FORM 1

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Please prirt or type your neme, mNlllng
addrcss, agency name, and posltlon below:
STATEMENT OF
FTNANCIAL INTBRBSTS
2A'3,
FOR OFFICE USE ONLY:
LAST NAME
*
FIRST NAME
-
MIDDLE NAME :
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CITY:
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COUNW:
NAME OF OFFICE OR POSITION HEID OR SOUGHT:
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You are not limited to th gxc6 on the llnes on ttb form, Attach addhlonal sheets, lf nece$ary,
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CHECK ONLY rF
ff
CnruoronrE oR
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NEWEMPLOYEE ORAPPO|NTEE
*"N"
BOTH PARTS OF THIS SECTION MUST BE COMPLETED
**N*
DISCLOSURE PERIOD:
THIS SIATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENOAR
YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW TMIETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER (mgl check one):
{ DEcEMBER31,2013
oa D spEcTFyTnxyEARTFoTHERTHANTHEcALENDARyEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOTIAR VALUES, WHICH REQUIRES FEWER
CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for
further details). CHECK THE ONE YOU ARE USTNG:
*--
4 coMPARATtvE(pERcENTAcElrHREsHoLDs
aa tr DoLLARVALUETHRESHoLDS
PART A
-
PRllulARY SOURCES OF INCOME
lMajor
sources of income to the reporting person - See instructions]
(lf you have nothing to roport, write "none" or "nla")
NAME OF SOURCE
I
oF rNcoME
I
souRcE's
ADDRESS
I
DEscRtpIoN oF THE souRcE's
I PRINCIPALBUSINESSACTIVITY
'*
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"
PART B
-
SECONDARY SOURCES OF INCOI,IE
[Major
customers, clients, and other sources of income to businesses owned by the reporting person - See instructionsl
(lf you have nothing to repor! write "none" or.'nla..)
NAME OF
BUSINESS ENTIry
I
NAME OF MAJOR SOURCES
I
I
oF BUSTNESS,TNCOME
I
ADDRESS
OF SOURCE
I
PR|NCIPAT BUSTNESS
I
ACTTVTTY OF SOURCE
"
4/.
"
PART C
-
REAL PROPERW
[Land,
buildings or,r/ned by the reporting person - See instructions]
(lf you have nolhing to reporl, write "none" or "n/a")
FILING INSTRUCTIONS for
when and where to file this
form are located at the bottom
of page 2,
INSTRUCTION$ on who must
file this form and how to fill it
out begin on page 3.
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-
CE FORM I - E fecive: Janusry 1, 2014.
Adoptgd by referanco in Rut 3+8.202t1), FA.C
(Gontlnued on revorse sld6) PAGE 1
PART D
-
tNTAilGtBLE
pERSOitAL
PROPERW
[Stocks,
bonds, certificates of deposit, etc. - see instructions]
{lt
you have nothlng to report, write'none" or "nla")
I
NAMEoFGRED|ToR|-ADDRESSoFCRED|ToR
PART E
-
LIABILITIES [Major
debts - See instruc$onsl
(lf you have nothlng to roport, wdte "none' or "nla')
llo
3. 6o; /a-t tf.ccf . ?c.satol+,tsf. l*fe?-
-r=
igOe?
8a
zrtac..s 4,2c. ?easaoola
Fl J2$-o2
v
(tf you have nothing to repor! write "nons" or "nla")
BUStNEss ENTtry # r
r
BUslNEss ENTlry # 2
NAME OF BUSTNESS ENrlrY
|
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'
I
PART F
-
INTERESTS lN SpEclFlED BUSINESSES [Ownarshlp
or poclttons ln certaln
gpes of busineeseg'se instructlonsl
ADDRESS OF BUSINESS ENTIW
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WTH ENTITY
I OVVN MORE THAN A 5% INTEREST IN THE BUSINESS
NATURE OF MY OIINERSHIP INTEREST
SIGNATURE
(reouired):
kfrz/4
DATE SIGNED
(reouiredl:
t
/t,/tv
-
f a certified
public accountffised
under ch$ter 4i3, or attomey in good standing with the Florida Bar
prepared this form for you,
ihe musl complete the following statement:
.
prepared
the CE Form 1 in accordance with Section 1'12.3145, Florida Statutes,
Inoilied'ge and belief, the disclosure herein is true and correct.
he or
my
Signature
Date
WHAT TO FILE:
Afier completing all parts of this form, lnClgdbC
3igning snd datlno lt send back only the first
sheet (pages 'l and 2) for filing.
lf you havo nothlng to roport in a particular
section,
you must write 'none" or "rVa" in that
section(s).
NOTE:
MULTIPLE FILING UNNECESSARY:
Generally, a person who has filed Form 1 for a
calendar or fiscal year is not required to file a
second Form 1 for the same year. However' a
candidate who previously filed Form 1 because of
another
pubtic po$ition must at least fle a copy of
his or her original Form 1 when gualifying.
WHERE TO FILE:
lf you were mailed the form by the Commlssion
on Ethics or a County SupoMsor of Eleciions for
your annual disdosure filir, retum the form to that
location.
Local officers/employees
file with the Supervisor
of Elections of the county in which they permanendy
reside. (lf you do not permanenty eside in Florida'
file with the Supervisor of lhe county where your
agency has its headguarters.)
State offcer4s or qecilled slrte ettproyees file
with the Commission on Ethics, P.O. Drawer 15709'
Tallahassee, FL 32317-5709; physical address:
325 John Knox Road, Building E' Suiie 200'
Tallahassee, FL 32303.
WHEN TO FILE:
lninatty, each local ofrcer/employee, state oficer,
and speofied state employee must file lslfiin
30 days of the date of his or her appdntrnent
or of the beginnitE of employnent. Appointees
who must be confirmed by the Senate must file
prior to confrmation, even if that is less than
30 days from the date of their appointnent.
Candidales for pubticly-eteded local offce must file
st the same time they file their qualirying papers.
Thercafter, local oftcers/employees, state offices
and specifed state employees are required to file
by July 1st following eadl calendar year in whiclt
they hold their positions.
Finally, at the end of ofice or employmert, eadl
local oficer/employee, stiate offcer, and specifted
state employee is required to file a final disclosure
form (Form 1F) within 60 days of leaving office or
employment. Hoarever, filing a CE Fofm 1F (Final
Statement of Financial Interests) does ngl
telievs
tre filer of filing a CE Form 1 if he or she was in their
position on December 31, 20'13.
Candida|.c,s
file this form together with
qualirying
PaPers.
To determine what category your position falls
under, see the 'V\ltro Must File" Instruolions on
page 3.
Facsimiles
will not be accePted.
their
CE FORM 1 - Eltec{ve: January 1,2014.
Adoptd by cisronce in Rule 3+8.202(l)' F.A.C.
PAGE 2