Non-Incumbent Candidate Form 1 SampleNon -Incumbent -Sample -Form 1
2023 Form 1- Statement of Financial Interests
General Information
Name: Candidate For Office
Address: 123 Ethics Way, Tallahassee, FL 32312
County: Leon
Organization
Suborganization Title
N/A
CANDIDATE FOR
Position
Special District
Agency Name
ABC Special District
Position sought or held
Seat 1
Disclosure Period
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2023 .
Primary Sources of Income
PRIMARY SOURCE OF INCOME (Over $2,500) (Major sources of income to the reporting person)
(If you have nothing to report, write "none" or "n/a")
Name of Source of Income
Source's Address
Description of the Source's
Principal Business Activity
ABC Company
123 Company Way, Tallahassee, FL
Landscaping
Printed from the Florida EFDMS System
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2023 Form 1- Statement of Financial Interests
Secondary Sources of Income
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, write "none" or "n/a")
Name of Business Entit y
Name of Major Sources of
Business' Income
Address of Source
Principal Business
Activity of Source
N/A
Real Property
REAL PROPERTY (Land, buildings owned by the reporting person)
(If you have nothing to report, write "none" or "n/a")
Location/Description
456 Property Lane, Tallahassee, FL 32399
Intangible Personal Property
INTANGIBLE PERSONAL PROPERTY (Stocks, bonds, certificates of deposit, etc. over $10,000)
(If you have nothing to report, write "none" or "n/a")
Type of Intangible
Business Entity to Which the Property Relates
Stock
Bank Account
Printed from the Florida EFDMS System
ABC Company
First National Bank
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2023 Form 1- Statement of Financial Interests
Liabilities
LIABILITIES (Major debts valued over $10,000):
(If you have nothing to report, write "none" or "n/a")
Name of Creditor
Address of Creditor
First National Bank
123 Bank Lane, Tallahassee, FL 32399
Interests in Specified Businesses
tibM
INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions in certain types of businesses)
(If you have nothing to report, write "none" or "n/a")
Business Entity # 1
N/A
Signature of Filer
IF I
Candidate For Office
Digitally signed: 05/29/2024
Printed from the Florida EFDMS System Page 3 of 3