Liliam Hatfield December 2012 Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME—FIRST NA E—MIDDLE N ME: NAME OF AGENCY:
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MAILINGA DRES : OFFICE OR OSITIO ELD:
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CITY: ZIP: COUNTY: QUARTER ENDING(CHECK NE): YEAR
iMARCH ❑JUNE ❑SEPTEMBER ❑DECEMBER 201.2—
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
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❑ 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 FLORIDA \\
COUNTY OF mil'',Ae —
depose on oath or affirmation and say that the information disclosed Sworn to(o�irmed)and su scribed before me this
c2y day of_� �C°-�c°n9 G�/� ,20
herein and on any attachments made by me constitutes a true accurate, by 41 1 4W
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and total listing of all gifts required to be reported by Section 112.3148, C-11-�
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Florida Statutes. Signature of ary Public-State of Florida
(Print,Type,or Stamp mmissioned Name of Nota r ubI(C).Z f
SIGN URE OF REPORTING IFFICIAL Personally Known OR Produced Identifi n �'/
Type of Identification Produced ! •"' `�°�
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 32317-5709;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)
Estevez, Maria
From: Peacock,Althea
Sent: Friday, November 30, 2012 5:32 PM
To: Diaz, Natasha; Heaton, Mary; Farmer, Gary; Tackett, Deborah; Rodriguez, Jennifer; Denis,
Cristina; Chiovaro, Carmela; Ferreiro, Ines; Hatfield, Liliam; Cardillo, Lilia; Martinez, Katherine;
Hall, Borinquen; Leon, Alexis; Gillis, Brian; Ajami, Richard; Rosario, Dirnorah; Estevez, Maria;
Fink, Jay; Saltrick, Richard; Wheaton, Elizabeth; Gonzalez, Jose; Alvarez, Mike- Public
Works; Zamora, Alberto; Cano, Jorge; Sarmiento, Fiorella; Bistolfi, Juan; Trigo, Linette;
Dukes, Ebony; Levy, Ronald; Ramirez, Howard; Singh, Narinder; Gonzalez, Antonio; Blanco,
Linda; Sand, Lily; Castell, George; Hemmings, Laurel; Smith, Treisa
Cc: Sklar, Max; Peacock, Althea
Subject: Employee Recognition Program
Congratulations!
As part of the City's Employee Recognition Program, the Administration will be recognizing those employees
who, in the past year, have exemplified the City's Vision, Mission and Values. All department directors were
asked to submit the names and the justification for the recognition of their top 5% performing employees to the
City Manager's Office.
Because you have been recognized by your department head, you are entitled to receive an Art Basel
Vernissage Ticket or a Day Pass. Please familiarize yourself with the City's Gift Policy and fill out the Gift
Disclosure Form and disclose the gift.
You may contact me at ext. 6513 to redeem your Vernissage Ticket or your Day Pass.
Thank you!
Althea
MIAMIBEACH
Althea Peacock, Executive Office Associate 1
OFFICE OF THE CITY MANAGER
1700 Convention Center Drive,Miami Beach,FL 33139
Tel:305-673-7000 ext.6513/Fax:305-673-7782! www.miamibeachfl.gov
altheapeacock @miamibeachfl.gov
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