Qualifying documents~,.
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OFFICE USE ONLY
LOYALTY OATH
CANDIDATES WITH NO PARTY AFFILIATION ~ ~' ~'' ~ ~ ~j n
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(Sections 876.05-876.10. Florida Statutes)
qn 7
STATE OF FLORIDA CIT~~~t~iC'~~I` 1~- COUNTY
PLEASE PRINT
I
r ~~ /~i~~~r ~ ~ ~~~ /es ~.~ •g~-
First Name Middle NameAnittal Last Nam•
a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do
hereby soler•.-~~~I;; shaar or affir~„ ;hat 1 will support the Constitution of the United States and of the State of Fkxida.
.OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
(PLEASE t+RINT NAME AS YOU WISH IT TO A-YEAn tNr THE BALLOT -NAME AIA11 NOT eE CHANGED AFTER THE END OF t]UALIFrtNG)
~~~'~ ~ NIA N/A
am a candidate for the office of
_
to}ticel (district) (circuit)
~ ~ I am a qualified elector of f~9/,,~y~~ r~,? b ~- County, Florida.
o-~~PI
1 am a qualified elector of the City of Miami Beach, Florida, residing within the City at least one year before qualifyirtp
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for City of Miami Beach elected office, with my legal residence being: ~7L~ ~ A~rc.~ .~ ~
rdinances and Charter of said City and under the Constitution and the
th
d
e o
er
Miami Beach, Florida. I am qualified un
laws of Florida to hold the office to which I desire to be nominated or elected. I have qualified for no other public office
fn the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from
n ffice from which I am required to -esign pursuant to Section 99.012, Florida Statutes.
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ THE FOREGOING LOYALTY OATH AND OATH OF
LAND DIN EACH ARE TRUE.
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= Notary t~ulDNc - ~ a Fbtkb SW RN TO AND SUBSCRIBED before me th
Notary Name: Ca: Ci u,t'Y1 ~• ~ oa,l-i~ ~~
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9ooq
2007
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~%' y . Ca""~0^'~ D037b299 Notary Public, State of Florida
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' Commission Expires: ~~~ DG Persona
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Produced ID: Type:
SIGN HERE
Signature o1 Candidate
S ~h'' E _
Mallinp Address Oay Phone Fax Number
City State Zip Code Date gned
DS-OE 2~a (Rev. 011103)
FORM l STATEMENT OF 2006
PNaseprintorrypeyourname,mailing FINANCIAL INT'EREST'S
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ress, agency name, an
posi
on
e
ow:
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LAST NAME --_,FIRr-S-T NAh1E -- MIDDLE NAME . ~ FOR OFFICE
S ~6% f¢ •l ~ 1~+~ i ,L C- / ./_( l~/( ~~. ~~ .~ ~r~ ~' ~ USE ONLY:
MAILINGADDRESS r~ o
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lu r'ode r;. rn ''T'i
CITY: ~ LIF' COUNIY ~-~ ..o
NAME OF AGENCY : ~ O ~ ;"~"[
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®~ G " 1 ~ /T ~~ ( t~ ~ 1~ G Conf. Code~r~ ~ t~
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NAME OF OFFICE OR POSITION HELD OR 50UGHT: P
Req
Code
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You an 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 ~ ~ 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 THF_R (check one}:
COMPARATIVE (PERCENTAGE) THRESHOLDS ¢@ ~ 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 ADDRE55 PRINCIPAL BUSINESS ACTIVITY
~~~~ ~C ~~~GE~ ;~ vti•4.~..1s , ~o~c ~I ~, -
~A-.tivS ST.
F~T7~~k'~'e ~ Li4 tom)
~
GC.({ S('Ct,"iCl r -}-
1, ~- C~-~ V l
~C'tt~C
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 wher
t
fil
thi
f
e
o
e
s
orm are locat-
ed at the bottom of page 2.
INSTRUCTIONS on who must Fite
this form and how to fill it out begin
on page 3.
OTHER FORMS you ma
need to
y
file are described on page 6.
~~ ~ ~.~~.~ ~ - cu. v~uui t~.onunuea on reverse stile} PAGE 1
I PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] I
TYPF (1F INTANC;IRI F I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
~~
PART E -LIABILITIES (Major debts]
NAME OF CREDITOR ADDRESS OF CREDITOR
/rr'~c:~/"r/~'
PART F -~ INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions in certain types of businesses]
BUSINESS ENTITY # 1 I BU5INE5S ENTITY # 2 I BUSINESS ENTITY # 3
OWNERSHIP INTEREST
I IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ~ '
SIGNATURE (required):
WHAT TO FILE:
After completing all parts of this form, including
signing and dating it, send back only the first
sheet (pages 1 and 2) far filing.
If you have nothing to report in a particular
section, you must write "none" or "n!a" in that
section(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 51GNED (required): ~~ ~~- . 7r "d- C~ Cg '~
FILING INSTRUCTIONS:
WHERE TO FILE:
If you were mailed the form by the Commission
on Ethics or a County Supervisor of Elections for
your annual disGosure filing, return the form to
that location.
Local orilcers/eetiptoyeesfIle with the Supervisor
of Elections of tfte county in which they perma-
nently reside. (If you do not permanently reside
in Florida, fife with the Supervisor of the county
where your agency has its headquarfers.}
State ofltcers ar specified state employees
fife with the Commission on Ethics, P.O. Drawer
15748, Tallahassee, FL 32317-5749; physical
address: 3644 Maclay t3aulevard, South, Suite
201, Tallahassee, FL 32312.
Candidates file this form together with their
qualifying papers.
To determine what category your position
fails under, see the "Who Must Fite" Instructions
on page 3.
WHEN TO FILE:
Initially, each local officer/employee, state
officer, and specified state employee must
file within 30 days of the date of his or her
appointment ar 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 publicly-elected local office
must file at fhe same time they file their
qualifying papers.
Thereafter, local officers/employees, state
officers, and specified state employees are
required to file by July 1st fottowing each
calendar year in which they hold their posi-
tions.
Finally, at the end of offrce or employment,
each local officerJemptoyee, state officer, and
specified state employee is required to file a
final disclosure form (Form 1F} within 60 days
of leaving office or employment.
CE FORM 1 - Eff. 1!2007 PAGE 2
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