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