Qualifying documentsv:
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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
~
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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
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LAST NAME --FIRST NAME -- MIDDLE NAME . ~ FOR OFFICE
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MAILING ADORE SS
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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.
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PAGE 2
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