Jerry Libbin June 2012 Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY:
UBBIN, JERRY CITY OF MIAMI BEACH
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 CONVENTION CENTER DRIVE COMMISSIONER
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
MIAMI BEACH, FL 33139 DADE ❑MARCH JUNE SEPTEMBER ❑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 fads,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 ATTACHED �; �
c.�
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
Cn
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 FLORIDA
COUNTY OF
depose on oath or affirmation and say that the information disclosed Swor to(or affirm d)and su cribed before me this
day of '20
herein and on any attachments made by me constitutes a true accurate,
by ,s
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes. (Signature .Notary Pu -State of
(Print,Type,or Stamp Co�ssioned Name of Notary Public) a 0 �
J,��TU>V6P9_EPORTING OFFICIAL Personally Known ✓ OR Produced Identification 3
Type of Identification Produced or P
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 32317-570 prim
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calenda un,
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.) ~r
bs
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)�"
-2
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Jerry Libbin
Ticket Distribution for April—June 2012
City of Miami Beach Mayor and Commission Office
DATE EVENT VALUE
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
6/2/12 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
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