The URL can be used to link to this page

Home My WebLink AboutForm 1 . FORM 1 STATEMENT OF 2004 Please print or type your name, mailing I FINANCIAL INTERESTS I address. agency name, and position below: LAST NAME -- FIRST NAME -- MIDDLE NAME: FOR OFFICE DERMER DAVID USE ONLY: MAILING ADDRESS: 1700 Convention Center Drive ID Code Miami Beach, Florida 33139 Miami Dade CITY: ZIP: COUNTY: ID No. NAME OF AGENCY: City of Miami Beach 1700 Convention Center Drive, MB, FL 33139 Conf. Code NAME OF OFFICE OR POSITION HELD OR SOUGHT: P. Req. Code MAYOR OF THE CITY OF MIAMI BEACH CHECK ONLY IF [i] CANDIDATE OR D NEW EMPLOYEE OR APPOINTEE PDF 2004 "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): [il DECEMBER 31. 2004 QB 0 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 REFLECTS EITHER (check one): ~ COMPARATIVE (PERCENTAGE) THRESHOLDS QB 0 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 ROSE DERMER I/V TRUST 2525 Flamingo PL, M.B. FL 33140 NY CITY RENTAL PROPERTY DERMER RESIDUARY TRUST 2525 Flamingo PL. M.B. ,FL 33140 NY CITY RENTAL PROPERTY PRUDENCE INVESTMENTS, INC. 2525 Flamingo PL. M.B.,FL 33140 None-Voting Shares Rental Pronertv. Miami PRUDENCE DEVELOPMENT, INC. 2525 Flamingo PL. M. B. , FL 33140 None-Voting Shares Rpnt".<Il 1:': ~onf>rtv Miami 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 N/A PART C - REAL PROPERTY [Land. buildings owned by the reporting person] FILING INSTRUCTIONS for when and where to file this form are locat- 67nn..fl7fl? NY 72 Avenne Miami FL (Owned bv Prudence Investmen ed at the bottom of page 2. S None Voting Shares listed above) INSTRUCTIONS on who must file 7205-7275 NW 68 S t. Miami, FL (owned by Prudence Development this form and how to fill it out begin on page 3. NOne vot:1ng snares .L.Ll:; L.I::U ~~~._, OTHER FORMS you may need to file are described on page 6. CE FORM 1 - Eft. 1/2005 (Continued on reverse side) PAGE 1 PAGE TWO - DAVID DERMER PART D - INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.] TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES N/A PART E - LIABILITIES [Major debts] NAME OF CREDITOR ADDRESS OF CREDITOR YAFFA DERMER 2525 Flamingo Place, Miami Beach, FL 33140 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 ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS N / A ACTIVITY POSITION HELD WITH ENTITY I OVI/N MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF ~;n OWNERSHIP I \REST /1 IFJNY( t>F fARTS/, THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE D SIGNAT 0RE (re ~)f~ ~ DATE SIGNED (;q;i~ 6/ oS- A rct~ _. v v FILING 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 officerlemployee, state signing and dating it. send back only the first on Ethics or a County Supervisor of Elections officer, and specified state employee must sheet (pages 1 and 2) for filing. for your annual disclosure filing. return the form file within 30 days of the date of his or her to that location. appointment or of the beginning of employ- Local officers/employees file with the Supervisor ment. Appointees who must be confirmed by of Elections of the county in which they perma- the Senate must file prior to confirmation, even nently reside. (If you do not permanently reside if that is less than 30 days from the date of their NOTE: in Florida, file with the Supervisor of the county appointment. MULTIPLE FILING UNNECESSARY: where your agency has its headquarters.) Candidates for publicly-elected local office Generally, a person who has filed Form 1 for a State officers or specified state employees must file at the same time they file their calendar or fiscal year is not required to file a file with the Commission on Ethics, P.O. Drawer qualifying papers. second Form 1 for the same year. However, a 15709, Tallahassee. FL 32317-5709; physical Thereafter. local officers/employees, state candidate who previously filed Form 1 because address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are of another public position must at least file a copy 201. Tallahassee, FL 32312. required to file by July 1 st following each of his or her original Form 1 when qualifying. Candidates file this form together with their calendar year in which they hold their posi- qualifying papers. tions. To determine what category your position Finally, at the end of office or employment. 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 - Eft. 1/2005 PAGE 2 PAGE THREE - DAVID DERMER SOURCE 336 LEX, INC. ADDRESS 336 Lexington Avenue, NY DESCRIPTION Commercial Rental Property (Minority Shareholder)