Michael Gongora September 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: 21 P: COUNTY- FOR QUARTER ENDING(CHECK ONE): YEAR
MIAMI BEACH, FL 33139 DADS ❑MARCH ClJUNEEPTEMBER ❑DECEMBER 20 0'1
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 ATTACH D
`fir i 0 `A,
t
❑ 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 FLO DA
COUNTY OF
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed-)and bscribe efore me this
1Q0 day of �Cg�m ,20 /a
herein and on any attachments made by me constitutes a true accurate,
by .� i G� L ��
and total listing of all gifts re q ed to be reported by Section 112.3148,
a
I ida St tes. (Signature of Not
K1
o (Print,Type,or Stamp C mmissioned Name of Notary Public)
IGNATURE OF REPORTING OFFICIAL Personally Known �o OR Produced Identification
Type of Identification Produced
PART D—FILING INSTRUCTIONS a�``"°�"'''�� ALEJANDRO J.FERNANDEZ
ry f Florida
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Ta aM9T0-M0ftPkq%iD8 8.2013
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida-32312.The form must be filed no later th t f th itftiWlM"D 5227
that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should dis bv June 30.
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)
I
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Michael Gongora
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 @ $75.06 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
8/18/12 Pridelines Youth Services Event
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
1 tickets @ $150.00 ea. $150.00
8/23/12 LaCoste Grand Opening
Provided by Lacoste
1026 Lincoln Road
Miami Beach, FL 33139
Sunglasses $150.00
8/31-9/4-/12 Miami International Home Show
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
10 tickets @ $10.00 ea. $100.00
9/12/12 IL Volo
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
1) *;A-oto n e74 cn e 1 co nn
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Michael Gongora
Ticket Distribution for July—September 2012
City of Miami Beach Mayor and Commission Office
DATE EVENT VALUE
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
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
9/15/12 11 th 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
9/16/12 IL Volo
Provided by City of Miami Beach
1700.Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $79.50 ea. $159.00
9/18/12 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
s FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Michael Gongora
Ticket Distribution for July—September 2012
City of Miami Beach Mayor and Commission Office
DATE EVENT VALUE
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
9/30/12 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