Form 1FORM 1 STATEMENT OF 2004
.is.o.r,.t or yo,.r.ame,..a','ng FINANCIAL INTERESTS
address, agency name, and position below:
LAST NAME -- FIRST NAM~- .............. FOR OFFICE
USE ONLY:
20051175 1/2
MAILING ADDRESS: Saul Gross
Miami Beach Mayor and City Commission
... 1700 Convention Center Dr iD Code
Miami Beach, FL 33139
CITY · ZiP: cOUNTy: ID No.
NAME OF AGENCY:
NAME OF ~)FFICE OR POSITION HELD OR SOUGHT: P. Req. Code
CHECK ONLY IF ~'1 CANDIDATE OR U NEW EMPLOYEE OR
APPOINTEE
PDF 2004
· *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
FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT iS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):
A
~L.~ DECEMBER 31, 2004 OR [] 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
instruct~ns for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):
'r-"-'¢'~l COMPARATIVE (PERCENTAGE) THRESHOLDS OR [] DOLLAR VALUE THRESHOLDS
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
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
and where to file this form are Iocat-
' INSTRUCTIONS on who must file
ql4, - Gq3 ~041~a~.4~a ~v~... IvL;m,~ ~ . G~ StTv~$ this form and how to fill it out begin
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Eft. 1/2005 (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
PART E ~ LIABILITIES [Major debts]
NAME OF CREDITOR ADDRESS OF CREDITOR
PART F ~ INTERESTS IN SPEOIFIED 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 ~J J¥
PRiNCiPAL BUS NESS
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): ~ fi ~ll O,..~
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 officer, and specified state employee must
sheet (pages 1 and 2) for filing, for your annual disclosure filing, return the form file within 30 days of the date of his or her
to that location, appointment or of the beginning of employ-
ment. Appointees who must be confirmed by
Local officers/employees file with the Supervisor the Senate must file prior to confirmation, even
of Elections of the county in which they perma- if that is less than 30 days from the date of their
nently reside. (If you do not permanently reside appointment.
NOTE: in Florida, file with the Supervisor of the county
MULTIPLE FILING UNNECESSARY: where your agency has its headquarters.) Candidates for publicly-elected local office
must file at the same time they file their
Generally, a person who has filed Form 1 for a State officers or specified state employees qualifying papers.
calendar or fiscal year is not required to file a file with the Commission on Ethics, P.O. Drawer
second Form 1 for the same year. However, a 15709, Tallahassee, FL 32317-5709; physical Thereafter, local officers/employees, state
candidate who previously filed Form I because address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are
of another public position must at least file a copy .201, Tallahassee, FL 32312. required to file by July 1st following each
calendar year in which they hold their posi-
of his or her original Form 1 when qualifying. Candidates file this form together with their
tions.
qualifying papers. Finally, at the end of office or employment,
To determine what category your position each local officer/employee, state officer, and
falls under, see the "Who Must File" Instructions specified state employee is required to file a
on page 3. final disclosure form (Form 1F) within 60 days
of leaving office or employment.
CE FORM I - Eft. 1/2005 PAGE 2
~ o ',~