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HomeMy WebLinkAboutFinancial DisclosureFORM 1 STATEMENT OF 2022 Please print ortype your name, mailing FINANCIAL INTERESTS address, agency name, and position below: LA T NAME -- FIRST NAME — MIDDLE NAME: MA1� 1(t Q MA CI GADDRESS sv4< A-5 CIT ZIP c�aS it(4 J`�} NAME OF AGENb r _[ Ct � 0� (,�G��YSTf��t NAME OF FFICE OR POSITION HELD OR SOUGHT: C4+-/ CdWt4C. ( C UN l/C(�apt 3 CHECK ONLYIE 110 CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** FOR OFFICE USE ONLY: l?ECEIVED AVG 15 PO City of 23 City Cle k sb0 f c t DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2022. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE 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). CHECK THE ONE YOU ARE USING (must check one): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS Q-R W 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 "n/a") NAME OF SOURCE OF INCOME SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY WdJW.TLuafA i Dft� JWW.dui J' Coj44 C-T oGtSu�%I 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 "n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nla") I PRINCIPAL BUSINESS ACTIVITY OF SOURCE You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM t . Elleclrve January t 2013 ICondnuetl on revere eidel PAGE t In.n.eled try roleren. in Rule 34-8 20201. F 4.0 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 joiii1 ou Z,44Y,_ �.Y flAw ZV-eU Wk ov"Al PART E — LIABILITIES [Major debts - See instructions] I (if you have nothing to report, write "none" or 'Wa") •� NAME OF CREDIT R ADDRESS OF CREDITOR PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (if you have nothing to report, write "none" or 'Wa") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 NAME OF BUSINESS ENTITY 1 �� ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY I I POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS 1 / NATURE OF MY OWNERSHIP INTEREST PART G — TRAINING For elected municipal officers, appointed school superintendents, and commissioners of a community redevelopment agency created under Part 111, Chapter 163 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: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Cha<r473, or attorney Signature: in good standing with the Florida Bar prepare is form for you, he or she must complete the following statemen I, , prepared the CE Form 1 in accordance with Se 52d112.3145, Florida Statutes, and the I instructions to the form. Upo y reasonable knowledge and belief, the disclosu7ned: d correct. Date Signed. !' /•, CPA/Atto ` Date 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 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.) 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 Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd. Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@leg.state.fl.us and retain a copy for your records. Do not file by both mail and email. Choose only one filino method. Form 6s will not be accepted via email. 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 officer/employee, 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 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 of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2022. CE FORM 1 - Effective: January 1. 2023. Incorporaled by reference in Rule 3449.202(1). FA.C. PAGE 2