Financial Interest CE Form 1
.
STATEMENT OF'-
FINANCIAL INTERESTS
2000
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NAME - FIRST NAME - MIDDLE NAME:
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MAILING ADORE S:
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CITY: ZIP:
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COUNTY:
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NAME OF REPORTING PE~~?N:SAG!;N,C;C: r 6
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CHEC QME OF THE FOLLOWING (see "Who Must File" on page 3):
o LOCAL OFFICER 0 STATE OFFICER
~CANDIDATE 0 SPECIFIED STATE EMPLOYEE
LIST OFFICE OR POSITION HELD OR SOUGHT: { ,1r'1
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DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON
A FISC!~ ~R PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):
)l( DECEMBER 31,2000 QR 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 ~F~CTS EITHER (check one):
X COMPARATIVE (PERCENTAGE) THRESHOLDS (old method) QR 0 DOLLAR VALUE THRESHOLDS (new method)
PART A - PRIMARY SOURCES OF INCOME [Major sources of income to the reporting pel1lon]
NAME OF SOURCE SOURCE'S
OF INCOME ADDRESS
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DESCRIPTION OF THE SOURCE'S
PRINCIPAL BUSINESS ACTIVITY
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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
located at the bottom of page 2,
INSTRUCTIONS on who must file
this form and how to fill it out begin
on page 3 of this packet.
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Ell, 112001
(Continued on reverse side)
PAGE 1
PART E - LIABILITIES [Major debts]
NAME OF CREDITOR
ADDRESS OF CREDITOR
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
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
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IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET. PLEASE CHECK HERE [J
SIGNATURE: ~
WHAT TO FILE:
After completing all parts of this form, including
signing and dating it, send back only the first
sheet (pages 1 and 2) for filing,
NOTE: MULTIPLE FILING UNNECES-
SARY:
Generally, a person who has filed Form 1 for a
calendar or fiscal year is not required to file a sec-
ond Form 1 for the same year. However, a candi-
date who previously filed Form 1 because of
another public position must at least file a copy of
his or her original Form 1 when quallfying.
CE FORM 1 ,Eft, 1/2001
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DATE SIGNED:
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FILING INSTRUCTIONS:
WHERE TO FILE:
If you were mailed the form by the Commission
on Ethics or a County Supervisor of Elections for
your annual disclosure filing, return the form to
that location.
Local officers file with the Supervisor of
Elections of the county in which you permanently
reside. (If you do not permanently reside in
Florida, file with the Supervisor of the county
where your agency has its headquarters.)
State officers or specified state employees file
with the Commission on Ethics, P.O. Drawer
15709, Tallahassee, FL 32317,5709,
Candidates file this form together with your qual-
ifying papers.
To determine what category your position
falls under, see the "Who Must File" Instructions
on page 3.
1/ /0/
WHEN TO FILE:
Initially, each local officer, state officer, ani
specified state employee must file within 3.
days of the date of his or her appointment or c
the beginning of employment. Appointees wh
must be confirmed by the Senate must file pric
to confirmation, even if that is less than 3
days from the date of their appointment.
Candidates for publicly,elecled local offie
must file at the same time they file their qual
tying papers,
Thereafter, local officers, state officers, an
specified state employees are required to fi
by July 1st following each calendar year
which they hold their positions.
Finally, at the end of office or employme
each local officer, state officer, and SpecifiE
state employee is required to file a final disci,
sure form (Form 1 F) within 60 days of leavir
office or employment.
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