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Qualifying documents LOYALTY OATH CANDIDATES WITH NO PARTY AFFILIATION (Sections 876.05-876 t0, Florida Statutes) OFFICE USE ONLY 101 I, Mi~~~;%M r~ ~, COUNTY ~~C~ STATE OF FLORIDA PLEASE PRINT (C~ Gtr ~ C ~~''~-fi4 v~ ~ ©'r~ ~ ~ /~~ First Nams 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 spier-~~~ly sh-gar or affir~„ ~`~at I will support the Constitution of the United States and of the State of Fkltida. .OATH OF CANDIDATE (Section 99.021, Florida Statutes) (PLEASE /WNT NAME Ai VOU VNSH IT TO A-Pk~>i1CON THE eALIOT -NAME MAC NOT RE CHANGED AiTER 7NE END Oi QUALIFYING) sm a candidate for the office of C ~ sM m' ~' °Ne ~ N!A N/A ---' (offtca) (district) (c)rtult) . t am a qualified elector of ~~ G(/1/~ ~ I~GC~2- County, Florida. lo-o~P) am s quatit~ed elector of the City of Miami Beach, Florida, residing within the City at least o e year before qu lifyirt~ for City of Miami Beach elected office, with my legal residence being: ~t~3f3 ~ ~ ~'~ v>s ~e-t~3A. M ~~.~; ~, Miami Beach, Florida. I am qualified under the ordinances and Charter of said City and under the Con titution and the l.attvs 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 anv once from which I am reouired 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. idW LILYIA11 R. IWFIELO DtGIry PtIbNC - SIDfs of Fktrfdo V~ilart6pMatFab 18,2009 CominMNOn # DD 375299 wtdai By Natbrld NofaryAnn, SIGN HERE SWORN TO AND SUBSCRIBED b f9re< me thi ~ day of ~~_ 2007, Notary Nart1 Notary Public, to a of Florida Commission Expires: ~- / ~ ~ Personally Known: Produced ID: Type: of Ca s83~ ~11~s fie. ~~ ~~- zoo- ~o~ ~ .~~ u~Z-zz~z Mallinp Address Oay Phane Fat umber City State Zip Code Date Signed OS-OE 2s8 (R~v. 08100 FORM 1 STATEMENT OF ~~ ~ ~ ~.~ Pl.asaprintortype your name, mailing FINANCIAL INT'EREST'S ZUU~ ~G.I _~ ~~ gyp: ~ ~ address, agency name, and position below: LU J 1 LAST NAME --FIRST NAf~1E -- f IDD E NAME : ~ -r I 1 Y t,L~~ch:~5 O~F ~CF ~C71~ O~LL ~~ ~Gtel C~jY ~~ USE ONLY:E l . ~ . MAILINGpADDR/E'S_S ~ ,p ~{' 5438 ~ ~ 1 rn~ In W -t"r Il:, t'txle ~i ~ ~ ~ 3.~~~f~ ,~ - t~ CITY : ZIF' COUN I Y ID No. NAME OF AGENCY . C~ ~~ ~( Gwt,r ~ Conf Code NAME OF OFFICE OR POSITION HELD uR SOUGHT : ~ P. P.eq. Code Wl,r~i ~~QvL ~~J _~ You an not limited to the s ce on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF CANDIDATE OR ~ NEW EMPLOYEE OR APPOINTEE F'DF 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 FISCA~R. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one): DECEMBER 31, 2406 (ZR ~ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR- MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLCS THAT ARE ABSOLUTE DOLLAR VALUES. WHICH REQUI ES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAG E VALUES (see insV ions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHF_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 ADDRESS PRINCIPAL BUSINESS ACTIVITY ~~r 9~ ~~ iZ~ ~~h~~~ P~~~-~o~= ~.- (mow ~~~„_, C~c, l C~.~~ 33i 3~ c~+ti- --~ 3 3 ( 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) F{LING INSTRUCTIONS for when {~,~ ~,` 5~ C~ Illty~ „vQ,, $~- ~ ~ ~~ r~ and where to file this form are locat- ed at the bottom of page 2. INSTRUCTIONS on who must file O~ ~ ~ '3/ ~ ~ 1 C~.Z , n;~ ~; ~2' ~ ~ lD _1 !" ` 7 tohis aor Sand how to fill it out begin P 9 OTHER FORMS ~~ ~ ~~ h `~ ~ you may need to file are described on 6 f ~ ~ ~ page . ~~ rvrcm i - tn. irtuur (c:ontinued on reverse side) PAGE 1 D I PART D - INTANGIBLE PERSONAL PROPERTY [Stocks. bonds. certifir_ates of deposit. e!c j l TY"Pt OF INTANGIELE , B'JSWESS ENTITY TO WHICH THE PRr~NFRTY RELl,TE_c ~ ~ -_ 4, PART E -LIABILITIES (Major dehts] NAME OF CREDITOR ADDRESS OF CREDITOR l,~~ii,nGl ~/J ~~Ce1fyQ I .~1 dn.fi ~e-.I l ~ lam, ~ SeG aiG, ~.~~e~ft,r) l Lf i lira ; (~Ji ~. ~i-P /~ l~ n^; PART F -INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses] BUSINESS ENTITY # 1 1 BUSINESS ENTITY # 2 I BUSINESS ENTITY # 3 OF THAN A 5% THE BUSINESS AY INTEREST ~.~~/)~" IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE (required): `/~~~~~''-"' , ~~ n~ J DATE SIGNED (required): ~ ~ O 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). WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disGosure fding, return the form to that location. Local olfcers/employeesfIle 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.) Stsfs officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 3600 Maclay Boulevard. Soutn, 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 appointment. Candidates for publicly-elected local office must file at the same time they file their qualifying papers. Thereafter, local officers/employees, state officers, and specified 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 specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or emplovment 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. CE FORM 1 - Eff. 1!2007 PAGE 2 ~ 63.964 ~ 0 2 S 0 s~o olo~oz~ DATE a PAY TO THE ORDER OF '~ ~ ~ sA.~rr~e ~ DOLLARS e ~~ a ©/ Mellon United National Bank laml, FbAtla ~, n ~ ~ ~`~ MEMO G l r ~ h ~~~ _(///~/,'~~/r __ "" x:06700 46~: 0 LO LO 246771t' 0 280 CAMPAIGN ACCOUNT OF MICHAEL GONGORA "2007" 5838 COLLINS AVE., UNIT 3A MIAMI BEACH FL 33140 w