Ford - 2021 Form 1 - 8-29-22 FORM 1 STATEMENT OF 2021
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:
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MAILING ADDRESS ; / A
CITY: ZIP: COUNTY: {
AUG 2 9 2022
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NAME OF AG BY:. ...._.......__
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NAME OF OFFICE'OR POSITION HELD ORSOUGHT;
/
/ "IIi At/ ( iJ4i )
CHECK ONLY IF CM
ANDIDATE 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 c ck one):
nCOMPARATIVE(PERCENTAGE)THRESHOLDS DE 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
Re.t l c.,4144 SAI es 53ti 13 oteh Avc / Ott )r- R E Sale-�
eni 536 13e,ci, Avr AEI& � rL S•d S��ds
R G Les44011 S-6 13G«ti Ave. 14+1•/3r h�ft �oirtn,P/u•i/ `c•s4�•.j
Tae<d-i H4bi <� f't M4141 ,�,{1, 7I? /f'l,},o••� Ra. A#1. '3 i.F1 A-Pr (10141e- ti.v1 r
PART B-- SECONDARY SOURCES OF INC6ME
[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
1003 /V . 3 f� 5f• -1L-1(4#"1116, I 1 tL 32250 sheets, if necessary.
FILING 1013 31'4 5f. 'i / �l and where to file this form are
when
� located at the bottom of page 2.
119114 W' Hwy /00 13,inaL/I �/"� 32L18 INSTRUCTIONS on who must file
this form and how to fill It out
begin on page 3.
CE FORM 1•Effective:January 1,2022 (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")
L ' TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
5Te/,kms AM)5 heVA
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME� OF CREDITOR ADDRESS OF CREDITOR
/V/ont
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
F
NAME OF BUSINESS ENTITY [�I-( ZLI- dd �JJ
ADDRESS OF BUSINESS ENTITY 'j 3� /R GitG h AJt�/1'li+4-ha .wc1.) t-L
PRINCIPAL BUSINESS ACTIVITY Arm•
POSITION HELD WITH ENTITY /'1/�oi4, {
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS I/�5
NATURE OF MY OWNERSHIP INTEREST Se/c ONge
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
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
Code 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:
01/21
/ 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. Po 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 1F(Final Statement
your completed form and any attachments as a pdf(do not use any of Financial Interests)does nol relieve the filer of filing a CE Form 1
other format), send it to CEForm1@leg.state.fl.us and retain a copy if the filer was in his or her position on December 31,2021.
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 1,2022. PAGE 2
Incorporated by reference In Rule 34-8.202(1),F.A.C.