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Qualifying Documents GóngoraLOYALTY OATH OFFICE USE ONLY CANDIDATES WITH NO PARTY AFFILIATION n >~ (Sections 876.05-876.10, Florida Statutes) ~ .moo STATE OF FLORIDA ~: ~ rn ~ ...o ,,.~ ~C' COUNTY ~~' ~ Please Print ~ ~:: u % -v ~' ~ ~' ;'~ -,~ t -n First Name Middle Name/Initial Last 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) r ~~ ~o ~iC~C . -~ ~prQ I, (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the office of ~rVh ~P~tc~i~ Cn .i~¢~' o h N/A N/A • _ (office) (district) (circuit) . I am a qualified elector of ~I;GM~I " ~~'~ County, Florida. (group) 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: SP~~BC~IhnS -i~sv~. ~k~~1, 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 any office from which I am required to resign pursuant to Section 99.012, Florida Statutes. Signature of Can date Telephone Number Email Address s~ ~ ~ .q-1,~. ~#3,~ ' ~3e~ 3~i ,~o Address City State ZIP Code 1~ Sworn to (or affirmed) and subscribed before me this ~~ , day of _~~-' 200 / . ~N111111111//l/// ~~~`~~~~P~.R. HgT~~i,~// ~ ~ ~ Personally Known: / or ~~ ~. , ~MjSStpH ' ~0~! • ~V ~~~ary ~'8 ~~o' Produced Identification: $ ~~' g 9~ ; wm *~ ~ ~• ~ •*' Type of Identification Produced: p ;• #D D 832367 ; Q,` R _ ~9`.gay~aedmN ~e~••Qe S gnature of Notary Public-State o Flor' ~~ iO•'•:"bl~~;;:~••F~~~~~ Print, Type or Stamp Commissioned Name of Notary Public \\\ // /~~J/J Ilf 11 lilll o~ ~\ ;YG.Gorti DS-DE 24B (Rev. 05/08) FORM 1 STATEMENT OF 2008 Please print or type your name, mailing FINANCIAL INTERESTS addr d i ess, agency name, an pos tion below: C7 N _ LAST NAME -FIRST NAME -- MIDDLE NAME : "'~ ~^'_~~ fl('~ FOR OFFICE -~.; ~ CJ" ( fi~E' ~ ~~ ~15~ ~it USE ONLY: ~ ~ 1..~ MAILING AD ESS : t" "'C7 ,,.,~ ~' _. ~. ~ 83~ C~ ~ 1- -~s eve. v~ ~' 3~ ID Code ~~y~ CITY : ZIP : COUNTY ~.~/' .~: ~ r-r' tt7 NAME OF AGENCY `~~'V111'L%SS'i ?~/V Conf. Code NAME OF O E OR POSITION HELD OR SOUGHT : P. Req. Code C ~- 3 C~~- ~r ~ v ~n~; s~ ~>~ You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. CHECK ONLY IF ~ANDIDATE OR ^ NEW EMPLOYEE OR APPOINTEE "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 FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one): . ~ • ./ L I G DECEMBER 31, 2008 t~ ^ SPECIFY 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 THRESHOLD5, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instru ons for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one): COMPARATIVE (PERCENTAGE) THRESHOLDS QJ3 ^ 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 ~ P~ l~ k~ P~ l ~ fFl h~-~-~- ~~~ z~ - )~'~' fiver L-a~ -F, r r>'1 Go,- 1 ~~-z 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] FILING INSTRUCTIONS for when d h 583~, C_© ~'i n ~ ~3/~ a ~ ~ ~ 33 an w ere to file this form are locat- ed at the bottom of page 2. Oo N E 3 r z ~ G{ ~, 3 3 f 3 INSTRUCTIONS on who must file CGt lano( 'h h f%Y! ~~drit~ this form and how to fill it out begin on page 3. OTHER FORMS you may need to file are described on page 6. ~~ ~ ~~~~•~ ~ - ~,,. i,cvv~ (Continued on reverse side) PAGE 1 ' PART D -INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] I TYPE OF INTANGIBLE 1 BUSINESS ENTITY TO WHICH THE PROPERTY RELATES ol'~~ Gesil/v~ / 2 (,>S~' ~G~ N PART E -LIABILITIES (Major debts] NAME OF CREDITOR ADDRESS OF CREDITOR ~ ~,, ' ' ~N~ v ar /V ~ M~t ss ~ . 1 ~'a ~Otr~„1 ~ ~I~ ~_ _ zl~~ 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 <- ~ .3 PRINCIPAL BUSINESS ACTIVITY 1C~f~ POSITION HELD ` ~ ~ WITH ENTITY , ~ t ~ C+~1~ • c I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST ~~.i ~~ IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ^ SIGNATURE %~/~~~ 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). 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. DATE SIGNED (requ q/>> FILING INSTRUCTIONS:. WHERE TO FILE: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. Local otifcers/employeestile with the Supervisor of Elections of the county in which they perma- nently reside. (lf you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 3600 Maclay 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 "Who Must Fiie" 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 fife 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 officerlemployee, state officer, and specified state employee is required to file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. CE FORM 1 - Eff. 1/2009 PAGE 2 III/ ------ --- ~~ a ' ~ ~ D i; 7o O n f ~ ~ _ ~ ~ m ~ a ' ~~ ~ , ~ z ~ b ~ ~ (~ ~ V / ~ l / r O x C'1 O ~ C> C ~ ~ O n a m r ~- O O z O O D ,~ N O v I I ~ O i i i I I ji , m i i i O '~ ' r L rn ~ ~ p N (V F-- m ~ o a~3 ~ ~ I~ N ~~ J ~ ~ s