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Michael Góngora June 2012 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY: GONGORA, MICHAEL CITY OF MIAMI BEACH MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY: ZIP: COUNTY: FOR QUART -R ENDING(CHECK ONE): YEAR MIAMI BEACH, FL 33139 DADS OMARCH JUNE SEPTEMBER O DECEMBER 20 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 n,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 ATTACHED cn 1-7 N ` 7.; ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET c'? En 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 A . COUNTY depose on oath or affirmation and say that the information disclosed Sworn (or affi d)and sub cribed before e this day of 20 herein a'nd on any attachments made by me constitutes a true accurate, �i.t��• by and total listing of all gifts requi d to be reported by Section 112.3148, ♦•y= *ATURE (Signatur of Nota blic-State of F (Print,Type,or Stamp Co issioned Name of Notary Public) c) £ ING O ICIAL Personally Known VOR Produced Identification Type of Identification Produced 3 0 0 PART D—FILING INSTRUCTIONS � � H a► T This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5 3i-3 z cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calend q r p 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.) •j CE FORM 9-EFF. 1/2007 (See reverse side for inst c s 3 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Michael Gongora Ticket,Distribution for April—June 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 4/5/2012 Paco Lucia Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $75.00 ea. $150.00 4/28/2012 Charly Garcia Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $86.50 ea. $173.00 5/12/12 Buika In Concert Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $50.00 ea. $100.00 6/1/12 Ecomb Fundraiser Dinner Provided by City of Miami Beach 1700 Convention-Center Dr. Miami Beach, FL 33139 1 tickets @ $100.00 ea. $100.00 6/2/12 Miami Beach Chamber of Commerce Gala Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 1 tickets @ $300.00 ea. $300.00 6/5/12 Coca-Cola Partnership Event Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 1 tickets @ $71.89 $71.89 6/16/12 Spanish Classical Ballet Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $68.50 ea. $137.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Michael Gongora Ticket Distribution for April—June 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 6/17/12 Spanish Classical Ballet Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $68.50 ea. $137.00