Ray - Form 1 - 08-24-201tO .lY "►
Please print or type your name, mailing
address, agency name, and position below:
STAT W R NT' 0101
1f1I Ik CItA\1I4 JLPf IP_RJIJ?J?S1PS
LAST NAME -- FIRST NAME --_MIDDLE NAME
Ray Terri
MAILING ADDRESS :
1 748 Ocean Grove Drive
20119
FOR OFFICE USE ONLY:
CITY : ZIP : COUNTY :
Atlantic Reach 32233 Duval
NAME OF AGENCY :
City of Atlantic Beach
NAME OF OFFICE OR POSITION HELD OR SOUGHT :
MayoraSeat 1
CHECK ONLY IF ris CANDIDATE OR � NEW EMPLOYEE OR APPOINTEE
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DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019.
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 u 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 "nla")
NAME OF SOURCE
OF INCOME
Shareholder LoanRepay/Pay RoyalPaws, 1748 OcoanGrDr, A13
SOURCE'S
ADDRESS
DESCRIPTION OF THE SOURCE'S
PRINCIPAL BUSINESS ACTIVITY
S Corp-Cons.Sery+Products
PART 3 as 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 "nia")
NAME OF NAME OF MAJOR SOURCES
BUSINESS ENTITY OF BUSINESS' INCOME
ADDRESS
OF SOURCE
13FK West Enterprises
PRINCIPAL BUSINESS
ACTIVITY OF SOURCE
SalesAgreement
Consumer Services
2445AIx. LkDr, MarietttaGa
PART C cm REAL PROPERTY [Land, buildings owned by the reporting person - See instructions]
(If you have nothing to report, write "none" or "n/a")
n/a
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.
CE FORM 1 - Effective: January 1, 2020
Incorporated by reference in Rule 34-8.202(1), F.A.C.
(Continuod on rovorso sido)
PAGE 1
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions]
(If you have nothing to report, write "none" or "ala")
TYPE OF INTANGIBLE
BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
Brokerage Account
Wells Fargo
Shareholder Notes
Royal Paws Resort & Day Spa, Ltd
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none' or "nla")
NAME OF CREDITOR
ADDRESS OF CREDITOR
n/a
PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions]
(If you have nothing to report, write "none'
NAME OF BUSINESS ENTITY
or "n/a")
BUSINESS ENTITY # 1
BUSINESS ENTITY # 2
ADDRESS OF BUSINESS ENTITY
Royal Paws Resort & Day SpaLtd
PRINCIPAL BUSINESS ACTIVITY
S Corp Consumer Serv.+Prod
POSITION HELD WITH ENTITY
President
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS
Yes
NATURE OF MY OWNERSHIP INTEREST
Sole Owner - Founder
PART G — TRAINING
For elected municipal 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 U
SIGNATURE OF FILER:
Signature:
Date Signed:
August 24, 2020
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
foram to that location. To determine what category your position falls
under, see page 3 of instructions.
Local ofcers/employees file with the Supervisor of Elections
of the county in which they permanently reside. (If you do not
permanently reside in Flonda, 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 your 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
filing method. Form 6s will not be accepted via email.
CE FORM - Effective: January 1, 2020.
Incorporated by reference in Rule 34-8.202(1), F.A.C.
CPA or ATTORNEY SIGNATURE ONLY
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:
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 1 F) within 60 days of
leaving office or employment. Filing a CE Form 1F (Final Statement
of Financial Interests) does rst relieve the filer of filing a CE Form 1
if the filer was in his or her position on December 31, 2019.
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