Jerry Libbin September 2012 Forum 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY:
LIBBIN, 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 -715EPTEMBER 13 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,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 ATTACH D
❑ 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 FLORI A
COUNTY OF 1 A
depose on oath or affirmation and say that the information disclosed Sworn to(or aff med)and ubscribed before me this
Og O day of 20/a
herein and on any attachments made by me constitutes a true accurate,
by t- Q L
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes. ` (Signature o of Pub -State of lori a)
(Print,Type,or Stamp ommissioned Name of Notary Public)
SIG ATURE /PORTING OFFICIAL Personally Known V OR Produced Identification
Type of Identification Produced
,,.got "pie%
PART D FILING INSTRUCTIONS ,� ALEJANDRO J.FERNANDE da
—
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 157 2 13
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no la r t132 �t day 9pfA@IL�o%fr� a 2
that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it s
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)
f
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Jerry Libbin
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
7/28/12 Gian Marco
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $88.50 ea. $177.00
8/04/12 Arango y Sanint
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $53.50 ea. $107.00
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
9/15/12 XVII International Ballet Festival Gala
Provided by City of Miami Beach
1700,Convention Center Dr.
Miami Beach, FL 33139
1 tickets @ $125.00 ea. $125.00
• o
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Jerry Libbin
Ticket Distribution for July— September 2012
City of Miami Beach Mayor and Commission Office
DATE EVENT VALUE
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 11`" 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
r
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
9/28/12 South Beach Adult Expo
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $54.95 ea. $109.90
9/29/12 South Beach Adult Expo
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $54.95 ea. $109.90
9/30/12 South Beach Adult Expo
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $54.95 ea. $109.90