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Patricia Deann Walker March 2012 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) 2oj2jUN 18 PM 2: 38 LAST NAME—FIRST NAME--MIDDLE NAME: NAME OF AGENCY: Walker Patricia Deann City of Miami Beach CITY CLEF, 6� 5 OFFICE MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive Chief Financial Officer;Pension Trustee CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR Miami Beach 33139 Miami Dade ®MARCH ❑JUNE ❑SEPTEMBER ❑DECEMBER 2012 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 January 2012 Ballet Tickets Program II $335 Miami City Ballet 2200 Liberty Avenue Miami Beach,FL 33139 February 2012 Ballet Tickets Program III $335 Miami City Ballet 2200 Liberty Avenue Miami Beach,FL 33139 ❑ 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 FLORID COUNTY OF LUr�'c�l� depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and su�cnbed before me this day of 201 herein and on any attachments made by me constitutes a true accurate, by and total listing of all gifts required to be reported by Section 112.3148, ZZ"cok".111H1f/� Florid tutes. (Sign ure o ••ri e° •�\SSIOIy c�•.• j•O� 21.20 A/ e (Print,Type,or Stamp Commissaied:om6 of Notary USI*)= SIGNATURE OF REPORTING OFFICIAL Personally Known OR�V jced Ideptifrfation Type of Identification Produced % • gnn :C= PART D—FILING INSTRUCTIONS ��i9 '�.�`.••• •o`��\` lfllll 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):!F�