HomeMy WebLinkAboutFinancial DisclosureFORM I STATEMENT OF 2015
Please print or type your name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address, agency name, and position below:
T NAME - FIRST NAME -MIDDLE NAME
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NAME OF AGENCY: C/erkscls&!zo
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NAME OF OFFICE OR POSITION HELD OR SOUGHT
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You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF Q�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):
yld DECEMBER 31, 2015 -R ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
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
for further details). CHECK THE ONE YOU ARE USING (must check one):
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS QR DOLLAR VALUE THRESHOLDS
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..nla")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
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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 "nla")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
At, Ne—
PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See Instructions)
(If you have nothing to report write "none" or "nla") FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
eNE
INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM I - Eeod January 1, 2e16 (Continued on uverm Mae) PAGE t
Incaponied ay rebrence r, Ruk aA- M(1). FAC.
PART O — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, cedificates of deposit, etc. - See instructions]
(If you have nothing to report, write "none" or "nla")
PART E — LIABILITIES (Major debts - See instructions)
(If you have. nothing to report, write "none" or "nia")
NAME OF CREDITOR
THE PROPERTY RELATES
ADDRESS OF CREDITOR
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses -Soo Instructions]
(if you have nothing to report, write "none" or "Na")
BUSINESS ENTITY If i BUSINESS ENTITY # 2
TAME OF BUSINESS ENTITY I ns n 4n�.
BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5% INTEREST IN THE
MY OWNERSHIP INTEREST
PART G — TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
SIGNATURE OF FILER:
Signature:
Date Signed:
gobs%Laly
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 riling.
WHERE TO FILE:
CPA or ATTORNEY SIGNATURE ONLY
If a cergfied public accountant licensed under Chapter 473, or attorney
in goad 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.
CPA/Allomey Signature:
Date Signed:
If you were mailed the fans by the Commission
on Ethics or a County Supervisor of Elections for
your annual disclosure filing, return the form to
that location.
If you have nothing to report in a particular Local olRcerslemployees file with the
section, you must write "none" or "Na" in that Supervisor of Elections of the county in which they
secbon(s). permanently reside. (If you do not permanently
reside in Florida, file with the Supervisor of the
NOTE:
MULTIPLE FILING UNNECESSARY:
A candidate who previously filed Form 1 because
of another public position must file a copy of
his or her Forth 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.
Facsimiles will not be accented,
county where your agency has its headquarters.)
State officers or specified state employees
fife with the Commission on Ethics, RO. Drawer
15709, Tallahassee, FL 32317-5709; physical
address: 325 John Knox Road, Building E. Suite
200. Tallahassee, FL32303.
Candidates file ]his form together with their
qualifying papers.
To determine what category your position falls
under, see page 3 of instructions.
WHEN TO FILE
Initially, each local officedemployee, state officer,
and specified state employee must file within
30 days of the dale 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 dale of their appointment.
Candidates must file at the same lime they file
their qualifying papers.
Thereafter, file by July 1 following each calendar
year in which they hold their positions.
Finally, file a final disclosure form (Forth IF)
within 60 days of leaving office or employment.
Filing a CE Form 1F (Final Statement of Financial
Interests) does 001 relieve the filer of filing a CE
Form 1 if the filer was in his or her position on
December 31, 2015.
CE FORM t - Eft p Jmiuery 1, 2019. PAGE 2
Inter JW by W.. in Rda ar41202(1). FA.0
NOTICE
Annual Statements of Financial Interests are due July 1. If the annual form is not filed or postmarked by September
1, an automatic fine of $25 for each day late will be imposed, up to a maximum penalty of $1,500. Failure to file also
can result in removal from public office or employment. [s. 112.3145, F.S.]
In addition, failure to make any required disclosure constitutes grounds for and may be punished by one or more
of the following: disqualification from being on the ballot, impeachment, removal or suspension from office or
employment, demotion, reduction in salary, reprimand, or a civil penalty not exceeding $10,000. IS. 112.317, F.S.]
T FILE FORM 1:
1) Elected public officials not serving in a political subdivision of the
state and any person appointed to fill a vacancy in such once, unless
required to file full disclosure on Form 6.
2) Appointed members of each board, commission, authority, or
council having statewide jurisdiction. excluding members of solely advisory
bodies, but including judicial nominating commission members; Directors
of Enterprise Florida, Scripps Florida Funding Corporation, and Career
Source Florida; and members of the Council on the Social Status of Black
Men and Boys; the Executive Director, Governors, and senior managers of
Citizens Property Insurance Corporation; Governors and senior managers
of Florida Workers' Compensation Joint Underwriting Association; board
members of the Northeast Fla. Regional Transportation Commission;
members of the board of Triumph Gulf Coast, Inc; members of the board
of Florida Is For Veterans, Inc.; and members of the Technology Advisory
Council within the Agency for State Technology.
3) The Commissioner of Education, members of the State Board of
Education, the Board of Governors, and the local Boards of Trustees and
Presidents of state universities.
4) Persons elected to once in any political subdivision (such as
municipalities. counties, and special districts) and any person appointed to
fill a vacancy in such office, unless required to file Form 6.
5) Appointed members of the following boards, councils,
commissions, authorities, or other bodies of county, municipality, school
district, Independent special district, or other political subdivision: the
governing body of the subdivision; community college or junior college
district boards of trustees; boards having the power to enforce local code
provisions; boards of adjustment; community redevelopment agencies;
planning or zoning boards having the power to recommend, create, or
modify land planning or zoning within a political subdivision, except for
citizen advisory committees, technical coordinating committees, and similar
groups who only have the power to make recommendations to planning or
zoning boards; pension or retirement boards empowered to invest pension
or retirement funds or determine entitlement to or amount of pensions or
other retirement benefits.
6) Any appointed member of a local government board who is
required to file a statement of financial interests by the appointing authority
or the enabling legislation, ordinance, or resolution creating the board.
7) Persons holding any of these positions in local government:
mayor; county or city manager, chief administrative employee or finance
director of a county, municipality, or other political subdivision; county or
municipal attorney, chief county or municipal building inspector; county
or municipal water resources coordinator, county or municipal pollution
control director, county or municipal environmental control director, county
or municipal administrator with power to grant or deny a land development
permit; chief of police; fire chief, municipal clerk; appointed district school
superintendent; community college president; district medical examiner,
purchasing agent (regardless of title) having the authority to make any
purchase exceeding S20,000 for the local governmental unit.
8) Officers and employees of entities serving as chief administrative
officer of a political subdivision.
9) Members of governing boards of charter schools operated by a
city or other public entity.
10) Employees in the once of the Governor or of a Cabinet member
who are exempt from the Career Service System, excluding secretarial.
clerical, and similar positions.
11) The following positions in each slate department, commission,
board, or council: Secretary, Assistant or Deputy Secretary, Executive
Director, Assistant or Deputy Executive Director, and anyone having the
power normally conferred upon such persons, regardless of tile.
12) The following positions in each state department or division.
Director. Assistant or Deputy Director, Bureau Chief, Assistant Bureau
Chief, and any person having the power normally conferred upon such
persons, regardless of title.
13) Assistant Slate Attorneys, Assistant Public Defenders, criminal
conflict and civil regional counsel, and assistant criminal conflict and civil
regional counsel, Public Counsel, full-time state employees serving as
counsel or assistant counsel to a stale agency, administrative law judges,
and hearing officers.
14) The Superintendent or Director of a state mental health institute
established for training and research in the mental health field, or any major
state institution or facility established for corrections, training, treatment, or
rehabilitation.
15) State agency Business Managers, Finance and Accounting
Directors, Personnel Officers, Grant Coordinators, and purchasing agents
(regardless of title) with power to make a purchase exceeding $20,000.
16) The following positions in legislative branch agencies: each
employee (other than those employed in maintenance, clerical. secretarial,
or similar positions and legislative assistants exempted by the presiding
officer of their house); and each employee of the Commission on
Ethics.
I INSTRUCTIONS FOR COMPLETING FORM 1: 1
INTRODUCTORY INFORMATION (Top of Form): If your
name, mailing address, public agency, and position are already
printed on the form,you do not need to provide this information
unless it should be changed. To change any of this information,
write the correct information on the form, and contact your
agency's financial disclosure coordinator. You can find your
coordinator on the Commission on Ethics website: www.ethics.
state.0.us.
NAME OF AGENCY: The name of the governmental unit
which you serve or served, by which you are or were employed,
or for which you are a candidate.
OFFICE OR POSITION HELD OR SOUGHT: The title of
the office or position you hold, are seeking, or held duringg the
disclosure period even if you have since left that po ' i If ou
are a candidate for office or are a new employee or appointee,
check the appropriate box.
CE FORM 1 - Effw." Jo..q 1. 2016. 1=,p W Dy reference m Rule 368.02. FAO.
PUBLIC RECORD: The disclosure form and everything
attached to it is a public record. Your Social Security Number
is not required and You should redact it from any documents
YOU pie. if you are an active or former officer or employee listed
In Section 119.071, F.S., whose home address is exempt from
disclosure, the Commission will maintain that confidentiality if
you submit a written request.
DISCLOSURE PERIOD: The tax year for most individuals
is the calendar year (January 1 through December 31). If that
is the case for you, then your financial interests should be
reported for the calendar year 2015; check that box. If you file
your IRS tax return based on a tax year that is not the calendar
year, you should specify the dates of your tax year in this
Portion of the form and check the appropriate box. This is the
disclosure period" for your report.
..
Filers have the option of reporting based on gdhg thresholds that are comparative (usually, based on percentage values) or
thresholds that are based on absolute dollar values. The instructions on the following pages specifically describe the different
thresholds. Check the box that reflects the choice you have made. You must use the type of threshold you have chosen for each
part of the form. In other words, if you choose to report based on absolute dollar value thresholds, you cannot use a percentage
I, IT CJl lulu ulI dl lv W41 VI IT 1W IUI I11.
PART A — PRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(b)1, F.S.)
PartA is intended to require the disclosure of your principal sources
of income during the disclosure pedod. You do not have to disclose the
amount of income received and you need not list voter oublie salery from
serving in the position(s) which requires you to file this form. The income
of your spouse need not be disclosed; however, if there is joint income
to you and your spouse from properry you own jointly (such as interest
or dividends from a bank account or stocks), you should disclose the
source of that income if it exceeded the threshold.
Please list in this part of the form the name, address, and principal
business activity of each source of your income which exceeded $2,500
of gross income received by you in your own name or by any other
person for your use or benefit.
"Gross income" means the same as it does for Income tax
purposes, even if the income is not actually taxable, such as interest
on tax-free bonds. Examples include: compensation for services,
income from business, gains from property dealings, interest, rents,
dividends, pensions, IRA dishibutions, social security, distributive share
of partnership gross income, and alimony, but not child support.
Examples
— If you were employed by a company that manufactures
computers and received more than 52,500, list the name of the
company, its address, and its principal business activity (computer
manufacturing).
— If you were a partner in a law firth and your distributive share
of partnership gross income exceeded S2,500, list the name of the
firm, its address, and its principal business activity (practice of law).
— If you were the sole proprietor of a retail gift business and your
gross income from the business exceeded $2,500, list the name of
the business, its address, and its principal business activity (retail
gift sales).
a business entity (a corporation, partnership, LLC, limited partnersil
proprietorship, joint venture, trust, firm, etc., doing business in Florida)
and,
(2) You received more than $5,000 of your gross income during the
disclosure period from that business entity.
li your interests and gross income exceeded these thresholds, then for that
business entity you must list every source of income to the business entity
which exceeded 10% of the business entity's gross income (computed on
the basis of the business entity's most recently completed fiscal year), the
source's address, and the source's principal business activity.
Examples:
— You are the sole proprietor of a dry cleaning business, from which
you received more than 55,000. If only one customer, a uniform rental
company, provided more than 10% of your dry cleaning business, you
must list the name of the uniform rental company, its address, and its
principal business activity (uniform rentals).
— You are a 20% partner in a partnership that owns a shopping mall
and your partnership income exceeded the above thresholds. List each
tenant of the mall that provided more than 10% of the partnership's gross
income and the tenant's address and principal business activity.
PART C — REAL PROPERTY
)Required by s. 112.3145(3)(b)3, F.S.)
In this part, list the location or description of all real property in Florida
in which you owned directly or indirectly at any time during the disclosure
period in excess of 5% of the property's value. You are not required to list
vour residences. You should list anv vacation homes if you derive income
Indirect ownership includes situations where you are a beneficiary of a
trust that owns the property, as well as situations where you own more than
5% of a partnership or corporation that owns the property. The value of the
property may be determined by the most recently assessed value for lax
purposes, in the absence of a more current appraisal.
— If you received income from investments in stocks and bonds. The location or description of the property should be sufficient to enable
list each individual comoanv from which you derived more than anyone who looks at the form to identify the property. A street address should
$2,500. Do not aggregate all of your investment income. be used. if one exists.
— If more than $2,500 of your gross income was gain from the sale
of property (not just the setting price), list as a source of income the
purchaser's name, address and principal business activity. If the
purchaser's identity is unknown, such as where securities listed
on an exchange are sold through a brokerage firm, the source of
income should be listed as "sale of (name of company) stock," for
example.
— It more than $2,500 of your gross income was in the form of
interest from one particular financial institution (aggregating interest
from all CD's, accounts, etc., at that institution), list the name of the
institution, its address, and its principal business activity.
PART B — SECONDARY SOURCES OF INCOME
(Required by s. 112.3145(3)(b)2, F.S.]
This part is intended to require the disclosure of major customers, clients,
and other sources of income to businesses in which you own an interest.
It is not for reporting income from second lobs That kind of income should
be reported in Part A "Primary Sources of Income." if it meets the reporting
threshold. You will not have anything to report unless, during the disclosure
period:
(1) You owned (either directly or indirectly in the form of an equitable or
beneficial interest) more than 5% of the total assets or capital stock of
CE FORM 1 - Ela wto Ad t. 2016. Incorppvt6E tri Wererca in Rub 10.6272. FA.0
PART D — INTANGIBLE PERSONAL PROPERTY
[Required by s. 112.3145(3)(b)3, F.S.]
Describe any intangible personal property that, at any time during the
disclosure period, was worth more than $10,000 and stale the business
entity to which the property related. Intangible personal property includes
things such as cash on hand, stocks, bonds, certificates of deposit, vehicle
leases, interests in businesses, beneficial interests in trusts, money owed
you, Deferred Retirement Option Program (DROP) accounts, the Florida
Prepaid College Plan, and bank accounts. Intangible personal property
also includes investment products held in IRAs, brokerage accounts, and
the Florida College Investment Plan. Note that the product contained in
a brokerage account, IRA, or the Florida College Investment Plan is your
asset—not the account or plan itself. Things like automobiles and houses
you own, jewelry, and paintings are not intangible property. Intangibles
relating to the same business entity may be aggregated; for example, CDs
and savings accounts with the same bank. Property owned as tenants by
the entirety or as joint tenants with right of survivorship should be valued at
100%. The value of a leased vehicle is the vehicle's present value minus the
lease residual (a number found on the lease document).
PART E — LIABILITIES
[Required by s. 112.3145(3)(b)4, F.S.)
List the name and address of each creditor to whom you owed more
than S10,000 at any time during the disclosure period. The amount of the
liability of a vehicle lease is the sum of any past -due payments and all
unpaid prospective lease payments. You are not required to list the amount
of any debt. You do not have to disclose credit card and retail installment
accounts, taxes owed (unless reduced to a judgment), indebtedness on a life
insurance policy owed to the company of issuance, or contingent liabilities. A
"contingent liability" is one that will become an actual liability only when one
or more future events occur or fail to occur, such as where you are liable
only as a guarantor, surety, or endorser on a promissory note. If you are a
.co -maker" and are jointly liable or jointly and severally liable, then it is not a
contingent liability.
PART F — INTERESTS IN SPECIFIED BUSINESSES
[Required by s. 112.3145(5), F.S.)
The types of businesses covered in this disclosure include: slate and
federally chartered banks; slate and federal savings and loan associations;
cemetery companies; insurance companies; mortgage companies; credit
unions; small loan companies; alcoholic beverage licensees; pari-mutuel
wagering companies, utility companies, entities controlled by the Public
Sendce Commission; and entities granted a franchise to operate by either a
city or a county government.
PART A — PRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)l, F.S.]
Part A is intended to require the disclosure of your principal
sources of income during the disclosure period. You do not have to
disclose the amount of income received and you need not list your
public salary received from serving in the position(s) which reouires
you to file this form, but this amount should be included when
calculating your gross income for the disclosure period. The income of
your spouse need not be disclosed: however, if there is joint income to
you and your spouse from property you own jointly (such as interest or
dividends from a bank account or stocks), you should include all of that
income when calculating your gross income and disclose the source of
that income if it exceeded the threshold.
Please list in this part of the form the name, address, and principal
business activity of each source of your income which exceeded 5%
of the gross income received by you in your own name or by any other
person for your benefit or use during the disclosure period.
"Gross income" means the same as it does for income tax
purposes, even if the income is not actually taxable, such as interest
on tax-free bonds. Examples include: compensation for services,
income from business, gains from property dealings, interest, rents,
dividends, pensions. IRA distributions, social security, distributive
share of partnership gross income, and alimony, but not child support.
Examples
— If you were employed by a company that manufactures
computers and received more than 5% of your gross income from
the company, list the name of the company, its address, and its
principal business activity (computer manufacturing).
— If you were a partner in a law firm and your distributive share
of partnership gross income exceeded 5% of your gross income,
then list the name of the firth, its address, and its principal
business activity (practice of law).
— If you were the sole proprietor of a retail gift business and
your gross income from the business exceeded 5% of your total
gross income, list the name of the business, its address, and its
principal business activity (retail gift sales).
— If you received income from investments in stocks and
bonds, list each individual company from which you derived
Disclose in this part the fad that you owned during the disclosure period an
interest in, or held any of certain positions with the types of businesses listed
above. You must make this disclosure if you own or owned (either directly or
indirectly in the form of an equitable or beneficial interest) at any time during
the disclosure period more than 5% of the total assets or capital stock of one
of the types of business entities listed above. You also must complete this part
of the forth for each of these types of businesses for which you are, or were at
any time during the disclosure period, an officer, director, partner, proprietor, or
agent (other than a resident agent solely for service of process).
If you have or held such a position or ownership interest in one of
these types of businesses, list the name of the business, its address and
principal business adivily, and the position held with the business (f any). If
you own(ed) more than a 5% interest in the business, indicate that fad and
describe the nature of your interest.
PART G —TRAINING CERTIFICATION
[Required by s. 112.3142, F.S.]
If you are a Constitutional or elected municipal officer whose term
began before March 31 of the year for which you are filing, you are
required to complete four hours of ethics training which addresses
Article II, Section 8 of the Florida Constitution, the Code of Ethics
for Public Officers and Employees, and the public records and open
meetings laws of the state. You are required to certify on this form
that you have taken such training.
(End of Dollar Value Thresholds Instructions.)
more than 5% of your gross income. Do not aggregate all of your
investment income.
— If more than 5% of your gross income was gain from the sale
of property (not just the selling price), list as a source of income
the purchaser's name, address, and principal business activity.
If the purchaser's identity is unknown, such as where securities
listed on an exchange are sold through a brokerage firm, the
source of income should be listed as "sale of (name of company)
stock.* for example.
— If more than 5% of your gross income was in the form of
interest from one particular financial institution (aggregating
interest from all CD's. accounts, etc., at that institution), list the
name of the institution, its address, and its principal business
activity.
PART B — SECONDARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)2, F.S.]
This part is intended to require the disclosure of major customers,
clients, and other sources of income to businesses in which you own
an interest. It is not for reporting income from second lobs. That kind
of income should be reported in Part A, "Primary Sources of Income,"
if it meets the reporting threshold. You will not have anything to report
unless during the disclosure period:
(1) You owned (either directly or indirectly in the form of an
equitable or beneficial interest) more than 5% of the total assets or
capital stock of a business entity (a corporation, partnership, LLC,
limited partnership, proprietorship, joint venture, trust firth, etc.,
doing business in Florida); and,
(2) You received more than 10% of your gross income from that
business entity; and,
(3) You received more than $1,500 in gross income from that
business entity.
If your interests and gross income exceeded these thresholds, then
for that business entity you must list every source of income to the
business entity which exceeded 10% of the business entity's gross
income (computed on the basis of the business entity's most recently
completed fiscal year), the source's address, and the source's
principal business activity.
Examples:
— You are the sole proprietor of a dry cleaning business, from
which you received more than 10% of your gross income —an
amount that was more than $1,500. If only one customer, a uniform
rental company, provided more than 10% of your dry cleaning
business, you must list the name of the uniform rental company.
its address, and its principal business activity (uniform rentals).
— You are a 20% partner in a partnership that owns a shopping
mall and your partnership income exceeded the thresholds listed
above. You should list each tenant of the mall that provided more
than 10% of the partnership's gross income, and the tenant's
address and principal business activity.
PART C — REAL PROPERTY
[Required by s. 112.3145(3)(a)3, F.S.)
In this part, list the location or description of all real property in
Florida in which you owned directly or indirectly at any time during
the disclosure period in excess of 5% of the property's value. You
are not reouired to list your residences You should list any vacation
homes, if you derive income from them.
Indirect ownership includes situations where you are a
beneficiary of a trust that owns the property, as well as situations
where you own more than 5% of a partnership or corporation that
owns the property. The value of the property may be determined by
the most recently assessed value for tax purposes, in the absence
of a more current appraisal.
The location or description of (he property should be sufficient to
enable anyone who looks at the form to identify the property. A street
address should be used, if one exists.
PART D — INTANGIBLE PERSONAL PROPERTY
[Required by s. 112.3145(3)(a)3, F.S.)
Describe any intangible personal property that, at any time
during the disclosure period, was worth more than 10% of your total
assets, and state the business entity to which the property related.
Intangible personal property includes things such as cash on hand,
stocks, bonds, certificates of deposit, vehicle leases, Interests in
businesses, beneficial interests in trusts, money owed you, Deferred
Retirement Option Program (DROP) accounts, the Florida Prepaid
College Plan, and bank accounts. Intangible personal property also
includes investment products held in IRAs, brokerage accounts, and
the Florida College Investment Plan. Note that the product contained
in a brokerage account. IRA, or the Florida College Investment Plan
is your asset—not the account or plan itself. Things like automobiles
and houses you own, jewelry, and paintings are not intangible
property. Intangibles relating to the same business entity may be
aggregated; for example, CD's and savings accounts with the same
bank.
Calculations: To determine whether the intangible property
exceeds 10% of your total assets, total the fair market value of
all of your assets (including real property, intangible property, and
tangible personal property such as jewelry, furniture, etc.). When
making this calculation, do not subtract any liabilities (debts) that
may relate to the property. Multiply the total figure by 10% to arrive
at the disclosure threshold. List only the intangibles that exceed
this threshold amount. The value of a leased vehicle is the vehicle's
present value minus the lease residual (a number which can be
found on the lease document). Property that is only jointly owned
property should be valued according to the percentage of your joint
ownership. Property owned as tenants by the entirety or as joint
tenants with right of survivorship should be valued at 100%. None of
your calculations or the value of the property have to be disclosed on
the form.
Example: You own 50% of the stock of a small corporation that
is worth 5100,000, the estimated fair market value of your home
and other property (bank accounts, automobile, fumilure, etc.)
is $200,000. As your total assets are worth $250,000, you must
disclose intangibles worth over $25,000. Since the value of the
stock exceeds this threshold, you should list 'stock' and the
name of the corporation. If your accounts with a particular bank
exceed $25,000, you should list 'bank accounts' and bank's
name.
CE FORM t -Eff a wt lm 1. 2016 Ircpp IW M nner In RWe Se.9.= FA.0
PART E — LIABILITIES
[Required by s. 112.3145(3)(b)4, F.S.]
List the name and address of each creditor to whom you owed any
amount that, at any time during the disclosure period, exceeded your
net worth. You are not required to list the amount of any debt or your
net worth. You do not have to disclose: credit card and retail installment
accounts, taxes owed (unless reduced to a judgment), indebtedness
on a life insurance policy owed to the company of issuance, or
contingent liabilities. A'contingent liability" is one that will become
an actual liability only when one or more future events occur or fail
to occur, such as where you are liable only as a guarantor, surety, or
endorser on a promissory note. If you are a'co-maker and are jointly
liable or jointly and severally liable, it is not a contingent liability.
Calculations: To determine whether the debt exceeds your
net worth, total all of your liabilities (including promissory notes,
mortgages, credit card debts, judgments against you, etc.). The
amount of the liability of a vehicle lease is the sum of any past -due
payments and all unpaid prospective lease payments. Subtract
the sum total of your liabilities from the value of all your assets as
calculated above for Part D. This is your 'net worth.' List each creditor
to whom your debt exceeded this amount unless it is one of the types
of indebtedness listed in the paragraph above (credit card and retail
installment accounts, etc.). Joint liabilities with others for which you
are `jointly and severally liable,' meaning that you may be liable for
either your part or the whole of the obligation, should be included in
your calculations at 100% of the amount owed.
Example: You owe $15,000 to a bank for student loans, $5,000
for credit card debts, and $60,000 (with spouse) to a savings
and loan for a home mortgage. Your home (owned by you and
your spouse) is worth $80,000 and your other property is worth
$20,000. Since your net worth is $20,000 ($100,000 minus
$80,000), you must report only the name and address of the
savings and loan.
PART F—INTERESTS IN SPECIFIED BUSINESSES
[Required by s. 112.3145, F.S.]
The types of businesses covered in this disclosure include. state
and federally chartered banks; state and federal savings and loan
associations; cemetery companies; insurance companies; mortgage
companies; credit unions; small loan companies: alcoholic beverage
licensees: pari-mutuel wagering companies, utility companies, entities
controlled by the Public Service Commission; and entities granted a
franchise to operate by either a city or a county government.
Disclose in this part the fact that you owned during the
disclosure period an interest in, or held any of certain positions with.
the types of businesses listed above. You are required to make this
disclosure if you own or owned (either directly or indirectly in the
form of an equitable or beneficial interest) at any time during the
disclosure period more than 5% of the total assets or capital stock
of one of the types of business entities listed above. You also must
complete this part of the forth for each of these types of businesses
for which you are, or were at any time during the disclosure period,
an officer, director, partner, proprietor, or agent (other than a resident
agent solely for service of process).
If you have or held such a position or ownership interest in one of
these types of businesses, list the name of the business, its address
and principal business activity, and the position held with the business
(if any). If you own(ed) more than a 5% interest in the business,
indicate that fact and describe the nature of your interest.
PART G —TRAINING CERTIFICATION
[Required by s. 112.3142, F.S.]
If you are a Constitutional or elected municipal officer whose term
began before March 31 of the year for which you are filing, you are
required to complete four hours of ethics training which addresses
Article II, Section 8 of the Florida Constitution, the Code of Ethics
for Public Officers and Employees, and the public records and open
meetings laws of the state. You are required to certify on this form that
you have taken such training.
(End of Percentage Thresholds Instructions.)