Jose Smith June 2012 Form 9 QUARTERLY 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 ❑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 PEON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKIN�IE Wr
C _ y
Please sE a attached Exhibit"A"
-n CrJ
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O
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 FLORIIBmi-Dade
COUNTY OF Iyyi
depose on oath or affirmation and say that the Information disclosed Sworn to(or affirmed)and subscribed t20 before me this 12
o) / St day of
herein and on any attachments made by me constitutes a true accurate,
b J6jeArnith
and total listing of all gifts required to be reported by Section 112.3148, &SPVv
Alond . (� natur f N ry P bllc-6\�`gIgAR N@)���///
R,q
rint,Type,or Stamp missioned Uf N y
EPO FICIAL Pe rsonally Known OR Prod Cf Jdentifr ro%-'io.
Type of Identification Produced
PART D—FILING INSTRUCTIONS V
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahass�6��fQ6jf�� b9gphysi-
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The forth must be filed no later than the last YA0 111110% endar uarler
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)12"
Over a $100
Date Description Monetaiy Name of person Address of person
Rec. of gift Value malting the gift malting the gift
3-27-12 Program IV $170.00 City of Miami Beach 1700 Convention Center Drive
Coppelia Miami Beach,PL 33139
4-18-12 Buika $100.00
5-15-12 Exotica Expo $210.00 "-" " -- " "-" " -- It
5-18-12 Spanish Classical $137.00 "-" " -- " "-" " -- "
Night
5-18-12 Spanish Classical $137.00
- Night
5-18-12 Los Toreros Muertos $117.00
5-23-12 Arango y Sanint $107.00
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
Smith,Jose City of Miami Beach,City Attorney's Office
STREEADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Dr.4th Floor City Attorney
CITY: Miami Beach FOR QUARTER ENDING(Check One):
ZIP: 33139 ❑ MARCH U JUNE
COUNTY: Miami-Dade County ❑ SEPT. ❑ DEC. YEAR:20 12.
PART A: STATEMENT OF GIFTS.List below each gift,or series of gifts,from one person or entity in
excess of$100,accepted by you during the calendar quarter for which this statement is being filed.Describe the gift
and state the monetary value of the gift,the name and address of the person making the gift,and the.dates the gifts
were received.If any of these facts are unknown or not applicable,state this on the form.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 OFPERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
Please seE attached Exhibit
N
O
n
M N
CHECK HERE IF CONTINUED ON SEPARATE SHEET. '
PART B: RECEIPT PROVIDED BY PERSON MAKING THE GIFT.If any receipt for a gifts'
listed.above was.provided to you by the person making the gift,you are required to attach a copy of that receipt toohis T;
form.You may attach an explanation of any differences between the information.disclosed on this form and the CA)
information on the receipt.CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM. ❑ — N
PART C: FILING INSTRUCTIONS.The signed and notarized form must be filed no later than the last day
of the calendar quarter that follows the quarter for which this form applies.For example,if a gift is received in March,
it should be disclosed by the end of the next quarter,i.e.,June 30.County personnel file with the Clerk of the Board
of County Commissioners, 111 NW 1"St.,Suite 17-10,Miami,FL 33128.Municipal personnel file with their
respective municipal clerks.
PART D: OATH.
I, the person whose name appears at the beginning of STATE.OF FLORIDA
this form, do depose on oath or affirmation and say COUNTY OF Miami-Dade
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, Sworn to(or affirmed)and subscribed before me this
and total listing of all gifts required to be reported by a 1 Srday of June 20 12 ,
Section -11.1 (e)(4) of t Code of Miami-Dade
Cou by Jose Smith
( ume of Per a i is ure)
Vgnutu of Nedif P i Stute of F rido
S n, ur Pe n ng Gift Disclosure A,I
-- (Prini,Type,or Stomp Commissions -me o{N6• }h)••/� //
Personally known to me or� Aced entitriq'C�� 9Z
Type of Identification ProduS NV +� •
COEO?J2o)o
Over a $100
Date Description Monetary Name of person Address of person
Rec. of gift Value malting the gift malting the gift
3-27-12 Program IV $170.00 City of Miami Beach 1700 Convention Center Drive .
Coppelia Miami Beach,FL 33139
4-18-12 Buika $100.00 it cc " -- " "-" it -- "
5-15-12 Exotica Expo $210.00
5-18-12 Spanish Classical $137.00
Night
5-18-12 Spanish Classical $137.00
Night
5-18-12 Los Toreros Muertos $117.00
5-23-12 Arango y Sanint $107.00