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Michael Gongora March 2012 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME—MIDDLE NAME: NAME OFAGENCY: GONGORA, MICHAEL CITY OF MIAMI BEACH MAILINGADDRESS: OFFICE OR POSITION HELD: 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY: ZIP: COUNTY: ??FFLLP�R QUARTER ENDING(CHECK ONE): YEAR MIAMI BEACH, FL 33139 DADE IMARCH ❑JUNE ❑SEPTEMBER ❑ DECEMBER 20 toZ PART A—STATEMENT OF GIFTS Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the 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 on the form.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 other gifts.You are not required to file this statement for any calendar quarter during which you did not receive a reportable gift. DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT SEE ATTACH D (� N � N '•g•a ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET v� 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 FLORID�� / COUNTY OF LJC�CJ� depose on oath or affirmation and say that the information disclosed Swore}to(or affirmed)and subs abed before me this / day ofl/1Q� 20 _ herein and on any attachments made by me constitutes a true accurate, by and total listing of all gifts requir to be reported by Section 112.3148, d I ida tutes. (Signature of Notary Public-State of Florida) a 8 (Print,Type,or Stamp Co issioned Name of Notary Public) Q 9 IGNATURE OF REPORTING to be Personally Known �OR Produced Identification o �, 'M� X Type of Identification Produced v 8 z .E � E PART D—FILING INSTRUCTIONS to This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-57 ph ,�jr,,,,� m cal address:3600 Maday Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calend �'•., 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 inst o i2' FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Michael Gongora Ticket Distribution for January—March 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 1/7/2012 Miami City Ballet Program II Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00 2/8/2012 Legends of Russian Ballet Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $60.00 ea. $120.00 2/9/2012 Le Corsire Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $60.00 ea. $120.00 2/10/2012 Le Corsire Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $60.00 ea. $120.00 2/11/2012 Forever Tango Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.50 ea. $107.00 2/14/2012 Chirino Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $98.50 ea. $197.00 2/16/2012 International Boat Show Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 10 tickets @ $18.00 ea. $180.00 RE: Commissioner Michael Gongora Ticket Distribution for January—March 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 2/18/2012 Miami City Ballet Program III Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00 2/18/2012 Miami Dade County League of Cities Gala Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $215.71 ea. $431.42 2/23/2012 Food and Wine "Moet Hennessy Q Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $300.00 ea. $600.00 2/24/2012 Food and Wine Burger Bash Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $225.00 ea. $450.00 2/25/2012, Food and Wine Grand Tasting Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 - 2 tickets @ $225.00 ea. $450.00 2/25/2012 Food and Wine Best Thing Ever Ate Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $110.00 ea. $220.00 2/25/2012 Miami Wine.and Spirits Expo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $75.00 ea. $150.00 RE: Commissioner Michael Gongora Ticket Distribution for January—March 2012 City of Miami Beach Mayor and-Commission Office DATE EVENT VALUE 2/26/2012 Food and Wine Trucks on the Beach Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $95.00 ea. $190.00 2/26/2012 Miami Wine and Spirits Expo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $75.00 ea. $150.00 3/1/2012 Miami City Ballet Symphonic Dances Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00 3/5/2012 Guns and Roses Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $62.50 ea. $125.00 3/9/2012 John Leguizamo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.00 ea. $106.00 3/10/2012 John Leguizamo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.00 ea. $106.00 3/11/2012 John Leguizamo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.00 ea. $106.00 RE: Commissioner Michael Gongora Ticket Distribution for January—March 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 3/15/2012 Ballet Folklorico Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $68.50 ea. $137.00 3/18/2012 Equality Florida Annual Miami Gala Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $125.00 ea. $250.00 3/23/2012 Miami Home and Design Show Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 10 tickets @ $10.00 ea. $100.00 3/31/2012 Miami City Ballet Program IV Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00