Qualifying documentsOFFICE USE ONLY
LOYALTY OATH
CANDIDATES WITH NO PARTY AFFILIATION
(Sections 876.05-876.10, Florida Statutes) ~ ~ ~, ~ {
I ~~~~~
STATE OF FLORIDA Miami-Dade COUNTY
PLEASE PRINT
First Name Middb NameAnitial Last Name
a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do
hereby Bolen-.•'!;; shaar or affin ~ ~ that I will support the Constitution of the United States and of the State of Florida.
.OATH OF CANDIDATE
~-- (5eclitx199.021, Florida Statutes)
I, ~- ~SCc. C~ v %.z
(PEASE PRINT NAME AS VOU WISH IT TO A-PEAR ON THE t1ALLOT - NAME Ab-~ NOT 0E CHANGED AFTER THE END OF pUALIFYING)
am a candidate for the office of ~dM/1?~~SSiD~C/' ^ //(~Dd~ ~~ NSA NlA ,
~(~j (of}ic. (d~trict) (circuit)
~I~OrJ I am a qualified elector of ~%~/(any- f~~t~. County, Florida.
( ro
1 am a qualified elector of the City of Miami Beach, Florida, residing within th Cit ~t ast `e/y r b ~ lifying
for City of Miami Beach elected office, with my legal residence being: r7/~/a ~/7~ ~. ~u•; ~~~!~'*'
Miami Beach, Florida. I am qualified under the ordinances and Charter of said City and under the Constitution and the
Laws of Florida to hold the office to which I desire to be nominated or elected. 1 have qualified for no other public office
in the state, the term of which office or any part thereof runs concurrent with the office 1 seek; and I have resigned from
n Rce from which I am reouired to resign vursuant to Section 99.012, Florida Statutes_
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING LOYALTY OATH AND OATH OF
CANDID+ E AND THAT THE FACTS STATED IN EACH ARE TRUE.
,~;;;1:"••,,, IILIAM R: H,gFEtp SWORN;~T~~ AND SUBSCRIBED be ore me this v~ ~- day
';may PtlbNc - Rade of Flotidp of =iE~r~~~`"`2007, Notary Name: ~: ~~~-~/n /2~ ~IQ~~
s~, =~-~'CommiNat6ph~Febta2p,pq Notary Public State of Florida
'•~,q;, Carirrtialort +~ DD 375299 Commission Expires: ~- / D ~/ Personally Known
bnUsdSyNt~INoridNolbryAan. Produced ID: Type:
SIGN HERE
1 natur ' Candidate
~a ~ ~ ~~ ,1 ~~,L
Mallinp Address Day Phone Faz Number
City State Zip Code D e Signed
OS-DE 246 (Rov. x8101)
:FORM 1 STATEMENT OF 2006
Please print or type your name, mailing FINANCIAL INTERESTS
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L S NAME -- FIRST NAME -- MIDDLE NAME : FOR OFFICE
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MAILING ADDRESS : /
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CITY : ZIP : COUNTY : ~,
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ID No. ~
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NAME OF AGENCY : f'" ~
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NAME CFFICE OR POSITION HELD OR S~HT :
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You are not limited to the pace on the lines on this form. A ach a itional sheets, if necessary. ~; w
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CHECK ONLY IF dCANDIDATE OR ~ NEW EMPLOYEE OR APPOINTEE ~'' ~DF 2006
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"`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 `I,EAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):
~rJJ[ DECEMBER 31, 2D06 QR ~ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS THE CPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH
REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS. WHICH ARE USUALLY B ASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (ch eck 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 INC
OME ADDRESS RINCIPAL BUSINES
A
CTIVITY
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p e ?'~/-C »~ e i~ ~ ~ Olt S r'S .
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PART B -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to bus inesses owned by the reporting person]
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
B
USINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
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PA T C - E PRO [La uildings owned by t e repo ing son] ,~,/
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~ FILING INSTRUCTIONS for when
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,v, an d where to file this form are locat-
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~30 % C~1i /8 /~~ /3.? ~{/ ~/G ~ IN STRUCTIONS on who must file
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~70 C'I~I ~ l1IG ~''4lJ ~~~I. S.(,f~• / /7/~
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1'! • this form and how to fill it out begin
on page 3.
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/6~,~'/ ~ L~ ~ ~~i,0~ ~ ' /.U O THER FORMS you may need to
70 ~ ~!/~ 7~ ~t~ ~,/Q ~ /J~ . fil e are described on page 6.
CE FORM 1 - Eff. 1!2007 (Continued on reverse side) PAGE 7
PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
TYPE OF INTANGIBLE L BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
Ci ~ s~i,t7c ~ IJ la
PART E -LIABILITIES [Major debts]
NAME OF CREDITOR ADDRESS OF CREDITOR
~ ,~ Me~i~G a~i~ ~s ~ M~ 3~/3
5~ f D o ~3oo,c h~iia~ ~C a/a~,~
Mud .Czts:~ D ax .3608 d6/;~ ~ o/
PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
NAME OF
BUSINESS ENTITY
I ACTIVIITY L BUSINESS
TH ENTITY
NATURE OF MY
OWNERSHIP INTEREST
I IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ® I
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) 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
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/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.)
Stafe 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 officers/employees, 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.
PAGE 2
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CITY OF MIAMI BEACH ~ `- " c`-'`~° ~ ' `
No.
Cash ^ Credit Card Check # ! (~ '
$~;~~ 4
Received Of ~~~i ; ~.~ A „R,. A A ~ . 20
For ~(, , _._-
(THIS INFORMATION MUST BE COMPLETED) finance Director
By
Account Number: ~ ~ .
Preparers Dept. ~~~~-~
.-, EXT: