Michael Gongora Form 9 Quarter I MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-7411
June 27, 2019
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find a Quarterly Gift Disclosure State Form
(9), for the quarter ending March 2019, for the following City of Miami Beach Personnel:
• Michael Gongora — City of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
xi
Raf el E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
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- Group III
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade VIMARCH UJUNE USEPTEMBER ❑DECEMBER 20 19
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
02/15/2019 SOBE Food&Wine Festival- $150 each($300) SOBE Food and Wine 3063 Court Street Syracuse,
Italian Bites on the Beach(2 tickets) Festival NY 13208
02/15/2019 SOBE Food&Wine Festival- $250 each($500) SOBE Food&Wine 3063 Court Street Syracuse,
Burger Bash(2 tickets) Festival NY 13208
•
02/15/2019
SOBE Food&Wine Festival-
Beachs;de BBQ(2 tickets) $1 /7�75 ($3$350) SOBE Food and Wine 3063 Court Street Syracuse,
Festival NY 13208
SOBE Food&Wine Festival-Bacardi Beach $115($230) SOBE Food and Wine 3063 Court Street Syracuse,
02/15/2019 Carnival(2 tickets) Festival NY 13208
I 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 r _ %1 i\7
COUNTY OF /� i4- '
if/•
depose on oath or affirmation and saythat the information disclosed Swo r rmed ,and sued before me this
p day of at) - /,�20
herein and on any attachments made by me constitutes a true accurate, by �1 ,/h (J- I /'O ' `t4
and total listing of all gifts required to be reported by Section 112.3148, 4101101.
Florida Statutes. , ign. rs of Notary e. .lic-StihB iwdoe14gostin
CAT NOTARY PUBLIC
(Print,Type,or Stamp mmis. ` -. �- uoircr
SIGNATURE OF REPORTING FFICIAL Personally Known � OR`R�•�,.,.'. .e� ' +:'�rPG168171
Type of Identification Produced / to ' Expires 12/14/2021
PART D—FILING INSTRUCTIONS
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi-
cal address:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.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.1/2007(Refer to Rule 34-7.010(1)(g),F.A.C.)(Rev.6/2016) (See reverse side for instructions)°
DATE RECEI' DESCRIPTION OF GIFT MONETAR`NAME OF PERSON MAKING TI ADDRESS OF PERSON MAKING GIFT
2/13/2019 SOBE Food & Wine Festival - General Admission $191.25 SOBE Food &Wine Festival 3063 Court Street Syracuse, NY 13208
2/13/2019 SOBE Food &Wine Festival - General Admission $191.25 SOBE Food &Wine Festival 3063 Court Street Syracuse, NY 13208
Baptist Health South Florida 6855 Red
3/1/2019 Baptist Health Gala Tickets(2) $175 each Baptist Health- Erin Dowd Road, Suite 500 Coral Gables, FL 33143
41/1444141 ,
City of Miami Beach USPS CERTIFIED MAIL
City Clerk
1700 Convention Center Dr
Miami Beach FI 33139
9214 8901 9403 8385 4687 25
FLORIDA COMMISSION ON ETHICS
PO Box 15709
TALLAHASSEE FL 32317-5709
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