Raul J. Aguila - December 2012 Form 9 � � -r J
Form 9 QUARTERLY GIFT DISCLOSURE y `� 4h�
(GIFTS OVER $100) - - . .
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY: --
�6vtLf1 , EZ.AUL o.5� c cri of McRrvir C35ACH , FL-
MAILING ADDRESS: OFFICE OR POSITION HELD:
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CITY: M �M ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
M 6=4 C 1 / FL 331 ( DMARCH ❑JUNE OSEPTEMBER %DECEMBER 20 (Z
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 ad• • s 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.•.icable,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 disc= e gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not ceive 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 B ERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the p on making the gift,you are required to attach a copy of that receipt to this
form.You may attach an explanation of any differences betw n the information disclosed on this form and the information a on on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHE 0 THIS FORM
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLO'/ p,�t/fl/`7
COUNTY OF. '��I
depose on oath or affirmation and say that the information disclosed Sworn too(or affirmed)and s4pscribed before me this
17"`"71` day of EM/ate ,20 / 3
herein and on any attachments made by me constitutes a true accurate,
by 1; 4_`.�(_ (� !L�'ice►
and total listing of all gifts required to be reported by Section 112.3148,
Gc zX7c�� Ce_f*,,t
Florida Statutes. (Signature of Notary Public-State of Florid Ali 41911110
\ • E C A /�i��y
(Print,Type,or Stamp ommissioned Name of Notd�ber8 �'0 �
SIGNATURE OF R PORTING OFFICIAL Personally Known OR Produced Identifi. tiort mQ 2�9cu,•
Type often ,�ation Produced = • 4
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PART D—FILING INSTRUCTIONS 10
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This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida Al 00
cal address:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.The form must be filed no later than the last day of the calendarquarter
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)ro-