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Qualifying documentsv: I f,, ~ ; LOYALTY OATH CANDIDATES WITH NO PARTY AFFILIATION (Sections 876.05-876.(0, Florida Statutes) I, STATE OF FLORIDA OFFICE USE ONLY RECFI~/~D 1001 SEP - 7 AM ! I ~ 59 CITY C~t~~6~eICE COUNTY PLEASE PRINT first Name Middta 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:-~~~:y swaar or affin~ ~ that I will support the Constitution of the United States and of the State of Florida. OATH OF CANDIDATE . (Section 99.021, Florida Statutes) I, (rIEASE IIUN A!: YOU WISH IT TO A-PEAN ON THE lAILOT-NAME AIRY NOT OE GNANGEO AFTER THE ENO OF QUALIFYING) am a candidate for the office of L~jyr /~j _r :,/'~f/ ~G~/~~ ~ N!A N!A • ~~, ~ ~ -'~ toK~.) (dl,tr+ct) (ctrcule- . 1 am a qualified elector of ---~~..t2~~r, ~~~ County, Florida. lo-o~vl I am a qualified elector of the City of Miami Beach, Florida, residing within the Cit at least one year before qualifyirt~ tot City of Miami Beach elected office, with my legal residence being: t->s~ l=' ~j ~ r` L,~,~., Miami Beach, Florida. I am qualified under the ordinances and Charter of said City and under the onstitution and the Caws 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 snv nlTir•n fmrn u•F~ir•h I ~m rPnuirprt In re5lOrt ourSUant t0 SeCtiDn 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. ' SW RN TO AND SUBSCRIBED b ore me this ~ d o`""~ P e,,,, ULIAM a. twFlEtp of _007, Notary Name:. =_ =may PubNc - stole a Fbrlda Notary Public, Sta a of Florida N, '~~Cott'"tr0"S~~tE~ Commission Expires: ~ /~' D Personally Known: ~ ~`%'~an~;.~~ - ~"""~01 e ~ 37~ Produced ID: Type: SIGN HERE Signature of Mallinp Addr.ss Oay Phona Fax Numb.r ~-~ ~~'2tc_. ~ - ~ ~ / /ice ~r~~~ ~T ' (~ ~~a Q~tv i4~_A` State Lp Code Date Signed FORM l STATEMENT OF ~~'~ , 2006 ~ , ~ , Pl~as~ print or type your name, mailing (j ~ r ~ ~ ~ name and pos,tion below: 1' I NA N C I A L I I~ I E R E S T S ~ 7 •dd-Na agenc y , , n Tr ~ p~/~• LAST NAME --FIRST NAME -- MIDDLE NAME . ~ FOR OFFICE L~k~~, , ~~ ~" ~ USE ONLY: S ~ . , f ~ ~C~ MAILING ADORE SS 1. ~/ - _ /!) ~~ ~~ CITY : CIF . '-O ~ l Ire No. NAME OF AGENCY Conf. Code NAME OF OFFICE OR POSITIUN HELD UP, SOUGHT : P. P,eq. Code 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 CALENDAP. YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one): _ ' j[ Q ~/ DECEMBER 31, 2006 (~R ~ SPEC{FY 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 tree instructions 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 ~1r' PART B -SECONDARY SOURCES OF INGOME (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 fil thi f e s orm are locat- • ~ 1 7 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. ..~ rvnrv, , - cn, v~uui tc.onunued on reverse side} PAGE 1 9 I PART D -INTANGIBLE PERSONAL PROPERTY Stocks. bonds. certrf~cates of rfeposrt etc j I TYPE OF INTANGIBLE [ BUSINESS Et~lTITY TO WHICH THE PROPERTY RELfTES PART E -LIABILITIES [Major debts] NAME dF CREDITOR 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 ' /~/ /~ " ADDRESS OF BUSINESS ENTITY ~ ~ ~/ ~/ PRINCIPAL BUSINESS ACTIVITY i/ ~/ ~/ POSITION HELD VNTH ENTITY ~/ / i / I OWN MORE THAN A 5% ~ INTEREST IN THE BUSINESS / /i NATURE OF MY OWNERSHIP INTEREST ( l! /~• IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE (required): WHAT TO FILE: After completing all Paris Hof this form, including signing and dating it, send back only the first sheet (pages 1 and 2) for filing. (t 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. ADDRESS OF CREDITOR DATE SIGNED (required): WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual discosure fling, return the form to that location. Local ort-cers/empfoyeesfile wdh the Supervisor of Elections of the county in which they perma- nently reside. (1/ you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Sfafe officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address' 3600 MaGay 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 "UVho Must Fite" Instructions on page 3. C/ . WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file wlfhin 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 offrcers, 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 officerlemptoyee, stale officer, and specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. c,t rurcnn i - tn. Trzuur PAGE 2 j; 0 `s N ~ ~#~8 I ~ ~ ~ ~~ ~ ~ ~~ ~~ J J o ~ o ~ I i ~~ ~ ~ ~ t1v ~~ 1~1 ~~ a , ~: 0 s ~ ~~ o ~W ' c0 ~ Z ~ ~ I ~ ' ~ ! i U a ~ ~ , s M aoLL ~ ~ L J U ° ~ ^ ' ' a Q ` s ~ ,~~ Nag N ¢¢ l~I ~ s ~ ru'' ~• c O L ~ f J V p ~ l oc C7 ~ I ~~ pm~~ - ~~W~ i ~ , ti II'' c ~~ ? ~ C ~ ~ ~ .`~ o ? J . ~" ~I o ~ ~ , ,., ~ ~ f, ~g ~ ~ ^ ~ \ ~, ~ LL .~ I W ~ l~Fp ~ Qp¢ a F- O ~ O LL 1 i M ~ ~ N O ~ ~~ N O O Z ~ V m I L U ,L O t W U ~ ~~ 3 C w c O oa J d v W m Z oc Z ` ~ ; G _ ~ ~