Qualifying Documents SeguiLOYALTY OATH OFFICE USE ONLY
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CANDIDATES WITH NO PARTY AFFILIATION ~'" ~ ° ~ ~ ~:;~ ~ ("~
(Sections 876.05-876.10, Florida Statutes) ~
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STATE OF FLORIDA ~~
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First Name Middle Name/Initial ast Name
a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do
hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida.
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
1, v ;
(PLEASE PRI NAME AS YOU WISH IT TO R ON THE BALLOT -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the office of ~m >M i s5 %Drt.-~/ N/A N/A
,
(office) (district) (circuit)
. I am a qualified elector of .>_ a~ C- County, Florida.
(grou
I am a qualified elector of the City of Miami Beach, Fla., residing within the City at least one year before qualify-
ing for the City of Miami Beach elected office, with my legal residence being: +SS(DJ ~e~(1N ~ n~. ,(3C
Miami Beach, Fla. I am qualified under the ordinances and Charter of said City and under the Constitution and
the Laws of Florida to hold 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 an which I am required to resign pursuant to Section 99.012, Florida Statutes.
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Signature of Candidate Telephone Number Em it Address
Address City State 21P Code
5'yo r ~m ~ ~t ti s ~9`c ~?: a,.~,,.' 1~ EgtZ ~ ~='/ 33 ~ yo
Sworn to (or affirmed) and subscribed before me this ~~ day of _ ~-7,~-' 200,.
Personally Known: or
duced Identification: ~~~'~v~-~ ~~
Type of Identification Produced: ~C
Sign ture of N Public - f Florida`
Print T r t m Commis i ned~am # ? tary lic
.~~Y PL'' KERRY HERNANDEZ
_.: ._ MY COMMISSION ti DD 626373
:~,p EXPIRES: May 3, 2011
'%F or F~,;.•' Bonded Thru Notary Public Underwriters
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l'S3/Y
DS-DE 24B (Rev. 05/08)
FORM 1 STATEMENT OF
eddress, apemy ~», and Pearson below:
P'""°""`~`~"°''°"r'~°~~"'~ ~ FINANCIAL INTERESTS
-FIRST NAME -
v~ I .3~ ~~0 YY~ ~ -~
CITY : ZIP : COUNTY
NAME OF'AGENCY//~' ~
l~b1M 1M) SS t d lf\ P~
NAME OF O FICE OR POSITION HELD OR SOUGHT
You are not limited bo the a oa tM NMe on thb form. Attaeh additions sheets, if neeeesary,
CHECK ONLY IF CANDIDATE OR ~ NEW EMPLOYEE OR APPOINTEE
ID No.
Conf. Code
P. Req. Code
"BOTH PART8 OF THiS SECTION MUST BE COMPLETED"
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR RNANCIAL 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 (d,ea~ one);
DECEMBER 31, 2008 Qj3 ^ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATMK3 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 (see
instructions for further details), PLEASE STATE BELOW R THIS STATEMENT REFL EITHER (diadc one);
^ COMPARATIVE (PERCENTAGE) THRESHOLDS Qg
DOLLAR VALUE THRESHOLDS
PART A -PRIMARY SOURCES OF INCOME [Major sources of income to the reporting Penton)
NAME ~ SOURCE SOURCE'S
OF INCOME DESCRIPTION OF THE SOURCE'S
ADDRESS PRINCIPAL BUSINESS ACTIVITY
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rt•.y, ox
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PART B -SECONDARY SOURCES OF INCOME (Major customers, dieMs, and other soun>~ of income to bus~sses owned the r
NAME OF NAME OF MAJOR SOURCES ~ ePorti~ Person)
BUSINESS ENTITY OF BUSINESS' INCOME ADDRESS PRINCIPAL BUSINESS
_ OF SOURCE ACTIVITY OF SOURCE
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.rocs ,4n .~ 7ra~~ o~r~
PART C -- REAL PROPERTY [Land, bu8dings owned by the roportirgl person]
CE FORM 1 - Eff. 1/2008
(CorKinusd on roverse aids)
FOR OPf S~,p
USE O
2008
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ID codeti " . ' ~,
FILING INSTRUCTIONS for when
and where to fife this form an locat-
ed at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to NII it out begin
on page 8.
OTHER FORMS you may need to
file are described on page 8.
PAGE 1
PART D -INTANGIBLE PERSONAL PROPERTY (Stocks, bonds, certificates of deposd, etc.)
~ /TYPE OF INTANGIBLE BUSINESS ENTITY TO YIMICH THE PROPERTY RELATES
~V
PART E -LIABILITIES [Major debts)
NAME OF CREDITOR
'd
PART F - INTERfi:STt3 tN SPEgF1ED BUSINESSts.8 (Owrtersf~p or positions in certain types of businesses)
BUSINESS ENTITY * 1
BUSINESS ENTITY #r 2
BUSINESS ENTITY ~ 3
BUSINESS ENTITY `J
AD SS
BUSINESS ENTITY
PRI
ACTMTY
POSITION HELD
WITH ENTITY
I OHYN THAN A 5'16
INTEREST IN THE BUSINESS
NATURE OF MY
OWNERSHIP INTEREST
IF ANY OF PARTS A THROU CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ^
SIGNATURE (required): DATE SIGNED (requN+adi: Q 8/,3 ~~
(((
WHAT TO FILE:
After kxtntpletirtg ar parts of this form, inclidittg
signing and dating it, send back only the first
sheet (pages 1 and 2) for filing.
If you have nothing to report in a partlxilar
sectron, you must write "none" or "Na" in that
section(s).
FatazimNea will not be accepted,
NOTE:
MULTIPLE FILING UNNECESSARY:
GenenNy, a parser who hss filed Form 1 for a
cabndar or fiscal year is not required to fib a
second Form 1 for the same year. However, a
candidate who previously fitstl Form 1 bepuse
of another public position must at bast fib a copy
of his or her original Fonn 1 when quaNfying.
CE FARM 1 _ CR 1MM0
ADDRESS OF CREDITOR
WHERE TO FILE:
If you were mailed the form by the Gommission
on Ethics or a Gounty Supervisor of Elections for
your annual discbsure filatg, return the form to
that location.
Local ofDoashmp/oyess fNe with the Supervisor
of Elections of the courtly in whiclt they perma-
nently reside. (N you do not permanently reside
in Florida, file with the Supervisor of the county
where your agency has its headquarters.)
State officers ar apecMed stars !"~
file with the Cortrrtissicxt on Ethics, P.O. Drawer
15709, TaNshas~e, FL 32317-5709; physical
address: 3600 Maclay Boulevard, South, Suite
201, Tallahass~, FL 32312.
Cand/dahs fib this form together with their
quaif/ying papers.
To determine what category your position
falls under, see the "tNho Must Fib" Instructions
on page 3.
WHEN TO FILE:
1nlNdfy, eactt bcal officer/em~oyee, state
olRoer, and apectified state empl>yee trwst
file wJtlNn 30 days of the date of his or her
appointment or of the beginning of empby-
ment. Appointees who must be confirrt-ed Dy
the Senate must file prior to oortfirrrwtion, even
if that ~ leas than 30 days from the dam of tF-eir
appointment.
CanoYdares for publicly-elek~ekt local of6k;e
must file at the same time they fib their
qualifying Papers.
Thereafter, local officars/employees, state
officers, and speclfisd state employees are
required to fib by Juy 1st following each
cabndar year in which they hokl ttteir posi-
tions.
Hnapy, at the end of office or employment,
each local ofioer/errtl-byee, state officer, and
specified state err~tloyse is required to fib a
final disclosure form (Fenn 1F) within 60 days
of having office or anolovmer-t.
PAGE 2
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