HomeMy WebLinkAboutDocumentation_Pension General_Tab 20_05/03/2010 THE LAW OFFICES OF
PERRY & JENSEN, LLC
ANN H. PERRY BONNI SPATARA JENSEN
aperry@perryjensenlaw.com bsjensen @perryjensenlaw.com
MEMORANDUM
VIA ELECTRONIC MAIL DELIVERY
TO: VILLAGE OF TEQUESTA GENERAL EMPLOYEES' PENSION TRUST FUND
Board of Trustees
FROM: Bonni S. Jensen
Fund Legal Counsel
DATE: May, 2010
RE: ANNUAL FORM 1 FILING
Attached is Commission on Ethics (CE) Form 1 which must be filed by Trustees with
the Supervisor of Elections for the county in which they reside, prior to July 1 each year.
The instructions for filing and completing the form are also attached. Please note that it
is recommended that current or former law enforcement officers and firefighters do not use
their home addresses on the form; if you do not have a post office box, you may use your
work address.
You may also complete the form online using your keyboard to fill in the information,
tabbing from one section to the next. However, you must print the completed form, sign
and date it, then send it to the Supervisor of Elections for the county in which you
reside There is no current system available to file online.
It is important that you timely file this form because the penalty for failure to timely
file is $25.00 per day, to a maximum of $1,500.00. 1 suggest that you file this form by
certified mail, return receipt requested, or and keep a photo copy of the form for your files.
Several Trustees have had to show proof of filing in the past, so it is my practice to always
get a receipt for such documents.
If you have any questions or if I may be of any assistance to you at all, please do
not hesitate to contact me or one of my assistants.
BSJ /adt
E -Copy: Administrator
400 EXECUTIVE CENTER DRIVE, SUITE 207 -e WEST PALM BEACH FLORIDA 33401 -2922
PH: 561.686.6550 •:• Fx: 561.88 2802
H: II - ce aneous LL BOARDS\201 0\201 0 Form 1 Cvr Memompd
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USING ELECTRONIC FORMS
There are two options for utilizing our online forms if you are using the Free
Adobe Acrobat Reader ®:
1. You may print a blank form, fill it out, sign it and send it in.
2. Or, you can type your disclosure information directly on the form
and then print it out, sign it and send it in.
For Option 2:
• Select the hand tool F.,,R from the Acrobat toolbar menu.
• Move the hand inside a field. Click when it changes to an I -beam pointer v,..
The I -beam pointer allows you to type text. The hand tool will also become a
pointer tool when it passes over a box, which allows you to click and check the
box.
• Press tab to accept the information you have typed and go to the next field.
• Press shift +tab to accept the information you have typed and go to the previous
field.
• Typed text that goes beyond the limit of a field will not be printed. You may
shorten the entry by using generally accepted abbreviations.
• You may also use your mouse to move from field to field.
• Use the zoom tool 'S to magnify the page for easier viewing.
IMPORTANT — PLEASE READ:
• OPEN UP THE APPROPRIATE SET OF INSTRUCTIONS FOR THE FORM OR
PRINT THEM OUT. CAREFULLY READ AND FOLLOW THE INSTRUCTIONS
FOR COMPLETING THE FORM. THEY CONTAIN HELPFUL INFORMATION
AND EXAMPLES TO ASSIST YOU.
• FORMS CANNOT BE ELECTRONICALLY SUBMITTED.
• USE THE PRINT BUTTON ON THE ADOBE TOOL BAR TO PRINT THE FORM.
YOUR INTERNET PRINT BUTTON WILL NOT PRINT THE FORM.
• FILLED -IN FORMS CANNOT BE SAVED ON YOUR COMPUTER IF YOU
ATTEMPT TO SAVE YOUR FORM, IT WILL CLEAR ALL THE INFORMATION
YOU INPUT.
• MAKE SURE THAT YOU MAKE A COPY OF YOUR COMPLETED, SIGNED
DISCLOSURE FORM AND KEEP IT WITH YOUR IMPORTANT PAPERS.
FORM 1 STATEMENT OF 2009
Please print or type your name, mailing FINANCIAL INTERESTS
address, agency name, and position below:
LAST NAME -- FIRST NAME -- MIDDLE NAME: FOR OFFICE
USE ONLY:
MAILING ADDRESS :
ID Code
CITY: ZIP : COUNTY:
ID No.
NAME OF AGENCY:
Conf. Code
NAME OF OFFICE OR POSITION HELD OR SOUGHT: P. Req. Code
You are not limited to the space on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF ❑ CANDIDATE OR ❑ 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 (check one):
❑ DECEMBER 31, 2009 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
THE LEGISLATURE ALLOWS FILERS 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 (check one):
❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS
PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person]
(If you have nothing to report, you must write "none" or "n /a ")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF 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]
(If you have nothing to report, you must write "none" or "nia ")
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] FILING INSTRUCTIONS for
(If you have nothing to report, you must write "none" or "n /a ") 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.
OTHER FORMS you may need
to file are described on page 6.
CE FORM 1 - Eff. 1/2010 (Continued on reverse side) PAGE 1
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc.]
(If you have nothing to report, you must write "none" or "n /a ")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
PART E — LIABILITIES [Major debts]
(If you have nothing to report, you must write "none" or "nia ")
NAME OF CREDITOR ADDRESS OF CREDITOR
PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses]
(If you have nothing to report, you must write "none" or'Wa ")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3
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
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE (required): DATE SIGNED (required):
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, including If you were mailed the form by the Commission Initially, each local officer /employee, state
signing and dating it, send back only the first on Ethics or a County Supervisor of Elections for officer, and specified state employee must
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to file within 30 days of the date of his or her
that location. appointment or of the beginning of employ -
If you have nothing to report in a particular ment, Appointees who must be confirmed by
of Elections of the
section, you must write "none" or "n /a" in that Local bo of the to couunty nty in permanently r which they p reside le with the Supervisor the Senate must file prior to confirmation, even
nently reside. (If you do not section(s). ey if that is less than 30 days from the date of their
appointment.
in Florida, file with the Supervisor of the county
Facsimiles will not be accepted. where your agency has its headquarters.) Candidates for publicly - elected local office
NOTE: State officers or specified state employees must file at the same time they file their
MULTIPLE FILING UNNECESSARY: file with the Commission on Ethics, P.O. Drawer qualifying papers.
Generally, a person who has filed Form 1 for a 15709, Tallahassee, FL 32317 -5709; physical Thereafter, local officers / employees, state
calendar or fiscal year is not required to file a address: 3600 Maclay Boulevard, South, Suite officers, and specified state employees are
second Form 1 for the same year. However, a 201, Tallahassee, FL 32312. required to file by July 1st following each
candidate who previously filed Form 1 because Candidates file this form together with their calendar year in which they hold their posi-
of another public position must at least file a copy qualifying papers. tions.
of his or her original Form 1 when qualifying. Finally, at the end of office or employment,
To determine what category your position each local officer /employee, state officer, and
falls under, see the "Who Must File" Instructions specified state employee is required to file a
on page 3. final disclosure form (Form 1F) within 60 days
of leaving office or employment.
CE FORM 1 - Eff. 1/2010 PAGE 2
INSTRUCTIONS FOR COMPLETING FORM I
STATEMENT OF FINANCIAL INTERESTS
WHO MUST FILE FORM 1:
All persons who fall within the categories of "state officers," 'local officers /employees," "specified state employees,' as well as candidates for elective local office,
are required to file Form 1. Positions within these categories are listed below. Persons required to file full financial disclosure (Form 6) and officers of the judicial
branch do not file Form 1 (see Form 6 for a list of persons who must file that form).
STATE OFFICERS include the following positions for state officials: county or city manager; chief administrative employee of a county, municipal -
1) Elected public officials not serving in a political subdivision of the state ity, or other political subdivision; county or municipal attorney; chief county or
and any person appointed to fill a vacancy in such office, unless required to municipal building inspector; county or municipal water resources coordina-
file full disclosure on Form 6. tor; county or municipal pollution control director; county or municipal envi-
2) Appointed members of each board, commission, authority, or council ronmental control director; county or municipal administrator with power to
having statewide jurisdiction, excluding members of sole advisory bodies; grant or deny a land development permit; chief of police; fire chief; municipal
but including judicial nominating commission members; Directors of the clerk; appointed district school superintendent; community college president;
Florida Black Business Investment Board, Enterprise Florida, Scripps Florida district medical examiner; purchasing agent (regardless of title) having the
Funding Corporation, Workforce Florida, and Space Florida; Members of the authority to make any purchase exceeding $15,000 for the local governmen-
Florida Commission on Tourism. Florida Substance Abuse and Mental Health tal unit.
Corporation, and the Council on the Social Status of Black Men and Boys; and SPECIFIED STATE EMPLOYEES include the following positions
Governors and senior managers of Citizens Property Insurance Corporation for state employees:
and Automobile Joint Underwriting Association. 1) Employees in the office of the Governor or of a Cabinet member who
3) The Commissioner of Education, members of the State Board of are exempt from the Career Service System, excluding secretarial, clerical,
Education, the Board of Governors, and the local Boards of Trustees and and similar positions.
Presidents of state universities. 2) The following positions in each state department, commission,
LOCAL OFFICERS /EMPLOYEES include the following positions board, or council: Secretary, Assistant or Deputy Secretary, Executive
for officers and employees of local government: Director, Assistant or Deputy Executive Director, and anyone having the
1) Persons elected to office in any political subdivision (such as munici- power normally conferred upon such persons, regardless of title.
palities, counties, and special districts) and any person appointed to fill a 3) The following positions in each state department or division: Director,
vacancy in such office, unless required to file full disclosure on Form 6. Assistant or Deputy Director, Bureau Chief, Assistant Bureau Chief, and any
2) Appointed members of the following boards, councils, commissions, person having the power normally conferred upon such persons, regardless
authorities, or other bodies of any county, municipality, school district, inde- of title.
pendent special district, or other political subdivision: the governing body 4) Assistant State Attorneys, Assistant Public Defenders, Public
of the subdivision; a community college or junior college district board of Counsel, full -time state employees serving as counsel or assistant counsel
trustees; a board having the power to enforce local code provisions; a board to a state agency, administrative law judges, and hearing officers.
of adjustment; a planning or zoning board having the power to recommend, 5) The Superintendent or Director of a state mental health institute estab-
create, or modify land planning or zoning within the political subdivision, lished for training and research in the mental health field, or any major state
except for citizen advisory committees, technical coordinating committees, institution or facility established for corrections, training, treatment, or reha-
and similar groups who only have the power to make recommendations to bilitation.
planning or zoning boards; a pension board or retirement board empowered 6) State agency Business Managers, Finance and Accounting Directors,
to invest pension or retirement funds or to determine entitlement to or amount Personnel Officers, Grant Coordinators, and purchasing agents (regardless
of a pension or other retirement benefit. of title) with power to make a purchase exceeding $15,000.
3) Any other appointed member of a local government board who is 7) The following positions in legislative branch agencies: each employ -
required to file a statement of financial interests by the appointing authority or ee (other than those employed in maintenance, clerical, secretarial, or similar
the enabling legislation. ordinance, or resolution creating the board. positions and legislative assistants exempted by the presiding officer of their
4) Persons holding any of these positions in local government: Mayor; house); and each employee of the Commission on Ethics.
INSTRUCTIONS FOR COMPLETING FORM 1:
INTRODUCTORY INFORMATION (At Top of Form): listed in Section 119.071(4)(d), F.S., are encouraged to provide an address
other than their home address.
If your name, mailing address, public agency, and position are
already printed on the form, you do not need to provide this informa- DISCLOSURE PERIOD: The tax year for most individuals is the calendar
tion unless it should be changed. To change any of this information, year (January 1 through December 31). If that is the case for you, then
write the correct information on the form, then contact your agency's your financial interests should be reported for the calendar year 2009; just
financial disclosure coordinator. Your coordinator is identified in the check the box and you do not need to add any information in this part of
financial disclosure portal on the Commission on Ethics website: the form. However, if you file your IRS tax return based on a tax year that is
vrww.ethics.state.fl.us. not the calendar year, you should specify the dates of your tax year in this
portion of the form and check the appropriate box. This is the time frame
NAME OF AGENCY: This should be the name of the governmental unit or "disclosure period" for your report.
which you serve or served, by which you are or were employed, or for MANNER OF CALCULATING REPORTABLE INTERESTS: As noted in
which you are a candidate. For example, "City of Tallahassee," "Leon
County," or "Department of Transportation." this portion of the form, the Legislature has given filers the option of report-
ing based on either thresholds that are comparative (usually, based on
OFFICE OR POSITION HELD OR SOUGHT: Use the title of the office percentage values) or thresholds that are based on absolute dollar values.
or position you hold, are seeking, or held during the disclosure period (in The instructions on the following pages specifically describe the different
some cases you may not hold that position now, but you still would be thresholds. Simply check the box that reflects the choice you have made.
required to file to disclose your interests during the last year you held that You must use the type of threshold you have chosen for each part of the
position). For example, "City Council Member," "County Administrator," form. In other words, if you choose to report based on absolute dollar
"Purchasing Agent," or 'Bureau Chief." if you are a candidate for office or value thresholds, you cannot use a percentage threshold on any part of
are a new employee or appointee, check the appropriate box. the form.
MAILING ADDRESS: If your home address appears on the form but
you prefer another address be shown, change the address as described
above If you are an active or former officer or employee listed in Section
119.071(4)(d), F.S., whose home address is exempt from disclosure,
the Commission is required to maintain the confidentiality of your home (CONTINUED on page 4) C&-
address if you submit a written request for confidentiality. Persons
CE FORM 1 - Eff. 1/2010 PAGE 3
PART A - PRIMARY SOURCES OF INCOME (1) You owned (either directly or indirectly in the form of an
equitable or beneficial interest) during the disclosure period more
[Required by Sec. 112.3145(3)(a)l or (b)1, Fla. Stat.] than five percent (5 %) of the total assets or capital stock of a
Part A is intended to require the disclosure of your principal sources of business entity (a corporation, partnership, limited partnership,
income during the disclosure period. You do not have to disclose the amount proprietorship, joint venture, trust, firm, etc., doing business in
of income received. The sources should be listed in descending order, Florida); and
with the largest source first. Please list in this part of the form the name, (2) You received more than ten percent (10 %) of your gross income
address, and principal business activity of each source of your income which during the disclosure period from that business entity; and
(depending on whether you have chosen to report based on percentage (3) You received more than $1,500 in gross income from that
thresholds or on dollar value thresholds) either: business entity during the period.
exceeded five percent (5 %) of the gross income received by you in (b) If you are reporting based on dollar value thresholds:
your own name or by any other person for your benefit or use during the
disclosure period, or (1) You owned (either directly or indirectly in the form of an
equitable or beneficial interest) during the disclosure period more
exceeded $2,500.00 (of gross income received during the disclosure than five percent (5 %) of the total assets or capital stock of a
period by you in your own name or by any other person for your use or
benefit}. business entity (a corporation, partnership, limited partnership,
proprietorship, joint venture, trust, firm, etc., doing business in
You need not list your public salary received from serving in the Florida); and
position(s) which requires you to file this form, but this amount should be (2) You received more than $5,000 of your gross income during
included when calculating your gross income for the disclosure period. The the disclosure period from that business entity.
income of your spouse need not be disclosed. However, if there is joint
income to you and your spouse from property held by the entireties (such as If your interests and gross income exceeded the appropriate thresholds listed
interest or dividends from a bank account or stocks held by the entireties), above, then for that business entity you must list every source of income to
you should include all of that income when calculating your gross income and the business entity which exceeded ten percent (10 %) of the business entity's
disclose the source of that income if it exceeded the threshold. gross income (computed on the basis of the business entity's most recently
completed fiscal year), the source's address, and the source's principal
"Gross income" means the same as it does for income tax purposes, business activity.
including all income from whatever source derived, such as compensation for Examples:
services, gross income from business, gains from property dealings, interest,
rents, dividends, pensions, social security, distributive share of partnership — You are the sole proprietor of a dry cleaning business, from which
gross income, and alimony, but not child support, you received more than 10% of your gross income (an amount that was
Examples: more than $1,500) (or, alternatively, more than $5,000, if you are using
dollar value thresholds). If only one customer, a uniform rental company,
— If you were employed by a company that manufactures computers provided more than 10% of your dry cleaning business, you must list
and received more than 5% of your gross income (salary, commissions, the name of the uniform rental company, its address, and its principal
etc.) from the company (or, alternatively, $2,500), then you should list business activity (uniform rentals).
the name of the company, its address, and its principal business activity — You are a 20% partner in a partnership that owns a shopping mall
(computer manufacturing).
and your partnership income exceeded the thresholds listed above. You
— If you were a partner in a law firm and your distributive share of should list each tenant of the mall that provided more than 10% of the
partnership gross income exceeded 5% of your gross income (or, partnership's gross income, the tenant's address and principal business
alternatively, $2,500), then you should list the name of the firm, its activity.
address, and its principal business activity (practice of law). — You own an orange grove and sell all your oranges to one marketing
— If you were the sole proprietor of a retail gift business and your gross cooperative. You should list the cooperative, its address, and its principal
income from the business exceeded 5% of your total gross income (or, business activity if your income met the thresholds.
alternatively, $2,500), then you should list the name of the business, its
address, and its principal business activity (retail gift sales). PART C — REAL PROPERTY
— If you received income from investments in stocks and bonds, you [Required by Sec. 112.3145(3)(a)3 or (b)3, Fla. Stat.]
are required to list only each individual company from which you derived
more than 5% of your gross income (or, alternatively, $2,500), rather In this part, please list the location or description of all real property (land
than aggregating all of your investment income. and buildings) in Florida in which you owned directly or indirectly at any time
— If more than 5% of your gross income (or, alternatively, $2,500) during the previous tax year in excess of five percent (5 %) of the property's
was gain from the sale of property (not just the selling price), then value. This threshold is the same, whether you are using percentage
you should list as a source of income the name of the purchaser, the thresholds or dollar thresholds. You are not required to list your residences
purchaser's address, and the purchaser's principal business activity. If and vacation homes; nor are you required to state the value of the property
the purchaser's identity is unknown, such as where securities listed on on the form.
an exchange are sold through a brokerage firm, the source of income Indirect ownership includes situations where you are a beneficiary of
should be listed simply as "sale of (name of company) stock," for a trust that owns the property, as well as situations where you are more
example. than a 5% partner in a partnership or stockholder in a corporation that owns
— If more than 5% of your gross income (or, alternatively, $2,500) the property. The value of the property may be determined by the most
was in the form of interest from one particular financial institution recently assessed value for tax purposes, in the absence of a more current
(aggregating interest from all CD's. accounts, etc., at that institution), appraisal.
list the name of the institution, its address, and its principal business The location or description of the property should be sufficient to
activity. enable anyone who looks at the form to identify the property. Although a
legal description of the property will do, such a lengthy description is not
PART B - SECONDARY SOURCES OF INCOME required. Using simpler descriptions, such as "duplex, 115 Terrace Avenue,
Tallahassee" or 40 acres located at the intersection of Hwy. 60 and 1 -95, Lake
[Required by Sec. 112.3145(3)(x)2 or (b)2, Fla. Stat.] County' is sufficient. In some cases, the property tax identification number of
This part is intended to require the disclosure of major customers, the property will help in identifying it: "120 acre ranch on Hwy. 902, Hendry
Tax ID # 131 - 45863."
clients, and other sources of income to businesses in which you own an County, (CONTINUED on page 5) ce-
interest. You will not have anything to report unless:
(a) If you are reporting based on percentage thresholds:
CE FORM 1 - Eff. 112010 PAGE 4
Examples: PART E — LIABILITIES
— You own 1/3 of a partnership or small corporation that owns both a [Required by Sec. 112.3145(3)(a)4 or (b)4, Fla. Stat.]
vacant lot and a 12% interest in an office building. You should disclose
the lot, but are not required to disclose the office building (because your In this part of the form, list the name and address of each private or
1/3 of the 12% interest —which equals 4% —does not exceed the 5% governmental creditor to whom you were indebted for a liability in any amount
threshold), that, at any time during the disclosure period, exceeded:
— If you are a beneficiary of a trust that owns real property and your (1) your net worth (if you are using percentage thresholds), Q
interest depends on the duration of an individual's life, the value of your (2) $10,000 (if you are using dollar value thresholds).
interest should be determined by applying the appropriate actuarial table
to the value of the property itself, regardless of the actual yield of the You are not required to list the amount of any indebtedness or your net
property. worth. You do not have to disclose any of the following: credit card and retail
installment accounts, taxes owed (unless reduced to a judgment), indebted -
PART D — INTANGIBLE PERSONAL PROPERTY ness on a life insurance policy owed to the company of issuance, contingent
liabilities, and accrued income taxes on net unrealized appreciation (an
[Required by Sec. 112.3145(3)(a)3 or (b)3, Fla. Stat.] accounting concept). A "contingent liability' is one that will become an actual
liability only when one or more future events occur or fail to occur, such as
Provide a general description of any intangible personal property that, at
any time during the disclosure period, was worth more than: where you are liable only as a guarantor, surety, or endorser on a promissory
note. If you are a "co- maker" and have signed as being jointly liable or jointly
(1) ten percent (10 %) of your total assets (if you are using percentage and severally liable, then this is not a contingent liability; if you are using the
thresholds), or $10,000 threshold and the total amount of the debt (not just the percentage
(2) $10,000 (if you are using dollar value thresholds), of your liability) exceeds $10,000, such debts should be reported.
Calculations for persons using comparative (percentage) thresholds: In
and state the business entity to which the property related. Intangible per- order to decide whether the debt exceeds your net worth, you will need to
sonal property includes such things as money, stocks, bonds, certificates of
total all of your liabilities (including promissory Hates, mortgages, credit card
deposit, interests in partnerships, beneficial interests in a trust, promissory debts, lines of credit, judgments against you, etc.). Subtract this amount from
notes owed to you, accounts receivable by you, IRA's, and bank accounts.
the value of all your assets as calculated above for Part D. This is your "net
Such things as automobiles, houses, jewelry, and paintings are not intan-
worth." You must list on the form each creditor a whom your debt exceeded
gible property. Intangibles relating to the same business entity should be this amount unless it is one of the types of indebtedness fisted i the para-
aggregated; for example, two certificates of deposit and a savings account graph above (credit card and retail installment accounts, etc.). Joint liabilities
with the same bank. Where property is owned by husband and wife as ten-
ants by the entirety (which usually will be the case) the property should be with others for which you are "jointly and severally liable," meaning that you
valued at 100 %. may be liable for either your part or the whole of the obligation, should be
included in your calculations based upon your percentage of liability, with
Calculations: In order to decide whether the intangible property exceeds the following exception: joint and several liability with your spouse for a debt
10% of your total assets, you will need to total the value of all of your assets which relates to property owned by both of you as "tenants by the entirety"
(including real property, intangible property, and tangible personal property (usually the case) should be included in your calculations by valuing the asset
such as automobiles, jewelry, furniture, etc.). When making this calculation, at 100% of its value and the liability at 100% of the amount owed.
do not subtract any liabilities (debts) that may relate to the property —add Examples for persons using comparative (percentage) thresholds:
only the fair market value of the property. Multiply the total figure by 10 to
arrive at the disclosure threshold. List only the intangibles that exceed this — You owe $15,000 to a bank for student loans, $5,000 for credit
threshold amount. Jointly owned property should be valued according to the card debts, and $60,000 (with your spouse) to a savings and loan for a
percentage of your joint ownership, with the exception of property owned by home mortgage. Your home (owned by you and your spouse) is worth
husband and wife as tenants by the entirety, which should be valued at 100 %. $80,000 and your other property is worth $20,000. Since your net worth
None of your calculations or the value of the property have to be disclosed on is $20,000 ($100,000 minus $80,000), you must report only the name
the form. If you are using dollar value thresholds, you do not need to make and address of the savings and loan.
any of these calculations. — You and your 50% business partner have a $100,000 business loan
Examples for persons using comparative (percentage) thresholds: from a bank, for which you both are jointly and severally liable. The
— You own 50% of the stock of a small corporation that is worth value of the business, taking into account the loan as a liability of the
$100,000, according to generally accepted methods of valuing small business, is $50,000. Your other assets are worth $25,000, and you
owe $5,000 on a credit card. Your total assets will be $50,000 (half of
businesses. The estimated fair market value of your home and other
a business worth $50,000 plus 0 of other assets). Your liabilities,
property (bank accounts, automobile, furniture, etc.) is $200,000. As et w
n
your total assets are worth $250,000, you must disclose intangibles for purposes of calculating your net worth, will be only n v , because
worth over $25,000. Since the value of the stock exceeds this threshold, the full amount of the business loan already was includeed d in the
you should list "stock'' and the name of the corporation. If your accounts business. Therefore, your net worth is $45,00 Since your r v 50% share
of the $100,000 business loan exceeds this net worth figure, you must
with a particular bank exceed $25,000, you should list "bank accounts" list the bank.
and bank's name.
— When you retired, your professional firm bought out your partner- PART F — INTERESTS IN SPECIFIED
ship interest by giving you a promissory note, the present value of
which is $100,000. You also have a certificate of deposit from a bank BUSINESSES
worth $75,000 and an investment portfolio worth $300,000, consisting [Required by Sec. 112.3145(5), Fla. Stat.]
of $100,000 of IBM bonds and a variety of other investments worth
between $5,000 and $50,000 each. The fair market value of your The types of businesses covered in this disclosure are only: state and
remaining assets (condominium, automobile. and other personal prop- federally chartered banks; state and federal savings and loan associations;
erty) is $225,000. Since your total assets are worth $700,000, you must cemetery companies: insurance companies (including insurance agencies);
list each intangible worth more than $70,000. Therefore, you would list mortgage companies; credit unions; small loan companies; alcoholic bever-
"promissory note" and the name of your former partnership, "certificate age licensees; pari- mutuel wagering companies, utility companies, entities
of deposit" and the name of the bank, "bonds" and "IBM," but none of controlled by the Public Service Commission; and entities granted a franchise
the rest of your investments. to operate by either a city or a county government.
(CONTINUED on page 6) c�3f-
CE FORM 1 - Eff. 1/2010 PAGE 5
You are required to disclose in this part of the form the fact that you disclosure period, an officer, director, partner, proprietor, or agent (other than
owned during the disclosure period an interest in, or held any of certain posi- a resident agent solely for service of process).
tions with, particular types of businesses listed above. You are required to If you have or held such a position or ownership interest in one of these
make this disclosure if you own or owned (either directly or indirectly in the apes of businesses, list (vertically for each business): the name of the busi-
form of an equitable or beneficial interest) at any time during the disclosure ness, its address and principal business activity, and the position held with
period more than five percent (5 %) of the total assets or capital stock of one the business (if any). Also, if you own(ed) more than a 5% interest in the
of the types of business entities granted a privilege to operate in Florida that business, as described above, you must indicate that fact and describe the
are listed above. You also must complete this part of the form for each of nature of your interest.
these types of businesses for which you are, or were at any time during the
(End of Instructions.)
PENALTIES
A failure to make any required disclosure constitutes grounds for and may be punished by one or more of the following. dis-
qualification from being on the ballot, impeachment, removal or suspension from office or employment, demotion, reduction in
salary, reprimand, or a civil penalty not exceeding $10, 000. [Sec. 112.317, Florida Statutes]
Also, if the annual form is not filed by September 1st, a fine of $25 for each day late will be imposed, up to a maximum
penalty of $1,500. (Section 112.3145, F.S. ].
OTHER FORMS YOU MAY NEED TO FILE
IN ORDER TO COMPLY WITH THE ETHICS LAWS
In addition to filing Form 1, you may be required to file one or more of the special purpose forms listed below, depending on your particular position,
business activities, or interests. As it is your duty to obtain and file any of the special purpose forms which may be applicable to you, you should carefully
read the brief description of each form to determine whether it applies.
Form 1 F — Final Statement of Financial private gain (or loss) or to the special gain (or loss) of a relative, busi-
Interests Required of local officers, state officers, and speci- ness associate, or one by whom he or she is retained or employed. Each
fied state employees within 60 days after leaving office or employment. appointed state officer who seeks to influence the decision on such a
This form is used to report financial interests between January 1 st of the measure prior to the meeting must file the form before undertaking that
last year of office or employment and the last day of office or employ- action. [Sec. 112.3143, Fla. Stat.]
ment. [Sec. 112.3145(2)(b), Fla. Stat.] Form 8B — Memorandum of Voting Conflict for
Form IX — Amended Statement of Financial County, Municipal, and Other local Public
Interests To be used by local officers, state officers, and speci- Off icers: Required to be filed (within 15 days of abstention) by
fied state employees to correct mistakes on previously filed Form 1's. each local officer who must abstain from voting on a measure which
[Sec. 112.3145(9), Fla. Stat.] would inure to his or her special private gain (or loss) or the special gain
Form 2 — Quarterly Client Disclosure Re ions) of a relative, business associate, one whom he or she is
y Required retained or employed. Each appointed local al official who seeks to influ-
of local officers, state officers, and specified state employees to ence the decision on such a measure prior to the meeting must file the
disclose the names of clients represented for compensation by them- form before undertaking that action. [Sec. 112.3143, Fla. Stat.]
selves or a partner or associate before agencies at the same level of
government as they serve. The form should be filed by the end of the Form 9 — Quarterly Gift Disclosure Required of
calendar quarter (March 31, June 30, Sept. 30, Dec. 31) following the local officers, state officers, specified state employees, and state
calendar quarter in which a reportable representation was made. [Sec, procurement employees to report gifts over $100 in value. The form
112.3145(4), Fla. Stat.] should be filed by the end of the calendar quarter (March 31, June 30,
Form 3A — Statement of Interest in Competitive September re o December following the calendar quarter in which
l� the gift was re ce i ved. [Sec. 112. 3148, Fla. Stat.]
Bid for Public Business Required of public officers and Form 10 — Annual Disclosure of Gifts from
public employees prior to or at the time of submission a bid for public Governmental Entities and Direct Support
business which otherwise would violate Sec. 112.313(3 ) or 112.313(7). Organizations and Honorarium Event Related
Fla. Stat. [Sec. 112.313(12)(b), Fla. Stat.]
Form 4A — Disclosure of Business Transaction Expenses Required of local officers, state officers, specified
Transaction, state employees, and state procurement employees to report gifts
Relationship, or Interest Required of public officers and over $100 in value received from certain agencies and direct support
employees to disclose certain business transactions, relationships, or organizations: also to be utilized by these persons to report honorarium
interests which otherwise would violate Sec. 112.313(3) or 112.313(7), event - related expenses paid by certain persons and entities.The form
Fla. Stat. [Sec. 112.313(12) and (12)(e), Fla. Stat.] should be filed by July 1 following the calendar year in which the gift or
Form 8A — Memorandum of Voting Conflict for honorarium event - related expense was received. [Sec. 112.3148 and
State Officers Required to be filed by a state officer within 15 112.3149, Fla. Stat.]
days after having voted on a measure which inured to his or her special
AVAILABILITY OF FORMS; FOR MORE INFORMATION
Copies of these forms are available from the Supervisor of Elections Questions about any of these forms or the ethics laws may be
in your county; from the Commission on Ethics. Post Office Drawer addressed to the Commission on Ethics, Post Office Drawer 15709,
15709, Tallahassee, Florida 32317 -5709; telephone (850) 488 -7864; Tallahassee, Florida 32317 -5709; telephone (850) 488 -7864.
and at the Commission's web site: www.ethics.state.fl.us.
CE FORM 1 - Eff. 112010 PAGE 6