Qualifying Documents - LeveyLOYALTY OATH OFFICE USE ONLY
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CANDIDATES WITH NO PARTY AFFILIATION
(Sections 876
05-876
10
Florida Statutes) ~
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STATE OF FLORIDA / ~~ ~.
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First Name Middle Name/Initial t Name
a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do
hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida.
OATH OF CANDIDATE
(Se ion 99.021, Florida Statutes)
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(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE LOT -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the office of .~~ .F ~~l~l ~ N/A N/A
(office)-, (district) (circuit)
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County, Florida.
I am a qualified elector of
1
(group)
I am a qualified elector of the City of Miami Beach, Fla., residing within the City at least one year before qualify-
ing for the City of Miami Beach elected office, with my legal residence being: ~777~/J/EO'~'rt' ~" /~~~( ,
Miami Beach, Fla. I am qualified under the ordinances and Charter of said City and under the Constituti~ed
the Laws of Florida to hold 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.
Signature of Candidate Telephone Number Email Addres ~ % ~'
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Address City
State ZIP Code
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Sworn to (or affirmed) and subscribed before me this _ ~ 1 day of ~, 200.
Personally Known: _ \ or
Produced Identification:
Type of Identification Produced: ~(~ ~ ~~Z A
Signature of Notary Public -State of Florida
Print, Type or Stamp Commissioned Name of Notary Public
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i ^~i~"~~'~%~;: ANNMODESITT
?.'`~•` ~'~ °:; MY COMMISSION # DD 868726
s. ~~a EXPIRES: September 10, 2013
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~'~%':,;;~; n, ~ Bonded Thru Notary Public Undervrtiters
DS-DE 24B (Rev. 05/08)
FORM 1 STATEMENT OF 2008
Please print or type your name, mailing FINANCIAL INTERESTS ?p ' ~.'~
address, agency name, and poskion below: A~
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LAST NAME -FIRST NAME --MIDDLE NAME : FOR OFFICE ~
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MAILINGU~ ES~~v~~ /U ~~ USE ONLY: ~~I' i;'~~ ff~[ ' , '` 4~ ~~
ID Code '
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CITY : ZIP : COUNTY
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NAME OF AGENCY
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NAME OF OF E OR POSITION HELD OR SOUGHT : P. Req. Code
You are not limked to the ace on the lines on this form. Attach addkional sheets, if necessary.
CHECK ONLY IF ~ NDIDATE OR ^ NEW EMPLOYEE OR APPOINTEE
"BOTH PARTS OF THIS SECTION MUST BE COMPLETED"
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, 2008 .~ ^ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):
^ COMPARATIVE (PERCENTAGE) THRESHOLDS Q@ ^ DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sours of income to the reporting person]
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME
ADDRESS
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' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for when
~7 ~
7 / ~~~ ~" ~~ l' / ~.S~~O~/1L"-- and where to file this form are locat-
ed at the bottom of page 2.
. INSTRUCTIONS on who must file
,/ this form and how to fill it out begin
on page 3.
OTHER FORMS
you may need to
file are described on page 6.
"' ' `"""' ' "' """" (Continued on reverse side) PAGE 1
PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
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PART E -LIABILITIES (Major debts)
NAME OF CREDITOR OF CREDITOR
ADDRESS
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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
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ^
SIGNATURE (required): ~ DATE SIGNED (required):
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FILING 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/employee, state
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified state employee must
sheet (pages 1 and 2) for filing. your annual discosure filing, return the form to fife wlfhin 30 days of the date of his or her
that location. appointment or of the beginning of employ-
If you have nothing to report in a particular
"
"
"
" Local officers/employees file with the Supervisor ment. Appointees who must be confirmed by
the Senate must file prior to confirmation, even
in that
or
n!a
none
section, you must write of Elections of the county in which they perms- if that is less than 30 days from the date of their
section(s). nently reside. (If you do not permanently reside
appointment.
in Florida, file with the Supervisor of the county
Facsimiles will not be accepted. where your agency has Its headquarters.) Candidates for publicly-elected local office
must file at the same time they file their
NOTE: Slate officers or specified state employees qualifying papers.
MULTIPLE FILING UNNECESSARY:
fife with the Commission on Ethics, P.O. Drawer
FL 32317-5709; physical
Tallahassee
15709
Thereafter, local officerslemployees, state
Generally, a person who has filed Form 1 for a ,
,
address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are
calendar or fiscal year is not required to file a FL 32312.
Tallahassee
201 required to file by July 1st following each
second Form 1 for the same year. However, a ,
, calendar year in which they hold their posi-
candidate who previously filed Fonn 1 because Candidates file this form together with their lions.
of another public position must at least file a copy qualifying papers.
of his or her original Form 1 when qualifying. To determine what category your position Finally, at the end of office or employment,
each local officer/employee, state officer, and
falls under, see the "Who Must File" Instructions specified state employee is required to file a
on a e 3.
p g final disclosure form (Form 1 F) within 60 days
of leaving office or employment.
CE FORM 1 - Eff. 1/2009 PAGE 2
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