**** 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 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 OR  DOLLAR VALUE THRESHOLDS
FORM 1
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 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 "n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE 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.
FOR OFFICE USE ONLY:
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n/a")
CE FORM 1 - Effective: January 1, 2020 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1), F.A.C.
NAME OF OFFICE OR POSITION HELD OR SOUGHT :
NAME OF AGENCY :
CHECK ONLY IF
CANDIDATE OR
NEW EMPLOYEE OR APPOINTEE
MAILING ADDRESS :
LAST NAME -- FIRST NAME -- MIDDLE NAME :
Please print or type your name, mailing
address, agency name, and position below:
CITY : ZIP : COUNTY :
STATEMENT OF
FINANCIAL INTERESTS
2019
FILING INSTRUCTIONS:
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
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
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 "n/a")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2
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
I
f 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 your 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 CEForm1@leg.state.fl.us and retain a copy
for your records. Do not file by both mail and email. Choose only one
filing 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 1F) within 60 days of
leaving office or employment. Filing a CE Form 1F (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, 2019.
CE FORM 1 - Effective: January 1, 2020. PAGE 2
Incorporated
by reference in Rule 34-8.202(1), F.A.C.
SIGNATURE OF FILER:
Signature:
____________________________________________
Date Signed:
____________________________________________
CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or 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.
CPA/Attorney Signature: ______________________________
Date Signed: _______________________________________
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.
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 required 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 the 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 $100,000, the estimated fair market value of
your home and other property (bank accounts, automobile,
furniture, 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.
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 form 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
service 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.)
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.
[s. 112.317, F.S.]
1) Elected public officials not serving in a political subdivision of the
state and any person appointed to fill a vacancy in such office, 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; board members of Triumph Gulf Coast, Inc;
board members 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, the local Boards of Trustees and
Presidents of state univ
ersities, and the Florida Prepaid College Board.
4) Persons elected to office 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, and except for representatives of a
military installation acting on behalf of all military installations within that
jurisdiction; pension or retirement boards empowered to invest pension
or retirement funds or determine entitlement to or amount of pensions or
other retirement benefits, and the Pinellas County Construction Licensing
Board.
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 $35,000 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 office 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 state 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 title.
12) The following positions in each state department or division:
Director, Assistant or Deputy Director, Bureau Chief, and any person
having the power normally conferred upon such persons, regardless of
title.
13) Assistant State 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 state 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
$35,000.
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.
INSTRUCTIONS FOR COMPLETING FORM 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.fl.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.
DISCLOSURE PERIOD: The “disclosure period” for your
report is the calendar year ending December 31, 2019.
OFFICE OR POSITION HELD OR SOUGHT: The title of
the office or position you hold, are seeking, or held during the
disclosure period even if you have since left that position. If you
are a candidate for office or are a new employee or appointee,
check the appropriate box.
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 file. 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.
WHO MUST FILE FORM 1:
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 6
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 3
PART APRIMARY SOURCES OF INCOME
[
Required by s. 112.3145(3)(b)1, 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 any public salary or public position(s). 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 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 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 $2,500, 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 $2,500, 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).
— If you received income from investments in stocks and bonds,
list each individual company from which you derived more than
$2,500. Do not aggregate all of your investment income.
— If more than $2,500 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 $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 jobs. 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, 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.
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 $5,000. 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
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 the 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.
P
ART 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 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, 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 $10,000 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(6), 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 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 form 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
service 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.)
PART APRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)1, 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 any public salary or public position(s), but income from
these public sources 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 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 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
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 jobs. 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, firm,
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.
Filers have the option of reporting based on either 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
threshold on any part of the form.
MANNER OF CALCULATING REPORTABLE INTEREST
IF YOU HAVE CHOSEN DOLLAR VALUE THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
IF YOU HAVE CHOSEN COMPARATIVE (PERCENTAGE) THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 5
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C.. PAGE 4
PART APRIMARY SOURCES OF INCOME
[
Required by s. 112.3145(3)(b)1, 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 any public salary or public position(s). 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 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 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 $2,500, 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 $2,500, 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).
— If you received income from investments in stocks and bonds,
list each individual company from which you derived more than
$2,500. Do not aggregate all of your investment income.
— If more than $2,500 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 $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 jobs. 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, 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.
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 $5,000. 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
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 the 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.
P
ART 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 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, 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 $10,000 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(6), 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 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 form 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
service 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.)
PART APRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)1, 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 any public salary or public position(s), but income from
these public sources 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 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 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
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 jobs. 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, firm,
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.
Filers have the option of reporting based on either 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
threshold on any part of the form.
MANNER OF CALCULATING REPORTABLE INTEREST
IF YOU HAVE CHOSEN DOLLAR VALUE THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
IF YOU HAVE CHOSEN COMPARATIVE (PERCENTAGE) THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 5
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C.. PAGE 4
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 required 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 the 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 $100,000, the estimated fair market value of
your home and other property (bank accounts, automobile,
furniture, 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.
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 form 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
service 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.)
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.
[s. 112.317, F.S.]
1) Elected public officials not serving in a political subdivision of the
state and any person appointed to fill a vacancy in such office, 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; board members of Triumph Gulf Coast, Inc;
board members 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, the local Boards of Trustees and
Presidents of state univ
ersities, and the Florida Prepaid College Board.
4) Persons elected to office 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, and except for representatives of a
military installation acting on behalf of all military installations within that
jurisdiction; pension or retirement boards empowered to invest pension
or retirement funds or determine entitlement to or amount of pensions or
other retirement benefits, and the Pinellas County Construction Licensing
Board.
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 $35,000 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 office 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 state 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 title.
12) The following positions in each state department or division:
Director, Assistant or Deputy Director, Bureau Chief, and any person
having the power normally conferred upon such persons, regardless of
title.
13) Assistant State 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 state 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
$35,000.
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.
INSTRUCTIONS FOR COMPLETING FORM 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.fl.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.
DISCLOSURE PERIOD: The “disclosure period” for your
report is the calendar year ending December 31, 2019.
OFFICE OR POSITION HELD OR SOUGHT: The title of
the office or position you hold, are seeking, or held during the
disclosure period even if you have since left that position. If you
are a candidate for office or are a new employee or appointee,
check the appropriate box.
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 file. 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.
WHO MUST FILE FORM 1:
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 6
CE FORM 1 - Effective: January 1, 2020. Incorporated by reference in Rule 34-8.202, F.A.C. PAGE 3