HomeMy WebLinkAboutFinancial Interest Statement
. STATEMENT OF '
FINANCIAL INTERESTS
2000
NAME OF REPORTING PERSON'S AGENCY:
MAILING 5S~?s'
CHECK Qt!f. OF THE FOLLOWING (see "Who Must File' on page 3):
o I,9CAL OFFICER
13-CANDIDATE
o STATE OFFICER
o SPECIFIED STATE EMPLOYEE
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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):
o DECEMBER 31,2000 QB 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
DOLLARffUES' WHICH REQUIRES FEWER CALCULATIONS (see instructions for further details), PLEASE STATE BELOW WHETHER THIS STATE-
MENT RE ECTS EITHER (check one):
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
OF INCOME ADDRESS
DESCRIPTION OF THE SOURCE'S
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
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FILING INSTRUCTIOK&lor
when and where tcoi'tile thiS-'form are
located at the bo~ 01 page 2,
'> " ,17
INSTRUCTIO~ or"Who must IlIe
this form and how to f1ll it out begin
on page 3 of this packet.
PART C - REAL PROPERTY [Land, buildings owned by the reporting person]
OTHER FORMS you may need to
file are described on page 6.
CE FORM 1 ' Eft, 1/2001
(Continued on reverse side)
PAGE 1
'!C"'f';'
"'ai:::::IHTANGIBLE PERSONAL PROPERTY
PART E - LIABILITIES [Major debts)
, , ,NAME OF CREDITOR
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 INTE ST
ADDRESS OF CREDITOR
PART F - INTERESTS IN SPECIFIED B SIN ESSES [Ownership or positions in certain types of businesses]
B SINESS ENTITY # 1 BUSINESS ENTITY # 2
BUSINESS ENTITY # 3
PARTS A THROUG
ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0
SIGNATURE:
.1"
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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,
NOTE: MULTIPLE FILING UNNECES-
SARY:
Generally, a person who has filed Form 1 for a
calendar or fiscal year is not required to file a sec--
ond Form 1 for the same year. However, a candi-
date 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.
CE FORM 1 ' Elf, 112001
DATE SIGNE
- -"~ g '{p <D I
CTIONS:
WHERE TO FILE:
If you were mailed the form by the Commission
on Ethics or a County SupelVisor of Elections for
your annual disclosure filing, return the form to
that location.
Local officers file with the Supervisor of
Elections of the county in which you permanently
reside. (If 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,
Candidates file this form together with your qual-
ifying papers.
To determine what category your position
falls under, see the 'Who Must File" Instructions
on page 3,
WHEN TO FILE:
Initially, each local officer, state officer, and
specified state employee must file within 30
days of the date of his or her appointment or of
the beginning of employment. 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 file at the same time they file their quali-
fyin9 papers,
Thereafter, local officers, state officers, and
specified state employees are required to file
by July 1st following each calendar year in
which they hold their positions.
Finally, at the end of office or employment
each local officer, state officer, and specified
state employee is required to file a final disclo.-
sure form (Form 1 F) within 60 days of leaving
office or employment.
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