8/11/2019 Hayward Form 1
http://slidepdf.com/reader/full/hayward-form-1 1/2
FORM
1
k
Please
prirt
or type
your
neme, mNlllng
addrcss, agency
name,
and
posltlon
below:
STATEMENT
OF
FTNANCIAL
INTBRBSTS
2A'3,
FOR OFFICE
USE
ONLY:
LAST NAME
*
FIRST
NAME
-
MIDDLE NAME :
'D
ll.tnrtr{
4rL/o-'
l^^p3
t|o.
6,atc
tz
I
to
'94.jil {
lx
ls:
CITY:
fcnsc
tol-
zt?:
Jz,f
2l
COUNW:
NAME OF OFFICE
OR POSITION
HEID
OR SOUGHT:
y'le7o-
You are not limited to
th€
gxc6
on the llnes
on ttb
form,
Attach
addhlonal sheets, lf nece$ary,
.-
CHECK ONLY rF
ff
CnruoronrE
oR
O
NEWEMPLOYEE
ORAPPO|NTEE
*"N"
BOTH
PARTS OF THIS SECTION MUST
BE COMPLETED
**N*
DISCLOSURE PERIOD:
THIS SIATEMENT
REFLECTS
YOUR FINANCIAL
INTERESTS
FOR
THE PRECEDING
TAX
YEAR, WHETHER BASED
ON A
CALENOAR
YEAR OR ON A FISCAL
YEAR.
PLEASE
STATE BELOW
TMIETHER
THIS
STATEMENT
IS
FOR THE
PRECEDING TAX YEAR
ENDING
EITHER
(mgl
check
one):
{ DEcEMBER31,2013
oa
D
spEcTFyTnxyEARTFoTHERTHANTHEcALENDARyEAR:
MANNER OF
CALCULATING
REPORTABLE INTERESTS:
FILERS
HAVE
THE
OPTION
OF USING REPORTING
THRESHOLDS
THATARE ABSOLUTE
DOTIAR
VALUES,
WHICH REQUIRES
FEWER
CALCULATIONS,
OR
USING
COMPARATIVE THRESHOLDS,
WHICH
ARE USUALLY BASED
ON
PERCENTAGE VALUES
(see
instructions
for
further
details).
CHECK
THE
ONE YOU ARE USTNG:
*--
4
coMPARATtvE(pERcENTAcElrHREsHoLDs
aa
tr
DoLLARVALUETHRESHoLDS
PART A
-
PRllulARY
SOURCES
OF INCOME
lMajor
sources
of income
to the reporting
person
-
See
instructions]
(lf
you
have
nothing
to roport,
write
"none"
or
"nla")
NAME OF
SOURCE
I
oF
rNcoME
I
souRcE's
ADDRESS
I
DEscRtpIoN
oF
THE
souRcE's
I PRINCIPALBUSINESSACTIVITY
'*
f^-
"
PART B
-
SECONDARY
SOURCES
OF INCOI,IE
[Major
customers,
clients, and other
sources of income
to
businesses
owned by the reporting
person
-
See instructionsl
(lf
you
have
nothing
to repor write "none"
or.'nla..)
NAME
OF
BUSINESS
ENTIry
I
NAME OF MAJOR
SOURCES
I
I
oF BUSTNESS,TNCOME
I
ADDRESS
OF SOURCE
I
PR|NCIPAT
BUSTNESS
I
ACTTVTTY
OF SOURCE
" 4/. "
PART C
-
REAL PROPERW
[Land,
buildings
or,r/ned
by
the
reporting
person
-
See
instructions]
(lf
you
have
nolhing
to reporl,
write
"none"
or
"n/a")
FILING INSTRUCTIONS
for
when and where
to file
this
form
are located
at the bottom
of
page
2,
INSTRUCTION$
on who
must
file this form
and how
to
fill it
out begin on
page
3.
t
t 7ao
7t+,,.a..'17
fu..nF
,rto-r2
Esc
Co
-
CE FORM
I
-
E
fecive: Janusry
1,
2014.
Adoptgd
by
referanco in Rut€
3+8.202t1), FA.C
(Gontlnued
on revorse sld6)
PAGE
1
8/11/2019 Hayward Form 1
http://slidepdf.com/reader/full/hayward-form-1 2/2
PART
D
-
tNTAilGtBLE
pERSOitAL
PROPERW
[Stocks,
bonds,
certificates
of deposit,
etc.
-
see
instructions]
{lt
you
have
nothlng
to
report,
write'none"
or
"nla")
I
NAMEoFGRED|ToR|-ADDRESSoFCRED|ToR
PART
E
-
LIABILITIES
[Major
debts
-
See instruc$onsl
(lf
you
have
nothlng
to
roport,
wdte
"none'
or "nla')
llo
3.
6o; /a-t
tf.ccf
.
?c.satol+,tsf.
l*fe?-
-r=
igOe?
8a
zrtac..s
4,2c.
?easaoola
Fl
J2$-o2
v
(tf you
have
nothing
to
repor
write
"nons"
or
"nla")
BUStNEss
ENTtry
#
r
r
BUslNEss ENTlry
#
2
NAME
OF
BUSTNESS
ENrlrY
|
' -'
'
I
PART F
-
INTERESTS
lN SpEclFlED
BUSINESSES
[Ownarshlp
or
poclttons
ln certaln
gpes
of
busineeseg'se€
instructlonsl
ADDRESS
OF
BUSINESS
ENTIW
PRINCIPAL BUSINESS ACTIVITY
POSITION
HELD
WTH
ENTITY
I
OVVN
MORE
THAN
A
5%
INTEREST
IN
THE
BUSINESS
NATURE
OF
MY
OIINERSHIP
INTEREST
SIGNATURE
(reouired):
kfrz/4
DATE SIGNED
(reouiredl:
t
/t,/tv
-
f a certified
public
accountffised
under
ch$ter
4i3,
or
attomey
in
good
standing
with the
Florida
Bar
prepared
this
form for
you,
ihe
musl complete
the
following
statement:
. prepared the
CE Form
1
in accordance
with Section
1'12.3145,
Florida Statutes,
Inoilied'ge
and
belief,
the
disclosure
herein
is
true
and correct.
he
o
my
Signature
Date
WHAT
TO FILE:
Afier completing
all
parts
of
this
form,
lnClgdbC
3igning
snd
datlno
lt
send
back
only the
first
sheet
(pages
'l
and
2) for
filing.
lf
you havo
nothlng
to
roport
in
a
particular
section,
you
must
write
'none"
or
"rVa"
in
that
section(s).
NOTE:
MULTIPLE
FILING
UNNECESSARY:
Generally,
a
person
who
has
filed
Form
1
for
a
calendar
or
fiscal
year
is not
required
to
file
a
second
Form
1
for
the
same
year.
However'
a
candidate
who
previously
filed
Form
1 because
of
another
pubtic
po$ition
must
at
least
fle
a
copy
of
his or
her
original
Form
1 when
gualifying.
WHERE
TO
FILE:
lf
you
were
mailed
the form by the
Commlssion
on
Ethics
or
a
County
SupoMsor
of
Eleciions
for
your
annual
disdosure
filir€,
retum the
form to
that
location.
Local
officers/employees
file with the
Supervisor
of
Elections
of the
county
in which they
permanendy
reside.
(lf
you
do
not
permanenty
eside
in
Florida'
file with
the
Supervisor
of
lhe
county where
your
agency
has
its
headguarters.)
State
offcer4s
or
qecilled
slrte
ettproyees
file
with the
Commission
on Ethics,
P.O.
Drawer
15709'
Tallahassee,
FL
32317-5709;
physical
address:
325
John
Knox
Road, Building
E'
Suiie
200'
Tallahassee,
FL
32303.
WHEN
TO
FILE:
lninatty,
each
local ofrcer/employee,
state
ofice
and
speofied
state employee
must
file lslfi
30 days
of
the
date
of his or
her
appdntrne
or of the
beginnitE
of employnent.
Appointee
who must
be confirmed
by the Senate
must
f
prior
to confrmation,
even
if
that
is
less
th
30 days
from the date
of
their
appointnen
Candidales
for pubticly-eteded
local
offce
must
f
st the same
time they
file
their
qualirying
papers.
Thercafter,
local oftcers/employees,
state
office
and specifed
state employees
are
required
to
f
by
July 1st
following eadl
calendar
year
in whi
they
hold
their
positions.
Finally,
at
the
end of ofice or
employmert,
ea
local
oficer/employee,
stiate offcer,
and
specift
state
employee
is required to
file a final
disclosu
form
(Form 1F) within
60
days
of leaving
office
employment.
Hoarever,
filing a CE Fofm
1F
(Fin
Statement
of
Financial
Interests) does
ngl
telie
tre
filer
of
filing a CE
Form
1 if he
or she
was
in
th
position
on
December
31, 20'13.
Candida|.c,s
file this
form together
with
qualirying
PaPers.
To determine
what
category
your
position
falls
under,
see
the 'V\ltro
Must
File"
Instruolions
on
page
3.
Facsimiles
will not
be accePted.
their
CE
FORM
1
- Eltec{ve:
January
1,2014.
Adopt€d
by
cisronce
in
Rule
3+8.202(l)'
F.A.C.
PAGE
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