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Ed Tobin September 2012 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY: TOBIN, ED CITY OF MIAMI BEACH MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY: ZIP: COUNTY: FOR QUARTER ENDI G(CHECK ONE): YEAR MIAMI BEACH,_FL 33139 DADE ❑MARCH ❑JUNE EPTEMBER ❑DECEMBER 201G-- 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 riot 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 L� ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET i O r°' 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 1F 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 OF depose on oath or affirmation and say that the information disclosed Sworn to(or a firmed)and ubscribed before me this day of L6Ce� � 20 01 herein and on any attachments made by me constitutes a true accurate, //�� �- byC."fW. .6 /V_8 and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. (Signature of Notary (Print,Type,or Stamp ommis " SIGNATURE EPO Personally Known OR roU i ,entification Type of Identification Produced ALEJANDRO J.FERNAN EZ ids PART D—FILING INSTRUCTIONS MY'C=M•EXPIM Dec 8,2018 Comani> Wn dt 00 915227 This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 157097, a-Ti hassee,F76 n a_3T3 1 -5 i- 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. 1/200,7 (See reverse side for instructions) " FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Ed Tobin Ticket Distribution for July—September 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 7/19/12 Swim Fashion Week Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $100.00 ea. $200.00 7/21/12 Made in Fashion Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $75.00 ea. $150.00 9/12/12 IL Volo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $79.50 ea. $159.00 9/14/12 Chris Isaak Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $69.50 ea. $139.00 9/16/12 IL Volo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $79.50 ea. $159.00 9/15/12 XVII International Ballet Festival Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $65.00 ea. $130.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Ed Tobin Ticket Distribution for July—September 2012 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 9/15/12 11th Annual Miami Int'1 Wine Fair Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $125.00 ea. $250.00 9/18/12 Jethro Tull/Ian Anderson Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $57.50 ea. $115.00 9/19/12 IL Volo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $79.50 ea. $159.00