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Home My WebLink About6/28/2021 - Form 1 - Statement of Financial InterestsFORM 1 STATEMENT OF 2020 FINANCIAL INTERESTS FOR OFFICE USE ONLY: Michelle J. Gomez- 236654 Broward County 4910 Woodlands Blvd Tamarac, FL 33319 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, 2020. 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 11 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 SOURUE SOURCE'S DEbURIP I ION OF I HE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY C0-(l a aw�e wJ - (J, �-e 2a C ,'i 11 i 6 33'! 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] 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 (Q �t ��OYILE J�2,� .2G sheets, if necessary. FILING INSTRUCTIONS for when 33-�111 and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file [� / / / / �� `r /L/// 0�0 this to fill it out begin onadh3w 9� page ¢ec�r�.unmaencay�atieetcranuen}e7}q_�uuugi), r.H.c. (Continued on reverse side) PAGE 1 PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "In/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES -rrYe 2 1,C-) / 2-� f PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "Irl NAME OF CREDITOR ADDRESS OF CREDITOR JLu "A6c ded . 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 "nla") BUSINESS ENTITY# 1 BUSINESS ENTITY # 2 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 PART G —TRAINING For elected municipal officers, appointed school superintendents, and commissioners of a community redevelopment agency created under P rt III, Chapter 163 required to complete annual ethics training pursuant to section 112.3142, F.S. y 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: 1, prepared the CE C / Form 1 in accordance with Section 112.3145, Florida Statutes, and the v instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. Date Signed: CPA/Attorney Signature: f�Z' ��"�&4 _ / 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. pp use. Do 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 1 F) within 60 days of Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1 F (Final Statement your completed form and any attachments as a pdf (do not use any of Financial Interests) does not relieve the filer of filing a CE Form 1 other format), send it to CEForml @le .state.fl.us and retain a copy if the filer was in his or her position on December 31, 2020. 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, 2021. Incorporated by reference in Rule 34-8.202(1), F.A.C. Form 1 2020 STATEMENT OF FINANCIAL INTERESTS Additional Sheet Pagel Michelle J. Gomez — 236654 Broward County 4910 Woodlands Boulevard Tamarac, FL 33319 Part D — Intangible Personal Property continued: Voya Intermediate Bond Portfolio (S) Voya Retirement Growth (A) Voya Growth and Income Portfolio (A) Voya Large Cap Growth Portfolio (A) Voya Russell Mid Cap Growth Index Port (S) Goldman Sachs Income Builder C Part E — Liabilities continued: Space Coast Credit Union (Home Loan) 3700 Lakeside Drive, Miramar, FL 33027 Ed South (Student Loans) c/o AES, P.O. Box 2461, Harrisburg, PA 17105-2461 TD Bank (Office Building Loan) 7100 W. Commercial Boulevard, Tamarac, FL 33321 CC�r��C J�y