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                  FORM 1                                STATEMENT OF                                                                                2009
     Please print or type your name, mailing
     address, agency name, and position below:     1 FINANCIAL INTERESTS
     LAST NME -- FIRST NAME -- MIDDLE NAME :
           .81,                                                                                                  FO    FFICE
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                                          ____                 Q,/                                               U	   ONLY:
     MAILING ADDRESS :
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    CITY :	
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                                                                                                                              ID Code



                                                                                                                              ID No.
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    NAME OF AGENCY :                                                                                                                                         §1
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     NAME OF OFFICE OR POSITION HELD OR SOUGHT :                                                                              R R. Code	
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    You are not limited to the space on the lines on this form. Attach additional sheets, if ne 	   any.                                                     n0
                                                                                                                                                             -TI
    CHECK ONLY IF' CANDIDATE	                    OR	         q NEW EMPLOYEE OR APPOINTEE

                                                       *1 313TH 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	        q	         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):
    q	        COMPARATIVE (PERCENTAGE) THRESHOLDS 	                            Ca
                                                                                	                   q	         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

    /40€-1-e-         eD10--/ A n J C S                                                   a
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    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 sport , you must write "none" or "n/a")
               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]
             (If you have nothing to report, you must write "none" or "n/a")                                             FILING INSTRUCTIONS for
                                                                                                                         when and where to file this form
                                                                                                                         are located at the bottom of page 2.
     _.7 2 /3 A./r “15 tome	                                       e4fie, CostitiPe-- 3290,
                                                                               i                                         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 "nla")
                   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 "n/a")
                     NAME OF CREDITOR                                                                  ADDRESS OF CREDITOR

               A_J//


    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 "n/a")
                                                BUSINESS ENTITY # 1             BUSINESS ENTITY # 2                                BUSINESS ENTITY # 3

    NAME OF BUSINESS ENTITY                         t-VA
    ADDRESS OF BUSINESS ENTITY
                                                  Ay4
    PRINCIPAL BUSINESS ACTIVITY                   All 4
    POSITION HEW WITH ENTITY
                                                   Ai /A
    I OWN MORE THAN A 5%
    INTEREST IN THE BUSINESS                         —1/1
    NATURE OF MY
    OWNERSHIP INTEREST                              /---///


            IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE                                                             q
    SIGNATURE (required):	                y	                     ,..A___A---	
                                                                              7 	                         DATE SIGNED (require :
                                                                                                                                    ..7.-- to
                  r>	
                                                            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, stat
    signing and dating it, send back only the first	         on Ethics or a County Supervisor of Elections for	    officer, and	 specified state employee mu
    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
                                                             that location.	                                       appointment or of the beginning of emplo
    If you have nothing to report in a particular                                                                  ment. Appointees who must be confirmed b
                                                             Local officers/ p	
                                                             Lora/ officers/em ployees file with the Supervisor    the Senate must file prior to confirmation, eve
    section, you must write "none" or "n/a" in that 	        of Elections of the county in which they perms-
    section(s). 	                                                                                                  if that is less than 30 days from the date of the
                                                             nently reside. (If you do not permanently reside
                                                                                                                   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 offi
                                                                                                                   must file at the same time they file th
    NOTE:	                                                    State officers or specified state employees	         qualifying papers.
    MULTIPLE FILING UNNECESSARY:	                            file with the Commission on Ethics, P.O. Drawer 	
    Generally, a person who has filed Form 1 for a	           15709, Tallahassee,	 FL 32317-5709; physical	        Thereafter,	 local officers/employees,	 sta
    calendar or fiscal year is not required to file a 	       address: 3600 Maday Boulevard, South, Suite	         officers, and specified state employees a
                                                             .201, Tallahassee, FL 32312. 	                        required to file by July 1st following ea
    second Form 1 for the same year. However, a 	
                                                                                                                   calendar year in which they hold their po
    candidate who previously filed Form 1 because 	           Candidates file this form together with their 	
    of another public position must at least file a copy	                                                          lions.
                                                              qualifying papers.	
    of his or her original Form 1 when qualifying.                                                                 Finally, at the end of office or employme
                                                                     To determine what category your position	     each local officer/employee, state officer, a
                                                              falls under, see the "Who Must File" Instructions	   specified state employee is required to file
                                                              on page 3.	                                          final disclosure form (Form 1F) within 60 da
                                                                                                                   of leaving office or employment.

    CE FORM 1 - Eff. 1/2010
              •




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posted:9/29/2011
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