FORM 1X AMENDMENT TO
STATEMENT OF FINANCIAL INTERESTS
LAST NAME - FIRST NAME - MIDDLE NAME
(Same as on original Form 1):
MAILING ADDRESS:
CITY: ZIP: COUNTY:
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
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]
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'S INCOME OF SOURCE ACTIVITY OF SOURCE
(If you have nothing to report, write "none" or "n/a")
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n/a")
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
CE FORM 1X - Effective: January 1, 2019 PAGE 1
Incorporated by reference in Rule 34-8.209, F.A.C.
THIS FORM AMENDS THE (Choose one)
FORM 1 I FILED FOR THE YEAR: _________________
(Use a separate Form 1X for each Form 1 you are amending.)
FORM 1F I FILED FOR THE PERIOD
January 1, ___________ THROUGH ____________________
(Must be between January 1 of the last year in which you held public office
or employment and the last date you held that office or employment.)
DURING THAT YEAR, I HELD, OR WAS A CANDIDATE FOR, THE
POSITION OF: _____________________________________________
WITH THIS GOVERNMENTAL AGENCY: ____________________
__________________________________________________________
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.
FILING INSTRUCTIONS:
IF ANY OF PARTS A THROUGH H ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
PART F INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions]
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
CE FORM 1X - Effective: January 1, 2019 PAGE 2
Incorporated by reference in Rule 34-8.209, F.A.C.
Return the form to the location where you filed
the Form 1 or 1F that you are seeking to amend.
Local officers
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) and send it to
CEForm1@leg.state.fl.us. Do not file by both mail
and email. Choose only one filing method.
Candidates should have filed their Form 1
together with their qualifying papers.
QUESTIONS:
About this form or the ethics laws may be
addressed to the Commission on Ethics, Post
Office Drawer 15709, Tallahassee, Florida
32317-5709; physical address: 325 John Knox
Road, Bldg E, Ste 200, Tallahassee, FL 32303;
telephone (850) 488-7864.
PART H EXPLANATION OF CHANGES
PART E LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
(If you have nothing to report, write "none" or "n/a"
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 _______________________________________
WHO MUST FILE FORM 1, Statement of Financial Interests:
All persons who fall within the categories of "state officers," "local officers," "specified state employees," as well as candidates
for elective local office, are required to file Form 1. Positions within these categories are described, generally, below; the
categories are specifically found in Section 112.3145, F.S. Persons required to file full and public financial disclosure (Form 6)
and officers of the judicial branch do not file Form 1 (see Form 6 for a list of persons who must file that form).
STATE OFFICERS include the following state officials: (1) persons holding elective State office, unless required to file full
disclosure on Form 6; (2) appointed members of boards, commissions, etc. having statewide jurisdiction, excluding members of
solely advisory bodies; and (3) certain State university system personnel.
LOCAL OFFICERS include the following local government positions: (1) persons holding elective office in any political
subdivision (such as municipalities, counties, and special districts), unless required to file full disclosure on Form 6; (2) appointed
members of certain boards, councils, commissions, authorities, and other bodies of counties, municipalities, school districts,
independent special districts, and other political subdivisions; and (3) persons holding certain appointive positions or employment
positions in local government.
SPECIFIED STATE EMPLOYEES include a number of state positions in the executive, legislative, and judicial branches.
MANNER OF CALCULATING REPORTABLE INTEREST
As noted on the form, 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.
CE FORM 1X - Effective: January 1, 2019 PAGE 3
Incorporated by reference in Rule 34-8.209, F.A.C.
INTRODUCTORY INFORMATION (Top of Form):
NAME, DISCLOSURE PERIOD, NAME OF POSITION, and NAME OF AGENCY: Use the same
information as on the original Form 1 or 1F you are seeking to amend. If you are amending forms for more
than one disclosure period please use a separate Form 1X for each disclosure period you wish to amend.
MAILING ADDRESS: Use your current mailing address.
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.
MANNER OF CALCULATING REPORTABLE INTERESTS: Check the box that corresponds to the type
of thresholds you used for the original Form 1 or 1F you are seeking to amend.
PARTS A through G:
Use these sections of the form to report the new information you believe should have been reported on
your original Form 1 or 1F, continuing on a separate sheet if necessary. Instructions for individual
sections are found on pages 3-5, attached.
PART H:
Use this section of the form to explain the changes you are making in your original Form 1 or 1F.
INSTRUCTIONS FOR COMPLETING FORM 1X:
PART A — PRIMARY 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 the amount of income received, and you need not list your
public salary 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
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.
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
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).
CE FORM 1X - Effective: January 1, 2019 PAGE 4
Incorporated by reference in Rule 34-8.209, F.A.C.
IF YOU HAVE CHOSEN DOLLAR VALUE THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
PART A — PRIMARY 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 the
amount of income received, and you need not list your public salary
received from serving in the position(s) which requires 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, 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), then 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.
IF YOU HAVE CHOSEN COMPARATIVE (PERCENTAGE) THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
CE FORM 1X - Effective: January 1, 2019 PAGE 5
Incorporated by reference in Rule 34-8.209, F.A.C.
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(5), 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 an 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.)
CE FORM 1X - Effective: January 1, 2019 PAGE 6
Incorporated by reference in Rule 34-8.209, F.A.C.
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.)