June 1, 2010 Financial Disclosure Packet (revised)

8/7/2019 June 1, 2010 Financial Disclosure Packet (revised)

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CITY OF MIAMI, FLORIDA

I N T E R ~ O F F I C E MEMORANDUM

Honorable Mayor and Members JuneL2010TO of the City Commission LlATE FILE

Financial Disclosure F01l11SSUBJECT

~ ~ f f : b FROM - . -n sc rlla A. r hompson ~ REFERENCES"ity Clerk ENCLOSURES Exhibits A - H

PLEA S E NOTE THAT SOME O F THE INF O R MA T ION BEL O W H AS C HANG EDFR O M PR IO R YEARS.

ST A T E OF FLORID A F INA NCIAL DISC LO S UR E REQ U IR E M ENTS

(to be fil ed by J u l ~' 1, 2010)

Under State of Florida and Miami-Dade County Financial Di sclosure requirements (See "ExhibitA " Memo: Memo provided by Miami-Dade County and the Miami-Dade Commission on -~ t h i c s and Public Trust regarding Financial Disclosure Requirements), any person elected to oft-Ice in anypolitical subdivision is required to tIle "Form I - Statement of Financial Interests." (Exhihi t B). Acopy of this form is attached, which must be tIled by you pursuant to law by Thursday, July I,2010, with the M IAMI-D AD E COUN TY SUPERVI SO R O F EL EC TIONS, at the followingaddress:

II'by mail, please send to: Lester SolaMiami-Dade County Supervisor of ElectionsElections DepartmentP.O. Box 521550Miami, Florida 33152

Ifby hand, deliver to: Lester SolaMiami- Dade County Su pervisor of ElectionsElections Department2700 N .W, 87 AvenueMiami, Florida 33172

PE NALTIES

Public officers, candidates for public office, or public employees required to file FO R M 1annual disclosure are subject to automatic fines of $25 for each day late the form is fIled afterSeptember I, up to a maximum 0[$1,500 [Section 11 2.3145, Fl a. Stat.[

A failure to make any required disclosure constitutes grounds for and may be punished byone or more of the following: disqualification from being on the ballot, impeachment, removal or


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suspension from office or employment, demotion, reduction in salary, reprimand, or a civil penaltynot exceeding $10,000. ISec 112.317, Fla. Stat.)

Any inquiries regarding appeals of fines should be directed to the Miami-Dade CountyCommission on Ethics and Public Trust at (305) 5 7 9 - 2 5 9 4 ; \ \ ' ~ Y \ ~ J ] l i m n 1 ~ h l ~ I ( , : , ~For

additional infonnation, please review the language contained in the Code of Ethics fiJr PublicOfficers and Employees found in Pati 1II of Chapter 112, Florida Statues ISection 112.3145, Fla.Stat.l

STATE OF FLORIDA AND MIAMI-DADE COUNTY REQUIREMENT FORREPORTING GIFTS (ANNUAL AND QUARTERLY FILING)

i . Also, pursuant to the memo from Miami-Dade County an d the Miami-DadeCommission on Ethics and Public. Trust (Exhibit A) , other forms that you need to file inorder to comply with th e ethics laws include:

(i) FORM 9 QUARTERLY GIFT DISCLOSURE

Each person required to file FORM 1 STATEMENT OF FINANICAL INTEREST orrequired to file financial disclosure under the Miami-Dade County Code of Ethics, must fileFORM 9, entitled: "Qual1erly Gift Disclosure" (Exhibit C). FORM 9 must be filed with theCommission on Ethics by the end of the calendar quat1er (March 31, June 30, September 30, orDecember 31) following the calendar quat1er in which the gift w0l1h over $100 (other than giftsfrom relatives, gifts prohibited from being accepted, gifts primarily associated with his or herbusiness employment, and gifts otherwise required to be disclosed) was received. ISec. 112.3148,Fla. Stat. an d Miami-Dade County Code Section 2-11.J.(e)J

(ii) FORM JO ANNUAL DffiCLOSURE OF GIFTS FROMGOVERNMENT AL ENTITIES AND DIRECT SUPPORTORGANIZATIONS AND HONORARIUM EVENTS RELATEDEXPENSES

State government entities, airport authorities, counties, municipalities, school boards,water management districts, the Tri-County Commuter Rail Authority, and the TechnologicalResearch and Development Authority may give a gift worth over $100 to a person required to fileFORM I or FORM 6, and to State procurement employees, if a public purpose can be shown to rthe gift. Also, a direct-suPPol1 organization to r a governmental entity may give such a gift to aperson who is an ofticer or employee of that entity. These gifts are to be rep0l1ed on FORM 10(E'Chibit D), to be filed by July I, 2010.

The governmental entity or direet-support organization giving the gift must provide theofficer or employee with a statement about the gift no later than March 1 of the tollowing year. Th eofficer or employee then must diselose this information by filing a statement by July I, 2010 withhis or her annualtinancial disclosure that describes the gift and lists the donor, the date of the gift,and the value of the total gifts provided during the calendar year. State procurement employees tiletheir statements with the Florida Commission 011 Ethics. (Sec. 112.3148, Fla. Stat.1

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In addition, a person required to file FORM I , wryo receives expenses or payment ofexpenses r e l ~ t e d to an honorarium event from someone who is prohibited from giving him or he ran honorarium, must disclose annually the name, address, and aftI1iation of the donor, th e amountof the expenses, the date of the event, a descri ption of the expenses paid or provided, and the totalvalue of the expenses on FORM 10. Th e disclosure must be tIled by July I, 20 10, for expenses

received during the previous calendar year, with the ofticer's or employee's FORM1.

ISec.112.3148 and 112.3149, Fla. Stat.1

2. Where to file FORM 9 AND FORM 10:

Public ofticers and employees who are required to tile FORM 9 and/or FORM 10 tile with: Florida Commission on Ethics

P.O. Drawer 15709Tal1ahassee, FL 32317-5709

Public officers an d employees wh o are required to file FORM 9 and/or FORM 10 are

also required to comply with the Miami-Dade County Code of Ethics gi n disclosurerequirement. Miami-Dade County Code of Ethics Ordinance, Sec. 2 ~ 1 1 . 1 ( e ) . Said disclosureshall be made by tiling a C O p y of the disclosure FORM 9 and/or FORM 10 with:

Ifby mail, please address to: Priscilla A. Thompson, CMC, City Clerk City Clerk's Oftlce P.O. Box 330708Miami, Florida 33233-0708

l fby hand, please deliver to: Priscilla A. Thompson, CMC, City Clerk Miami City Hall

3500 Pan American Drive Miami, Florida 33133

3. FORM 2 QUARTERLY CLIENT DISCLOSURE

Th e Form 2 Quarterly Client Disclosure Form (Exhibit E) is required to be completed byindividual who (o r whose professional tInn) has represented a client for a fee before an agency athis or he r level of government, with certain exceptions. This form is du e not later than the lastda y of the calendar quarter (March 31, June 30, September 30, or December 31) to r the previouscalendar qUalier in which a reportable representation occurred.

Public officers who are required to file FORM 2 tIle with:

Ifby mail, please address to: Lester SolaMiami-Dade County Supervisor of ElectionsElections DepartmentP.O. Box 521550Miami, Florida 33152

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EXHIBIT A


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Financial Disclosure Requirements(2010)

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STATE REQUIREMENTS LOCAL OFFICERS & CANDIDATES FOR LOCAL OFFICE *

FORMS TO FILE WHEN FILED WHERE FILED

Statement of Financial Interests (STATE FORM 1)

Officers & employees file within 30days of appointment or employmentand then annually by July 1 of eachyear

Candidates for local elective officefile at the same time qualifying papersare filed

Miami Dade Elections Department2700 NW 87 th Ave.Miami, FL 33172

or

P.O. Box 521550Miami, FL 33152-1550

Candidates for municipal office file withrespective municipal clerks. Candidates forcounty office file with the Miami-DadeCounty Department of Elections

Final Statement of FinancialInterests(STATE FORM 1F)

Within 60 days after leaving office oremployment, unless taking anotherposition that requires financialdisclosure


or

P.O. Box 521550Miami, FL 33152-1550

Amendment to Statement of Financial Interests(STATE FORM 1X)

When seeking to amend a previouslyfiled STATE FORM 1


or

P.O. Box 521550Miami, FL 33152-1550

Quarterly Gift Disclosure(STATE FORM 9)

No later than the last day of thecalendar quarter ( i.e ., March 31, June30, Sept. 30, Dec. 31, for any giftreceived from an individual or singleentity during the previous calendarquarter and valued in excess of $100

No reporting required if no gifts werereceived

Florida Commission on EthicsP. O. Drawer 157093600 Maclay Boulevard South, Suite 201Tallahassee, FL 32317-5709

Gifts from GovernmentalEntities , Direct-SupportOrganizations, Honorarium EventRelated Expenses(STATE FORM 10)

July 1, annually, if a reportable gift,honorarium, or honorarium-relatedexpenses were received during thepreceding calendar year

Florida Commission on EthicsP. O. Drawer 157093600 Maclay Boulevard South, Suite 201Tallahassee, FL 32317-5709

Quarterly Client Disclosure , foran individual who (or whose professional firm)has represented a client for a fee before anagency at his or her level of government, withcertain exceptions (STATE FORM 2)

No later than the last day of eachcalendar quarter ( i.e ., March 31, June30, Sept. 30, Dec. 31) for the previouscalendar quarter in which a reportablerepresentation occurred.


or

P.O. Box 521550Miami, FL 33152-1550


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STATE REQUIREMENTS

*LOCAL OFFICERS & CANDIDATES FOR LOCAL OFFICE as defined by Fla. Stat. 112.3145(1) (a) (2009)

1. Every person who is elected to office in any political subdivision of the state, and every person who isappointed to fill a vacancy for an unexpired term in such an elective office.

2. Any appointed member of any of the following boards, councils, commissions, authorities, or other bodies of any county, municipality, school district, independent special district, or other political subdivision of the state:

a. The governing body of the political subdivision, if appointed;b. An expressway authority or transportation authority established by general law;c. A community college or junior college district board of trustees;d. A board having the power to enforce local code provisions;e. A planning or zoning board, board of adjustment, board of appeals, or other board having the power to

recommend, create, or modify land planning or zoning within the political subdivision, except forcitizen advisory committees, technical coordinating committees, and such other groups who only have

the power to make recommendations to planning or zoning boards;f. A pension board or retirement board having the power to invest pension or retirement funds or thepower to make a binding determination of one's entitlement to or amount of a pension or otherretirement benefit; or

g. Any other 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 resolutioncreating the board.

3. Any person holding one or more of the following positions: mayor; county or city manager; chief administrative employee of a county, municipality, or other political subdivision; county or municipal attorney;chief county or municipal building code inspector; county or municipal water resources coordinator; county ormunicipal pollution control director; county or municipal environmental control director; county or municipaladministrator, with power to grant or deny a land development permit; chief of police; fire chief; municipal

clerk; district school superintendent; community college president; district medical examiner; or purchasingagent (regardless of title) having the authority to make any purchase exceeding $15,000, on behalf of anypolitical subdivision of the state or any entity thereof.


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STATE REQUIREMENTS CIRCUIT COURT JUDGES, COUNTY JUDGES, CLERKS OF CIRCUIT COURTS,SHERIFFS, COUNTY COMMISSIONERS, also referred to as Elected Constitutional Officers

FORMS TO FILE WHEN FILED WHERE FILEDFull and Public Disclosure of Financial Interests(STATE FORM 6)

Incumbent officials must file annuallyby July 1

Candidates must file at the time of qualifying

Florida Commission on EthicsP. O. Drawer 157093600 Maclay Blvd. South, Suite 201Tallahassee, FL 32317-5709.

Candidates file with the officer beforewhom they qualify

Final Full and Public Disclosure of Financial Interests(STATE FORM 6F)

Within 60 days after leaving publicoffice, unless taking another positionthat requires full and public financial

disclosure using STATE FORM 6

Florida Commission on EthicsP. O. Drawer 157093600 Maclay Blvd. South, Suite 201

Tallahassee, FL 32317-5709

Amendment to Full and PublicDisclosure of Financial Interests(STATE FORM 6X)

When seeking to amend a previouslyfiled STATE FORM 6

Florida Commission on EthicsP. O. Drawer 157093600 Maclay Blvd. South, Suite 201Tallahassee, FL 32317-5709

Quarterly Gift Disclosure , but notrequired of judges(STATE FORM 9)

No later than the last day of thecalendar quarter ( i.e ., March 31, June30, Sept. 30, Dec. 31) for any giftreceived from an individual or singleentity during the previous calendarquarter and valued in excess of $100.No reporting required if no gifts werereceived.


Gifts from Governmental Entities,Direct-Support Organizations,Honorarium Event RelatedExpenses , but not required of judges(STATE FORM 10)

July 1, annually, if a reportable gift,honorarium, or honorarium-relatedexpenses were received during thepreceding calendar year


Quarterly Client Disclosure , for anindividual who (or whoseprofessional firm) has represented aclient for a fee before an agency athis or her level of government, withcertain exceptions (STATE FORM 2)

No later than the last day of thecalendar quarter ( i.e ., March 31, June30, Sept. 30, Dec. 31) for the previouscalendar quarter in which a reportablerepresentation occurred


or

P.O. Box 521550Miami, FL 33152-1550


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FINANCIAL DISCLOSURE REQUIREMENTS(2010)

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COUNTY REQUIREMENTS CERTAIN COUNTY & MUNICIPAL PERSONNEL & NON-EXEMPT ADVISORY BOARDMEMBERS


Financial Disclosure is satisfied byfiling any one of the following 2009 Federal Income Tax Return

for individuals or most recent federalincome tax return for corporations

Financial Statement(MIAMI-DADE CO. Form)

Source of Income Statement(MIAMI-DADE CO. Form)

Statement of Financial Interests

(STATE FORM 1)

By July 1, 2010, by 12:00 Noon

NOTE ALSO Candidates file at the same time

qualifying papers are filed Consultants file within 30 days

of execution of their countycontracts, and by July 1 st everyyear thereafter

County personnel file withMiami Dade Elections Dept.2700 NW 87 th Ave.Miami, FL 33172

or

P.O. Box 521550Miami, FL 33152-1550

Municipal personnel file withrespective municipal clerk

Gift Disclosure is satisfied by filing thefollowing

Quarterly Gift Disclosure(MIAMI-DADE CO. Form)

No later than the last day of thecalendar quarter ( i.e ., March 31, June30, Sept. 30, Dec. 31) for any giftreceived from an individual or singleentity during the previous calendarquarter and valued in excess of $100.

No reporting required if no gifts werereceived.

County personnel file withthe Miami Dade Clerk of theBoard of Co. Commissioners111 NW 1 st St., #17-202Miami, FL 33128


CERTAIN COUNTY & MUNICIPAL PERSONNEL & NON-EXEMPT ADVISORY BOARDMEMBERS include the County Attorney and Assistant County Attorneys; County Manager, Assistant County

Managers, and Special Assistants to the County Manager; Heads or Directors of County Departments and theirAssistant or Deputy Department Heads; Employees of the Miami-Dade County Police Dept. with the Rank of Captain, Major, and Chief; Building and Zoning Inspectors; Any Architect, Professional Engineer, LandscapeArchitect, or Registered Land Surveyor performing services for Miami-Dade County pursuant to a contract; LocalAutonomous and Semi-Autonomous Personnel, Boards, and Agencies who were not required to file under Statelaw; Local Personnel who perform quasi-judicial functions who were not required to file under State law; LocalAdvisory Personnel, whose sole or primary responsibility is to recommend legislation or give advice to the Boardof County Commissioners, including Members of any County Board, who were not required to file under Statelaw (except those exempted by ordinance or resolution); Candidates for certain County and Municipal ElectiveOffice.

References to County positions are applicable to comparable municipal positions. Compliance with State financialdisclosure requirements automatically satisfies Miami-Dade County disclosure requirements, but compliance withMiami-Dade County disclosure requirements does not satisfy State requirements.


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FINANCIAL DISCLOSURE REQUIREMENTS(2010)

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COUNTY REQUIREMENTS FULL-TIME COUNTY & MUNICIPAL EMPLOYEES ENGAGED IN OUTSIDEEMPLOYMENT

FORMS TO FILE WHEN FILED WHERE FILEDFile Both

Request for Outside Employment(MIAMI-DADE CO. Form)

and

Outside Employment Statement (MIAMI-DADE CO. Form)

Before accepting job, and every yearthereafter while engaged in outsideemployment, fileRequest for OutsideEmployment

File Outside EmploymentStatement by July 1, 2010, and eachyear thereafter while engaged inoutside employment.

Request for OutsideEmployment is filed withDPR and copy forwarded toHuman Resources Dept.111 NW 1 st St., #2020Miami, FL 33128

Outside EmploymentStatement is filed withMiami Dade Elections Dept.2700 NW 87 th Ave.Miami, FL 33172

or P.O. Box 521550Miami, FL 33152-1550


COUNTY REQUIREMENTSALL COUNTY EMPLOYEES AUTHORIZED TO APPROVE EXPENDITURES EXCEEDING$15,000 , including electronic signature approvals in ADPICS and FAMIS


Statement of Financial Interests(STATE FORM 1)

By July 1, 2010, by 12:00 Noon Miami Dade Elections Dept.2700 NW 87 th Ave.Miami, FL 33172

or

P.O. Box 521550Miami, FL 33152-15500


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**BOTH PARTS OF THIS SECTION MUST BE COMPLETED**DISCLOSURE PERIOD:

THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ONA FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (check one):

DECEMBER 31, 2009 OR SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:_________________

MANNER OF CALCULATING REPORTABLE INTERESTS:THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICHREQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (seeinstructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (check one):

COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS

FORM 1 STATEMENT OF 2009

FINANCIAL INTERESTS

CE FORM 1 - Eff. 1/2010 (Continued on reverse side) PAGE

NAME OF OFFICE OR POSITION HELD OR SOUGHT :

NAME OF AGENCY :

You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.

CHECK ONLY IF CANDIDATE OR NEW EMPLOYEE OR APPOINTEE

PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person](If you have nothing to report, you must write "none" or "n/a")

NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'SOF 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](If you have nothing to report , you must write "none" or "n/a")

NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESSBUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE

FILING INSTRUCTIONS for when and where to file this formare located at the bottom of page 2.

INSTRUCTIONS on who mustfile this form and how to fill it outbegin on page 3.

OTHER FORMS you may needto file are described on page 6.

ID Code

ID No.

Conf. Code

P. Req. Code

MAILING ADDRESS :

LAST NAME -- FIRST NAME -- MIDDLE NAME :

Please print or type your name, mailingaddress, agency name, and position below:

FOR OFFICEUSE ONLY:

CITY : ZIP : COUNTY :

PART C -- REAL PROPERTY [Land, buildings owned by the reporting person](If you have nothing to report, you must write "none" or "n/a")

EXHIBIT B


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FILING INSTRUCTIONS:

SIGNATURE (required): DATE SIGNED (required):

IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE

PART D INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.](If you have nothing to report, you must write "none" or "n/a")

TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES

PART E LIABILITIES [Major debts](If you have nothing to report, you must 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]

(If you have nothing to report, you must write "none" or "n/a") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3

NAME OF BUSINESS ENTITY

ADDRESS OF BUSINESS ENTITY

PRINCIPAL BUSINESS ACTIVITY

POSITION HELD WITH ENTITY

I OWN MORE THAN A 5%INTEREST IN THE BUSINESSNATURE OF MYOWNERSHIP INTEREST

WHAT TO FILE:After completing all parts of this form, includingsigning and dating it, send back only the firstsheet (pages 1 and 2) for filing.

If you have nothing to report in a particular section, you must write "none" or "n/a" in thatsection(s).

Facsimiles will not be accepted.

NOTE:MULTIPLE FILING UNNECESSARY:Generally, a person who has filed Form 1 for acalendar or fiscal year is not required to file asecond Form 1 for the same year. However, acandidate who previously filed Form 1 becauseof another public position must at least file a copyof his or her original Form 1 when qualifying.

WHERE TO FILE:If you were mailed the form by the Commissionon Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form tothat location.

Local officers/employees file with the Supervisor of Elections of the county in which they perma-nently reside. (If you do not permanently residein Florida, file with the Supervisor of the countywhere your agency has its headquarters.)

State officers or specified state employeesfile with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-5709; physicaladdress: 3600 Maclay Boulevard, South, Suite201, Tallahassee, FL 32312.

Candidates file this form together with their qualifying papers.

To determine what category your positionfalls under, see the "Who Must File" Instructionson page 3.

WHEN TO FILE:Initially , each local officer/employee, stateofficer, and specified state employee mufile within 30 days of the date of his or her appointment or of the beginning of employ-ment. Appointees who must be confirmed bythe Senate must file prior to confirmation, evenif that is less than 30 days from the date of their

appointment.Candidates for publicly-elected local officemust file at the same time they file their qualifying papers.

Thereafter , local officers/employees, stateofficers, and specified state employees arerequired to file by July 1st following eachcalendar year in which they hold their posi-tions.

Finally , at the end of office or employment,each local officer/employee, state officer, andspecified state employee is required to file afinal disclosure form (Form 1F) within 60 daysof leaving office or employment.

CE FORM 1 - Eff. 1/2010 PAGE


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INSTRUCTIONS FOR COMPLETING FORM 1:

STATE OFFICERS include the following positions for state officials: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 tofile full disclosure on Form 6.

2) Appointed members of each board, commission, authority, or councilhaving statewide jurisdiction, excluding members of sole advisory bodies;but including judicial nominating commission members; Directors of theFlorida Black Business Investment Board, Enterprise Florida, Scripps FloridaFunding Corporation, Workforce Florida, and Space Florida; Members of theFlorida Commission on Tourism, Florida Substance Abuse and Mental HealthCorporation, and the Council on the Social Status of Black Men and Boys; andGovernors and senior managers of Citizens Property Insurance Corporationand Automobile Joint Underwriting Association.

3) The Commissioner of Education, members of the State Board ofEducation, the Board of Governors, and the local Boards of Trustees andPresidents of state universities.

LOCAL OFFICERS/EMPLOYEES include the following positionsfor officers and employees of local government:

1) Persons elected to office in any political subdivision (such as munici-

palities, counties, and special districts) and any person appointed to fill avacancy in such office, unless required to file full disclosure on Form 6.2) Appointed members of the following boards, councils, commissions,

authorities, or other bodies of any county, municipality, school district, inde-pendent special district, or other political subdivision: the governing bodyof the subdivision; a community college or junior college district board oftrustees; a board having the power to enforce local code provisions; a boardof adjustment; a planning or zoning board having the power to recommend,create, or modify land planning or zoning within the political subdivision,except for citizen advisory committees, technical coordinating committees,and similar groups who only have the power to make recommendations toplanning or zoning boards; a pension board or retirement board empoweredto invest pension or retirement funds or to determine entitlement to or amountof a pension or other retirement benefit.

3) Any other appointed member of a local government board who isrequired to file a statement of financial interests by the appointing authority or

the enabling legislation, ordinance, or resolution creating the board.4) Persons holding any of these positions in local government: Mayor;

county or city manager; chief administrative employee of a county, municipal-ity, or other political subdivision; county or municipal attorney; chief county ormunicipal building inspector; county or municipal water resources coordina-tor; county or municipal pollution control director; county or municipal envi-ronmental control director; county or municipal administrator with power togrant or deny a land development permit; chief of police; fire chief; municipalclerk; appointed district school superintendent; community college president;district medical examiner; purchasing agent (regardless of title) having theauthority to make any purchase exceeding $15,000 for the local governmen-tal unit.

SPECIFIED STATE EMPLOYEES include the following positionfor state employees:

1) Employees in the office of the Governor or of a Cabinet member whoare exempt from the Career Service System, excluding secretarial, clerical,and similar positions.

2) The following positions in each state department, commission,board, or council: Secretary, Assistant or Deputy Secretary, ExecutiveDirector, Assistant or Deputy Executive Director, and anyone having thepower normally conferred upon such persons, regardless of title.

3) The following positions in each state department or division: Director,Assistant or Deputy Director, Bureau Chief, Assistant Bureau Chief, and anyperson having the power normally conferred upon such persons, regardlessof title.

4) Assistant State Attorneys, Assistant Public Defenders, PublicCounsel, full-time state employees serving as counsel or assistant counselto a state agency, administrative law judges, and hearing officers.

5) The Superintendent or Director of a state mental health institute estab-lished for training and research in the mental health field, or any major stateinstitution or facility established for corrections, training, treatment, or reha-bilitation.

6) State agency Business Managers, Finance and Accounting Directors,Personnel Officers, Grant Coordinators, and purchasing agents (regardlessof title) with power to make a purchase exceeding $15,000.

7) The following positions in legislative branch agencies: each employ-ee (other than those employed in maintenance, clerical, secretarial, or similar

positions and legislative assistants exempted by the presiding officer of theirhouse); and each employee of the Commission on Ethics.


WHO MUST FILE FORM 1:All persons who fall within the categories of "state officers," "local officers/employees," "specified state employees," as well as candidates for elective local office,are required to file Form 1. Positions within these categories are listed below. Persons required to file full financial disclosure (Form 6) and officers of the judicialbranch do not file Form 1 (see Form 6 for a list of persons who must file that form).

INSTRUCTIONS FOR COMPLETING FORM 1STATEMENT OF FINANCIAL INTERESTS

INTRODUCTORY INFORMATION (At Top of Form):If your name, mailing address, public agency, and position arealready printed on the form, you do not need to provide this informa-tion unless it should be changed. To change any of this information,write the correct information on the form, then contact your agency'sfinancial disclosure coordinator. Your coordinator is identified in thefinancial disclosure portal on the Commission on Ethics website:www.ethics.state.fl.us.

NAME OF AGENCY: This should be the name of the governmental unitwhich you serve or served, by which you are or were employed, or for

which you are a candidate. For example, "City of Tallahassee," "LeonCounty," or "Department of Transportation."

OFFICE OR POSITION HELD OR SOUGHT: Use the title of the officeor position you hold, are seeking, or held during the disclosure period (insome cases you may not hold that position now, but you still would berequired to file to disclose your interests during the last year you held thatposition). For example, "City Council Member," "County Administrator,""Purchasing Agent," or "Bureau Chief." If you are a candidate for office orare a new employee or appointee, check the appropriate box.MAILING ADDRESS: If your home address appears on the form butyou prefer another address be shown, change the address as describedabove If you are an active or former officer or employee listed in Section119.071(4)(d), F.S., whose home address is exempt from disclosure,the Commission is required to maintain the confidentiality of your homeaddress if you submit a written request for confidentiality. Persons

listed in Section 119.071(4)(d), F.S., are encouraged to provide an addressother than their home address.

DISCLOSURE PERIOD: The tax year for most individuals is the calendaryear (January 1 through December 31). If that is the case for you, thenyour financial interests should be reported for the calendar year 2009; justcheck the box and you do not need to add any information in this part ofthe form. However, if you file your IRS tax return based on a tax year that isnot the calendar year, you should specify the dates of your tax year in thisportion of the form and check the appropriate box. This is the time frameor "disclosure period" for your report.

MANNER OF CALCULATING REPORTABLE INTERESTS: As notedthis portion of the form, the Legislature has given filers the option of report-ing based on either thresholds that are comparative (usually, based onpercentage values) or thresholds that are based on absolute dollar values.The instructions on the following pages specifically describe the differentthresholds. Simply check the box that reflects the choice you have made.You must use the type of threshold you have chosen for each part of theform. In other words, if you choose to report based on absolute dollarvalue thresholds, you cannot use a percentage threshold on any part ofthe form.

(CONTINUED on page 4)


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PART A PRIMARY SOURCES OF INCOME[Required by Sec. 112.3145(3)(a)1 or (b)1, Fla. Stat.]

Part A is intended to require the disclosure of your principal sources ofincome during the disclosure period. You do not have to disclose the amountof income received. The sources should be listed in descending order,with the largest source first. Please list in this part of the form the name,address, and principal business activity of each source of your income which(depending on whether you have chosen to report based on percentagethresholds or on dollar value thresholds) either:

exceeded five percent (5%) of the gross income received by you in

your own name or by any other person for your benefit or use during thedisclosure period, or

exceeded $2,500.00 (of gross income received during the disclosureperiod by you in your own name or by any other person for your use orbenefit).

You need not list your public salary received from serving in theposition(s) which requires you to file this form, but this amount should beincluded when calculating your gross income for the disclosure period. Theincome of your spouse need not be disclosed. However, if there is jointincome to you and your spouse from property held by the entireties (such asinterest or dividends from a bank account or stocks held by the entireties),you should include all of that income when calculating your gross income anddisclose the source of that income if it exceeded the threshold.

Gross income means the same as it does for income tax purposes,including all income from whatever source derived, such as compensation forservices, gross income from business, gains from property dealings, interest,rents, dividends, pensions, social security, distributive share of partnershipgross income, and alimony, but not child support.

Examples:

If you were employed by a company that manufactures computersand received more than 5% of your gross income (salary, commissions,etc.) from the company (or, alternatively, $2,500), then you should listthe 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 ofpartnership gross income exceeded 5% of your gross income (or,alternatively, $2,500), then you should list the name of the firm, itsaddress, and its principal business activity (practice of law).

If you were the sole proprietor of a retail gift business and your grossincome from the business exceeded 5% of your total gross income (or,alternatively, $2,500), then you should list the name of the business, itsaddress, and its principal business activity (retail gift sales).

If you received income from investments in stocks and bonds, youare required to list only each individual company from which you derivedmore than 5% of your gross income (or, alternatively, $2,500), ratherthan aggregating all of your investment income.

If more than 5% of your gross income (or, alternatively, $2,500)was gain from the sale of property (not just the selling price), thenyou should list as a source of income the name of the purchaser, thepurchasers address, and the purchasers principal business activity. Ifthe purchasers identity is unknown, such as where securities listed onan exchange are sold through a brokerage firm, the source of incomeshould be listed simply as sale of (name of company) stock, forexample.

If more than 5% of your gross income (or, alternatively, $2,500)was in the form of interest from one particular financial institution(aggregating interest from all CDs, accounts, etc., at that institution),list the name of the institution, its address, and its principal businessactivity.

PART B SECONDARY SOURCES OF INCOME[Required by Sec. 112.3145(3)(a)2 or (b)2, Fla. Stat.]

This part is intended to require the disclosure of major customers,clients, and other sources of income to businesses in which you own aninterest. You will not have anything to report unless :

(a) If you are reporting based on percentage thresholds:

(1) You owned (either directly or indirectly in the form of anequitable or beneficial interest) during the disclosure period morethan five percent (5%) of the total assets or capital stock of abusiness entity (a corporation, partnership, limited partnership,proprietorship, joint venture, trust, firm, etc., doing business inFlorida); and

(2) You received more than ten percent (10%) of your gross incomeduring the disclosure period from that business entity; and

(3) You received more than $1,500 in gross income from thatbusiness entity during the period.

(b) If you are reporting based on dollar value thresholds:

(1) You owned (either directly or indirectly in the form of anequitable or beneficial interest) during the disclosure period morethan five percent (5%) of the total assets or capital stock of abusiness entity (a corporation, partnership, limited partnership,proprietorship, joint venture, trust, firm, etc., doing business inFlorida); and

(2) You received more than $5,000 of your gross income duringthe disclosure period from that business entity.

If your interests and gross income exceeded the appropriate thresholds listedabove, then for that business entity you must list every source of income tothe business entity which exceeded ten percent (10%) of the business entitysgross income (computed on the basis of the business entitys most recentlycompleted fiscal year), the sources address, and the sources principalbusiness activity.

Examples: You are the sole proprietor of a dry cleaning business, from whichyou received more than 10% of your gross income (an amount that wasmore than $1,500) (or, alternatively, more than $5,000, if you are usingdollar value thresholds). If only one customer, a uniform rental company,provided more than 10% of your dry cleaning business, you must listthe name of the uniform rental company, its address, and its principalbusiness activity (uniform rentals).

You are a 20% partner in a partnership that owns a shopping malland your partnership income exceeded the thresholds listed above. Youshould list each tenant of the mall that provided more than 10% of thepartnerships gross income, the tenants address and principal businessactivity.

You own an orange grove and sell all your oranges to one marketingcooperative. You should list the cooperative, its address, and its principalbusiness activity if your income met the thresholds.

PART C REAL PROPERTY[Required by Sec. 112.3145(3)(a)3 or (b)3, Fla. Stat.]

In this part, please list the location or description of all real property (landand buildings) in Florida in which you owned directly or indirectly at any timeduring the previous tax year in excess of five percent (5%) of the propertysvalue. This threshold is the same, whether you are using percentagethresholds or dollar thresholds. You are not required to list your residencesand vacation homes; nor are you required to state the value of the propertyon the form.

Indirect ownership includes situations where you are a beneficiary ofa trust that owns the property, as well as situations where you are morethan a 5% partner in a partnership or stockholder in a corporation that ownsthe property. The value of the property may be determined by the mostrecently assessed value for tax purposes, in the absence of a more currentappraisal.

The location or description of the property should be sufficient toenable anyone who looks at the form to identify the property. Although alegal description of the property will do, such a lengthy description is notrequired. Using simpler descriptions, such as duplex, 115 Terrace Avenue,Tallahassee or 40 acres located at the intersection of Hwy. 60 and I-95, LakeCounty is sufficient. In some cases, the property tax identification number ofthe property will help in identifying it: 120 acre ranch on Hwy. 902, HendryCounty, Tax ID # 131-45863.



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Examples:

You own 1/3 of a partnership or small corporation that owns both avacant lot and a 12% interest in an office building. You should disclosethe lot, but are not required to disclose the office building (because your1/3 of the 12% interestwhich equals 4%does not exceed the 5%threshold).

If you are a beneficiary of a trust that owns real property and yourinterest depends on the duration of an individuals life, the value of yourinterest should be determined by applying the appropriate actuarial tableto the value of the property itself, regardless of the actual yield of theproperty.

PART D INTANGIBLE PERSONAL PROPERTY[Required by Sec. 112.3145(3)(a)3 or (b)3, Fla. Stat.]

Provide a general description of any intangible personal property that, atany time during the disclosure period, was worth more than:

(1) ten percent (10%) of your total assets (if you are using percentagethresholds), or

(2) $10,000 (if you are using dollar value thresholds),

and state the business entity to which the property related. Intangible per-sonal property includes such things as money, stocks, bonds, certificates ofdeposit, interests in partnerships, beneficial interests in a trust, promissorynotes owed to you, accounts receivable by you, IRAs, and bank accounts.Such things as automobiles, houses, jewelry, and paintings are not intan-

gible property. Intangibles relating to the same business entity should beaggregated; for example, two certificates of deposit and a savings accountwith the same bank. Where property is owned by husband and wife as ten-ants by the entirety (which usually will be the case), the property should bevalued at 100%.

Calculations: In order to decide whether the intangible property exceeds10% of your total assets, you will need to total the value of all of your assets(including real property, intangible property, and tangible personal propertysuch as automobiles, jewelry, furniture, etc.). When making this calculation,do not subtract any liabilities (debts) that may relate to the propertyaddonly the fair market value of the property. Multiply the total figure by 10% toarrive at the disclosure threshold. List only the intangibles that exceed thisthreshold amount. Jointly owned property should be valued according to thepercentage of your joint ownership, with the exception of property owned byhusband and wife as tenants by the entirety, which should be valued at 100%.None of your calculations or the value of the property have to be disclosed onthe form. If you are using dollar value thresholds, you do not need to makeany of these calculations.

Examples for persons using comparative (percentage) thresholds:

You own 50% of the stock of a small corporation that is worth$100,000, according to generally accepted methods of valuing smallbusinesses. The estimated fair market value of your home and otherproperty (bank accounts, automobile, furniture, etc.) is $200,000. Asyour total assets are worth $250,000, you must disclose intangiblesworth over $25,000. Since the value of the stock exceeds this threshold,you should list stock and the name of the corporation. If your accountswith a particular bank exceed $25,000, you should list bank accountsand banks name.

When you retired, your professional firm bought out your partner-ship interest by giving you a promissory note, the present value of

which is $100,000. You also have a certificate of deposit from a bankworth $75,000 and an investment portfolio worth $300,000, consistingof $100,000 of IBM bonds and a variety of other investments worthbetween $5,000 and $50,000 each. The fair market value of yourremaining assets (condominium, automobile, and other personal prop-erty) is $225,000. Since your total assets are worth $700,000, you mustlist each intangible worth more than $70,000. Therefore, you would listpromissory note and the name of your former partnership, certificateof deposit and the name of the bank, bonds and IBM, but none ofthe rest of your investments.

PART E LIABILITIES[Required by Sec. 112.3145(3)(a)4 or (b)4, Fla. Stat.]

In this part of the form, list the name and address of each private orgovernmental creditor to whom you were indebted for a liability in any amountthat, at any time during the disclosure period, exceeded:

(1) your net worth (if you are using percentage thresholds), or

(2) $10,000 (if you are using dollar value thresholds).

You are not required to list the amount of any indebtedness or your networth. You do not have to disclose any of the following: credit card and retail

installment accounts, taxes owed (unless reduced to a judgment), indebted-ness on a life insurance policy owed to the company of issuance, contingentliabilities, and accrued income taxes on net unrealized appreciation (anaccounting concept). A contingent liability is one that will become an actualliability only when one or more future events occur or fail to occur, such aswhere you are l iable only as a guarantor, surety, or endorser on a promissorynote. If you are a co-maker and have signed as being jointly liable or jointlyand severally liable, then this is not a contingent liability; if you are using the$10,000 threshold and the total amount of the debt (not just the percentageof your liability) exceeds $10,000, such debts should be reported.

Calculations for persons using comparative (percentage) thresholds: Inorder to decide whether the debt exceeds your net worth, you will need tototal all of your liabilities (including promissory notes, mortgages, credit carddebts, lines of credit, judgments against you, etc.). Subtract this amount fromthe value of all your assets as calculated above for Part D. This is your networth. You must list on the form each creditor to whom your debt exceededthis amount unless it is one of the types of indebtedness listed in the para-graph above (credit card and retail installment accounts, etc.). Joint liabilitieswith others for which you are jointly and severally liable, meaning that youmay be liable for either your part or the whole of the obligation, should beincluded in your calculations based upon your percentage of liability, withthe following exception: joint and several liability with your spouse for a debtwhich relates to property owned by both of you as tenants by the entirety(usually the case) should be included in your calculations by valuing the assetat 100% of its value and the liability at 100% of the amount owed.

Examples for persons using comparative (percentage) thresholds:

You owe $15,000 to a bank for student loans, $5,000 for creditcard debts, and $60,000 (with your spouse) to a savings and loan for ahome mortgage. Your home (owned by you and your spouse) is worth$80,000 and your other property is worth $20,000. Since your net worthis $20,000 ($100,000 minus $80,000), you must report only the nameand address of the savings and loan.

You and your 50% business partner have a $100,000 business loanfrom a bank, for which you both are jointly and severally liable. Thevalue of the business, taking into account the loan as a liability of thebusiness, is $50,000. Your other assets are worth $25,000, and youowe $5,000 on a credit card. Your total assets will be $50,000 (half ofa business worth $50,000 plus $25,000 of other assets). Your liabilities,for purposes of calculating your net worth, will be only $5,000, becausethe full amount of the business loan already was included in valuing thebusiness. Therefore, your net worth is $45,000. Since your 50% shareof the $100,000 business loan exceeds this net worth figure, you mustlist the bank.

PART F INTERESTS IN SPECIFIED

BUSINESSES[Required by Sec. 112.3145(5), Fla. Stat.]

The types of businesses covered in this disclosure are only : state anfederally chartered banks; state and federal savings and loan associations;cemetery companies; insurance companies (including insurance agencies);mortgage companies; credit unions; small loan companies; alcoholic bever-age licensees; pari-mutuel wagering companies, utility companies, entitiescontrolled by the Public Service Commission; and entities granted a franchiseto operate by either a city or a county government.



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AVAILABILITY OF FORMS; FOR MORE INFORMATION


OTHER FORMS YOU MAY NEED TO FILEIN ORDER TO COMPLY WITH THE ETHICS LAWS

In addition to filing Form 1, you may be required to file one or more of the special purpose forms listed below, depending on your particular position,business activities, or interests. As it is your duty to obtain and file any of the special purpose forms which may be applicable to you, you should carefullyread the brief description of each form to determine whether it applies.

Form 1F Final Statement of Financial Interests : Required of local officers, state officers, and specified state employees within 60 days after leaving office or employment.This form is used to report financial interests between January 1st of thelast year of office or employment and the last day of office or employ-ment. [Sec. 112.3145(2)(b), Fla. Stat.]

Form 1X Amended Statement of Financial Interests: To be used by local officers, state officers, and specified state employees to correct mistakes on previously filed Form 1s.[Sec. 112.3145(9), Fla. Stat.]

Form 2 Quarterly Client Disclosure: Requiredof local officers, state officers, and specified state employees todisclose the names of clients represented for compensation by them-

selves or a partner or associate before agencies at the same level ofgovernment as they serve. The form should be filed by the end of thecalendar quarter (March 31, June 30, Sept. 30, Dec. 31) following thecalendar quarter in which a reportable representation was made. [Sec.112.3145(4), Fla. Stat.]

Form 3A Statement of Interest in Competitive Bid for Public Business: Required of public officers andpublic employees prior to or at the time of submission of a bid for publicbusiness which otherwise would violate Sec. 112.313(3) or 112.313(7),Fla. Stat. [Sec . 112.313(12)(b), Fla. Stat.]

Form 4A Disclosure of Business Transaction,Relationship, or Interest: Required of public officers andemployees to disclose certain business transactions, relationships, orinterests which otherwise would violate Sec. 112.313(3) or 112.313(7),Fla. Stat. [Sec. 112.313(12) and (12)(e), Fla. Stat.]

Form 8A Memorandum of Voting Conflict for State Officers: Required to be filed by a state officer within 15days after having voted on a measure which inured to his or her special

private gain (or loss) or to the special gain (or loss) of a relative, busi-ness associate, or one by whom he or she is retained or employed. Eachappointed state officer who seeks to influence the decision on such ameasure prior to the meeting must file the form before undertaking thataction. [Sec. 112.3143, Fla. Stat.]

Form 8B Memorandum of Voting Conflict for County, Municipal, and Other Local Public Officers: Required to be filed (within 15 days of abstention) byeach local officer who must abstain from voting on a measure whichwould inure to his or her special private gain (or loss) or the special gain(or loss) of a relative, business associate, or one by whom he or she isretained or employed. Each appointed local official who seeks to influ-ence the decision on such a measure prior to the meeting must file theform before undertaking that action. [Sec. 112.3143, Fla. Stat.]

Form 9 Quarterly Gift Disclosure: Required local officers, state officers, specified state employees, and staprocurement employees to report gifts over $100 in value. The formshould be filed by the end of the calendar quarter (March 31, June 30,September 30, or December 31) following the calendar quarter in whichthe gift was received. [Sec. 112.3148, Fla. Stat.]

Form 10 Annual Disclosure of Gifts from Governmental Entities and Direct Support Organizations and Honorarium Event Related Expenses: Required of local officers, state officers, specified state employees, and state procurement employees to report giover $100 in value received from certain agencies and direct supportorganizations; also to be utilized by these persons to report honorariumevent-related expenses paid by certain persons and entities.The form

should be filed by July 1 following the calendar year in which the gift orhonorarium event-related expense was received. [Sec. 112.3148 and112.3149, Fla. Stat.]

Copies of these forms are available from the Supervisor of Electionsin your county; from the Commission on Ethics, Post Office Drawer15709, Tallahassee, Florida 32317-5709; telephone (850) 488-7864;and at the Commissions web site: www.ethics.state.fl.us.

Questions about any of these forms or the ethics laws may beaddressed to the Commission on Ethics, Post Office Drawer 15709,Tallahassee, Florida 32317-5709; telephone (850) 488-7864.

You are required to disclose in this part of the form the fact that youowned during the disclosure period an interest in, or held any of certain posi-tions with, particular types of businesses listed above. You are required tomake this disclosure if you own or owned (either directly or indirectly in theform of an equitable or beneficial interest) at any time during the disclosureperiod more than five percent (5%) of the total assets or capital stock of oneof the types of business entities granted a privilege to operate in Florida thatare listed above. You also must complete this part of the form for each ofthese types of businesses for which you are, or were at any time during the

disclosure period, an officer, director, partner, proprietor, or agent (other thana resident agent solely for service of process).

If you have or held such a position or ownership interest in one of thesetypes of businesses, list (vertically for each business): the name of the busi-ness, its address and principal business activity, and the position held withthe business (if any). Also, if you own(ed) more than a 5% interest in thebusiness, as described above, you must indicate that fact and describe thenature of your interest.

(End of Instructions.)

PENALTIESA 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. [Sec. 112.317, Florida Statutes]

Also, if the annual form is not filed by September 1st, a fine of $25 for each day late will be imposed, up to a maximum penalty of $1,500. [Section 112.3145, F.S. ].


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QUARTERLY GIFT DISCLOSURE(GIFTS OVER $100)

LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:

MAILING ADDRESS: OFFICE OR POSITION HELD:

CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEARq MARCH q JUNE q SEPTEMBER q DECEMBER 20___

Please list below each gift, the value of which you believe to exceed $100, accepted by you during the calendar quarter for which this statement isbeing led. You are required to describe the gift and state the monetary value of the gift , the name and address of the person making the gift, and thedate(s) the gift was received. If any of these facts, other than the gift description, are unknown or not applicable, you should so state on the form. Asexplained more fully in the instructions on the reverse side of the form, you are not required to disclose gifts from relatives or certain other gifts. Youare not required to le this statement for any calendar quarter during which you did not receive a reportable gift.

DATERECEIVED

DESCRIPTIONOF GIFT

MONETARYVALUE

NAME OF PERSONMAKING THE GIFT

ADDRESS OF PERSONMAKING THE GIFT

q CHECK HERE IF CONTINUED ON SEPARATE SHEET

If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to thisform. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.

q CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM

I, the person whose name appears at the beginning of this form, do

depose on oath or af rmation and say that the information disclosed

herein and on any attachments made by me constitutes a true accurate,

and total listing of all gifts required to be reported by Section 112.3148,

Florida Statutes.

_________________________________________ SIGNATURE OF REPORTING OFFICIAL

STATE OF FLORIDACOUNTY OF _______________________________ Sworn to (or af rmed) and subscribed before me this_______________ day of ______________________, 20____________

by _______________________________________________________

__________________________________________________________ (Signature of Notary Public-State of Florida)

__________________________________________________________ (Print, Type, or Stamp Commissioned Name of Notary Public)Personally Known _______ OR Produced Identi cationType of Identi cation Produced _________________________________

PART A STATEMENT OF GIFTS

PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT

PART C OATH

PART D FILING INSTRUCTIONS

Form 9

CE FORM 9 - EFF. 1/2007 (See reverse side for instructions) F

This form, when duly signed and notarized, must be led with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709; physi-cal address: 3600 Maclay Blvd. South, Suite 201, Tallahassee, Florida 32312. The form must be led no later than the last day of the calendar quarter that follows the calendar quarter for which this form is led (For example, if a gift is received in March, it should be disclosed by June 30.)

EXHIBIT C


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to a professional license or certificate; other personal services for which a fee is normally charged by the person providing the services;and any other similar service or thing having an attributable valueand not already described.

The following are NOT reportable as gifts on this form: salary, benefits,services, fees, commissions, gifts, or expenses associated primarilywith your employment, business, or service as an officer or director of a corporation or organization; contributions or expenditures reportedpursuant to the election laws, campaign-related personal servicesprovided without compensation by individuals volunteering their time, or any other contribution or expenditure by a political party; an honorariumor an expense related to an honorarium event paid to you or your spouse; an award, plaque, certificate, or similar personalized item givenin recognition of your public, civic, charitable, or professional service; anhonorary membership in a service or fraternal organization presentedmerely as a courtesy by such organization; the use of a governmentalagencys public facility or public property for a public purpose. Alsoexempted are some gifts from state, regional, and national organizationsthat promote the exchange of ideas between, or the professionaldevelopment of, governmental officials or employees.

HOW DO I DETERMINE THE VALUE OF AGIFT?

The value of a gift provided to you is determined using the actual cost tothe donor, and, with respect to personal services provided by the donor,the reasonable and customary charge regularly charged for such service

in the community in which the service is provided. Taxes and gratuitiesare not included in valuing a gift. If additional expenses are required asa condition precedent to the donors eligibility to purchase or provide agift and the expenses are primarily for the benefit of the donor or are of acharitable nature, the expenses are not included in determining the valueof the gift.

Compensation provided by you to the donor within 90 days of receivingthe gift shall be deducted from the value of the gift in determining thevalue of the gift.

If the actual gift value attributable to individual participants at an eventcannot be determined, the total costs should be prorated among allinvited persons. A gift given to several persons may be attributed amongall of them on a pro rata basis. Food, beverages, entertainment, etc.,provided at a function for more than ten people should be valued bydividing the total costs by the number of persons invited, unless the items

are purchased on a per-person basis, in which case the per-person costshould be used. Transportation should be valued on a round-trip basis unless only one-

way transportation is provided. Round-trip transportation expensesshould be considered a single gift. Transportation provided in a privateconveyance should be given the same value as transportation providedin a comparable commercial conveyance.

Lodging provided on consecutive days should be considered a singlegift. Lodging in a private residence should be valued at $44 per night.

Food and beverages consumed at a single sitting or event are a singlegift valued for that sitting or meal. Other food and beverages providedon a calendar day are considered a single gift, with the total value of allfood and beverages provided on that date being the value of the gift.

Membership dues paid to the same organization during any 12-monthperiod are considered a single gift.

Entrance fees, admission fees, or tickets are valued on the face value of the ticket or fee, or on a daily or per event basis, whichever is greater. If an admission ticket is given by a charitable organization, its value doesnot include the portion of the cost that represents a contribution to thatcharity.

Except as otherwise provided, a gift should be valued on a per occurrence basis.

FOR MORE INFORMATIONThe gift disclosures made on this form are required by Sec. 112.3148,Florida Statutes. Questions may be addressed to the Commissionon Ethics, Post Office Drawer 15709, Tallahassee, Florida 32317-5709 or by calling (850) 488-7864; information is also provided at:www.ethics.state.fl.us.

WHO MUST FILE THIS FORM? Any individual, including a candidate upon qualifying, who is required

by law to file full and public disclosure of his financial interests onCommission on Ethics Form 6, except Judges. (See Form 6 for a list of persons required to file that form.)

Any individual, including a candidate upon qualifying, who is requiredby law to file a statement of financial interests on Commission on EthicsForm 1. (See Form 1 for a list of persons required to file that form.)

Any procurement employee of the executive branch or judicial branch of state government. This includes any employee who participates throughdecision, approval, disapproval, recommendation, preparation of anypart of a purchase request, influencing the content of any specificationor procurement standard, rendering of advice, investigation, or auditingor in any other advisory capacity in the procurement of contractualservices or commodities as defined in Section 287.012, Florida Statutes,if the cost of such services or commodities exceeds $1,000 in any year.

NOTE: Gifts that formerly were allowed under Section 112.3148, F.S.,now may be prohibited expenditures under Sections 11.045 and112.3215, F.S.

WHAT GIFTS ARE REPORTABLE? Any gift (as defined below) you received which you believe to be in

excess of $100 in value, EXCEPT:1) Gifts from the following RELATIVES: father, mother, son, daughter,

brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife,

father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter,stepbrother, stepsister, half brother, half sister, grandparent, greatgrandparent, grandchild, great grandchild, step grandparent, stepgreat grandparent, step grandchild, step great grandchild, a personwho is engaged to be married to you or who otherwise holds himself or herself out as or is generally known as the person whom you intendto marry or with whom you intend to form a household, or any other natural person having the same legal residence as you.

2) Gifts which you are prohibited from accepting by Sections 112.313(4)and 112.3148(4), Florida Statutes. These include any gift which youknow or, with the exercise of reasonable care, should know wasgiven to influence a vote or other action in which you are expectedto participate in your official capacity; it also includes a gift worth over $100 from a political committee or committee of continuous existenceunder the elections law, from a lobbyist who lobbies your agency or who lobbied your agency within the past 12 months, or from a partner,firm, employer, or principal of such a lobbyist.

3) Gifts worth over $100 for which there is a public purpose, given toyou by an entity of the legislative or judicial branch, a department or commission of the executive branch, a water management districtcreated pursuant to s. 373.069, South Florida Regional TransportationAuthority, the Technological Research and Development Authority,a county, a municipality, an airport authority, or a school board; or a gift worth over $100 given to you by a direct-support organizationspecifically authorized by law to support the governmental agency of which you are an officer or employee. These gifts must be disclosedon Form 10.

A gift is defined to mean that which is accepted by you or by another in your behalf, or that which is paid or given to another for or on behalf of you, directly, indirectly, or in trust for your benefit or by any other means, for which equal or greater consideration is not given within90 days after receipt of the gift. A gift includes real property; the useof real property; tangible or intangible personal property; the use of tangible or intangible personal property; a preferential rate or termson a debt, loan, goods, or services, which rate is below the customaryrate and is not either a government rate available to all other similarlysituated government employees or officials or a rate which is availableto similarly situated members of the public by virtue of occupation,affiliation, age, religion, sex, or national origin; forgiveness of anindebtedness; transportation (unless provided to you by an agencyin relation to officially approved governmental business), lodging,or parking; food or beverage; membership dues; entrance fees,admission fees or tickets to events, performances, or facilities; plants,flowers, or floral arrangements; services provided by persons pursuant

PART E INSTRUCTIONS

CE FORM 9 - EFF. 1/2007


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FORM 10 ANNUAL DISCLOSURE OF GIFTS FROM GOVERNMENTAL

ENTITIES AND DIRECT SUPPORT ORGANIZATIONS ANDHONORARIUM EVENT RELATED EXPENSES

LAST NAME -- FIRST NAME -- MIDDLE NAME: THIS STATEMENT REFLECTS GIFTS AND HONORARIUM EVENTRELATED EXPENSES RECEIVED DURING CALENDAR YEAR 200____.

DO NOT FILE THIS FORM IF YOU HAVE NOTHING TO REPORT ON IT.

MAILING ADDRESS: NAME OF AGENCY:

CITY: ZIP: COUNTY: OFFICE OR POSITION HELD:

NOTICE: Under provisions of Sec. 112.317, Fla. Stat., a failure to make any required disclosure constitutes grounds for and may be punished by one or more of the following: impeachment, removal or suspension from office or employment, demotion, reduction in salary, reprimand or a fine up to $10,000.

PART A -- GIFTS (HAVING A PUBLIC PURPOSE) FROM GOVERNMENTAL ENTITIES NAME OF PERSON

PROVIDING GIFT(S)

TOTAL VALUE OF GIFTS

FROM THAT PERSON

DESCRIPTION OF

INDIVIDUAL GIFTS

DATE EACH

GIFT RECEIVED

PART B -- GIFTS FROM DIRECT SUPPORT ORGANIZATIONSNAME OF PERSONPROVIDING GIFT(S)

TOTAL VALUE OF GIFTSFROM THAT PERSON

DESCRIPTION OFINDIVIDUAL GIFTS

DATE EACHGIFT RECEIVED

PART C -- HONORARIUM EVENT RELATED EXPENSESEVENT #1 EVENT #2

INSTRUCTIONS on who must le this form

and how to ll it out areon the reverse side.

FILINGINSTRUCTIONSfor when and where to lethis form are located onthe reverse side.

NAME OF PERSONPAYING EXPENSES

ADDRESS OFPERSON

AFFILIATIONOF PERSON

AMOUNT OFHONORARIUM EXPENSES

DATE(S) OFTHE EVENT

DESCRIPTION OFEXPENSES PAID EACH DAY

TOTAL VALUE OFEXPENSES FOR THE EVENT

CE FORM 10 - EFF. 1/2007 (Continued on reverse side) PAGE 1

EXHIBIT D


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INSTRUCTIONS FOR

COMPLETING AND FILING FORM 10:

WHEN AND WHERE TO FILE: ByJuly 1 of the year following the year coveredby this form. Persons who file Form 1 or Form 6 should file this form with their Form1 or Form 6. State procurement employees(see definition below) file this form with theCommission on Ethics, P.O. Drawer 15709,Tallahassee, Florida 32317-5709; physicaladdress: 3600 Maclay Blvd. South, Suite101, Tallahassee, FL 32312. This form

need not be filed unless a reportable gift or expense was received during the time youheld public office or employment.

WHO MUST FILE FORM 10: Allpersons who are required to file Form1, Statement of Financial Interests, andall persons who file Form 6, Full andPublic Disclosure of Financial Interests,including candidates (comprehensive listsare part of each of those forms) exceptjudges . In addition, state procurementemployees are required to file Form 10,as well as former reporting individualsand procurement employees wholeft office or employment during the

calendar year covered by the report. Youare a procurement employee if you:

(1) Are an employee of an office,department, board, commission, or council of the executive or judicialbranches of state government; and

(2) Participate in the procurementof contractual services or commoditiescosting more than $1,000 in any year,through decision, approval, disapproval,recommendation, preparation of any partof a purchase request, influencing thecontent of any specification or procurementstandard, rendering of advice, investigation,auditing, or any other advisory capacity.

INTRODUCTORY INFORMATION (At the top of the form):CALENDAR YEAR: Write the year

covered by this form.NAME OF AGENCY: This should be

the name of the governmental unit whichyou serve or served, sought election to,or by which you are or were employed.For example, City of Tallahassee,Florida Senate, or Department of Transportation.

OFFICE OR POSITION HELD: Usethe title of the office or position you hold,sought, or held during the year covered

by this form (in some cases you maynot hold that position now, but you stillwould be required to file to disclose your interests during the last year you heldthat position) For example, City CouncilMember, Member, PurchasingAgent, or Bureau Chief.

MAILING ADDRESS: Write your current mailing address here. If you arean active or former officer or employeelisted in Section 119.071(4)(d),F.S.,whose home address is exempt fromdisclosure, the Commission is requiredto maintain the confidentiality of your home address if you submit a written

request for confidentiality . Persons listedin Section 119.071(4)(d),F.S. shouldprovide an address other than their home address, if possible.

PART A GIFTS FROMGOVERNMENTAL ENTITIES [Required by Sec. 112.3148, Fla. Stat.]

Entities of the legislative or judicialbranches, departments and commissions of the executive branch, counties, municipalities,airport authorities, school boards, water management districts created by 373.069,F.S., the Technological Research andDevelopment Authority, and the South FloridaRegional Transportation Authority may give,either directly or indirectly, a gift worth over $100 to persons who file Form 1 or Form 6or to state procurement employees if a publicpurpose can be shown for the gift. Part Ashould be used to list such gifts. Under thelaw, these governmental entities are requiredto provide you with a statement concerningthese gifts by March 1; attach this statementto Form 10.

PART B GIFTS FROM DIRECTSUPPORT ORGANIZATIONS[Sec. 112.3148, Fla. Stat.]

Direct support organizations specificallyauthorized by law to support a governmentalentity may give a gift worth over $100 to aperson who files Form 1 or Form 6 or to astate procurement employee if the personor employee is an officer or employee of thatgovernmental entity. Part B should be usedto list such gifts. Under the law, these directsupport organizations are required to provideyou with a statement concerning these giftsby March 1; attach this statement to Form 10.

PART C HONORARIUM EVENTRELATED EXPENSES [Required by Sec. 112.3149, Fla. Stat.]

Reporting individuals who file Form 1and Form 6 and state procurement employeesare prohibited from accepting an honorarium(a payment in exchange for a speech, oralpresentation, writing, and the like) from apolitical committee or committee of continuousexistence, from a lobbyist who lobbies them or their public agency (or has done so within theprevious 12 months), and from the employer,principal, partner, or firm of such a lobbyist.However, these persons and entities maypay or provide a reporting individual or procurement employee and his or her spousefor actual and reasonable transportation,lodging, event or meeting registration fee,and food and beverage expenses related toan event at which a speech, presentation, or writing will be made by the public officer or employee. Part C should be used to describethese honorarium event related expenses.Under the law, the persons or entities payingfor or providing such expenses are required toprovide you with a statement concerning themwithin 60 days of the honorarium event; attachthis statement to Form 10.

NOTE

Gifts that formerly were allowed under Sections 112.3148 and 112.3149, F.S.,now may be prohibited expenditures under Sections 11.045 and 112.3215, F.S.

FOR MORE INFORMATIONQuestions about this form or the ethicslaws may be addressed to the Commissionon Ethics, Post Office Drawer 15709,Tallahassee, Florida 32317-5709; telephone(850) 488-7864; information is also providedat: www.ethics.state.fl.us.

IF ANY OF PARTS A THROUGH C ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE qREMEMBER TO ATTACH COPIES OF ALL STATEMENTS PROVIDED TO YOU BY PERSONS AND ENTITIES PROVIDING OR PAY-ING FOR THE GIFTS AND HONORARIUM EVENT RELATED EXPENSES DISCLOSED ON THIS FORM. YOU MUST DISCLOSEALL OF THESE KINDS OF GIFTS AND EXPENSES EVEN THOUGH YOU DID NOT RECEIVE A STATEMENT OR REPORT FROMTHE PERSON OR ENTITY PROVIDING THEM. YOU MAY EXPLAIN ANY DIFFERENCES BETWEEN THE ATTACHED REPORTSAND STATEMENTS AND THE INFORMATION PROVIDED ON THIS FORM BY ATTACHING AN EXPLANATION TO THE FORM.

SIGNATURE: DATE SIGNED:

CE FORM 10 - EFF. 1/2007 PAGE 2


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FORM 2 QUARTERLY CLIENT DISCLOSURE

CE FORM 2 - EFF. 1/2001

LAST NAMEFIRST NAMEMIDDLE NAME

MAILING ADDRESS

CITY ZIP COUNTY

YEARFOR QUARTER ENDING (Check One)

q MARCH q JUNE q SEPTEMBER q DECEMBER

NAME OF AGENCY

OFFICE HELDq ELECTED CONSTITUTIONAL

OFFICERq STATE OFFICERq LOCAL OFFICER

POSITION HELD

qSPECIFIED STATE EMPLOYEE

1. If you are a state officer, elected constitutional offi-cer of state government, or specified employee

Please list below the names of all clients who were represent-

ed for a fee or commission during the previous calendar quar-ter before any agency at the state level of government eitherby you or by any partner or associate of a professional firm ofwhich you are a member and of which representation you haveactual knowledge. Also list the name of the agencies beforewhich such clients were represented.

2. If you are a local officer or elected constitutional offi-cer of local government

Please list below the names of all clients who were represent-ed for a fee or commission during the previous calendar quar-ter before any agency within the political subdivision you serveeither by you or by any partner or associate of a professionalfirm of which you are a member and of which representationyou have actual knowledge. Also list the names of the agen-cies before which such clients were represented.

NOTE: Representation includes actual physical attendance onbehalf of a client in an agency proceeding, letters written ordocuments filed on behalf of a client, and personal communi-cations made with the officers or employees of any agency on

behalf of a client. Representation DOES NOT include appear-ances before any court, or Chief Judges of CompensationClaims or judges of compensation claims, representations onbehalf of your agency in your official capacity, the preparationand filing of forms and applications merely for the purpose ofobtaining or transferring a license based on a quota or a fran-chise of such agency, or a license or operation permit toengage in a profession, business or occupation, so long as theissuance or granting of such license, permit, or transfer, a vari-ance, a special consideration, or a certificate of public conve-nience and necessity does not require substantial discretion.You are NOT required to disclose appearances in ministerialmatters, i.e., where the person before whom you represent a

client takes action in a prescribed manner in obedience to themandate of legal authority, without the exercise of the personsown judgement or discretion as to the proprietary of the actiontaken. For example, filing a document with a Circuit CourtClerk is a ministerial matter since it requires no discretionaryaction by the Clerk.

NOTICE : UNDER PROVISIONS OF FLORIDASTATUTES 112.317, A FAILURE TO MAKE ANYREQUIRED DISCLOSURE CONSTITUTES GROUNDSFOR AND MAY BE PUNISHED BY ONE OR MORE OFTHE FOLLOWING: IMPEACHMENT, REMOVAL OR SUS-PENSION FROM OFFICE OR EMPLOYMENT, DEMO-TION, REDUCTION IN SALARY, REPRIMAND, OR ACIVIL PENALTY NOT TO EXCEED $10,000.

FILING INSTRUCTIONSLocal officers: This form, when completed and signed, should be filed with the

Supervisor of Elections of the county in which you are principally employed or a resident.State officers, elected constitutional officers, or specified state employees: Please file

with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709.It is due not later than the last day of the calendar quarter following the calendar quar-

ter during which the representation was made. (Example: If a representation was made inMarch, the form disclosing it should be filed by June 30.) This form need not be filed ifno reportable representations were made during the quarter.

NAME OF CLIENTS NAME OF AGENCIES CHECK IF REPRESENTEDBY YOU

qq CHECK IF CONTINUED ON SEPARATE SHEET Signature

DISCLOSURE OF CLIENTS REPRESENTED BEFORE AGENCIES [Required by Fla.Stat. 112.3145(4[NOTE: Under Art. II, 8(e), Fla. Const., and 112.313(9), Fla. Stat., members of the Legislature are prohibited from personally representing another person or entity for

compensastion before State agencies (other than judicial tribunals). However, members of the Legislature are required to list below any such appearances before State agencies

made by any partner or associate of a professional firm of which the legislator is a member. Also, public officers and their firms are prohibited by 112.313(7), Fla. Stat., from repre-senting clients before boards on which they serve. Note also that local government attorneys and their firms are prohibited by 112.313(16), Fla. Stat., from representing privateclients before the local governments they serve.]

EXHIBIT E


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Sec. 2-619. - Financial disclosure.

(a) Reporting requirement:(1) In addition to the financial disclosure requirements of state law and county Code,the mayor and city commissioners are required to provide the following information to

the city clerk in writing by July 1 of each year:*

Note : The reporting requirement applies to all persons serving in the designatedcapacities on December 31, 1986 and on December 31 of succeeding years.Information required to be reported by July 1 shall be the information in existence as ofDecember 31 of the preceding calendar year.

a. Description of all assets which have a value in excess of $5,000.00 includinghousehold goods.b. All liabilities which exceed $5,000.00 including the name and address of all creditors

including debts or money owed in excess of $5,000.00 including credit card and retailinstallment accounts, taxes owed, indebtedness on a life insurance policy and accruedincome taxes on net unrealized appreciation.c. All sources of income due a business entity in excess of ten percent of the grossincome of a business entity in which the reporting person held a material interest andfrom which he/she received an amount which was in excess of ten percent of his/hergross income during the disclosure period and which exceeds $1,500.00. The period forcomputing the gross income of the business entity is the fiscal year of the businessentity which ended on, or immediately prior to, the end of the preceding calendar year.d. Net worth, i.e., the difference between total assets and total liabilities.(2) An affidavit of the person reporting shall be executed attesting to the accuracy ofthe disclosures.(b) As an alternative to the requirements set forth in subsection (a) above, a copy of thereporting person's filed return for the current year's federal income tax return may beprovided.(c) Any elected official who is a partner in a law firm or a stockholder in a professionalassociation must disclose, in writing, to the city clerk the name of any client whoserepresentation results in a contribution of ten percent or more of the gross income:(1) To the law firm in which said official is a partner;(2) To the professional association in which said official is a stockholder or has anownership interest; or

(3) To the elected official directly.(d) Every person who is convicted of a violation of this section shall be punished asprovided in section 1-13.

(Ord. No. 10219, 1, 2-12-87; Code 1980, 2-309)

EXHIBIT F
http://void%280%29/http://void%280%29/


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CITY OF MIAMI

PUBLIC DISCLOSURE OF FINANCIAL INTERESTS(Subject to City Code Section 2-619)

NOTE: As an alternative to the requirements set forth in the above-cited Code Section, the person filingthis report may provide a copy of the current years Federal income tax return (See last page forInstructions ).

____________________________________________________________________________________________

LAST NAME FIRST NAME MIDDLE INITIAL OFFICE HELD

____________________________________________________________________________________________RESIDENCE ADDRESS CITY ZIP CODE COUNTY

ASSETS AND LIABILITIES IN EXCESS OF $5,000

[PART A] - ASSETS [PART B] - LIABILITIES

ASSETS OVER $5,000 :

DESCRIPTION VALUE Please list below the name and address of everyperson, whether individual or corporation, towhom you owe a liability exceeding $5,000,and the total amount of indebtedness.Liability is defined as any monetary debt orobligation owed by you to another person,including credit card retail installment accounts;taxes owed; indebtedness on a life insurancepolicy owed to the issuing company; or accruedincome taxes on net unrealized appreciation.

Name/Address of Creditors: Amount Owed:

1.

2.

EXHIBIT G


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Continued Assets Over $5,000: Continued Liabilities (Creditors/Amount Owed)3.

HOUSEHOLD GOODS/PERSONAL EFFECTSHousehold goods and personal effects may be

reported in a lump sum if their aggregate valueexceeds $5,000. This category includes any of the following (if not held for investmentpurposes): jewelry; stamp collections; guns andnumismatic properties; art objects; householdequipment and furnishings; clothing; otherhousehold items; and vehicles for personal use.The aggregate value of my household goodsand personal effects as described above is :

$ _______________________

4.

[PART C] - NET WORTH

Net worth is the difference between total assets and total liabilities, not merely those listed inPART A (above), which have a value in excess of $5,000. Please enter your net worth as of December 31 of the tax year or a more recent date.

My net worth as of ___________________, 20______ was $___________________

[PART D] - AFFIDAVIT

The information disclosed herein and on any attachments hereto is true and correct to my knowledge.

___________________________________________ ________________________Signature of Person Reporting Date

State of FloridaCounty of _________

On this the _____ day of ____________ ,20 ____ , before me, the undersigned Notary Public of the State of Florida, the foregoing instrument was acknowledged by:______________________________________________________

(Name of person signing and his/her title (public officer, trustee or personal representative)

_____________________________________ SEAL OF OFFICE:NOTARY PUBLIC, STATE OF FLORIDA

Personally known to me or Produced identification: __________________________

(Type of Identification Produced) DID take an oath DID NOT take an oath.


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- - - - - - - - - . . . , - - - - - - - - - - - - - - - .... - - - - , - - - - - -POLICY NUMBER:APM- 2 - 08

SUBJECT:

CITY OF MIAMI

ADMINISTRATIVE POLICY

SOCIAL SECURITY NUMBERS

DATE:

:June 26 , 2008

REVlSIONSREVlSED DATE O

Documents

June 1, 2010 Financial Disclosure Packet (revised)