Harding- Form 1- 6-19-17 FORM 1 STATEMENT OF 2016
Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME—FIRST NAME--MIDDLE NAME:
Harding Mitchell Ray
MAILING ADDRESS:
635 Jasmine Street Received
CITY: ZIP: COUNTY: JUN 1 9 2017
Atlantic Beach, FL 32233 Duval
NAME OF AGENCY:
City Of Atlantic Beach
NAME OF OFFICE OR POSITION HELD OR SOUGHT: Office of City Clerk
City Commissioner, Seat 5
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF l0' CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** 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 ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER(must check one):
DECEMBER 31, 2016 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER
CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES(see instructions
for further details). CHECK THE ONE YOU ARE USING(must check one):
❑ COMPARATIVE (PERCENTAGE)THRESHOLDS OR 41 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
MRH Security Services Inc 25 West 6th Street, Atlantic Beach FL 32233 Owner, Security Guard Services
Advanced Electronics Specialists Inc 25 West 6th Street, Atlantic Beach FL 32233 Owner, Electronics Company
Veterans Administration 810 Vermont Ave, NW Washington DC 201420 Veterans Disability Compensation
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
NA NA NA NA
PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
and where to file this form are
NA 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 1,2017 (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
NA NA
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
Dovenmuele Mortgage 1 Corporate Dr., Suite 360 Lake Zurich, IL 60047-8945
Wells Fargo Dealer Services PO Box 19733, Irvine CA 92623-9733
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 NA NA
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.
C] 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 Ed
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:
, prepared the CE j,y9( i - -► 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:
1 9 ��� �� I � CPA/Attorney Signature:
J v Date Signed:
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form,including If you were mailed the form by the Commission Initially,each local officer/employee,state officer,
sianina and datina it, send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within
sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment
that location. or of the beginning of employment. Appointees
If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file
section,write"none"or"n/a"in that section(s). Supervisor of Elections of the county in which they prior to confirmation, even if that is less than
permanently reside. (If you do not permanently 30 days from the date of their appointment.
NOTE: reside in Florida, file with the Supervisor of the Candidates must file at the same time they file
MULTIPLE FILING UNNECESSARY: county where your agency has its headquarters.) their qualifying papers.
A candidate who files a Form 1 with a qualifying State officers or specified state employees Thereafter,file by July 1 following each calendar
officer is not required to file with the Commissionyear in which they hold their positions.
file with the Commission on Ethics, P.O. Drawer
or Supervisor of Elections. 15709, Tallahassee, FL 32317-5709: physical Finally, file a final disclosure form (Form 1F)
address: 325 John Knox Road, Building E, Suite within 60 days of leaving office or employment.
Facsimiles will not be accepted. 200,Tallahassee,FL 32303. Filing a CE Form 1F(Final Statement of Financial
Interests)does I19g relieve the filer of filing a CE
Candidates file this form together with their Form 1 if the filer was in his or her position on
qualifying papers. December 31,2016.
To determine what category your position falls
under,see page 3 of instructions.
CE FORM 1•Effective.January 1,2017. PAGE
Incorporated by reference in Rule 34.8.202(1),F.A.C.
Part E—Liabilities—Continued
Name OF Creditor Address of Creditor
Harley Davidson Financial Services PO Box 22048, Carson City, NV 89721-2048
Gateway One Finance 160 N Riverview Dr. Suite 100, Anaheim CA 92808