Qualifying documentsLOYALTY OATH
CANDIDATES WITH NO PARTY AFFIt.IATION
(Sections 876 AS-8T6 t0, Florida Statutes)
R~C:~i~F~ __ _ __
FFICE U5E ONLY
200 SEP -4 P!1 IZ~ 1
CI Y CLE.i~i~~`S G~= ~ ICE.
Mi:jrni-Dade COUNTY
STATE OF FLORIDA --
PLEASE PRINT
~Q~~ 1 ~e~ ~~s ~~~r~
I~ Last Name
First Name Middy NameAnitial
s citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do
hsxeby solerr.•~t;; s~'aar or affln~~ :tiai I will support the Constitution of the United 5iates and of the State of Florida.
.OATH OF CANDIDATE
($edion 99.021. Florida Statutes)
(-LEASE /IYHT NAME Ai VOU 1MSM ~T TO A--EA1r ON TiE Mlt-~T- MAW` wY NOT SE CNANt:EG AFTER THE END Oi OUALIFI/VK.)
wA N!A ,
tlm a candidate for the office of ~,Ornm t SS+~'~r ~ _ '
. ~ feel (dhtrict) (clrcuk)
- 1 am a qualified elector of (~~ ~- ~QCJ.~ _ County, Florida.
Is"O"pl within the Ci~tY at feast one year before quaNfyhtp
1 stun s tualified elector of the City of Miami Beach, Fbrida, resid'mg i i3p J~-II~JCG~rr ~~ (~'~, ~' ~31~I
1be City of Miami Beach elected office, with my dal residence being:
Mf~mi Beach, Fbrida. tam qualified under the ordinances and Charter of said City and under the Constitution and tits
Laws of Florida to hold the office to which I desire to be nominated or elected. 1 have qualified for no other public oAke
It1 1t1N sbte. the term of which office or any part thereof runs conctxrent wtth the office I seek: and I have resigned from
_ ~ _~ . -- ---.-•_-~ ~ _..~:.........~.~~nt ~ Section 99.012. Florida Statutes--
~1NOER IpENALTIES OF PERJURY, t DECLARE THAT I HAVE READ THE FOR
CANDIDATE AND THAT~~ IN EACH ARE TRUE.
~q' ULLIANBEAUCHAMP gyiy N TO AND SUBSCR
~; MY COMMISSION # DD 530416 of Qr~~ 207, Notary N
EXPIRES: April 29, 2010
'j ,~,n,,,~,,,wscu~w~err Notary Public,
Commission Expires:
Produced ID: YPe~
SIGN HERE
~ ~ ~~ r~-~ i ~~ ~~~~~r ~~
MaNino /lddress
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3 LOYALTY OATH AND OATH OF
efore a this day
f Flonda
/~ Personally Known: /
Sisnature of candidate
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pay Pttone
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Fors Number
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:FORM: 1 STATEMENT OF 2006
Please print or type your name, mailing FINANCIAL INTERESTS
i
b
l
on
e
ow:
address, agency name, and posit
LAST NAME --FIRST NAME -- MIDDLE NAME : FOR OFFICE
-~- h ~~ n ~ lJ USE ONLY:
MAILING ADDRESS
I
ID Code
'M~ c~~ .~eo~- ~3~`~ '~'~\Q ~GC~-e
CITY : ZIP : COUNTY
ID No.
NAME OF AGENCY
Conf. Code
~t'(\'c'~ l ! ~4r
NAME OF OFFICE OR POSITION HELD OR SOUGHT : P. Req. Code
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 2 ~ 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
cA ~ '~~ ~
~ ~s~ n ~ ~ ~ 5 k-- I
. .
M~ l 31
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 locat-
I',~~ r„ m ed at the bottom of page 2.
' r ~ INSTRUCTIONS on who must file
\ ®
~~t
`
~ this form and how to fill it out begin
3
(~c~()1 ~
lW S~ P )... on page
.
11 ~ 1 /~ }' -}t ~~vd SO'~ Sully ~~RS 8th, F ~ OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Eff. 1/2007 (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
WQ' ~® Qv 1~~7~ ~( ~Of~f ~X ~~~ +~
PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
BUSINESS ENTITY # 1 ~, I BUSINESS ENTITY # 2 I BUSINESS ENTITY # 3
NAME OF xr ~~ ~~~ G~ ~ S
BUSINESS ENTITY
ADDRESS OF N $p (1 ln7 ~ 1 AY C 7~
BUSINESS ENTITY 1 31
PRINCIPAL BUSINESS ~ ~ ~
ACTIVITY (
POSITION HELD ~
l
,,
WITH ENTITY Ql
-
-` ~J _
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS 1 ~S
OWNERSOH PMNTEREST ~G('~r.pl~ ~.p ~ j (~~f
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
SIGNATURE {required): e~ vIXYN`
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) for 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 SIGNED (required): ~`~1 ~~
FILLNG INSTRUCTIONS:
WHERE TO FILE:
If you were mailed the form by the Commission
on Ethics or a County Supervisor of Elections for
your annual disclosure filing, return the form to
that location.
Local officers/emp/oyeesfile 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 Maclay 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 specified 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
dates for publicly-elected local office
file at the same time they file their
ing papers.
after, local officerslemployees, state
s, and specified state employees are
:d to file by July 1st following each
lar year in which they hold their posi-
Finally, at the end of office or employment,
each local officer/employee, 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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CITY OF MIAMI BEACH
(THIS INFORMATION MUST BE COMPLETED)
Account Number:_
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By
No.
Director
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