Qualifying documents D. Crystal NAIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive Miami Beach Florid 3 13
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ww.miamibeachfl.9 ov � ' ,
CITY CLERK'S OFFICE
Tel: 305-673-7411. Fax: 305-673-7254
Email: RafaelGranado @miamibeachfl.gov
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Before me, an officer authorized to administer oaths, personally appeared to me well
known who, being sworn, says that he/she is a candidate for the office of City
Commissioner (Group No. a2, (or Mayor) for the City of Miami Beach, Florida;
that he/she is a qualified elector of said City residing within the City at least one year
before qu lifying for City of Miami Beach elected office; that his/her legal residence is:
d 14 J'4 Kv_ , Miami Beach, Miami-Dade County,
Florida; that he/she is qualified under the ordinances (including Miami Beach City Code
Chapter 38 governing "Elections") and Charter of said City to hold such office; and that
he/s required qualification fee.
Dave Crystal
Candidate
ure of Can idate
Sworn to and subscribed before me this day of ml , 2013.
At,
Authorized Officer
R..e►.�trsL. �1Crs�►r woo
ct 1-0 13 Signature of Notary
NOTARY SEAL
Y y UUAM R.HATFlEW Date
'. MY COMMISSION S EE 844865
., EXPIRES:February 18,2017
Bonded Thru Notary Public Underwriters
F:\CLER\CLER\000_ELECTION\0000_2013 General Election\MISCELLANEOS WORD
DOCS\CANDIDATE'S OATH.Docx
CANDIDATE OATH 1 '°
NONPARTISAN OFFICE
2013 SEP -3 PIN 2: 21
P 11(Not for use by Judicial or C p `�' l.;j E-.' A l?
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021,Florida Statutes)
(PLEASE PRINT NAME AS YOU WISH IT TO PPEAR ON E BALLOT*-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
d
am a candidate for the nonpartisan office of j G, 1n1\
I (office) (district#)
GV-rjrj rl ; I am a qualified elector of h\Liow\j"} �� County, Florida;
(circuit#) (group 6r seat#) I
am qualified 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, Fl Statutes; and I will support the Constitution of the United States and the Constitution of the
State of Flor'
v �
x 136) 3 o -u o- A;V'C 6 6" ,) Jo
Signature of Candidate Telephone Number Em it Address
) o
Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): ' )
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities(see instructions on page 2 of this form):
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed) and subscribed before me this J day of , 20
I
Personally Known: or
ignature of Notary Public
Produced Identification: Print, i e Name of Notary Public
r LftJAM R.HATFlEID
,r MY COMMISSION k EC x44865
Type of Identification Produced: EXPIRES:Februanj lii.%017
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DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C.
i
FORM 1 STATEMENT OF 2012
Please print or type your name,mailing FINANCIAL INTERESTS
address,agency name,and position below: FOR OFFICE USE ONLY:
LAST NAME--FIR T NAME—MIDDLE NAME: ' SE; _ I : 2 !
C V,9 MAILING ADDRESS: i i .�� 0 F IF E-L 33 )q I Are - !
CITY: ZIP: COUNTY:.
NAME OF AGE Y:
C ` J'/��►��/a � old
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
You are not limited to th space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF CANDIDATE 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 O A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER( st check one):
DECEMBER 31, 2012 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESH DS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, W H ARE USUALLY BASED ON PERCENTAGE VALUES
(see instructions for further details). CHECK THE ONE YOU ARE USING:
❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR DOLLAR VALUE THRESHOLDS
PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions]
(If you have nothing to report,you must write"none"or"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUS ESS ACTIVITY
d 1,�,a 60caS 3) ,r, l OV
0 .& V " Ind tAW r 0ja v!L/j
r C 9 v OvS' t o % CL /y/
Cv Voo
PART B-- SECONDAR SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(if you have nothing to report,write"none"or"n/a")
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-See instructions] FILING INSTRUCTIONS for
(If you have nothing to report,you must write"none"or"n/a")
when and where to file this
A) 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.
CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. (Continued on reverse side) PAGE 1
ti
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,you must write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH VE PROPERTY RELATES
P – P" ° 2i
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,you must write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
ACS u Oak M214 41 y
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,you must write"none"or"n/a")
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 ❑
SIGNATUR d : DATE SIGNED (,re�„c uired):
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, If you were mailed the form by the Commission Initially, each local officer/employee,
including signing and dating it, send back on Ethics or a County Supervisor of Elections state officer, and specified state employee
only the first sheet(pages 1 and 2)for filing. for your annual disclosure filing, return the must file within 30 days of the date of
form to that location. his or her appointment or of the beginning
If you have nothing to report in a particular Local officers/employees file with the of employment. Appointees who must be
section,you must write"none"or"n/a"in that Supervisor of Elections of the county in confirmed by the Senate must file prior to
section(s). which they permanently reside. (If you do not confirmation, even if that is less than 30
permanently reside in Florida, file with the days from the date of their appointment.
NOTE: Supervisor of the county where your agency Candidates for publicly-elected local office
MULTIPLE FILING UNNECESSARY: has its headquarters.) must file at the same time they file their
Generally, a person who has filed Form 1 State officers or specified state employees qualifying papers.
for a calendar or fiscal year is not required file with the Commission on Ethics, P.O. Thereafter, local officers/employees, state
to file a second Form 1 for the same year. Drawer 15709,Tallahassee, FL 32317-5709. officers, and specified state employees
However, a candidate who previously filed are required to file by July 1st following
Form 1 because of another public position Candidates file this form together with their each calendar year in which they hold their
must at least file a copy of his or her original Qualifying papers. positions.
Form 1 when qualifying. To determine what category your position falls Finally, at the end of office or employment,
under,see the"Who Must File"Instructions on each local officer/employee,state officer,and
page 3. specified state employee is required to file a
final disclosure form(Form 1 F)within 60 days
Facsimiles will not be accepted. of leaving office or employment. However,
filing a CE Form 1 F (Final Statement of
Financial Interests) does nol relieve the filer
of filing a CE Form 1 if he or she was in their
position on December 31,2012.
CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. PAGE 2
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA T NAM —FIRST NAME—MIDDLE NAME: NAME OF AGENC :j e /`'liC,�n„�c
S40A L)MiC2 s2 Q, o�/ �
to
MAILIN ADDRESS: OFFICE OR POSITION HELD:
P� oX
CITY: ZIP: COUNTY: FOR QUARTS ENDING(CHECK ONE): YEA5
L ❑MARCH ZfJUNE ❑SEPTEMBER ❑DECEMBER 20
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is
being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the
date(s)the gift was received.If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
e a/ C
`a �3 �
_C=
C-00
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
—r,
PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT —'
If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy of that receipt to this
form.You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLORI
COUNTY OF
depose on oath or affirmation and say that the information disclosed Sworn to(or pffirmed)and sub ribed before pie this
r'7 A day of 20;(-r4-herein and on any attachments made by me constitutes a true accurate,
by !2 y
and total listing of all gifts re to be repo rfe by Section 112.3148,
Florida Statutes. (Signature of Notary Puubf-State of Florida)
of J
(Print,Type,or Stamp Commissio ed Name of Notary Public)
SJGNATU, E`PORTING OFFICIAL Personally Known OR Pr 9d • __-
Type of Identification Produced ✓ L
e
y •;;4 i
PART D—FILING INSTRUCTIONS " ' .< EXPIRES:February 18,2017
'' •�:�t;� 3onded Thru Notary Publk Underwriters
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi-
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calendar quarter
that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.)
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)�'