Jorge Exposito December 2012 7
. a
Forma 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY:
EXPOSITO, JORGE 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 'I�DECEMBER 201—A
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
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SEE ATTACH D
V FR'nn
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❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
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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 FLORID
COUNTY OF Ic x- sz
depose on oath or affirmation and say that the information disclosed Sworn to or affirmed)and ubs-cri`bed before me this
day of 120
herein and on any attachments made by me constitutes a true accurate,
by
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes. (Signature of Notary Public-State of Florida)
(Print,Type,or Stamp C missioned Name of Notary Public)
SIG U E F REPORTING OFFICIAL Personally Known OR Produced Identification
Type of Identification r c
%01 W-v Ave�n
BARBARA PAREDES
PART D—FILING INSTRUCTION * Notary Public-State of Florida
s, any Comm.Expires Nov 14,2016
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Dra er �� i'�has fdW 3h3 f f�V�pghy
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be fi �''a4L1't�han the last da of the calendar quart
that follows the calendar quarter for which this form is filed(For example,if a gift is received in M rc ,it ouTo n amclustuTy n
CE FORM 9-EFF. 1/2007 (See reverse side for instructions)
FORM 9 QUARTERLY GIFT DISCLOSURE
(ATTACHMENT)
RE: Commissioner Jorge Exposito
Ticket Distribution for October—December 2012
City of Miami Beach Mayor and Commission Office
DATE EVENT VALUE
10/20/2012 Miami City Ballet Program 1
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $85.00 ea. $170.00
11/9-18/2012 Miami International Auto Show
Provided by City of Miami Beach 1
1700 Convention Center Dr.
Miami Beach, FL 33139
10 tickets @ $10.00 ea. $100.00
1.1/24/2012 Hombres G y Miguel Mateos
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $88.50 ea. $177.00
12/05/2012 The MMG Tour Starring
Provided by City of Miami Beach
1700 Convention Center Dr.
Miami Beach, FL 33139
2 tickets @ $82.50 ea. $165.00