Form 1 - 2019 FORM 1 STATEMENT OF 2019
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below: I i
LAST NAME--FIRST NAME--MIDDLE NAME :
MAILING ADDRESS :
CITY: ZIP : COUNTY :
NAME OF AGENCY:
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
CHECK ONLY IF ❑ CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019.
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
PART C --REAL PROPERTY [Land, buildings owned by the reporting person-See instructions] You are not limited to the space on the
(If you have nothing to report,write"none"or"n/a") lines on this form.Attach additional
sheets, if necessary.
FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM 1-Effective:January 1,2020 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1),F.A.C.
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks, bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,write"none"or"n/a")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
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.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or attorney
Signature: 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.
Date Signed:
CPA/Attorney Signature:
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers.
Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form
form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission
under, see page 3 of instructions. or Supervisor of Elections.
Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer,
of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the
permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment.
where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to
the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their
Supervisor of Elections for the mailing address or email address to appointment.
use. Do not email your form to the Commission on Ethics, it will be
returned. Candidates must file at the same time they file their qualifying
State officers or specified state employees who file with the papers.
Commission on Ethics may file by mail or email. To file by mail, Thereafter, file by July 1 following each calendar year in which they
send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions.
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of
Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1 F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does not relieve the filer of filing a CE Form 1
other format), send it to CEForml@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31, 2019.
for your records. Do not file by both mail and email. Choose only one
filing method. Form 6s will not be accepted via email.
CE FORM 1-Effective:January 1,2020. PAGE 2
Incorporated by reference in Rule 34-8.202(1),F.A.C.
NOTICE
Annual Statements of Financial Interests are due July 1. If the annual form is not filed or postmarked by September 1,
an automatic fine of$25 for each day late will be imposed, up to a maximum penalty of$1,500. Failure to file also can
result in removal from public office or employment. [s. 112.3145, F.S.]
In addition,failure to make any required disclosure constitutes grounds for and may be punished by one or more of the
following: disqualification from being on the ballot, impeachment, removal or suspension from office or employment,
demotion, reduction in salary, reprimand, or a civil penalty not exceeding $10,000. [s. 112.317, F.S.]
WHO MUST FILE FORM 1:
1) Elected public officials not serving in a political subdivision of the director of a county, municipality, or other political subdivision; county
state and any person appointed to fill a vacancy in such office, unless or municipal attorney; chief county or municipal building inspector;
required to file full disclosure on Form 6. county or municipal water resources coordinator; county or municipal
2) Appointed members of each board, commission, authority, pollution control director; county or municipal environmental control
or council having statewide jurisdiction, excluding members of solely director; county or municipal administrator with power to grant or deny
advisory bodies, but including judicial nominating commission members; a land development permit; chief of police; fire chief; municipal clerk;
Directors of Enterprise Florida, Scripps Florida Funding Corporation, appointed district school superintendent; community college president;
and Career Source Florida; and members of the Council on the Social district medical examiner; purchasing agent (regardless of title) having
Status of Black Men and Boys; the Executive Director, Governors, the authority to make any purchase exceeding $35,000 for the local
and senior managers of Citizens Property Insurance Corporation; governmental unit.
Governors and senior managers of Florida Workers'Compensation Joint 8) Officers and employees of entities serving as chief administrative
Underwriting Association;board members of the Northeast Fla. Regional officer of a political subdivision.
Transportation Commission; board members of Triumph Gulf Coast, Inc; 9) Members of governing boards of charter schools operated by a
board members of Florida Is For Veterans, Inc.; and members of the city or other public entity.
Technology Advisory Council within the Agency for State Technology. 10) Employees in the office of the Governor or of a Cabinet member
3) The Commissioner of Education, members of the State Board who are exempt from the Career Service System, excluding secretarial,
of Education, the Board of Governors, the local Boards of Trustees and clerical, and similar positions.
Presidents of state universities, and the Florida Prepaid College Board. 11) The following positions in each state department, commission,
4) Persons elected to office in any political subdivision (such as board, or council: Secretary, Assistant or Deputy Secretary, Executive
municipalities, counties, and special districts)and any person appointed Director,Assistant or Deputy Executive Director, and anyone having the
to fill a vacancy in such office, unless required to file Form 6. power normally conferred upon such persons, regardless of title.
5) Appointed members of the following boards, councils, 12) The following positions in each state department or division:
commissions, authorities, or other bodies of county, municipality, school Director, Assistant or Deputy Director, Bureau Chief, and any person
district, independent special district, or other political subdivision: the having the power normally conferred upon such persons, regardless of
governing body of the subdivision; community college or junior college title.
district boards of trustees;boards having the power to enforce local code 13) Assistant State Attorneys,Assistant Public Defenders, criminal
provisions; boards of adjustment; community redevelopment agencies; conflict and civil regional counsel,and assistant criminal conflict and civil
planning or zoning boards having the power to recommend, create, or regional counsel, Public Counsel, full-time state employees serving as
modify land planning or zoning within a political subdivision, except for counsel or assistant counsel to a state agency,administrative lawjudges,
citizen advisory committees, technical coordinating committees, and and hearing officers.
similar groups who only have the power to make recommendations 14) The Superintendent or Director of a state mental health institute
to planning or zoning boards, and except for representatives of a established for training and research in the mental health field, or any
military installation acting on behalf of all military installations within that major state institution or facility established for corrections, training,
jurisdiction; pension or retirement boards empowered to invest pension treatment, or rehabilitation.
or retirement funds or determine entitlement to or amount of pensions or 15) State agency Business Managers, Finance and Accounting
other retirement benefits,and the Pinellas County Construction Licensing Directors, Personnel Officers, Grant Coordinators, and purchasing
Board. agents (regardless of title) with power to make a purchase exceeding
6) Any appointed member of a local government board who $35,000.
is required to file a statement of financial interests by the appointing 16) The following positions in legislative branch agencies: each
authority or the enabling legislation, ordinance, or resolution creating the employee (other than those employed in maintenance, clerical,
board. secretarial, or similar positions and legislative assistants exempted
7) Persons holding any of these positions in local government: by the presiding officer of their house); and each employee of the
mayor; county or city manager; chief administrative employee or finance Commission on Ethics.
INSTRUCTIONS FOR COMPLETING FORM 1:
INTRODUCTORY INFORMATION (Top of Form): If your OFFICE OR POSITION HELD OR SOUGHT. The title of
name, mailing address, public agency, and position are already the office or position you hold, are seeking, or held during the
printed on the form,you do not need to provide this information disclosure period even if you have since left that position. If you
unless it should be changed. To change any of this information, are a candidate for office or are a new employee or appointee,
write the correct information on the form, and contact your check the appropriate box.
agency's financial disclosure coordinator. You can find your PUBLIC RECORD: The disclosure form and everything
coordinator on the Commission on Ethics website:www.ethics. attached to it is a public record. Your Social Security Number
state.fl.us. is not required and you should redact it from any documents
NAME OF AGENCY. The name of the governmental unitoy u file. If you are an active or former officer or employee listed
which you serve or served, by which you are or were employed, in Section 119.071, F.S., whose home address is exempt from
or for which you are a candidate. disclosure, the Commission will maintain that confidentiality if
DISCLOSURE PERIOD: The "disclosure period" for your you submit a written request.
report is the calendar year ending December 31, 2019.
CE FORM 1-Effective:January 1,2020.Incorporated by reference in Rule 34-8.202,F.A.C. PAGE 3
MANNER OF CALCULATING REPORTABLE INTEREST
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.
PART A— PRIMARY SOURCES OF INCOME (1) You owned (either directly or indirectly in the form of an equitable
[Required by s. 112.3145(3)(b)1, F.S.] or beneficial interest) more than 5% of the total assets or capital
stock of a business entity (a corporation, partnership, LLC, limited
Part A is intended to require the disclosure of your principal partnership, proprietorship, joint venture, trust, firm, etc., doing
sources of income during the disclosure period. You do not have to business in Florida);and,
disclose any public salary or public position(s). The income of your (2) You received more than $5,000 of your gross income during the
spouse need not be disclosed; however, if there is joint income to disclosure period from that business entity.
you and your spouse from property you own jointly (such as interest
or dividends from a bank account or stocks), you should disclose the If your interests and gross income exceeded these thresholds,then for that
source of that income if it exceeded the threshold. 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
Please list in this part of the form the name, address, and the basis of the business entity's most recently completed fiscal year), the
principal business activity of each source of your income which source's address,and the source's principal business activity.
exceeded$2,500 of gross income received by you in your own name
or by any other person for your use or benefit. Examples:
"Gross income" means the same as it does for income tax — You are the sole proprietor of a dry cleaning business,from which
purposes, even if the income is not actually taxable, such as interest you received more than$5,000. If only one customer,a uniform rental
on tax-free bonds. Examples include: compensation for services, company, provided more than 10%of your dry cleaning business, you
income from business, gains from property dealings, interest, rents, must list the name of the uniform rental company, its address, and its
dividends, pensions, IRA distributions, social security, distributive principal business activity(uniform rentals).
share of partnership gross income, and alimony, but not child support. — You are a 20%partner in a partnership that owns a shopping mall
Examples: and your partnership income exceeded the above thresholds. List each
tenant of the mall that provided more than 10% of the partnership's
— If you were employed by a company that manufactures gross income and the tenant's address and principal business activity.
computers and received more than $2,500, list the name of the
company,its address,and its principal business activity(computer PART C— REAL PROPERTY
manufacturing).
[Required by s. 112.3145(3)(b)3, F.S.]
— If you were a partner in a law firm and your distributive share
of partnership gross income exceeded $2,500, list the name of In this part, list the location or description of all real property in Florida
the firm, its address, and its principal business activity(practice of in which you owned directly or indirectly at any time during the disclosure
law). 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
— If you were the sole proprietor of a retail gift business and your from them.
gross income from the business exceeded$2,500, list the name Indirect ownership includes situations where you are a beneficiary of a
(retail gift sales).the business, its address, and its principal business activity trust that owns the property,as well as situations where you own more than
(r 5%of a partnership or corporation that owns the property.The value of the
— If you received income from investments in stocks and bonds, property may be determined by the most recently assessed value for tax
list each individual company from which you derived more than purposes, in the absence of a more current appraisal.
$2,500. Do not aggregate all of your investment income. The location or description of the property should be sufficient to
— If more than $2,500 of your gross income was gain from the enable anyone who looks at the form to identify the property. A street
sale of property (not just the selling price), list as a source of address should be used, if one exists.
income the purchaser's name, address and principal business
activity. If the purchaser's identity is unknown, such as where PART D—INTANGIBLE PERSONAL PROPERTY
securities listed on an exchange are sold through a brokerage [Required by s. 112.3145(3)(b)3, F.S.]
firm, the source of income should be listed as"sale of(name of Describe any intangible personal property that,at any time during the
company)stock,"for example. disclosure period, was worth more than $10,000 and state the business
— If more than $2,500 of your gross income was in the form entity to which the property related. Intangible personal property includes
of interest from one particular financial institution (aggregating things such as cash on hand,stocks,bonds,certificates of deposit,vehicle
interest from all CD's, accounts, etc., at that institution), list the leases, interests in businesses, beneficial interests in trusts, money owed
name of the institution, its address, and its principal business you, Deferred Retirement Option Program (DROP) accounts, the Florida
activity. Prepaid College Plan, and bank accounts. Intangible personal property
also includes investment products held in IRAs, brokerage accounts, and
PART B—SECONDARY SOURCES OF INCOME the Florida College Investment Plan. Note that the product contained in
[Required by s. 112.3145(3)(b)2, F.S.] a brokerage account, IRA, or the Florida College Investment Plan is your
asset—not the account or plan itself.Things like automobiles and houses
This part is intended to require the disclosure of major customers, you own, jewelry, and paintings are not intangible property. Intangibles
clients, and other sources of income to businesses in which you own an relating to the same business entity may be aggregated;for example,CDs
interest. It is not for reporting income from second jobs.That kind of income and savings accounts with the same bank. Property owned as tenants by
should be reported in Part A"Primary Sources of Income," if it meets the the entirety or as joint tenants with right of survivorship should be valued at
reporting threshold.You will not have anything to report unless, during the 100%. The value of a leased vehicle is the vehicle's present value minus
disclosure period: the lease residual(a number found on the lease document).
CE FORM 1-Effective:January 1,2020.Incorporated by reference in Rule 34-8.202,F.A.C.. PAGE 4
PART E—LIABILITIES Disclose in this part the fact that you owned during the disclosure period an
[Required by s. 112.3145(3)(b)4, F.S.] 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
List the name and address of each creditor to whom you owed more indirectly in the form of an equitable or beneficial interest)at any time during
than$10,000 at any time during the disclosure period.The amount of the the disclosure period more than 5% of the total assets or capital stock of
liability of a vehicle lease is the sum of any past-due payments and all one of the types of business entities listed above.You also must complete
unpaid prospective lease payments.You are not required to list the amount this part of the form for each of these types of businesses for which you
of any debt.You do not have to disclose credit card and retail installment are, or were at any time during the disclosure period, an officer, director,
accounts, taxes owed (unless reduced to a judgment), indebtedness on partner,proprietor,or agent(other than a resident agent solely for service of
a life insurance policy owed to the company of issuance, or contingent process).
liabilities.A"contingent liability" is one that will become an actual liability If you have or held such a position or ownership interest in one of
only when one or more future events occur or fail to occur, such as where these types of businesses, list the name of the business, its address and
you are liable only as a guarantor, surety, or endorser on a promissory principal business activity,and the position held with the business(if any). If
note. If you are a "co-maker"and are jointly liable or jointly and severally you own(ed)more than a 5%interest in the business, indicate that fact and
liable,then it is not a contingent liability. describe the nature of your interest.
PART F—INTERESTS IN SPECIFIED BUSINESSES
PART G—TRAINING CERTIFICATION
[Required by s. 112.3145(6), F.S.]
[Required by s. 112.3142, F.S.]
The types of businesses covered in this disclosure include: state and
federally chartered banks;state and federal savings and loan associations; If you are a Constitutional or elected municipal officer whose
cemetery companies; insurance companies; mortgage companies; credit service began before March 31 of the year for which you are filing,
unions; small loan companies; alcoholic beverage licensees; pari-mutuel You are required to complete four hours of ethics training which
wagering companies, utility companies, entities controlled by the Public addresses Article 11, Section 8 of the Florida Constitution, the Code
Service Commission;and entities granted a franchise to operate by either a of Ethics for Public Officers and Employees, and the public records
city or a county government. and open meetings laws of the state.You are required to certify on
this form that you have taken such training.
(End of Dollar Value Thresholds Instructions.)
PART A— PRIMARY SOURCES OF INCOME more than 5% of your gross income. Do not aggregate all of
[Required by s. 112.3145(3)(a)l, F.S.] your investment income.
Part A is intended to require the disclosure of your principal — If more than 5%of your gross income was gain from the sale
sources of income during the disclosure period. You do not have of property(not just the selling price), list as a source of income
to disclose any public salary or public position(s), but income from the purchaser's name, address, and principal business activity.
these public sources should be included when calculating your gross If the purchaser's identity is unknown, such as where securities
income for the disclosure period. The income of your spouse need listed on an exchange are sold through a brokerage firm, the
not be disclosed; however, if there is joint income to you and your source of income should be listed as"sale of(name of company)
spouse from property you own jointly (such as interest or dividends stock,"for example.
from a bank account or stocks),you should include all of that income — If more than 5% of your gross income was in the form of
when calculating your gross income and disclose the source of that interest from one particular financial institution (aggregating
income if it exceeded the threshold. interest from all CD's, accounts, etc., at that institution), list the
Please list in this part of the form the name, address, and name of the institution, its address, and its principal business
principal business activity of each source of your income which activity.
exceeded 5%of the gross income received by you in your own name PART B—SECONDARY SOURCES OF INCOME
or by any other person for your benefit or use during the disclosure
period. [Required by s. 112.3145(3)(a)2, F.S.]
"Gross income" means the same as it does for income tax This part is intended to require the disclosure of major customers,
purposes, even if the income is not actually taxable, such as interest clients, and other sources of income to businesses in which you own
on tax-free bonds. Examples include: compensation for services, an interest. It is not for reporting income from second jobs. That kind
income from business, gains from property dealings, interest, rents, of income should be reported in Part A,"Primary Sources of Income,"
dividends, pensions, IRA distributions, social security, distributive if it meets the reporting threshold.You will not have anything to report
share of partnership gross income,and alimony, but not child support. unless during the disclosure period:
Examples: (1) You owned (either directly or indirectly in the form of an
equitable or beneficial interest) more than 5% of the total assets
— If you were employed by a company that manufactures or capital stock of a business entity (a corporation, partnership,
computers and received more than 5/0 of your gross income LLC, limited partnership, proprietorship,joint venture, trust, firm,
from the company, list the name of the company, its address, etc., doing business in Florida); and,
and its principal business activity(computer manufacturing).
(2) You received more than 10%of your gross income from that
— If you were a partner in a law firm and your distributive share business entity; and,
of partnership gross income exceeded 5%of your gross income, (3) You received more than $1,500 in gross income from that
then list the name of the firm, its address, and its principal business entity.
business activity(practice of law).
— If you were the sole proprietor of a retail gift business and If your interests and gross income exceeded these thresholds, then
your gross income from the business exceeded 5% of your for that business entity you must list every source of income to the
total gross income, list the name of the business, its address, business entity which exceeded 10% of the business entity's gross
and its principal business activity(retail gift sales). income(computed on the basis of the business entity's most recently
completed fiscal year), the source's address, and the source's
— If you received income from investments in stocks and principal business activity.
bonds, list each individual company from which you derived
CE FORM 1-Effective:January 1,2020.Incorporated by reference in Rule 34-8.202,F.A.C. PAGE 5
Examples: PART E—LIABILITIES
— You are the sole proprietor of a dry cleaning business, from [Required by s. 112.3145(3)(b)4, F.S.]
which you received more than 10% of your gross income—an List the name and address of each creditor to whom you owed
amount that was more than $1,500. If only one customer, a
uniform rental company, provided more than 10% of your dry any amount that, at any time during the disclosure period, exceeded
cleaning business, you must list the name of the uniform rental your net worth. You are not required to list the amount any debt
company, its address, and its principal business activity(uniform in your net worth.You do not have to disclose: credit cardd and retail
rentals). installment accounts, taxes owed (unless reduced to a judgment),
indebtedness on a life insurance policy owed to the company of
— You are a 20%partner in a partnership that owns a shopping issuance, or contingent liabilities. A "contingent liability" is one
mall and your partnership income exceeded the thresholds that will become an actual liability only when one or more future
listed above. You should list each tenant of the mall that events occur or fail to occur, such as where you are liable only as
provided more than 10%of the partnership's gross income, and a guarantor, surety, or endorser on a promissory note. If you are a
the tenant's address and principal business activity. "co-maker"and are jointly liable or jointly and severally liable, it is not
a contingent liability.
PART C— REAL PROPERTY Calculations: To determine whether the debt exceeds your
[Required by s. 112.3145(3)(a)3, F.S.] net worth, total all of your liabilities (including promissory notes,
In this part, list the location or description of all real property in mortgages, credit card debts, judgments against you, etc.). The
Florida in which you owned directly or indirectly at any time during amount of the liability of a vehicle lease is the sum of any past-due
the disclosure period in excess of 5% of the property's value. You payments and all unpaid prospective lease payments. Subtract
are not required to list your residences.You should list any vacation the sum total of your liabilities from the value of all your assets
homes, if you derive income from them. 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
Indirect ownership includes situations where you are a the types of indebtedness listed in the paragraph above(credit card
beneficiary of a trust that owns the property, as well as situations and retail installment accounts, etc.). Joint liabilities with others for
where you own more than 5% of a partnership or corporation that which you are "jointly and severally liable," meaning that you may
owns the property.The value of the property may be determined by be liable for either your part or the whole of the obligation, should be
the most recently assessed value for tax purposes, in the absence included in your calculations at 100% of the amount owed.
of a more current appraisal.
000
The location or description of the property should be sufficient Example:You owe$, and to a bank for student loans, $5,
for credit card debts, and
to enable anyone who looks at the form to identify the property. A $60,000 (with spouse) to a savings
street address should be used, if one exists. and loan for a home mortgage. Your home (owned by you and
your spouse) is worth$80,000 and your other property is worth
PART D—INTANGIBLE PERSONAL PROPERTY $20,000. Since your net worth is $20,000 ($100,000 minus
[Required by s. 112.3145(3)(a)3, F.S.] $80,000), you must report only the name and address of the
savings and loan.
Describe any intangible personal property that, at any time
during the disclosure period, was worth more than 10% of your PART F—INTERESTS IN SPECIFIED BUSINESSES
total assets, and state the business entity to which the property [Required by s. 112.3145, F.S.]
related. Intangible personal property includes things such as cash
on hand, stocks, bonds, certificates of deposit, vehicle leases, The types of businesses covered in this disclosure include:
interests in businesses, beneficial interests in trusts, money owed state and federally chartered banks; state and federal savings and
you, Deferred Retirement Option Program (DROP) accounts, loan associations; cemetery companies; insurance companies;
the Florida Prepaid College Plan, and bank accounts. Intangible mortgage companies; credit unions; small loan companies; alcoholic
personal property also includes investment products held in IRAs, beverage licensees; pari-mutuel wagering companies, utility
brokerage accounts, and the Florida College Investment Plan. companies, entities controlled by the Public Service Commission;
Note that the product contained in a brokerage account, IRA, or the and entities granted a franchise to operate by either a city or a
Florida College Investment Plan is your asset—not the account or county government.
plan itself. Things like automobiles and houses you own, jewelry, Disclose in this part the fact that you owned during the
and paintings are not intangible property. Intangibles relating to the disclosure period an interest in, or held any of certain positions
same business entity may be aggregated; for example, CD's and with, the types of businesses listed above. You are required
savings accounts with the same bank. to make this disclosure if you own or owned (either directly or
Calculations: To determine whether the intangible property indirectly in the form of an equitable or beneficial interest) at any
exceeds 10% of your total assets, total the fair market value of time during the disclosure period more than 5% of the total assets
all of your assets (including real property, intangible property, and or capital stock of one of the types of business entities listed above.
tangible personal property such as jewelry, furniture, etc.). When You also must complete this part of the form for each of these types
making this calculation, do not subtract any liabilities (debts) that of businesses for which you are, or were at any time during the
may relate to the property. Multiply the total figure by 10%to arrive disclosure period, an officer, director, partner, proprietor, or agent
at the disclosure threshold. List only the intangibles that exceed (other than a resident agent solely for service of process).
this threshold amount.The value of a leased vehicle is the vehicle's If you have or held such a position or ownership interest in
present value minus the lease residual (a number which can be one of these types of businesses, list the name of the business, its
found on the lease document). Property that is only jointly owned address and principal business activity, and the position held with
property should be valued according to the percentage of your the business(if any). If you own(ed) more than a 5% interest in the
joint ownership. Property owned as tenants by the entirety or°as business, indicate that fact and describe the nature of your interest.
joint tenants with right of survivorship should be valued at 100%.
None of your calculations or the value of the property have to be PART G—TRAINING CERTIFICATION
disclosed on the form.
Example: You own 50% of the stock of a small corporation [Required by s. 112.3142, F.S.]
that is worth $100,000, the estimated fair market value of If you are a Constitutional or elected municipal officer whose
your home and other property (bank accounts, automobile, service began before March 31 of the year for which you are filing,
furniture, etc.) is $200,000. As your total assets are worth you are required to complete four hours of ethics training which
$250,000, you must disclose intangibles worth over$25,000. addresses Article II, Section 8 of the Florida Constitution, the Code
Since the value of the stock exceeds this threshold, you of Ethics for Public Officers and Employees, and the public records
should list "stock" and the name of the corporation. If your and open meetings laws of the state. You are required to certify on
accounts with a particular bank exceed $25,000, you should this form that you have taken such training.
list"bank accounts" and bank's name. (End of Percentage Thresholds Instructions.)
CE FORM 1-Effective:January 1,2020.Incorporated by reference in Rule 34-8.202,F.A.C. PAGE 6