HomeMy WebLinkAbout12/28/2022 - Form 1F - Final Statement of Financial InterestFORM 1F FINAL STATEMENT OF 2022
FINANCIAL INTERESTS
(TO BE FILED WITHIN 60 DAYS OF LEAVING PUBLIC OFFICE OR EMPLOYMENT)
LAST NAME — FIRST NAME — MIDDLE NAME:
NAME OF REPORTING PERSON'S AGENCY:
Gelin Elberg Mike
City of Tamarac
MAILING ADDRESS:
CHECK ONE OF THE FOLLOWING (see "Who Must File" on page 3):
5901 Abbey Road
LOCAL OFFICER ❑ STATE OFFICER
❑ SPECIFIED STATE EMPLOYEE
LIST OFFICE OR POSITION HELD: vice Mayor and District 2
City Commissioner
CITY: ZIP: COUNTY:
Tamarac 33321-4110 Broward
***,BOTH, PARTS OF THIS SECTION MUST BE COMPLETED***
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS MY FINANCIAL INTERESTS FOR THE PERIOD BETWEEN JANUARY 1, 2022 AND THE LAST DATE I HELD THE PUBLIC
OFFICE OR EMPLOYMENT DESCRIBED ABOVE, WHICH DATE WAS 12/27/2022 2022. (Date must be prior to 12/31/22)
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). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (must check one):
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR Cif 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'Wa")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
Gelin Benefits Group
4503 NW 103 Ave. Sunrise FL 33351
Employee benefits consulting
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, clients, and other sources of income to businesses owned by 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
City of Miramar
Consulting Fees
2300 Civic Center Place
Benefits consulting
City of Lauderdale Lakes
Commission fees
4300 NW 36th St
Benefits consulting
D. Ste henson Construction
Commission fees
6241 N Dixie Hwy # A
Benefits consulting
PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] FILING INSTRUCTIONS for when
(If you have nothing to report, write "none" or "n/a") and where to file this form are
located at the bottom of page 2.
IMP INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3 of this packet.
CE Form 1F Effective: January 1, 2022 (Continued on reverse side) PAGE 1
Incorporated by reference in Rule 34-8.208(2), 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 'In/a")
TYPE OF INTANGIBLE I BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
Stocks, ETF's & Mutual Funds I Gelin Benefits Group - TD Ameritrade (401)K
PART E — LIABILITIES [Major debts - See instructions]
(If you have nothing to report, write "none" or "n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
Capital One I P.O. Box 30285 Salt Lake City, UT 84130-0285
American Express I P.O. Box 650448 Dallas, TX 75265-0448 1
Chase 1P.O. Box 6294, Carol Stream, IL 60197-6294 1
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
NAME OF BUSINESS ENTITY N/A I
OF BUSINESS ENTITY
NCIPAL BUSINESS ACTIVITY
IPOSITION HELD WITH ENTITY
11 OWN MORE THAN A 5% INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER:
It
Date Signed:
December 28, 2022
WHEN TO FILE:
At the end of office or employment each
local officer, state officer, and specified
state employee is required to file a final
disclosure form (Form 1F) within 60 days
of leaving office or employment, unless he
or she takes another position within the
60-day period that requires filing financial
disclosure on Form 1 or Form 6.
WHERE TO FILE:
Local officers 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
CE Fonn 1F Effective: January 1, 2022
u¢J PUld— oy feielenCe In mule 34-C.ZV25(Y), 1-.A.G.
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:
1, 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
FILING INSTRUCTIONS:
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.
To determine what category your position
falls under, see the "Who Must File" Instructions
on page 3.
NOTE:
If you are leaving office or employment
during the first half of 2022, you may not
have filed Form 1 for 2021. In that case,
this is not the last form you will file. Form
1F covers January 1, 2022, through your
last day of office or employment. You
will be required to file Form 1 for 2021 by
July 1, 2022, and risk being fined if you
do not file Form 1 by the filing deadline,
even if you have already filed the CE
Form IF.
PAC,F