HomeMy WebLinkAboutFinancial DisclosureFORM 1 STATEMENT OF20192019
Please print or type your name, mailing I FINANCIAL INTI]t �17 E NTT R OFFICE USE ONLY:
address, agency name, and position below: 11 SUPERS 1 CI { itiii'-- EL C7101VO
%ST NAME — FIRST NAME — MIDDLE NAME:
Jim Hill
749 5 Fischer Cir
Sebastian FL 32958
Council Member
CITY:
ZIP
NAME OF AGENCY:
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
COUNTY:
2020 J itl —3 AM 10: 58
CHECK ONLY IF U CANDIDATE OR NEW EMPLOYEE OR APPOINTEE
*"** THIS SECTION MUST BE COMPLETED
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019.
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES, WHICH REC UIRES
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 OR ❑ DOLLAR VALUE THRESHOLDS
yPART A •- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] iJ1 (If you have nothing to report, write "none" or "n!a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
LIJW01I fW& 4 .MR 'l1WAW0"1.es qql( 5 PiScW6ieEAtt S66 3Z458 Cwl; 5EtaW1Cz6
I OT Gat F sGevtctrs t� t i t l u bl
1 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
0 l ra
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions]
You are not limited to the spacu on the
(If you have nothing to report, write "none" or "nfa")
lines on this form. Attach addit one]
sheets, if necessary.
FILING INSTRUCTIONS for when
pC,
and where to file this form r re
-
located at the bottom of pane 2.
INSTRUCTIONS on who must file
this form and how to fill it cut
begin on page 3.
CE FORM 1 - Effective: January 1, 2020 (continued on reverse side)
PAGE 1
Incoiporaled, by reference Io Rule U8 202(1); F.A.C.
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions]
(If you have nothing to report, write "none" or "nla")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
1
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF CREDITOR f(��'� ADDRESS OF CREDITOR
,u PIPE1 DOME L�,✓ W& 321 �frSEAdcW V44J T, SwPt1:303, AkAIDfr.N, CT 061jS0
s6hr,c- rAiw CIuorl 11a11UU S49R5'/(JLN
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses -See instructions]
iipthmg to it - rt, wtita npne' . .. I .)- -"--
BUSINESSENTITY#1 --- - _ - BUSINESS ENTITY #2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A5°/ INTEREST IN THE BUSINESSI
NATURE OF 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 LJ
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY �.,.
Signature:
Date Signe
1010L I212,0
L
FILING INSTRUCTIONS:
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. To determine what category your position falls
under, see page 3 of instructions.
Local offrcers/empfoyees 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.) Form 1 filers who file with
the Supervisor of Elections may file by mail or email. Contact your
Supervisor of Elections for the mailing address or email address to
use. Do not email vour form to the Commission on Ethios- it will be
returned.
4te officers or specified state employees who file with the
mmission an Ethics may file by mail or email. To file by mail,
id the completed forth to P.O. Drawer 15709, Tallahassee, FL
317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200,
lahassee, FL 32303. To file with the Commission by email, scan
rr completed form and any attachments as a pdf (do not use any
er format), send it to CEForn1@leg.state.fl.us and retain a copy
your records. Do not file by both mail and email. Choose only one
to method. Form 6s will not be accepted via email.
CE FORM 1- Effecwe: January 1, 2020.
In"rpareled by referee" In Rule 34-E.202(1), F.A.C.
If a certified public accountant licensed under Chapter 473. or attorney
in good standing with the Florida Bar prepared this farm 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
CPAlAttomey Signature:
Dale Signed:
Candidates file this form together with their filing papers.
MULTIPLE FILING UNNECESSARY: A candidate who files a Form
1 with a qualifying officer is not required to file with the Commission
or Supervisor of Elections.
WHEN TO FILE: Initially, each local officedemployee, 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 then 30 days from the data of their
appointment.
Candidates must file at the same time 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 (Form 1 F) within 60 days
leaving office or employment. Filing a CE Form 1 F (Final Statemenr-
of Financial Interests) does ILol relieve the filer of filing a CE Form 1
if the filer was in his or her position on December 31, 2019.
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