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Qualifying documentsLOYALTY OATH CANDIDATES WITH NO PARTY AFFILIATION (Sections 876.05-876.10, Florida Statutes) STATE OF FLORIDA I, OFFICE USE ONLY ~~~~~~~~ I" l~ ~ fem. ii ~i~"~ ~ F != I r ~ C OU NTY PLEASE PRINT ~~ ~ ~ ~ c`:~ 1~ ~~ rL-~ Z - Cyr ~~ rte, First Name Middle NameAnitlal Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby soler.-~•~ly swear or affir,~ l~ ~tiat I will support the Constitution of the United States and of the State of Florida. OATH OF CANDIDATE (Section 99.021, Florida Statutes) {PLEASE PRINT NAME AS YOU WISH IT TO /VPEAR ON THE {!ALLOT -//NAME MAY NOT BE CNANGEO AFTER THE END Of OUALIFYIflIG) am a candidate for the office of r, , GJ o l,/ t NIA N/A . (oHice) 1 (district) (circuit) . 1 am a qualified elector of .LL/~~ ~ h ~ / '- r~~iA- c-~ f' County, Florida. (a-o~P) 1 am a qualified elector of the City of Miami Beach, Florida, residing within the City at leastI 'one year before qualifying for City of Miami Beach elected office, with my legal residence being: 0 ~C1? u~: s f-f ~#2 ~,, N ~ fix- ~ u>© ~- Miami Beach, Florida. I am qualified under the ordinances and Charter of said City and under the Constitution and the taws 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 env n~re fmm wt^ich 1 am renuirPrl to resign pursuant to Section 99.012, Florida Statutes. UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ THE FOREGOING LOYALTY OATH AND OATH OF CANDIDATE AND THAT THE FACTS STATED IN EACH ARE TRUE. ~uti~wl It. FIATFIEtD SW RN TO AND SUBSCRIBED b~fgre me this `y ~ day . ; ~ Notary PubMc - SIoN of fbtkb of ~pc2007, Notary Name: ~~ l i'~°''' ~ ~f~d ~' ~AyCarrrrlwlant3t;11sFibta2t109 Notary Public, State. of Florida ~'~ Commhtbrt ~ OD 376299 c „oo-.•~ Bonded BytvoMortdNDlaryluet. Commission Expires: a ~/,~~n ~ Personally Known:!/ .,.;~:'~ Produced ID: Type: SIGN HERE of Candidate I:~L- ~ y~~~>~ E~f ~f ~o~.ti ~k~ ,~-~ o ,~ `3 o s ~~'~ 3 ~S/ 3o s ~~ / fz ~S_ Mallin~ Address Day Phone Fax Number ~/ , City State Zip Code Si OS-DE 24a (Rev. 08103) ~- FORM 1 STATEMENT OF 2006 dd ag ncy ~ame°a~d posrtion`bel FINANCIAL INTERESTS a ress, e ow: LAST NAME -FIRST NAME -MIDDLE NAME : FOR OFFICE Kruszewski -Frank John USE ONLY: MAILING ADDRESS 1800 Sunset Harbour Drive ID Code 2002 CITY : ZIP : COUNTY Miami Beach 33139 Miami-Dade ID No. NAME OF AGENCY City of Miami Beach Conf. Code NAME OF OFFICE OR POSITION HELD OR SOUGHT : P. Req. Code City Commissioner -Group VI You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF ~ CANDIDATE OR ~ NEW EMPLOYEE OR APPOINTEE PDF 2006 **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, 2006 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 instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one): ^/ 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 Gary Hennes Realty 1633 Jefferson Ave Real Estate Sales Coldwell-Banker 1691 Michigan Ave Real Estate Sales PART B -SECONDARY SOURCES OF INCOME [Major customers, Giants, 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 N/A PART C -REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for when and where to file this form are locat- N/A 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. CE FORM 1 - Eff. 1/2007 (Continued on reverse side) PAGE 1 I PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES IN/A PART E -LIABILITIES [Major debts] NAME OF CREDITOR ADDRESS OF CREDITOR HSBC Bank (home mortgage) ~ HSBC Bank Buffalo New York PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses] ~~H~~r= ~~ n/a BUSINESS ENTITY ADDRESS OF n/a BUSINESS ENTITY PRINCIPAL BUSINESS n/a ACTIVITY POSITION HELD n/a WITH ENTITY I OWN MORE THAN A 5% n/a INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST n/a BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 I BUSINESS ENTITY # 3 I IF ANY OF PARTS A THROUGH F ARE CONTIN~ED ON A SEPARATE SHEET, PLEASE CHECK HERE ® I SIGNATURE (required): WHAT TO FILE: After completing all parts of this form, induding signing and dating it, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, you must write "none" or "n/a" in that sedion(s). Facsimiles will not be accepted. NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form 1 for the same year. However, a candidate who previously filed Form 1 because of another public position must at least file a copy of his or her original Form 1 when qualifying. DATE SIGNED (required): ~` ~ ~ z~ ~- WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disdosure filing, return the form to that location. Local office-s/employees file with the Supervisor of Elections of the county in which they perma- nently 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; physical address: 3600 Maday Boulevard, South, Suite 201, Tallahassee, FL 32312. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see the "Who Must File" Instructions on page 3. WHEN TO FILE: Initially, each local officer/employee, state officer, and spedfied state employee must file within 30 days of the date of his or her appointment or of the beginning of employ- ment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates for publidy~lected local office must file at the same time they file their qualifying papers. Thereafter, local officers/employees, state officers, and spedfied state employees are required to file by July 1st following each calendar year in which they hold their posi- tions. Finally, at the end of office or employment, each local officer/employee, state officer, and spedfied state employee is required to fde a final disdosure form (Form 1 F) within 60 days of leaving office or employment. CE FORM 1 - Eff. 1/2007 PAGE 2 CO O T ~I ql n Ic Y N ~o ~ ~ ~ pr ql Z ~ l7 ~I ¢ ~ W W J Q Q LL ~ O U ~~~ ~ a m ~~~ a ~ z a d a WOD .&~ t7m ~`^ to m e i m ~~ ~ t~ ~~ a J ~~ ~\, Q ~~ ~ ~~ .~i I C}~ ~~ ~~, ~. ~ ti~ W Q Q A ~.. 1) 1 ~1 ~i 2 i ,~ a~ Y~ .~ ' j ~~~ !' a ~ [~ _~a W -[~ W ~~ RJ .a rf1 ~D 1, \ r. '` O ` E~ ~ -.~= v ' ti L. ~n ~-~ ~ p ~ `~ ~ o 0 o ,, ~ o m ^ .- , Y ~ ~ . ~ ~ o ~j d~0 m a ~ Hv .,n~~~au+v ae~w.-,® Arad>s c Nviaevn~ M t~ +r. ...Fr,~..,:~. CITY OF MIAMI BEACH P1C~:-Pfi=~~_?!?~:cnps,E~.= ':~~~=!;3~~1 ~'~f~'~~ 2 No. (THIS INFORMATION MUST BE COM--PAL /EYED) Account Number: ~~ 1 v ~~ -~S y QC~ J Preparsr: Dept:, Office Director By ExT• ~~ ~~ ~?~ ^ Cash ^Credit Card Chack ~ ~(~ /~ ~ ~ ~ /~ ~