Jose Smith March 2012 Y _
Form 9 QUARTEKLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME- MIDDLE NAME: NAME OF AGENCY:
Smith, Jose City of Miami Beach-City Attorney's Office
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Drive,4th Floor City Attorney
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade ZMARCH ❑JUNE ❑SEPTEMBER ❑ DECEMBER 2012
PART A— STATEMENT OF GIFTS r—
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which lh i�3tategi ri is
being filed.You are required to describe the gift and slate the monetary value of the gift,the name and address of the person making.ttde gift: nd thet
date(s)the gift was received. If any of these facts,other than the gift description,are unknown or not applicable,you should so state op-the f .As = )
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain otr giftYou C1
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift. 'r` CO
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS O�PERSCp "�-
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING TtE GI y... t`,
ij
C- d? ✓
Pleases a attached Exhibit"A" tl►
a CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy of that receipt to this
form.You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLO IDA
COUNTY OF Miami-Dade
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subscribed before me this :?
March day of March ,20 12
herein and on any attachments made by me constitutes a true accurate,
by Jose Smith
and I listing of all gifts required to be reported by Section 112.3148,
Florida S atutes. G (Si nature of Notary Florriid�a
YAMILEX MORALES
(Print,Type,or Stam Commission o�1 16,2013
R OF REPORTING OFFICIAL Personally Known OR Pr ' ifi T�F� ots
_ Type of Identificatio Produced
PART D— FILING INSTRUCTIONS
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi-
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calendar quarter
that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.)
CE FORM 9-EFF.1/2007 (See reverse side for instructions)
Over a$100
Date Description Monetary Name of person Address of person
Rec. of gift Value making the gift making the gift
1-17-12 Le Corsaire $120.00 City of Miami Beach 1700 Convention Center Drive
2-9-12 8:00 pm Miami Beach
1-17-12 Le Corsaire $120.00
1-17-12 Legends of Russian $120.00
Ballet
1-17-12 Forever Tango $107.00
2-11-2012 @ 8:30 p.m.
1-17-12 Paco de Lucia $150.00
1-17-12 John Leguizamo $106.00
3-9-12 @8:00 p.m.
1-17-12 John Leguizamo $106.00
3-10-12 @8:00 .m.
1-17-12 WillyChirino $197.00
1-19-12 Orig.MB Antique Show$136.00
2-10-12 Miami City Ballet $170.00
Program 3
2-13-12 Gian Marco $177.00
2-13-12 Lewis Black $99.00
2-13-12 Ballet Folclorico de $137.00
Antioquia
2-17-12 Miami Wine & Spirits $300.00
Expo
2-23-12 South Beach Wine&
Food Festival—Moet's
The Qu $600.00
2-23-12 South Beach Wine&
Food Festival—Burger
Bash $450.00
2-23-12 South Beach Wine & $450.00
Food Festival-Grand
Tasting
2-23-12 South Beach Wine & $190.00
Food Festival-Trucks
on the Beach
Over a $100
Date Description Monetary Name of person Address of person
Rec. of'gift Value making the gift making the gift
2-17-12 Symphonic Dances $170.00
2-29-12 Guns and Roses $125.00
3-14-12 Roberto Antonio $107.00
3-14-12 Charly Garcia $173.00
3-22-12 Wrestlemania $560.00
(3-29 to 4-1-12)