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HomeMy WebLinkAboutForm 1 Financial DisclosureFORM I STATEMENT OF 2014 Please print or type your name, mailing FINANCIAL INTEREST, Slm - t:-,;-.--;FQRwFFICE USE ONLY: 1 address. agency name, and position below: , 7 LAST NAME — FIRST NAME — MIDDLE NAME: 99 A.; 17 Sebastian Richard G111mor 744 Kroegel Ave Sebastian,FL32958 NAME OF AGENCY: 17 pd -P 6ek< 46, NAME OF OFFICE OR POSITION HEL 0 SOUGHT: �yof eb You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. 100 CHECK ONLY IF L] CANDIDATE OR Q 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, 2014 OR 0 SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: 1;11 MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions "or further details). CHECK THE ONE YOU ARE USING: VALUE THRESHOLDS. 13 COMPARATIVE (PERCENTAGE) THRESHOLDS OR a- DOLLAR PART A — PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (if you have nothing to report, write "none" or 'Wa") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY 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 "n1a") 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 - See instructions] (if you have nothing to report, write "none" or "nia") FILING INSTRUCTIONS for when and where to file this form are cated at the bottom of page 2. o ca INSTRUCTIONS on who must file 1 ST Se INSTRUCTIONS this form and how to fill It out begin on page 3. CE FORM 1- Effective: January 1. 2015 (Continued on reverse side) PAGE I Adopted by reference in Rule 34-8.202(1), FAC. PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See Instructions] (If you have nothing to report, write "none" or "n/a") NAME OF CREDITOR ADDRESS OF CREDITOR V, -6S" home. -(fl&4=,Pm- v= =1 Ta Qa/X -z) (,- Z Mss , .I PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] of you have nothing to report, write "none" or "nla") BUSINESS ENTITY # 1 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 INTEREST BUSINESS ENTITY # 2 IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE OF FILER: N CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or Signatu attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement I, prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. Date Signed: r lip 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 "nla" In that section(s). NOTE: MULTIPLE FILING UNNECESSARY: 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. A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. CPAIAttorney Signature: Date Signed: FILING INSTRUCTIONS: INHERE 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 officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has Its headquarters.) State oflTcers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates file this form together with their qualifying papers. To determine what category your position falls under, see the "Who Must File" Instructions on page 3. Facsimiles will not be accented. WHEN TO FILE: Initially, each local officerlemployee, 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 9 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 qualifying papers. Thereafter, local officers/employees, state officers, and specified state employees are required to file by duly 1 st following each calendar year In which they hold their positions. Finally, at the end of office or employment, each 1. local officerlemployee, state officer, and specif€e ' state employee is required to file a final disclosure form (Form IF) within 60 days of leaving office or employment. However, filing a CE Form 1 F (Final Statement of Financial Interests) does Dc A relieve the frier of filing a CE Form 1 if he or she was In their position on December 31, 2014. CE FORM t - Eftective:.Eanuary 1, 2015. PAGE 2 Adopted by rererenoe ia.Rete 34-8202(1), FAC.