Statement of Financial Interest
FORM 1 STATEMENT OF 2000
FINANCIAL INTERESTS
LAST NAME - FIRST NAME - MIDDLE NAME: NAME OF REPORTING PERSON'S AGENCY:
MAILING ADDRESS:
CHECK Q.t:!.E OF THE FOLLOWING (see "Who Must File" on page 3):
0 LOCAL OFFICER 0 STATE OFFICER
0 CANDIDATE 0 SPECIFIED STATE EMPLOYEE
CITY: ZIP: COUNTY: LIST OFFICE OR POSITION HELD OR SOUGHT:
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):
0 DECEMBER 31, 2000 OR 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
PRIOR TO 2001, THE THRESHOLDS FOR REPORTING FINANCIAL INTERESTS WERE COMPARATIVE, USUALLY BASED ON PERCENTAGE VAL-
UES. BEGINNING IN 2001, THE LEGISLATURE HAS ALLOWED FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE
DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS (see instructions for further details). PLEASE STATE BELOW WHETHER THIS STATE-
MENT REFLECTS EITHER (check one):
0 COMPARATIVE (PERCENTAGE) THRESHOLDS (old method) QB. 0 DOLLAR VALUE THRESHOLDS (new method)
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
~
~
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'S 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
located at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out begin
on page 3 of this packet.
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 - Eff. 112001
(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
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
ADDRESS OF
BUSINESS ENTITY
PRINCIPAL BUSINESS
ACTIVITY
POSITION HELD
WITH ENTITY
I OWN MORE THAN A 5%
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0
SIGNATURE: DATE SIGNED:
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, including If you were mailed the form by the Commission Initial/y, each local officer, state officer, and
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for specified state employee must file within 30
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to days of the date of his or her appointment or of
that location, the beginning of employment. Appointees who
Local officers file with the Supervisor of must be confirmed by the Senate must file prior
to confirmation, even if that is less than 30
Elections of the county in which you permanently days from the date of their appointment.
reside, (If you do not permanently reside in
NOTE: MULTIPLE FILING UNNECES- Florida, file with the Supervisor of the county Candidates for publicly-elected local office
SARY: where your agency has its headquarters.) must file at the same time they file their quali-
Generally, a person who has filed Form 1 for a State officers or specified state employees file fying papers.
calendar or fiscal year is not required to file a sec- with the Commission on Ethics, P.O. Drawer Thereafter, local officers, state officers, and
ond Form 1 for the same year. However, a candi- 15709, Tallahassee, FL 32317-5709. specified state employees are required to file
date who previously filed Form 1 because of Candidates file this form together with your qual- by July 1st following each calendar year in
another public position must at least file a copy of which they hold their positions.
his or her original Form 1 when qualifying. ifying papers.
To determine what category your position Final/y, at the end of office or employment
each local officer, state officer, and specified
falls under, see the "Who Must File" Instructions state employee is required to file a final disclo-
on page 3. sure form (Form 1 F) within 60 days of leaving
office or employment.
CE FORM 1 - Eft. 1/2001
PAGE 2
\-VHO MUST FILE FORM 1, Statement of Financial Interests:
All persons who fail within the categories of "state officers," "local officers," "specified state employees," as well as candidates for elective local office. are
required to file Form 1. Positions withm these categories are listed below. Persons required to file full financial disclosure (Form 6) and officers of the judicial
branch do not file Form 1 (see Forrn 6 for a list of persons who must file that form).
STATE OFFICERS include the following positions for state officials:
1) Elected public officials not serving in a political subdivision of the state
and any person appointed to fill a vacancy in such office, unless required to
file full disclosure on Form 6.
2) Appointed mernbers of each board, cornmission, author:ty, or council
having statewide jurisdiction, excluding members of solely advisory boaies.
3) Members of the Board of Regents, the Chancellor and Vice
Chancellors of the state university system, and Presidents of state universi-
ties.
LOCAL OFFICERS include the following positions for officers and
employees of local government:
1) Persons elected to office in any political subdivision (such as munici-
palities, counties, and special districts) and any person appointed to fill a
vacancy in such office, unless required to file full disclosure on Form 6.
2) Appointed members of the following boards, councils, commissions,
authorities, or other bodies of any county, municipality, school district, inde-
pendent special district, or other political subdivision: the governing body of
the subdivision; an expressway authority or transportation authority estab-
lished by general law; a community college or junior college district board of
trustees; a board having the power to enforce local code provisions; a plan-
ning or zoning board having the power to recommend, create, or modify land
planning or zoning within the political subdivision, except for citizen advisory
committees, technical coordinating committees, and similar groups who only
have the power to make recommendations to planning or zoning boards; a
pension board or retirement board empowered to invest pension or retirement
funds or to determine entitlement to or amount of a pension or other retire-
ment benefit.
3) Any other appointed member of a local government board who is
required to file a statement of financial interests by the appointing authority or
the enabling legislation, ordinance, or resolution creating the board.
4) Persons holding any of these positions in local government: Mayor;
county or city manager; chief administrative employee of a county, municipal-
ity, or other political subdivision; county or municipal attorney; chief county or
municipal building inspector; county or municipal water resources coordina-
tor; county or municipal pollution control director; county or municipal envi-
ronmental control director; county or municipal administrator with power to
grar.t or deny a land development permit; chief of police; fire chief; mun;cipal
clerk; district school superintendent; community college president; district
medical examiner; purchasing agent (regardless of title) having the authonty
to make any purchase exceeding $15,000 for the local governmental unit.
SPECIFIED STATE EMPLOYEES include the following posi-
tions for state employees:
1) Employees in the office of the Governor or of a Cabinet member who
are exempt from the Career Service System, excluding secretarial, clerical,
and similar positions.
2) The following positions in each state department, commission.
board, or council: Secretary, Assistant or Deputy Secretary, Executive
Director, Assistant or Deputy Executive Director, and anyone having the
power normally conferred upon such persons, regardless of title.
3) The following positions in each state department or division:
Director, Assistant or Deputy Director, Bureau Chief, Assistant Bureau Chief,
and any person having the power normally conferred upon such persons,
regardless of title.
4) Assistant Stale Attorneys, Assistant Public Defenders, Public
Counsel, full-time state employees serving as counselor assistant counsel to
a state agency, administrative law judges, and hearing officers.
5) The Superintendent or Director of a state mental health institute
established for training and research in the mental health field, or any major
state institution or facility established for corrections, training, treatment, or
rehabilitation,
6) State agency Business Managers, Finance and Accounting
Directors, Personnel Officers, Grant Coordinators, and purchasing agents
(regardless of title) with power to make a purchase exceeding $15,000.
7) The following positions in legislative branch agencies: each employ-
ee (other than those employed in maintenance, clerical, secretarial, or similar
positions and legislative assistants exempted by the presiding officer of their
house); and each employee of the Commission on Ethics,
INSTRUCTIONS FOR COMPLETING FORM 1:
INTRODUCTORY INFORMATION (At Top of Form):
NAME OF AGENCY: This should be the name of the governmental unit
which you serve or served, by which you are or were employed, or for
which you are a candidate. For example, "City of Tallahassee," "Leon
County," or "Department of Transportation."
LOCAL OFFICER, STATE OFFICER, SPECIFIED STATE EMPLOYEE,
AND CANDIDATE DESIGNATIONS: The positions for eac.'1 of these cat-
egories are listed above, under "Who Must File." Please check the box
for the position you hold, held during the disclosure period, or are seek-
ing.
OFFICE OR POSITION HELD OR SOUGHT: Use the title of the office or
position you hold, are seeking, or held during the disclosure period (in
some cases you may not hold that position now, but you still would be
required to file to disclose your interests during the last year you held that
position). For example, "City Council Member," "County Administrator,"
"Purchasing Agent," or "Bureau Chief."
MAILING ADDRESS: If your home address appears on the form but you
prefer another address be shown, mark through the address provided
and insert your office or other current address, The following persons
should not use their home addresses: active or former law enforcement
personnel, including correctional and correctional probation officers; per-
sonnel of the Department of Children and Family Services whose duties
include the investigation of abuse, neglect, exploitation, fraud, theft, or
other criminal activities; personnel of the Department of Health whose
duties are to support the investigation of child abuse or neglect; person-
nel of the Department of Revenue or local governments responsible for
revenue collection and enforcement or child support enforcement; fire-
fighters; current or former state attorneys, assistant state attorneys,
statewide prosecutors, and assistant statewide prosecutors; spouses
and children of the above; and county and municipal code inspectors
and code enforcement officers.
DISCLOSURE PERIOD: The tax year for most individuals is the cal-
endar year (January 1 through December 31). If that is the case for
you, then your financial interests should be reported for the calendar
year 2000; just check the box and you do not need to add any infor-
mation in this part of the form. However, if you file your IRS tax return
based on a tax year that is not the calendar year, you should specify
the dates of your tax year in this portion of the form and check the
appropriate box. This is the time frame or "disclosure period" for your
report.
MANNER OF CALCULATING REPORTABLE INTERESTS: As noted
in this portion of the form, beginning in 2001 the Legislature has given
filers the option of reporting based on ~ thresholds that are com-
parative (usually, based on percentage values) Q[ thresholds that are
based on absolute dollar values. The instructions on the following
pages specifically describe the different thresholds. Simply check the
box that reflects the choice you have made. You must use the type of
threshold you have chosen for each part of the form. In other words, if
you choose to report based on absolute dollar value thresholds, you
cannot use a percentage threshold on any part of the form.
(CONTINUED on page 4) (ir
CE FORM 1 - Eff. 1/2001
PAGE 3
Examples:
You own 1/3 of a partnership or small corporation that owns both a
vacant lot and a 12% interest in an office building. You should disclose
the lot, but are not required to disclose the office building (because your
1/3 of the 12% interest-which equals 4%-does not exceed the 5%
threshold).
If you are a beneficiary of a trust that owns real property and your
interest depends on the duration of an Individual's life, the value of your
interest should be determined by applying the appropriate actuarial
table to the value of the property itself, regardless of the actual yield of
the property.
PART D - INTANGIBLE PERSONAL PROPERTY
[Required by Sec. 112.3145(3)(a)3 or (b)3, Fla. Stat.]
Provide a general description of any intangible personal property that
was worth more than:
(1) ten percent (10%) of your total assets at the end of the disclosure
period (if you are using percentage thresholds), Q[
(2) $10.000 (if you are using dollar value thresholds).
and state the business entity to which the property related. Intangible per-
sonal property includes such things as money, stocks, bonds, certificates of
deposit, interests in partnerships, beneficial interests in a trust, promissory
notes owed to you, accounts receivable by you, IRA's, and bank accounts.
Such things as automobiles, houses, jewelry, and paintings are not intangible
property. Intangibles relating to the same business entity should be aggre-
gated; for example, two certificates of deposit and a savings account with the
same bank. Where property is owned by husband and wife as tenants by the
entirety (which usually will be the case), the property should be valued at
100%.
Calculations: In order to decide whether the intangible property exceeds
10% of your total assets, you will need to total the value of all of your assets
(including real property, intangible property, and tangible personal property
such as automobiles, jewelry, furniture, etc.). When making this calculation,
do not subtract any liabilities (debts) that may relate to the property-add only
the fair market value of the property. Multiply the total figure by 10% to arrive
at the disclosure threshold. List only the intangibles that exceed this thresh-
old amount Jointly owned property should be valued according to the per-
centage of your joint ownership, with the exception of property owned by
husband and wife as tenants by the entirety, which should be valued at 100%.
None of your calculations or the value of the property have to be disclosed
on the form. If you are using dollar value thresholds, you do not need to make
any of these calculations.
Examples for persons using comparative (percentage) thresholds:
You own 50% of the stock of a small corporation that is worth
$100,000, according to generally accepted methods of valuing small
businesses. The estimated fair market value of your home and other
property (bank accounts, automobile, furniture, etc.) is $200,000. As
your total assets are worth $250,000, you must disclose intangibles
worth over $25,000. Since the value of the stock exceeds this threshold,
you should list "stock" and the name of the corporation. If your accounts
with a particular bank exceed $25,000, you should list "bank accounts'
and bank's name.
When you retired, your professional firm bought out your partner-
ship interest by giving you a promissory note, the present value of which
is $100,000. You also have a certificate of deposit from a bank worth
$75,000 and an investment portfolio worth $300,000, consisting of
$100,000 of IBM bonds and a variety of other investments worth
between $5,000 and $50,000 each. The fair market value of your
remaining assets (condominium, automobile, and other personal prop-
erty) is $225,000. Since your total assets are worth $700,000, you must
list each intangible worth more than $70,000. Therefore, you would list
"promissory note' and the name of your former partnership, "certificate
of deposit" and the name of the bank, "bonds' and "IBM," but none of
the rest of your investments.
PART E - LIABILITIES
[Required by Sec. 112.3145(3)(a)4 or (b)4, Fla. Stat]
In this part of the form, list the name and address of each private or gov-
ernmental creditor to whom you were indebted at any time during the disclo-
sure period in an amount which exceeded:
(1) your net worth (if you are using percentage thresholds), 2!:
(2) $10,000 (if you are using dollar value thresholds).
You are not required to list the amount of any indebtedness or your net worth.
You do not have to disclose any of the following: credit card and retail install-
ment accounts, taxes owed (unless reduced to a judgment), indebtedness on
a life insurance policy owed to the company of issuance, contingent liabilities,
and accrued income taxes on net unrealized appreciation (an accounting
concept). A "contingent liability" is one that will become an actual liability only
when one or more future events occur or fail to occur, such as where you are
liable only as a guarantor, surety, or endorser on a promissory note. If you are
a "co-maker" and have signed as being jointly liable or jointly and severally
liable, then this is not a contingent liability; if you are using the $10,000
threshold and the total amount of the debt (not just the percentage of your lia-
bility) exceeds $10,000 such debts should be reported.
Calculations for persons using comparative (percentage) thresholds: In
order to decide whether the debt exceeds your net worth, you will need to
total all of your liabilities (including promissory notes, mortgages, credit card
debts, lines of credit, judgments against you, etc.). Subtract this amount from
the value of all your assets as calculated above for Part D. This is your "net
worth." You must list on the form each creditor to whom your debt exceeded
this amount unless it is one of the types of indebtedness listed in the para-
graph above (credit card and retail installment accounts, etc.). Joint liabilities
with others for which you are "jointly and severally liable," meaning that you
may be liable for either your part or the whole of the obligation, should be
included in your calculations based upon your percentage of liability, with the
following exception: joint and several liability with your spouse for a debt
which relates to property owned by both of you as "tenants by the entirety"
(usually the case) should be included in your calculations by valuing the asset
at 100% of its value and the liability at 100% of the amount owed.
Examples for persons using comparative (percentage) thresholds:
You owe $15,000 to a bank for student loans, $5,000 for credit card
debts, and $60,000 (with your spouse) to a savings and loan for a home
mortgage. Your home (owned by you and your spouse) is worth $80,000
and your other property is worth $20,000. Since your net worth is
$20,000 ($100,000 minus $80,000), you must report only the name and
address of the savings and loan.
You and your 50% business partner have a $100,000 business
loan from a bank, for which. you both are jointly and severally liable. The
value of the business, taking into account the loan as a liability of the
business, is $50,000. Your other assets are worth $25,000, and you owe
$5,000 on a credit card. Your total assets will be $50,000 (half of a busi-
ness worth $50,000 plus $25,000 of other assets). Your liabilities, for
purposes of calculating your net worth, will be only $5,000, because the
full amount of the business loan already was included in valuing the
business. Therefore, your net worth is $45,000. Since your 50% share
of the $100,000 business loan exceeds this net worth figure, you must
list the bank.
PART F -INTERESTS IN SPECIFIED BUSINESSES
[Required by Sec. 112.3145(5), Fla. Stat.]
You are required to disclose in this part of the form the fact that you
owned during the disclosure period an interest in, or held any of certain posi-
tions with, particular types of businesses. You are required to make this dis-
closure if you own or owned (either directly or indirectly in the form of an equi-
table or beneficial interest) at any time during the disclosure period more than
five percent (5%) of the total assets or capital stock of one of the types of
business entities granted a privilege to operate in Florida that are listed
below. You also must complete this part of the form for each of these types
of businesses for which you are, or were at any time during the disclosure
period, an officer, director, partner, proprietor, or agent (other than a resident
agent solely for service of process).
(CONTINUED on page 6) @""
CE FORM 1 - Eft. 1/2001
PAGE 5