Qualifying documents - Crystal rr�
ECFlFD
CANDIDATE OATH —
NONPARTISAN OFFICE 201 SEP - P11 1 03
CITY CLE,k'K'S OFFICE
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 9 .021, Florida Statutes)
1, e 1 ` 1 (PLEASE PRINT NAME D Q L/
U WI SH IT TO APPEAR N THE BAL OT * — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of /111`-' 4.rr ri .�' l% G.--, L c C L N/A ,
/� (office) (district #)
N/A , , V ; I am a ualified elector of i •- /
G 4 f �/ 4:-/' County, Florida;
(circuit #) (group or seat #)
I am a qualified elector of the City of Miami Beach Florid , resid}'ng within the City at least one year before qualifying for City of Miami Beach
elected office, with my legal residence being: 3 /i Lets /C , � , Miami Beach, Florida. I am qualified under the ordinances
and Charter of said City and under the Constitution and the Laf 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 any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of
the United S - and the Co • ution of the State of Florida.
ignature of Candidate Telephone �,dv 9 date pone Number C1, ErffaU Address 1 la cy
......-1 1 ) i
C \J'k il .)t, (�,,, ` L P b
1/4 . , ..:„.3 ) Li 1
Address
� City State ZIP Code
el
Candidate's Florida Voter Registration Number (located on your voter information card): IIQ 1 9
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
D c t ti
., v` XV`; S
S ylu
STATE OF FLORIDA
COUNTY OF ni/Ai'Llf— Q/ME:
Sworn to (or affirmed) and subscribed before (� j
ore me this 6 day of 56 - - 7 - "& - 1/96C77--- , 20 /1 .
NOTARY PUBLIC - STATE; 01:3aDFLr8c9Oh6RIDeo A '' " "' Robert E. r t or - ,,,, =COm;�:iission # l Personally Known: 80 Gi,( c e.c.,__.
Expires, (TUNE 03, 2013 Signature of Notary Public
BONDED THRII ATi .4vri ' flo 11ING CO., INC.
Produced Identification: Print, Type, or Stamp Commissioned Name of Notary Public
Type of Identification Produced:
DS -DE 25 (Rev. 5/11)
Rule 1S- 2.0001, F.A.C.
FORM 1 STATEMENT OF 2010
Please print or type your name, mailing FINANCIAL INTERESTS
address, agency name, and position below:
LAST NAME -- FIRST NAME -- MIDDLE NAME : FOR OFFICE
-6 USE ONLY:
- MAILING A0 DRESS : /
,P. a, 14,,E / //./
ID Code
/a, k, e l"-i?1 (A 4/ 35/ I t om.., --
, , i
CITY : �' zIP : COUNTY : c 4.!' °. A,
/ ID No. 1- A � .,�'/
y 9
NAME OF AGENCY : '
Conf. Code f '5►
4.
NAME OF OFFICE OR POSITIO,,V HELD OR SOUGHT : P. Req. Code 6%
You are not limited/to the s ce on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF CANDIDATE 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 YEA) PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one):
l DECEMBER 31, 2010 OR ® 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 THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see
instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REF CTS EITHER (must check one):
la COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS
i
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME I ADDRESS PRINCIPAL BUSINESS ACTIVITY
= -
_ I lieP 1I (I / � 4 / /15 $ tom/ -1--/✓ /
..", 0 j I co,,, cik, •-iNt-, tAN* .14 Pki. In 7 Qt.-. Cii i c ii./..6v
4 1∎ ' r , , , , Y ' A t � i 1 ( ti 4 1� ( ` * \ ,5 � 1/0 J ;i "rl t , k \ \ ,P\ , , o v � j ' ;' `,, j -;.'7\ i- -) '/% _,
J
J 2 A1-t- ,v, b S i- a r 1 '),- Ltik o w,t, ni,, /ie: FL ► � 1(I1 l'i r hi
PART B -- SECONDARY SOURCES OF INCOME [Major customers, clien s, and other sources of income to businesses own d by the reporting person]
(If you have nothing to report , you must write "none" or "n /a ")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
‘ Al l i / 74
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person] FILING INSTRUCTIONS for
(If you have nothing to report, you must write "none" or "n /a ")
when and where to file this form
j'+ 0 0 C-;) J i i >- u e , 3 / V (J o are located at the bottom of page 2.
•° ' ' '1 13 fw � � , � , �V`� 4 iis- / 4' PL. �ILII INSTRUCTIONS on who must
L ` file this form and how to fill it out
j begin on page 3.
OTHER FORMS you may need
to file are described on page 6.
CE FORM 1 - Effective' January 1, 2011 Refer to Rule 34- 8.202(1), F.A.C. (Continued on reverse side) PAGE 1
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
' (If you have nothing to report, you must write "none" or "n /a ")
TYPE OF INTANGIBL BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
W/ A
..........--... 1
PART E — LIABILITIES [Major debts]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF CREDITOR ADDRESS OF CREDITOR
( / L f j-> _ W� 1-, c1/4 ,, f Cc .t l / v l � li t er [J/ 1�t°' •- 4. 47/ d / / /f :��/
l L cla-tt,,,5-6.70 . .
_6 ,,,,it ...1 4 i,... f /1-.)e t).-0,-A ) PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
(If you have nothing to report, you must write "none" or "n /a ")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
NAME OF BUSINESS ENTITY Ai/ 4/ ,, '( J // -
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
W ANY OF PARTS A THROU_J; RE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK F.ERE
SIGNATURE (required): DATE SIGNED (required):
LING 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 Initially, each local officer /employee, state
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified state employee must
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to file within 30 days of the date of his or her
that location. appointment or of the beginning of employ -
If you have nothing to report in a particular ment. Appointees who must be confirmed by
section, you must write "none" or "n /a" in that Local officers /employees file with the Supervisor
y of Elections of the county in which they perma- the Senate must file prior to confirmation, even
section(s). nently reside. (If you do not permanently reside if that is less than 30 days from the date of their
in Florida, file with the Supervisor of the county appointment.
Facsimiles will not be accepted. where your agency has its headquarters.) Candidates for publicly - elected local office
NOTE: State officers or specified state employees must file at the same time they file their
MULTIPLE FILING UNNECESSARY: file with the Commission on Ethics, P.O. Drawer qualifying papers.
Generally, a person who has filed Form 1 for a 15709, Tallahassee, FL 32317 -5709; physical Thereafter, local officers /employees, state
calendar or fiscal year is not required to file a address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are
second Form 1 for the same year. However, a 201, Tallahassee, FL 32312. required to file by July 1st following each
candidate who previously filed Form 1 because Candidates file this form together with their calendar year in which they hold their posi-
of another public position must at least file a copy qualifying papers. tions.
of his or her original Form 1 when qualifying. Finally, at the end of office or employment,
To determine what category your position
falls under, see the "Who Must File" Instructions each local officer /employee, state officer, and
on page 3. 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 - Effective. January 1, 2011 . Refer to Rule 34 -8.202 (1), F.A.0 PAGE 2
•
l
DAVE CRYSTAL CAMPAIGN ACCOUNT t1 C 0S 226
P.O. BOX 416151 63- 1482/670
MIAMI BEACH, FL 33141 313
9 Date
l
Pay to the C '141 d r 2
Order of — —✓ Q . � 3�0, a0
Qi1 e // / ,�i ` Gecurly
. 7 L L - ��. jtvk� z jL ' Dollars n �ea
- - - - - -- ---- - - - - --
Hatk
la] Bank
America's Most Convenient Bank'
/1111 4 0 .01 0.4,110
For cv .
, t., hP
0226
Harland Clarke TD Bank, N.A.