Qualifying docs - E. Urquiza MIAMI BEACH .
ira-
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida'33139,
www.miamibeachfl.gov ?0I3 SEP -3 AM E0: 5
CITY CLERK'S OFFICE 1 'y� [;
Tel: 305-673-7411. Fax: 305-673-7254
Email: RafaelGranado @miamibeachfl.gov
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Before me, an officer authorized to administer oaths, personally appeared to me well
known who, being sworn, says that he/she is a candidate for the office of City
Commissioner (Group No. c- (or Mayor) for the City of Miami Beach, Florida;
that he/she is a qualified elector of said City residing within the City at least one year
before qu ifyi �V%for City of Miami Beach elected office; that his/her legal residence is:
, _� , Miami beach, Miami-Dade County,
Florida; that he/she is qualified under the ordinances (including Miami Beach City Code
Chapter 38 governing "Elections") and Charter of said City to hold such office; and that
he/she has paid the required qualification fee. Elsa Urquiza
Candidate
Signature of Candid o�
Sworn to an subscribed before me this 3 day of AL42013.
)V1 1; I a(21
Authorized Officer
r 1-77
�131��s Signature o otary
NOTARY SEAL
LILIAM R.HATFIELD �DJ�
g! MY COMMISSION#EE 844865 'a Date
y., ,:oQ= EXPIRES:Februa�&erw
01 s
P! Bonded Thru Notary Puriters 1
F:\CLER\CLER\000_ELECTION\0000_2013 General Election\MISCELLANEOS WORD
DOCS\CANDIDATE'S OATH.Docx
CANDIDATE OATH —
NONPARTISAN OFFICE
2013 SEP -3 AN 10: 51
(Not for use by Judicial or t,I !'T" C 16-`! v fr- F 11 CC
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021,Florida Statutes)
I, Elsa Urquiza
(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 nonpartisan office of Commissioner ,
(office) (district#)
Group I ; I am a qualified elector of Dade County, Florida;.
(circuit#) (group or seat#)
I am qualified under the Constitution and the Laws 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 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 States and the Constitution of the
State of Florida.
x (3054494-9060 elsa4commissioner @att.net
Signature of CaftiliclaW Telephone Number Email Address
227 E. Rivo Alto Dr. Miami Beach Florida 33139
Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): 108950691
* 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):
L-SAH UHR-KEY-SAH
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me this 2 day of , 20 �3 .
Personally Known: or
(Sjtjin`ature of Notary Publi
Produced Identification: Print.�y tary Public
R.HATFIELD �rA
Type of Identification Produced: o MYCOMMISS10N#EE8W65 f
.�; EXPIRES:February 18;2017
Bonded Thru Notary Public Underwriter.,
DS-DE 26(Rev.5/11) !^ Rule 1S-2.0001,F.A.C.
STATEMENT OF 2012
Please print or type your name,mailing FINANCIAL INTERESTS
1�1�1 1 r ?
address,agency name,and position below: r�`k I,` FOR'OFFIC.E USE ONLY: I
LAST NAME--FIRST NAME--MIDDLE NAME:
URQUIZA, Elsa, Maria. �ot� S P ii` �( ;
MAILING ADDRESS
227 E. Rivo Alto Dr. C l I t` L a',k 5 1
CITY: ZIP: COUNTY:
Miami Beach 33139 Dade
NAME OF AGENCY:
/ /
NAME OF OFFICE OR OSI ON HELD OR SOUGHT:
Commissioner, Group I
You are 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
**** 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(must check one):
® DECEMBER 31, 2012 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). CHECK THE ONE YOU ARE USING:
® COMPARATIVE(PERCENTAGE)THRESHOLDS OR ® DOLLAR VALUE THRESHOLDS
waamay MEMO=
PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions]
(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 ADDRESS PRINCIPAL BUSINESS ACTIVITY
Real estate rentals See attachment(Part C) apartment rental income
US OPM Washington, D.C. federal retirement pay
PART B;,- SECONDARY SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or'Wa")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
A
PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report,you must write"none"or'Wa") FILING INSTRUCTIONS for
when and where to file this
SEE ATTACHMENT form are located at the bottom
of page 2.
INSTRUCTIONS on who must
I ile this form and how to fill it
out begin on page 3.
CE FORM 1-Effective:January 1,2013.Reierto Rule 34-8.202(1),FAC. (Continued on reverse side) PAGE 1
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,you must write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
Savings account JP Morgan "Chase"
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,you must write"none"or-"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
Bank of America P.O. Box 961291, Ft.Worth,Texas 76161-0291
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,you must write"none"or"n1a")
BUSINESS ENTITY#1 BUSINESS ENTITY#2 BUSINESS ENTITY#3
NAME OF BUSINESS ENTITY N/A
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
SIGNATURE re uired : DATE SIGNED (required):
r' NO INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, If you were mailed the form by the Commission Initially, each local officer/employee,
including signing and dating it,send back on Ethics or a County Supervisor of Elections state officer, and specified state employee
only the first sheet(pages 1 and 2)for filing. for your annual disclosure filing, return the must file within 30 days of the date of
form to that location. his or her appointment or of the beginning
If you have nothing to report in a particular Local officers/employees file with the of employment. Appointees who must be
section,you must write"none"or'Wa"in that Supervisor of Elections of the county in confirmed by the Senate must file prior to
section(s). which they permanently reside. (If you do not confirmation, even if that is less than 30
permanently reside in Florida, file with the days from the date of their appointment.
NOTE: Supervisor of the county where your agency Candidates for publicly-elected local office
MULTIPLE FILING UNNECESSARY: has its headquarters.) must file at the same time they file their
Generally, a person who has filed Form 1 State officers or specified state employees qualifying papers.
for a calendar or fiscal year is not required file with the Commission on Ethics, P.O. Thereafter, local officers/employees, state
to file a second Form 1 for the same year. Drawer 15709,Tallahassee, FL 32317-5709. officers, and specified state employees
However, a candidate who previously filed are required to file by July 1st following
Form 1 because of another public position Candidates file this form together with their each calendar year in which they hold their
must at least file a copy of his or her original qualifying papers. positions.
Form 1 when qualifying. To determine what category your position falls Finally, at the end of office or employment,
under,see the"Who Must File"Instructions on each local officer/employee, state officer, and
page 3. specified state employee is required to file a
final disclosure form(Form 1 F)within 60 days
Facsimiles will not be accepted. of leaving office or employment. However,
filing a CE Form 1 F (Final Statement of
Financial Interests) does not relieve the filer
of filing a CE Form 1 if he or she was in their
position on December 31,2012.
CE FORM 1-Effective:January 1,2013.Refer to Ruiz 34-8202(1),F.A.C. PAGE 2
ATTACH M E NT
PART C
227 E. Rivo Alto ®r. Miami Beach, Fl 33139
821 Michigan Ave. Miami Beach, Fl 33139
830 Michigan Ave. Miami Beach, Fl 33139
901-911-917 6 Street, Miami Beach, Fl 33139
1010 9 Street, Miami Beach, FI 33139
1029 S.W. 1 Ave., Miami, Fl 33130
1323 West Ave., Miami Beach, Fl 33139
1327 West Ave., Miami Beach, Fl 33139
1401 Meridian Ave., Miami Beach, Fl 33139
1612-1614 Meridian Ave., Miami Beach, Fl 33139
1676 James Ave., Miami Beach, Fl 33139
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST AME—FIRST NAME—MIDDLE NAME- NAME OF AGENCY:
"a i 2a- r IE l5'+ - c l �
MAILING ADDRESS: / 0 F E66R PO I ION HELD:
05 o f �= �i✓J �7b � _G(�'1 ar• _ O ��l_r�l_i S�idov�G� — T
CITY: ZIP: COU TY: FOR QUARTER ENDING(CHECK ONE): YEAR
❑MARCH SJUNE ❑SEPTEMBER ❑DECEMBER 20_L3_
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is
being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the
date(s)the gift was received.If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
N c
C-)
r-- m
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT �� c
If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy,of that.`�receipt to this
form.You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM ®`L l+
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA
COUNTY OF
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subs gibed before m this l
rof day of ,20 /.
herein and on any attachments made by me constitutes a true accurate, �� 1
by OY
and total listing of all gifts required to be reported by Section 112.3148,
Flori lutes. (Signature of Notary Public-S to of Florida)
'
(Print,Type,or Stamp Commissioned Name of Notary Pu c)
SIGNATURE OF REPORTING ICI Personally Known OR Produced Identification D�
Type of Identification Produced
r MY COMMISSION#EE 644865
PART D—FILING INSTRUCTIONS EXPIRES:February 18,2017
• Bonded Thru Notary Public Underwriters
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709:physi-
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calendar quarter
that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.)
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)