HomeMy WebLinkAbout6/13/2022 - Form 1 - Statement of Financial InterestsFORM 1 STATEMENT OF 2021
FINANCIAL INTERESTS FOR OFFICE USE ONLY:
T9 P1 ****AUTO**ALL FOR AADC 331 1634
Michelle J Gomez 236654
Mayor Tamarac
4910 Woodlands Blvd
Tamarac, FL 33319-3569
IIIII�I�I�II�I��I�I�I�I'I�II�IIIIII�'�I�IIII�I�I�I�I�III���I�����
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 ch k one):
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR 17 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 OF SOURCE'S DESCRIPTION OF THE SOURCE'S
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 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")
Cie -5-3 ZQZgne
c
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.
(,�/✓%�(l<,� L3(
INSTRUCTIONS on who must file
q1 / / y q y/I
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")
TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
ticks -Jok( moo,l' T( i3O/71eu . r1(V31'
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME
,OF/CREDITOR /� ADDRESS OFlCREDITOR Q
rloorzie Drive, Tau
17
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 ENITITY # 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.
I IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Ifs I
SIGNATURE OF FILER:
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
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
CEForml @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.
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 1 F) within 60 days of leaving
office or employment. Filing a CE Form 1 F (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. Incorporated by reference in Rule 34-8.202, F A.C. PAGE 2
Form 1 2021
STATEMENT OF FINANCIAL INTERESTS
Additional Sheet
Page 1
Michelle J. Gomez — 236654
Mayor Tamarac
4910 Woodlands Boulevard
Tamarac, FL 33319
Part D — Intangible Personal Property continued:
Voya Large Cap Growth Portfolio
Voya Retirement Growth
Voya Russell Large Cap Growth Index
Voya Intermediate Bond Portfolio
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