HomeMy WebLinkAbout6/20/2016 - Form 1 - Statement of Financial InterestsFORM 1 STATEMENT OF 2015
Please print or type your name, mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY:
address, agency name, and position below:
L ST NAME - FIRST NAME -- MIDDLE NAM -
i told JUN 20 PH 3: 21
ILINGADDR S
F1 GO 1.(�y L(a1'1CL ►�
"X). 'QQ 1 I .,
CITY : ZIP : COUNTY
cL. `� `•' \
(N�A;�M`E^O, Fr�A^GENyCY :
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
You are not limited to the s ace on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF ANDIDATE OR LJ NEW EMPLOYEE OR APPOINTEE
**** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR
YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER (must check one):
DECEMBER 31, 2015 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE 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 kl' 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 SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
t���S�. C'F r\G�C� (�.
�(�`LS S • S�� ��'1 �Ce
�o�. % �
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 "Na")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESSINCOME 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'Wa")
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.
ct I-uHm 1 - Ettecuve. January 1, 2016 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.202(1), F.A.C.