Form 1 Amended Elsa Urquiza
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FORM 1
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STATEMENT OF
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FINANCIAL INTERESTS,:
2005
LAST N E - FIRST NAME - MIDDLE!'J~:
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MAlL~~G ADORES:-: .Q, /. A / I A
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Please prlnt or type YO\lr name, mailing
.ddress, agency name. and poswDn below;
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USE ONLY:
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10 Code
CITY: J.//
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NAME OF AGENCY:
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COUNTY: j) L
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Com. Code
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
P. Req. Code
CHECK ONLY IF 0 CANDIDATE OR 0 NEW EMPLOYEE DR APPOINTEE
PDF 2005
'.BOTH PARTS OF THIS SECTION MUST BE COMPLETED'"
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL lNTERESTS 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):
IQ'f DECEMBER 31, 2005 .QR D 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 detais). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):
o COMPARATIVE (PERCENTAGE) THRESHOLDS OR D DOLLAR VALUE THRESHOLDS
DESCRIPTION OF THE SOURCE'S
PRINCIPAL BUSINESS ACTIVITY
PART B - SECONDARY SOURCES OF INCOME [Major customers, dients, 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
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PART C - REAL PROPERlY [Land, buildings owned by the reporting person]
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FILING INSTRUCTIONS for when
and where to file this form are locat-
ed at the bottom of page 2.
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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 Ort page 6.
PAGE 1
Sep 08 06 01 :49p
PART 0 -INTANGIBLE PERSONAL PROPERTY (Stocks, bonds, certificales of deposit, etc.]
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
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PART E - LIABILITIES (Major debtsj
NAME OF CREDITOR ADDRESS OF CREDITOR
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PART F -INTERESTS IN SPECiFIED BUSINESSES (Ownership or positions in certain types of businesses]
BUSINESS ENTITY'" 1 BUSINESS ENTITY # 2 BUS1NESS ENTITY" 3
NAME OF
BUSINESS ENTITY
ADDRESS OF
BUSINESS ENTITY
PRINCIPAL BUSINESS
ACTIVITY
POSITION HELD
WITH ENTITY
I OWN MORE THAN A S%
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 0
SIGNATURE (required): ~~ ~.ru DATE SIGNED (required): q!gA~
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FII LH~(I INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of Ihis form, including If you were mailed the fonn by the Commission Initially, eactJ local officer/employee, slate
signing and dating ii, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified stale employee must
sheet (pages 1 and 2) for filing. your annual disclosure filing, retum the form to file within 30 days of the date of his or her
thaI 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 mus' be confirmed by
section, you must Wme "none" or "n/a" in that of Elections of lhe county in which they penna- the Senate musl file pnorto confirmalion, even
section(s). nently reside. (If you do not permanently reside if that is less than 30 days from the date of Iheir
in Florida, file with the Supervisor of the counly appointmenl.
Facsimiles will not be accepted. where your agency has its headquarters.) Candidates for pUblicly-elected local office
NOTE: State officers or specified state employees must file al the same time they file Iheir
MULTIPLE FlUNG UNNECESSARY: file with the Commission on Ethics, P.O. Drawer qualifying papers.
Generally, B person who has filed Fonn 1 for a 15709. Tallahassee, Fl 32317-5709; physical Thereaftet', local officers/employees, state
calendar or fiscal year is not required to file a address: 3600 Maclay Boulevard, South, Suile officers, and spedtied stale employees are
second Form 1 for the same year. However, a 201, Tallahassee, FL 32312. required to file by July 1s1 following each
candidate who previously filed Form 1 because Candidates file this form together with their calendar year in which they hold thei... pesi-
of another public posilicn must at least file a copy qualifying papers. tions.
of his or her original Form 1 when Qualifying. To determine what category your position FinafJy, at the end of office or employment,
1alls under, see the 'Who Must File" Instructions each local officer/employee, state officer, and
On page 3. specified slate employee is required to file a
final disdosure form (Form 1F) within 60 days
of leaving office or employment.
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