Glasser- Form 1- 6-20-17FORM 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:
G t PIS S E — E-LLEN
MAILING ADDRESS:
2(0o 6EAC-k Alit N1 lit
N IA Received
CITY: ZIP: COUNTY:
Al L-A lC., ..DLA6 H- 32Z3 3 UAVA (-- JUN 2 0 2017
NAME OF AGENCY:
C IT`( o f XLA k I CL 3E Ac (4
NAME OF OFFICE OR POSITION HELD OR SOUGHT: Office of City Clerk
t'nAk) e S [Ai— I
You are not limited to th pace on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF ANDIDATE OR J 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(rrysst check one):
Q/ DECEMBER 31, 2016 OR LI 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
CALCULATI NS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions
for further etails). 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
01rtcE or ?&.2J NN t- mANA&ErnE.N' P q..5Q-24 L c 50 PAI(0Q(1 2E:t(REJfl AN \ft4 i y
V 32.2-24
U N t J. v- N: I+ r L o t2-I t to N, 0 t V C A uCS o t(tt.l-G' FA Lu t_`I 1 m RE Z
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]
If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
and where to file this form are
7Mga ()) ,Pict-i-t'4" ) .- tAL- f t Al 1( L C h'I_ located at the bottom of page 2.
D -22
INSTRUCTIONS on who must file
H .Sfrt.) A FA(L_ D R-(v 1 /aor\ V ( u,c I L- 32 ZE"7 this for andpagh3ow to fill it outbegin
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.
r
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
I Q-A k`5/AA- 1J(C tc1SkligANCE. (om8eiwi
PART E—LIABILITIES [Major debts-See instructions]
If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
NvN - -
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 BUSIN SS ENTITY#2
NAME OF BUSINESS ENTITY i^ NII
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 municipa 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 attorneySignature: in good standing with the Florida Bar prepared this form for you,he or
she must complete the following statement:
I, prepared the CE
C ' 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 Signe :
2011
CPA/Attorney Signature:
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,
signing and dating 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 Commission file with the Commission on Ethics, P.O. Drawer year in which they hold their positions.
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 gQ 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 2
Incorporated by reference in Rule 34-8.202(1).F.A C