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Jerry Libbin March 2011 t. 4 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME — FIRST NAME — MIDDLE NAME. NAME OF AGENCY ' LIBBIN, JERRY 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 DADS ' tiVIARCH DJUNE OSEPTEMBER 0 DECEMBER 20 if. 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 SEE ATTACH D CD r.., — - C n; N 0 6 ;fie ' C3 CHECK HERE IF CONTINUED ON SEPARATE SHEET O m -1 1 h C PARTB — RECEIPT PROVIDED BY PERSON MAKING THE GIFT m, 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 1 I, the person whose name appears at the beginning of this form, do STATE OF FLORIDA co rn COUNTY OF A.4.4.4,1 i ° rn depose on oath or affirmation and say that the information disclosed Sworn to or affirmed) of subsc 'bed before me this _ /� day of , 20 (; }`-" � p 7 , herein and on any attachments made by me constitutes a true accurate, /and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. 7 N Q N J a n o � Y O N (Sign uat re of ry Public -State of Florida) o T >9-. // ,r za�w . . . . .X . , , (Print, Type, or Stamp Cgmmissioned Name of Notary Public)] ate`` °O j� SIr'ATURE • R' NG OFFICIAL y �/ Y , ° w Personal) Known OR Produced Identification Type of Identification Produced ° g Ai� R ° ti ll 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: 3600 Maclay Blvd. South, Suite 201, Tallahassee, Florida 32312. The form must betted 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 (See reverse side for instructions) ar" I FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE. Commissioner Jerry Libbin Ticket Distribution for January — March 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Jan 8 Miami City Ballet Program I Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00 Feb. 3 -7 Miami Beach Antique show Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 8 tickets @ $15.00 ea. $120.00 Feb. 12 Miami City Ballet Program III Provided by City of Miami Beach Miami Beach, FL 33139 2 ticket @ $.85.00 ea. $170.00 Feb.18 -21 Miami International Boat Show Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 8 tickets @ $16.00 ea. $128.00 Feb. 25 -27 Miami Wine &Spirits Expo Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $75.00 ea. $150.00 Feb. 24 South Beach Food and Wine (Burger Bash) Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $200.00 ea. $400.00 • • RE: Commissioner Jerry Libbin Ticket Distribution for January — March 2011 City of Miami Beach Mayor and Commission Office DATE EVENT ' VALUE Feb. 25 South Beach Food and Wine (Bubble Q) Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $350.00ea. $700.00 Feb. 26 South Beach Food and Wine (Grand Tasting) Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $225.00 ea. $450.00 Mar.4 Miami Beach Fashion Week Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $250.00 ea. $500.00 Mar.5 C.O.M.B. Kevin Hart Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $55.50 ea. $111.00 Mar. 19 C.O.M.B. Gal Costa Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $73.00 ea. $146.00 Mar. 26 Miami City Ballet #5 Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 • 2 tickets @ $89.00 ea. $178.00