2022 Qualifying Packet with amended memo dated 8-25-22MEMORANDUM
TO: Candidates for Mayor - Seat 1, Commissioner - Seat 4, and Commissioner - Seat 5
FROM: Donna L. Bartle, City Clerk
DATE: August 25, 2022
SUBJECT: 2022 Qualifying
Please read all of the materials in this packet very carefully. Candidates are responsible for meeting
all deadlines and correctly completing all required documents.
Qualifying will be held from Noon, August 29, 2022 — Noon, September 2, 2022. All qualifying
requirements must be completed and received by Noon (EST), September 2 for a candidate to be
qualified. Our physical location and mailing address is:
Office of the City Clerk
City of Atlantic Beach
800 Seminole Road
Atlantic Beach, FL 32233
WHAT TO FILE DURING THE OUALIFYING PERIOD:
1) Form DS -DE 302NP, CANDIDATE OATH- NONPARTISAN OFFICE, and
2) FORM 1, STATEMENT OF FINANCIAL INTERESTS- 2021, and
3) ELECTION ASSESSMENT FEE in the amount not less than the fee required, as follows:
Mayor- Seat 1 $ 106.72
Commissioner- Seat 4 $ 64.95
Commissioner- Seat 5 $ 64.95
OR
AFFIDAVIT OF FINANCIAL HARDSHIP.
THINGS TO REMEMBER:
1) Submit original documents to the City Clerk.
Exception: A public officer who has filed a financial disclosure statement for 2021 with the
Supervisor of Elections may file a copy with this office for qualifying.
2) Form DS -DE 302NP (and the Affidavit of Financial Hardship, if applicable) requires (sworn)
notarization. Review the document carefully and have it properly notarized. The City Clerk and her
staff are notaries and are available to notarize signatures when signed in their presence and with
proper i.d., if needed. Form 1 does not require notarization.
On Candidate Oath (Form DS -DE 302NP):
• Type or print your name the way you wish it to appear on the ballot. A candidate's name as
it is to appear on the ballot may not be changed after qualifying. Be sure to include any necessary
punctuation. (Please Note: See attached Notice regarding the use of nicknames on the ballot. If
you plan to use a nickname, please contact me.)
• Determine whether you should check the box: Please Note: If your last name consists of two
or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to
check the box, your name will be listed with the name appearing last on the line. Example: John
Jones Smith — If the last name has no hyphen and you do not check the box, the last name on the
ballot would be "Smith". If you check the box, your last name would be listed on the ballot as
"Jones Smith." If you have a hyphen within your last name, the last name would be listed as
"Jones -Smith".
• For "Office", enter Mayor -Seat 1, Commissioner -Seat 2, or Commissioner -Seat 3.
• For "District" and "Circuit #", enter N/A.
• For "Group or Seat #", enter either 1, 2, or 3 (whichever relates to the office).
• Provide your Voter Registration Number.
• Provide Phonetic spelling for audio ballot. (See Guide on page 2 of Form DS -DE 302NP)
• Provide telephone number, email address, and home address.
• Take a sworn oath administered by a notary, then sign in the notary's presence.
• The notary must complete and sign the notarization statement.
3) Candidates may submit qualifying papers by hand delivery or mail. The City Clerk will not accept
qualifying papers via facsimile All documents must have original signatures.
4) Qualifying fees must be paid by a properly executed check payable to the City of Atlantic Beach and
drawn upon the candidate's campaign account. If using a check (starter check) that does not have the
imprint in the upper left corner identifying it as a campaign account check — please write in the proper
information.
5) The campaign check must be signed by an appointed treasurer or deputy treasurer. A check signed
by a candidate who has not been designated as the treasurer or deputy treasurer is not acceptable.
6) Personal checks, cashier checks and money orders are not accepted.
7) You will be notified by email once you have been properly qualified.
Qualifying Memorandum Continued — August 23, 2022 Page 2 of 3
8) The qualifying fee cannot be returned to a candidate unless the candidate withdraws, in writing, before
the close of qualifying.
Please Note: 99.061(7)(a)(1), Florida Statutes
... "If a candidate's check is returned by the bank for any reason, the filing officer shall immediately
notify the candidate and the candidate shall have until the end of qualifying to pay the fee with a
cashier's check purchased from funds of the campaign account. Failure to pay the fee as provided
in this subparagraph shall disqualify the candidate.
We have enclosed the forms you need for qualifying. If you have any questions or require additional
assistance, please contact me at (904) 247-5809, (904) 200-9790, or at dbartle(a,coab.us.
ENCLOSURES
INFORMATION: NOTICE - USE OF NICKNAMES ON BALLOT
FORMS: FORM DS -DE 302NP, CANDIDATE OATH- NONPARTISAN OFFICE
FORM 1, STATEMENT OF FINANCIAL INTERESTS- 2019
AFFIDAVIT OF FINANCIAL HARDSHIP
Qualifying Memorandum Continued — August 23, 2022 Page 3 of 3
FLORIDA DEPARTMENT of STATE
•
CHARLIE CRIST KURT S. BROWNING
Governor Secretary of State
IMPORTANT NOTICE
TO: All Candidates Qualifying with the Division of Elections
FROM: Donald L. Palmer, Directoi-
Division of Elections
DATE: February 26, 2010
SUBJECT: Use of Nickname on Ballot
The candidate oath form that must be filed during the qualifying period requires you to designate
your "naive as you wish it to appear on ballot." Case law and Division of Elections Opinions 86-
06 and 09-05 permit a nickname to be printed on the ballot along with one's legal name (e.g.,
John J. "Bo" Jones) when the nickname is one by which the person is generally known or one
that the person has used as part of his or her legal name. The Division of Elections opinions
recognize that a qualifying officer may require the candidate to make a satisfactory showing that
the candidate is generally known by the nickname or the nickname has been used as part of the
candidate's legal name before a nickname is printed on the ballot.
If you plan to designate a nickname on your candidate oath form other than a generally
recognized shortened version of your legal name (e.g., "Rob" or "Bob" for Robert, "Bill"
for William, "DJ" for David Joseph, etc.), you should provide notice of your intention to
the Division of Elections well in advance of the qualifying period and make a satisfactory
showing that you are generally known by the nickname or that you have used the nickname
as part of your legal name. Failure to provide such information in advance may result in
the Division not having sufficient time during the qualifying period to determine if the
nickname may be printed the ballot.
Attached to this Notice is an example of an Affidavit that also mentions supporting
documentation that you may consider submitting to the Division of Elections in advance to show
that the nickname is legitimate.
NOTE: Division of Elections Opinion 86-06 states: Descriptive information such as a title (for
example, Dr. or M.D.), although not part of a person's name, is permissible only when two
persons of the same name or whose names are so similar as to reasonably cause confusion, seek
Division of Elections
R. A. Gray Building, Room 316 • 500 South Bronough Street • Tallahassee, Florida 32399-0250
Telephone: (850) 245-6200 • Facsimile: (850) 245-6217
election. dos.state. fl.us
All Candidates Qualifying with the Division of Elections
February 26, 2010
Page 2
the same office." Therefore, ordinarily, even if a candidate is commonly referred to as "Doctor,"
"Professor," or "Colonel," those titles would not be allowed as a nickname or as a part of a
nickname unless such descriptive information is reasonably necessary to avoid confusion among
candidates.
If you are a candidate who does not qualify with the Division of Elections and you desire to have
your nickname printed on the ballot, you should contact your qualifying officer well in advance
of the qualifying period to find out what the qualifying officer's requirements are to allow your
nickname to be printed on the ballot.
KRB/kfg
Sample Affidavit for Use of Nickname on Ballot
AFFIDAVIT OF (Insert legal name of candidate)
STATE OF FLORIDA
COUNTY OF
BEFORE ME, the undersigned authority, personally appeared (insert legal name of candidate), who
being first duly sworn or placed under affirmation, says:
1. My legal name is . I am over the age of eighteen (18) and the contents
of this affidavit are true and correct.
2. I am a candidate for the office of
3. My nickname is . I am generally known by this nickname or have used it as
part of my legal name. I have not created the nickname to mislead voters. I plan to designate this
nickname on my candidate oath as the name I wish to have printed on the ballot when I submit the
candidate oath form during the qualifying period for the above office.
4. Attached are (insert #) documents that show that my nickname is one by which I am generally
known or is one that I have used as a part of my legal name: (list the title of any documents or affidavits
from other persons reflecting that the candidate is generally known by the nickname or that it has been
used as part of the candidate's legal name)
Further, affiant sayeth not.
Signature of Affiant
Printed/Typed Name of Affiant
Sworn to and subscribed before me this day of 20 by (insert legal name of
candidate).
(SEAL)
Notary Public
Printed Name
Personally known or Produced Identification
Type of Identification Produced
CANDIDATE OATH -
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a
write-in candidate:
Write-in candidate
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
OFFICE USE ONLY
I,
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box n (see page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of
(Office) (District #)
; I am a qualified elector of County, Florida;
(Circuit #) (Group or Seat #)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I
have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office
I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes;
and I will support the Constitution of the United States and the Constitution of the State of Florida.
Candidate's Florida Voter Registration Number (located on your voter information card):
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
x
Signature of Candidate
Address
Telephone Number
City
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence ❑
this day of , 20
Personally Known ❑ OR Produced Identification ❑
Type of Identification Produced:
DS -DE 302NP (Rev. 05/2021)
Email Address
State ZIP Code
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
RESET
Rule 1S-2.0001, F.A.C.
Compound Last Names
If your last name consists of two or more names and has no hyphen, check the box in the Candidate Oath section. If you fail to
check the box, your name will be listed with the name appearing last on the line. Example: John Jones Smith — If the last name has
no hyphen and you do not check the box, the last name on the ballot would be "Smith." If you check the box, your last name would
be listed on the ballot as "Jones Smith." If you have a hyphen within your last name, the last name would be listed as "Jones -Smith."
Guide for Designating Phonetic Spelling
of Candidate's Name for Audio Ballot
1. Use tables below.
2. Use upper case for "stressed" syllables. Use lower case for "unstressed" syllables.
3. Use dashes (-) to separate syllables.
4. Add any notes such as rhyming examples, silent letters, etc.
Stressed Vowel Sounds
EE
E
A
AH
AH
UH
UH
AW
U
00
OU
0
El
Al
0I
YO0
B
D
F
G
H
HW
J
K
L
M
N
NG
P
(FEET) feet
(FIT) fit
(BED) bed
(KAT) cat (KAD) cad
(FAH-thur) father (PAHR) par
(HAHT) hot (TAH -dee) toddy
(FUHJ) fudge (FLUHD) flood
(CHUHRCH) church
(FAWN) fawn
(FUL) full
(FOOD) food
(FOUND) found
(FO) foe
(FEIT) fight
(FAIT) fate
(FOIL) foil
(FYOOR-ee-uhs) furious
(BED) bed
(DET) debt
(FED) fed
(GET) get
(HED) head
(HWICH) which
(JUHG) jug
(KAD) cad
(LAIM) /ame
(MAT) mat
(NET) net
(SING-uhr) singer
(PET) pet
NAME ON BALLOT
Mishaud
Jahn
Beauprez
Maniscalco
Tangipahoa
Monte
Tanya
Vowels
Unstressed Vowel Sounds
uh (SO-fuh) sofa (FING-guhr) finger
Certain Vowel Sounds with R
AHR (PAHR) par
ER (PER) pair
IR (PIR)peer
OR (POR) pour
OOR (POOR) poor
UHR (PUHR) purr
Consonants
R
S
T
V
Y
W
CH
SH
TS
TH
TH
ZH
Z
(RED) red
(SET) set
(TEN) ten
(VET) vet
(YET) yet
(WICH) witch
(CHUCRCH) church
(SHEEP) sheep
(ITS) its (PITS-feeld) Pittsfield
(THEI) Thigh
(THEI) Thy
(A-zhuhr) azure (VI-zhuhn) vision
(GOODZ) goods (HUH-buhz-tuhn) Hubbardston
Examples of Phonetically Spelled Names
PRONOUNCED AS
mee-SHO Cd' is silent)
HAHN (rhyme: fawn)
boo-PRAI (rhyme: hooray)
man-uh-SKAL-ko
TAN-ji-pah-HO-uh
Mahn -TAI
TAWN-yuh (not TAN)
Do not submit this page to the filing officer.
DS -DE 302NP (Rev. 05/2021) Rule 1S-2.0001, F.A.C.
FORM 1 STATEMENT OF 2021
Please print or type your name, mailing
address, agency name, and position below:
FINANCIAL INTERESTS I FOR OFFICE USE ONLY:
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, 2021.
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):
nCOMPARATIVE (PERCENTAGE) THRESHOLDS OR n 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 SOURCES
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
BUSINESS ENTITY OF BUSINESS' INCOME 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")
CE FORM 1 - Effective: January 1, 2022 (Continued on reverse side)
Incorporated by reference in Rule 34-8.202(1), F.A.C.
PRINCIPAL BUSINESS
ACTIVITY OF SOURCE
You are not limited to the space on the
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.
PAGE 1
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
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF CREDITOR
BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
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
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
BUSINESS ENTITY # 2
PART G — TRAINING For elected municipal officers, appointed school superintendents, and commissioners of a community redevelopment
agency created under Part III, Chapter 163 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
Signature:
Date Signed:
FILING INSTRUCTIONS:
If you were mailed the form by the Commission on Ethics or a County
Supervisor of Elections for your annual disclosure filing, return the
form to that location. To determine what category your position falls
under, see page 3 of instructions.
Local officers/employees file with the Supervisor of Elections
of the county in which they permanently reside. (If you do not
permanently reside in Florida, file with the Supervisor of the county
where your agency has its headquarters.) Form 1 filers who file with
the Supervisor of Elections may file by mail or email. Contact your
Supervisor of Elections for the mailing address or email address to
use. Do not email vour form to the Commission on Ethics, it will be
returned.
State officers or specified state employees who file with the
Commission on Ethics may file by mail or email. To file by mail,
send the completed form to P.O. Drawer 15709, Tallahassee, FL
32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200,
Tallahassee, FL 32303. To file with the Commission by email, scan
your completed form and any attachments as a pdf (do not use any
other format), send it to CEForm1@leg.state.fl.us and retain a copy
for your records. Do not file by both mail and email. Choose only one
filina method. Form 6s will not be accepted via email.
If a certified public accountant licensed under Chapter 473, or attorney
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.
CPA/Attorney Signature:
Date Signed:
Candidates file this form together with their filing papers.
MULTIPLE FILING UNNECESSARY: A candidate who files a Form
1 with a qualifying officer is not required to file with the Commission
or Supervisor of Elections.
WHEN TO FILE: Initially, each local officer/employee, state officer,
and specified state employee must file within 30 days of the
date of his or her appointment or of the beginning of employment.
Appointees who must be confirmed by the Senate must file prior to
confirmation, even if that is less than 30 days from the date of their
appointment.
Candidates must file at the same time they file their qualifying
papers.
Thereafter, file by July 1 following each calendar year in which they
hold their positions.
Finally, file a final disclosure form (Form 1F) within 60 days of
leaving office or employment. Filing a CE Form 1F (Final Statement
of Financial Interests) does not relieve the filer of filing a CE Form 1
if the filer was in his or her position on December 31, 2021.
CE FORM 1 - Effective: January 1, 2022. 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
state and any person appointed to fill a vacancy in such office, unless
required to file full disclosure on Form 6.
2) Appointed members of each board, commission, authority, or
council having statewide jurisdiction, excluding members of solely advisory
bodies, but including judicial nominating commission members; Directors
of Enterprise Florida, Scripps Florida Funding Corporation, and Career
Source Florida; and members of the Council on the Social Status of Black
Men and Boys; the Executive Director, Governors, and senior managers of
Citizens Property Insurance Corporation; Governors and senior managers
of Florida Workers' Compensation Joint Underwriting Association; board
members of the Northeast Fla. Regional Transportation Commission; board
members of Triumph Gulf Coast, Inc; board members of Florida Is For
Veterans, Inc.; and members of the Technology Advisory Council within the
Agency for State Technology.
3) The Commissioner of Education, members of the State Board
of Education, the Board of Governors, the local Boards of Trustees and
Presidents of state universities, and the Florida Prepaid College Board.
4) Persons elected to office in any political subdivision (such as
municipalities, counties, and special districts) and any person appointed to
fill a vacancy in such office, unless required to file Form 6.
5) Appointed members of the following boards, councils,
commissions, authorities, or other bodies of county, municipality, school
district, independent special district, or other political subdivision: the
governing body of the subdivision; community college or junior college
district boards of trustees; boards having the power to enforce local code
provisions; boards of adjustment; community redevelopment agencies;
planning or zoning boards having the power to recommend, create, or
modify land planning or zoning within a political subdivision, except for
citizen advisory committees, technical coordinating committees, and similar
groups who only have the power to make recommendations to planning
or zoning boards, and except for representatives of a military installation
acting on behalf of all military installations within that jurisdiction; pension
or retirement boards empowered to invest pension or retirement funds
or determine entitlement to or amount of pensions or other retirement
benefits, and the Pinellas County Construction Licensing Board.
6) Any 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 resolution creating the board.
7) Persons holding any of these positions in local government:
mayor; county or city manager; chief administrative employee or finance
director of a county, municipality, or other political subdivision; county or
municipal attorney; chief county or municipal building inspector; county
or municipal water resources coordinator; county or municipal pollution
control director; county or municipal environmental control director; county
or municipal administrator with power to grant or deny a land development
permit; chief of police; fire chief; municipal clerk; appointed district school
superintendent; community college president; district medical examiner;
purchasing agent (regardless of title) having the authority to make any
purchase exceeding $35,000 for the local governmental unit.
8) Officers and employees of entities serving as chief administrative
officer of a political subdivision.
9) Members of governing boards of charter schools operated by a
city or other public entity.
10) Employees in the office of the Governor or of a Cabinet member
who are exempt from the Career Service System, excluding secretarial,
clerical, and similar positions.
11) The following positions in each state department, commission,
board, or council: Secretary, Assistant or Deputy Secretary, Executive
Director, Assistant or Deputy Executive Director, and anyone having the
power normally conferred upon such persons, regardless of title.
12) The following positions in each state department or division:
Director, Assistant or Deputy Director, Bureau Chief, and any person
having the power normally conferred upon such persons, regardless of
title.
13) Assistant State Attorneys, Assistant Public Defenders, criminal
conflict and civil regional counsel, and assistant criminal conflict and civil
regional counsel, Public Counsel, full-time state employees serving as
counsel or assistant counsel to a state agency, administrative law judges,
and hearing officers.
14) The Superintendent or Director of a state mental health institute
established for training and research in the mental health field, or any major
state institution or facility established for corrections, training, treatment, or
rehabilitation.
15) State agency Business Managers, Finance and Accounting
Directors, Personnel Officers, Grant Coordinators, and purchasing agents
(regardless of title) with power to make a purchase exceeding $35,000.
16) The following positions in legislative branch agencies: each
employee (other than those employed in maintenance, clerical, secretarial,
or similar positions and legislative assistants exempted by the presiding
officer of their house); and each employee of the Commission on
Ethics.
17) Each member of the governing body of a "large -hub commercial
service airport," as defined in Section 112.3144(1)(c), Florida
Statutes, except for members required to comply with the financial
disclosure requirements of s. 8, Article II of the State Constitution.
INSTRUCTIONS FOR COMPLETING FORM 1:
INTRODUCTORY INFORMATION (Top of Form): If your
name, mailing address, public agency, and position are already
printed on the form, you do not need to provide this information
unless it should be changed. To change any of this information,
write the correct information on the form, and contact your
aaencv's financial disclosure coordinator. You can find your
coordinator on the Commission on Ethics website: www.ethics.
state.fl.us.
NAME OF AGENCY: The name of the governmental unit
which you serve or served, by which you are or were employed,
or for which you are a candidate.
DISCLOSURE PERIOD: The "disclosure period" for your
report is the calendar year ending December 31, 2021.
CE FORM 1 - Effective: January 1, 2022. Incorporated by reference in Rule 34-8.202, F.A.C.
OFFICE OR POSITION HELD OR SOUGHT: The title of
the office or position you hold, are seeking, or held during the
disclosure period even if vou have since left that position. If you
are a candidate for office or are a new employee or appointee,
check the appropriate box.
PUBLIC RECORD: The disclosure form and everything
attached to it is a public record. Your social security number.
bank account. debit. charge, and credit card numbers are not
reauired and vou should redact them from any documents you
file. If you are an active or former officer or employee listed in
Section 119.071, F.S., whose home address is exempt from
disclosure, the Commission will maintain that confidentiality if
vou submit a written and notarized request.
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 vou have chosen for each Dart 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.
IF YOU HAVE CHOSEN DOLLAR VALUE THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
PART A — PRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(b)1, F.S.]
Part A is intended to require the disclosure of your principal
sources of income during the disclosure period. You do not have to
disclose anv public salary or public position(s). The income of your
spouse need not be disclosed; however, if there is joint income to
you and your spouse from property you own jointly (such as interest
or dividends from a bank account or stocks), you should disclose the
source of that income if it exceeded the threshold.
Please list in this part of the form the name, address, and
principal business activity of each source of your income which
exceeded $2,500 of gross income received by you in your own name
or by any other person for your use or benefit.
"Gross income" means the same as it does for income tax
purposes, even if the income is not actually taxable, such as interest
on tax-free bonds. Examples include: compensation for services,
income from business, gains from property dealings, interest, rents,
dividends, pensions, IRA distributions, social security, distributive
share of partnership gross income, and alimony if considered gross
income under federal law, but not child support.
Examples:
— If you were employed by a company that manufactures
computers and received more than $2,500, list the 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
of partnership gross income exceeded $2,500, list the name of
the firm, its address, and its principal business activity (practice of
law).
— If you were the sole proprietor of a retail gift business and your
gross income from the business exceeded $2,500, list the name
of the business, its address, and its principal business activity
(retail gift sales).
— If you received income from investments in stocks and bonds,
list each individual company from which you derived more than
$2,500. Do not aggregate all of your investment income.
— If more than $2,500 of your gross income was gain from the
sale of property (not just the selling price), list as a source of
income the purchaser's name, address and principal business
activity. If the purchaser's identity is unknown, such as where
securities listed on an exchange are sold through a brokerage
firm, the source of income should be listed as "sale of (name of
company) stock," for example.
— If more than $2,500 of your gross income was in the form
of interest from one particular financial institution (aggregating
interest from all CD's, accounts, etc., at that institution), list the
name of the institution, its address, and its principal business
activity.
PART B — SECONDARY SOURCES OF INCOME
[Required by s. 112.3145(3)(b)2, F.S.]
This part is intended to require the disclosure of major customers,
clients, and other sources of income to businesses in which you own an
interest. It is not for reportina income from second iobs. That kind of income
should be reported in Part A "Primary Sources of Income," if it meets the
reporting threshold. You will not have anything to report unless, during the
disclosure period:
(1) You owned (either directly or indirectly in the form of an equitable
CE FORM 1 - Effective: January 1, 2022. Incorporated by reference in Rule 34-8.202, F.A.C..
or beneficial interest) more than 5% of the total assets or capital
stock of a business entity (a corporation, partnership, LLC, limited
partnership, proprietorship, joint venture, trust, firm, etc., doing
business in Florida); and,
(2) You received more than $5,000 of your gross income during the
disclosure period from that business entity.
If your interests and gross income exceeded these thresholds, then for that
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
the basis of the business entity's most recently completed fiscal year), the
source's address, and the source's principal business activity.
Examples:
— You are the sole proprietor of a dry cleaning business, from which
you received more than $5,000. If only one customer, a uniform rental
company, provided more than 10% of your dry cleaning business, you
must list the name of the uniform rental company, its address, and its
principal business activity (uniform rentals).
— You are a 20% partner in a partnership that owns a shopping mall
and your partnership income exceeded the above thresholds. List each
tenant of the mall that provided more than 10% of the partnership's
gross income and the tenant's address and principal business activity.
PART C — REAL PROPERTY
[Required by s. 112.3145(3)(b)3, F.S.]
In this part, list the location or description of all real property in Florida
in which you owned directly or indirectly at any time during the disclosure
period in excess of 5% of the property's value. You are not reauired to list
your residences. You should list anv vacation homes if vou derive income
from them.
Indirect ownership includes situations where you are a beneficiary of a
trust that owns the property, as well as situations where you own more than
5% of a partnership or corporation that owns the property. The value of the
property may be determined by the most recently assessed value for tax
purposes, in the absence of a more accurate fair market value.
The location or description of the property should be sufficient to
enable anyone who looks at the form to identify the property. A street
address should be used, if one exists.
PART D — INTANGIBLE PERSONAL PROPERTY
[Required by s. 112.3145(3)(b)3, F.S.]
Describe any intangible personal property that, at any time during the
disclosure period, was worth more than $10,000 and state the business
entity to which the property related. Intangible personal property includes
things such as cash on hand, stocks, bonds, certificates of deposit, vehicle
leases, interests in businesses, beneficial interests in trusts, money owed
you (including, but not limited to, loans made as a candidate to your own
campaign), Deferred Retirement Option Program (DROP) accounts, the
Florida Prepaid College Plan, and bank accounts in which you have an
ownership interest. Intangible personal property also includes investment
products held in IRAs, brokerage accounts, and the Florida College
Investment Plan. Note that the product contained in a brokeraae account.
IRA. or the Florida Colleae Investment Plan is vour asset—not the account
or plan itself. Things like automobiles and houses you own, jewelry, and
paintings are not intangible property. Intangibles relating to the same
business entity may be aggregated; for example, CDs and savings
accounts with the same bank. Property owned as tenants by the entirety or
as joint tenants with right of survivorship, including bank accounts owned in
such a manner, should be valued at 100%. The value of a leased vehicle
is the vehicle's present value minus the lease residual (a number found on
the lease document).
PAGE 4
PART E — LIABILITIES
[Required by s. 112.3145(3)(b)4, F.S.]
List the name and address of each creditor to whom you owed more
than $10,000 at any time during the disclosure period. The amount of the
liability of a vehicle lease is the sum of any past -due payments and all
unpaid prospective lease payments. You are not required to list the amount
of any debt. You do not have to disclose credit card and retail installment
accounts, taxes owed (unless reduced to a judgment), indebtedness on
a life insurance policy owed to the company of issuance, or contingent
liabilities. A "contingent liability" is one that will become an actual liability
only when one or more future events occur or fail to occur, such as where
you are liable only as a guarantor, surety, or endorser on a promissory
note. If you are a "co -maker" and are jointly liable or jointly and severally
liable, then it is not a contingent liability.
PART F — INTERESTS IN SPECIFIED BUSINESSES
[Required by s. 112.3145(7), F.S.]
The types of businesses covered in this disclosure include: state and
federally chartered banks; state and federal savings and loan associations;
cemetery companies; insurance companies; mortgage companies; credit
unions; small loan companies; alcoholic beverage licensees; pari-mutuel
wagering companies, utility companies, entities controlled by the Public
Service Commission; and entities granted a franchise to operate by either a
city or a county government.
Disclose in this part the fact that you owned during the disclosure
period an 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 indirectly in the form of an equitable or beneficial
interest) at any time during the disclosure period more than 5% of the total
assets or capital stock of one of the types of business entities listed above.
You also must complete this part of the form for each of these types of
businesses for which you are, or were at any time during the disclosure
period, an officer, director, partner, proprietor, or agent (other than a resident
agent solely for service of process).
If you have or held such a position or ownership interest in one of
these types of businesses, list the name of the business, its address and
principal business activity, and the position held with the business (if any). If
you own(ed) more than a 5% interest in the business, indicate that fact and
describe the nature of your interest.
PART G — TRAINING CERTIFICATION
[Required by s. 112.3142, F.S.]
If you are a Constitutional or elected municipal officer,
appointed school superintendent, or a commissioner of a community
redevelopment agency created under Part III, Chapter 163 whose
service began before March 31 of the year for which you are filing,
you are required to complete four hours of ethics training which
addresses Article II, Section 8 of the Florida Constitution, the Code
of Ethics for Public Officers and Employees, and the public records
and open meetings laws of the state. You are required to certify on
this form that you have taken such training.
IF YOU HAVE CHOSEN COMPARATIVE (PERCENTAGE) THRESHOLDS
THE FOLLOWING INSTRUCTIONS APPLY
PART A — PRIMARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)1, F.S.]
Part A is intended to require the disclosure of your principal
sources of income during the disclosure period. You do not have
to disclose any public salary or public position(s). but income from
these public sources should be included when calculatina your aross
income for the disclosure period. The income of your spouse need
not be disclosed; however, if there is joint income to you and your
spouse from property you own jointly (such as interest or dividends
from a bank account or stocks), you should include all of that income
when calculating your gross income and disclose the source of that
income if it exceeded the threshold.
Please list in this part of the form the name, address, and
principal business activity of each source of your income which
exceeded 5% of the gross income received by you in your own name
or by any other person for your benefit or use during the disclosure
period.
"Gross income" means the same as it does for income tax
purposes, even if the income is not actually taxable, such as interest
on tax-free bonds. Examples include: compensation for services,
income from business, gains from property dealings, interest, rents,
dividends, pensions, IRA distributions, social security, distributive
share of partnership gross income, and alimony if considered gross
income under federal law, but not child support.
Examples:
— If you were employed by a company that manufactures
computers and received more than 5% of your gross income
from the company, list the 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
of partnership gross income exceeded 5% of your gross income,
then list the name of the firm, its address, and its principal
business activity (practice of law).
— If you were the sole proprietor of a retail gift business and
your gross income from the business exceeded 5% of your
total gross income, list the name of the business, its address,
and its principal business activity (retail gift sales).
— If you received income from investments in stocks and
CE FORM 1 - Effective: January 1, 2022. Incorporated by reference in Rule 34-8.202, F.A.C.
bonds, list each individual company from which you derived
more than 5% of your gross income. Do not aggregate all of
your investment income.
— If more than 5% of your gross income was gain from the sale
of property (not just the selling price), list as a source of income
the purchaser's name, address, and principal business activity.
If the purchaser's identity is unknown, such as where securities
listed on an exchange are sold through a brokerage firm, the
source of income should be listed as "sale of (name of company)
stock," for example.
— If more than 5% of your gross income was in the form of
interest from one particular financial institution (aggregating
interest from all CD's, accounts, etc., at that institution), list the
name of the institution, its address, and its principal business
activity.
PART B — SECONDARY SOURCES OF INCOME
[Required by s. 112.3145(3)(a)2, F.S.]
This part is intended to require the disclosure of major customers,
clients, and other sources of income to businesses in which you own
an interest. It is not for reportina income from second iobs. That kind
of income should be reported in Part A, "Primary Sources of Income,"
if it meets the reporting threshold. You will not have anything to report
unless during the disclosure period:
(1) You owned (either directly or indirectly in the form of an
equitable or beneficial interest) more than 5% of the total assets
or capital stock of a business entity (a corporation, partnership,
LLC, limited partnership, proprietorship, joint venture, trust, firm,
etc., doing business in Florida); and,
(2) You received more than 10% of your gross income from that
business entity; and,
(3) You received more than $1,500 in gross income from that
business entity.
If your interests and gross income exceeded these thresholds, then
for that 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 the basis of the business entity's most recently
completed fiscal year), the source's address, and the source's
principal business activity.
PAGE 5
Examples:
— You are the sole proprietor of a dry cleaning business, from
which you received more than 10% of your gross income—an
amount that was more than $1,500. If only one customer, a uniform
rental company, provided more than 10% of your dry cleaning
business, you must list the name of the uniform rental company, its
address, and its principal business activity (uniform rentals).
— You are a 20% partner in a partnership that owns a shopping
mall and your partnership income exceeded the thresholds listed
above. You should list each tenant of the mall that provided more
than 10% of the partnership's gross income, and the tenant's
address and principal business activity.
PART C — REAL PROPERTY
[Required by s. 112.3145(3)(a)3, F.S.]
In this part, list the location or description of all real property in
Florida in which you owned directly or indirectly at any time during the
disclosure period in excess of 5% of the property's value. You are not
reauired to list your residences. You should list anv vacation homes. if
you derive income from them.
Indirect ownership includes situations where you are a beneficiary
of a trust that owns the property, as well as situations where you own
more than 5% of a partnership or corporation that owns the property.
The value of the property may be determined by the most recently
assessed value for tax purposes, in the absence of a more accurate
fair market value.
The location or description of the property should be sufficient to
enable anyone who looks at the form to identify the property. A street
address should be used, if one exists.
PART D — INTANGIBLE PERSONAL PROPERTY
[Required by s. 112.3145(3)(a)3, F.S.]
Describe any intangible personal property that, at any time during
the disclosure period, was worth more than 10% of your total assets,
and state the business entity to which the property related. Intangible
personal property includes things such as cash on hand, stocks,
bonds, certificates of deposit, vehicle leases, interests in businesses,
beneficial interests in trusts, money owed you (including, but not
limited to, loans made as a candidate to your own campaign), Deferred
Retirement Option Program (DROP) accounts, the Florida Prepaid
College Plan, and bank accounts in which you have an ownership
interest. Intangible personal property also includes investment products
held in IRAs, brokerage accounts, and the Florida College Investment
Plan. Note that the product contained in a brokeraae account. IRA. or
the Florida Colleae Investment Plan is your asset—not the account or
plan itself. Things like automobiles and houses you own, jewelry, and
paintings are not intangible property. Intangibles relating to the same
business entity may be aggregated; for example, CD's and savings
accounts with the same bank.
Calculations: To determine whether the intangible property
exceeds 10% of your total assets, total the fair market value of all of
your assets (including real property, intangible property, and tangible
personal property such as jewelry, furniture, etc.). When making this
calculation, do not subtract any liabilities (debts) that may relate to
the property. Multiply the total figure by 10% to arrive at the disclosure
threshold. List only the intangibles that exceed this threshold amount.
The value of a leased vehicle is the vehicle's present value minus the
lease residual (a number which can be found on the lease document).
Property that is only jointly owned property should be valued according
to the percentage of your joint ownership. Property owned as tenants
by the entirety or as joint tenants with right of survivorship, including
bank accounts owned in such a manner, should be valued at 100%.
None of your calculations or the value of the property have to be
disclosed on the form.
Example: You own 50% of the stock of a small corporation that
is worth $100,000, the estimated fair market value of your home
and other property (bank accounts, automobile, furniture, etc.)
is $200,000. As your total assets are worth $250,000, you must
disclose intangibles worth over $25,000. Since the value of the
stock exceeds this threshold, you should list "stock" and the name
of the corporation. If your accounts with a particular bank exceed
$25,000, you should list "bank accounts" and bank's name.
CE FORM 1 - Effective: January 1, 2022. Incorporated by reference in Rule 34-8.202, F.A.C.
PART E — LIABILITIES
[Required by s. 112.3145(3)(b)4, F.S.]
List the name and address of each creditor to whom you owed
any amount that, at any time during the disclosure period, exceeded
your net worth. You are not required to list the amount of any debt
or your net worth. You do not have to disclose: credit card and retail
installment accounts, taxes owed (unless reduced to a judgment),
indebtedness on a life insurance policy owed to the company of
issuance, or contingent liabilities. A "contingent liability" is one that will
become an actual liability only when one or more future events occur
or fail to occur, such as where you are liable only as a guarantor,
surety, or endorser on a promissory note. If you are a "co -maker" and
are jointly liable or jointly and severally liable, it is not a contingent
liability.
Calculations: To determine whether the debt exceeds your
net worth, total all of your liabilities (including promissory notes,
mortgages, credit card debts, judgments against you, etc.). The
amount of the liability of a vehicle lease is the sum of any past -due
payments and all unpaid prospective lease payments. Subtract
the sum total of your liabilities from the value of all your assets 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 the types
of indebtedness listed in the paragraph above (credit card and retail
installment accounts, etc.). Joint liabilities with others for which you
are "jointly and severally liable," meaning that you may be liable for
either your part or the whole of the obligation, should be included in
your calculations at 100% of the amount owed.
Example: You owe $15,000 to a bank for student loans, $5,000
for credit card debts, and $60,000 (with spouse) to a savings
and loan for a home mortgage. Your home (owned by you and
your spouse) is worth $80,000 and your other property is worth
$20,000. Since your net worth is $20,000 ($100,000 minus
$80,000), you must report only the name and address of the
savings and loan.
PART F — INTERESTS IN SPECIFIED BUSINESSES
[Required by s. 112.3145(7), F.S.]
The types of businesses covered in this disclosure include: state
and federally chartered banks; state and federal savings and loan
associations; cemetery companies; insurance companies; mortgage
companies; credit unions; small loan companies; alcoholic beverage
licensees; pari-mutuel wagering companies, utility companies, entities
controlled by the Public Service Commission; and entities granted a
franchise to operate by either a city or a county government.
Disclose in this part the fact that you owned during the
disclosure period an interest in, or held any of certain positions with,
the types of businesses listed above. You are required to make this
disclosure if you own or owned (either directly or indirectly in the
form of an equitable or beneficial interest) at any time during the
disclosure period more than 5% of the total assets or capital stock
of one of the types of business entities listed above. You also must
complete this part of the form for each of these types of businesses
for which you are, or were at any time during the disclosure period,
an officer, director, partner, proprietor, or agent (other than a resident
agent solely for service of process).
If you have or held such a position or ownership interest in
one of these types of businesses, list the name of the business, its
address and principal business activity, and the position held with
the business (if any). If you own(ed) more than a 5% interest in the
business, indicate that fact and describe the nature of your interest.
PART G — TRAINING CERTIFICATION
[Required by s. 112.3142, F.S.]
If you are a Constitutional or elected municipal officer,
appointed school superintendent, or a commissioner of a community
redevelopment agency created under Part III, Chapter 163 whose
service began before March 31 of the year for which you are filing,
you are required to complete four hours of ethics training which
addresses Article II, Section 8 of the Florida Constitution, the Code of
Ethics for Public Officers and Employees, and the public records and
open meetings laws of the state. You are required to certify on this
form that you have taken such training.
PAGE 6
I,
Florida Elections Commission
AFFIDAVIT OF FINANCIAL HARDSHIP
a can didate for the office of
Print Name
do hereby certify, pursuant to
Section 99.093(2), Florida Statutes, that I am unable to pay the 1% election assessment of
$ to qualify for nomination or election to public office because paying the assessment
would be an undue burden on my personal financial resources or on the financial resources available to
me. Under penalty of perjury, I declare that I have read the foregoing and that it is a true and correct
statement.
Date Signature of Candidate
Address:
City: State: Zip:
Sworn to (or affirmed) and subscribed before me this
Signature of Notary Public — State of Florida
day of , 20 by
Personally Known Produced Identification
Print, Type, or Stamp Commissioned Name of Notary Public Type of Identification Produced
Received by:
Name:
City
Telephone:
Date of Election: