OATH 9/07/2001
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LOYALTY OATH .',
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CANDIDATeS WITH NO PARTY AFFILIATION
(s..c::cr.s 375.C5-<975.1U. FO"'.c.a S:..t101es)
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STATE OF FLCPJDA
Miami-Dade
COUNTY
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- ~ Name
Mldd~ H.a.mei1nitJal
L..tstHame
a citizen of the State of Fierida and ef the United States of .".merica, . ., and a candidate fer pubEc offi-:e . _. do
hereby ~Iernnly s'le2r cr affirm tt-.al I ....iII s:Jooort the ec.,S:itLlticn of the United States and of the Slate of Fiorida
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OATH OF CM"'DIDATE
(S<dcn !l9r{>C.l"'.c.a St3lo1es) ~
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IP
am a candidate for the office of Q I
. I am a qualified elector of
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(Qfflco)
Miami-Dade
WA N/A
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(district) (dn:uit)
County. Florida.
(group). .
I am a qualified elector of the City of 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 any office from which I am
required to resign pursuant to Section 99.012, Florida Statutes.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING LOYALTY OATH AND OATH OF
CANDIDATE AND THAT THE FACTS STATED IN EACH ARE TRUE.
SIGN
~ER.E
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Mailing Address
('6 c!:f 37 'f;- G65"6 (:?CSl:3'13- ~3q){
Cay PlIo""
Fax Number
'\f\ i f\^N'1 ~ _1:\ c.-~ ~
City Stata
3'3 ) <[ )
Zip Cod.
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~ Signed
OS-Of :lAB (Re.. 1l/'39)
FORM 1 Sl'ATEMENT OF 2000
," \ ...:--' '.
"FINAN~l~L INTERESTS
LAST NAME FIRST NAME MIDDLE NAME:,-" . . (rE-\ REPORfNG PERSON'S AG~NC.Y ?~
,\ C.,- -
Rodriguez-Chomat, Jorge: \ , .,", \ '-\ 61 ~\\~'-"-l-.\ ~e..G,{?-
MAILING ADDRESS:
7136 Bonita Drive, Apt. 11 CHECK QNE. OF THE FOLLOWING (see "Who Must File" on page 3).
Miami 0 LOCAL OFFICER 0 STATE OFFICER
Beach 33141 Miami-Dade ~ CANDIDATE 0 SPECIFIED STATE EMPLOYEE
CITY: ZIP: COUNTY: LIST OFFICE OR POSITION HELD OR SOUGHT:
City Commissioner Group III
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 (check one):
~ DECEMBER 31, 2000 QB 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
PRIOR TO 2001, THE THRESHOLDS FOR REPORTING FINANCIAL INTERESTS WERE COMPARATIVE, USUALLY BASED ON PERCENTAGE VAL-
UES. BEGINNING IN 2001, THE LEGISLATURE HAS ALLOWED FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE
DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS (see instructions for further details). PLEASE STATE BELOW WHETHER THIS STATE-
MENT REFLECTS EITHER (check one):
0 COMPARATIVE (PERCENTAGE) THRESHOLDS (old method) QB 0 DOLLAR VALUE THRESHOLDS (new method)
PART A - PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person]
NAME OF SOURCE SOURCE'S DESCRIPTION'OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
'orge Rodriquez-Chomat & 825 Brickell Bav Driup, T.~'" rI-F-F; ~Q
/\,ssocJ.ates, P.A. Suite 1750
Miami, Fla. 33131
PART B _ SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person]
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'S INCOME OF SOURCE ACTIVITY OF SOURCE
PART C - REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for
when and where to file this form are
House-147l Stillwater Drive Miami Beach Fla. h("l;~'" located at the bottom of page 2.
owned wJ.th spouse) INSTRUCTIONS on who must file
UnJ.mproved lot-Holley by the.Sea, Florida this form and how to fill it out begin
on page 3 of this packet.
Unimproved lot-Royal Highlands, Florida OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Elf. 1/2001
(Continued on reverse side)
PAGE 1
PART D -INTANGIBLE PERSONAL PROPERTY [Slacks, bonds, certificates ~~~~~~S~'I etc.]
TYPE OF INTANGIBLE BU I ENTITY TO WHiCH THE PR()PERTY RCLATcS
NONEother than certif 'cates of stock of Jorge Rodriguez-Chomat &
Associates, P.A. a F1 rida professional association wholly owned by
Jorge Rodriguez-Choma
PART E - LIABILITIES [Major debts] I
NAME OF CREDITOR ADDRESS OF CREDITOR
NationsCredit .0.Box 659200 Dallas, Texas 75265-0200
American Express P.O. Box 530001 Atlanta, GA. 30353-0001
The Optima Card P.O. Box 804247 Chicago, IL. 60680-4104
Jaquar Credit Corn. P.O. Box 681811 Franklin, Tenn. 37068-1811
PART F - INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses}
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
NAME OF Jorge Rodriquez-Cho~ Associates.
BUSINESS ENTITY at & P.A
ADDRESS OF 825 Brickell Bav Dr Suite 1750 Miami
BUSINESS ENTITY ve Fla. 33131
PRINCIPAL BUSINESS Law Office
ACTIVITY
POSITION HELD Attorney
WITH ENTITY
I OWN MORE THAN A 5% 100%
INTEREST IN THE BUSINESS
NATURE OF MY 100% shareholder
OWNERSHIP INTEREST
IF ~F ~RTS A TfiROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE [J
SIGNATU~E: ((' (~,' ~ DATE SIGNED: 7,
(01 ( - September 2001
\ ElLING 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, state officer, and
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for specified state employee must file within 30
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to days of the date of his or her appointment or of
that location. the beginning of employment. Appointees who
Local officers file with the Supervisor of must be confirmed by the Senate must file prior
Elections of the county in which you permanently to confirmation, even if that is less than 30
reside. (If you do not permanently reside in days from the date of their appointment.
NOTE: MULTIPLE FILING UNNECES- Florida, file" with the Supervisor of the county Candidates for publicly-elected local office
SARY: where your agency has its headquarters.) must file at the same time they file their quali-
Generally, a person who has filed Form 1 for a State officers or specified state employees file lying papers.
calendar or fiscal year is not required to file a see- with the Commission on Ethics, P.O. Drawer Thereafter, local officers, state officers, and
ond Form 1 for the same year. However, a candi- 15709, Tallahassee, FL 32317-5709. specified state employees are required to file
date who previously filed Form 1 because of Candidates file this form together with your qual- by July 1 st following each calendar year in
another public position must at least file a copy of which they hold their positions.
his or her original Form 1 when qualifying. ifying papers.
To determine what category your position Finally, at the end of office or employment
falls under, see the 'Who Must File" Instructions each local officer, state officer, and specified
state employee is required to file a final disclo-
on page 3. sure form (Form 1 F) within 60 days of leaving
office or employment.
CE FORM 1 - Eff. 1/2001
PAGE 2