Hilda Fernandez March 2010
MIAMI-DADS COUNTY 2OIO ~~'~ 12 ~~ I I ~ Z~
QUARTERLY GIFT DISCLOSURE
LAST NAME-FIRST NAME MIDDLE NAME: NAME OF AGENCY:
i~ernan~ez -Hr Ica ~,~t amr ac
MAILING ADDRESS:
~~oo Convention ~en~r ~rrde OFFICE OR POSITION HELD:
Rsslstant L,t /I1ana er
CITY: j~ZIP: •~ COUNTY: ~jQ
rYltamc ,CJP.ac-~ :JS~~q M~aml"~a~+~- FOR UARTER ENDING (Check One): YEAR:
MARCH NNE SEPTEMBER DECEMBER 20/O
PART A -STATEMENT OF GIFTS
Please list below each gifr, or series of gifrs of 5100 or more, accepted by you during [he calendar quarter for which [his sli~ttement is
being filed. You are required to describe the gifr an d state the monetary value of the gifr, the name acid address of the person making
the gift, and the date(s) the gift was received. If any of these facts, other than the gifr description, are unknown or not applicable,
you should so state on the form: As explained more fidly in the instructions on the reverse side of the form, you are not required to
disclose gifts from relatives or certaut 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
RECEIVED OF GIFT VALUE MAKING THE PERSON MAKING
GIFT THE GIFT
2 ~19 tc e s ~o
8ur9er.Bash
~ 4.0 .O0 o. yy~~--tne.
and Food ~eStwal tfoo Ile3St.
M a ~ F
21~~ I 2 t cKets to ~
~' o. SeSC~, W one (lap0 NW /l03 St
(~ $U 15 . and Food l~stval IaMI FL 33((09
r
2
~ 9
~ 2 "l icl~{Cts tv Whet
"
`
• ~ . Beach W~rt~ (ooo NW /!03 S•t
~ D
1
i I
~57 i
~oods G'and ~'25 • O O and Foiod ~+st-v~ I AMI Fl. 331
ZI l ~ 1 D 2 Tickets to ~
g 2 F.I more JVIB 170o Washt n
W~1 >7
3.00 mram~ t
^ CHECK HERE IF CONTINiJED ON SEPARATE SHEET
PART B -RECEIPT PROVIDED BY PERSON MAKING THF. 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 behveen the information disclosed on this forni
and the information on-the receipt.
^ C:HECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM "
PART C -OATH
I, the person whose name appears at the beginning of this form, STATE OF FLORIDA
COUiVTY OF
do depose on oath or affirmation and say that the information
Sworn to (or aftirnied) and subscribed before me this
disclosed herein and on any attachments made by me consti- day of ,20
by
totes a tnte, acctuate, and rotal listing of all gifts required to be
(Signanue of Notary Public-State of Florida)
reported by Section 2-1 1.1 (e)(4) of the Code of Miami-Dade
Count '
SIGNAT OF REPORTING OFFICIAL
.i
PART D - FIL1N(7 INSTRUCTIONS
This form, when duly signed and notarized, must be filed with the Clerk of the Board of County Commission, 111 NW 1'$111x1,
Suite 17-202, Miami, Florida 33128. The form must be filed no later than the last day of the calendar quarter that follows the
calendar quarter for which this fom~ is Yled. (For example, if a gift is received in March, it should he disclosed by June 30.)
(Print, Type, or Sta~mp/C~~~~~~~issioned
Personally ICno«n .'V OR Produc
Type of Identification Produced-
~;;~~ P~-, NA1MA D PINEDO
'~~ ~ ~~' ~ ISSI # DD 598910
wary ~kdH~$: Sept tuber 26, 2010
."{.~~'~oa~~~` BondedThrutr'oterv ublicUndern~rilers