. Annual Salary $ I 1 %Assessment $ I Undue Burden r Yes r No
Submitted By: Name 'Donna L.Bartle,City Clerk Phone Number 1(904)247-5809
Address 1800 Seminole Road City 'Atlantic Beach Zip 32233
Remit to: Florida Elections Commission, 107 West Gaines Street, Suite 224, Tallahassee, Florida 32399