Jose Smith June 2011 Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME — FIRST NAME — MIDDLE NAME. NAME OF AGENCY
Smith, Jose City of Miami Beach
MAILING ADDRESS. OFFICE OR POSITION HELD
1700 Convention Center Dr., 4th Floor City Attorney
CITY ZIP* COUNTY* FOR QUARTER ENDING (CHECK ONE) YEAR
Miami Beach 33139 Miami -Dade ❑MARCH JUNE SEPTEMBER ❑ DECEMBER 20jJ
PART A — STATEMENT OF GIFTS
Please list below each gift, the value of which you believe to exceed $100, accepted by you during the calendar quarter for which this statement is
being filed. You are required to describe the gift and state the monetary value of the gift, the name and address of the person making the gift, and the
date(s) the gift was received. If any of these facts, other than the gift description, are unknown or not applicable, you should so state on the form. As
explained more fully in the instructions on the reverse side of the form, you are not required to disclose gifts from relatives or certain other gifts. You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
Please see attached Exhibit
�] CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B — RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C — OATH
I, the person whose name appears at the beginning of this form, do STATE OF FLORIDA
COUNTY OF Mi ami —Da rip
depose on oath or affirmation and say that the information disclosed Swom (, gr�effirmed) and subscribed before me this
r G 7 'l-- day of .Timp , 20 1 1
herein and on any attachments made by me constitutes a true accurate, g . -4
by JoGP Smith E Z
and total listing of all gifts required to be reported by Section 112.3148, 4.,,,,..$` "6
dre _`._%/ /
, ' C i AM ' 'c+ yio cl
Florida St. - (Signatur of Notary Puff -State of Florida) B ,
f vadafv C a GUY)ds
--- (Print, Type, or Stamp ommissioned Name of Notary Public) - 8110 a
'� � �+ RE• ING OFFICIAL Personally Known i OR Produced Identification f co o
Type of Identification Produced q ' • C '
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PART D — FILING INSTRUCTIONS o �
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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 32317 -5709; physi-
cal address: 3600 Maclay Blvd. South, Suite 201, Tallahassee, Florida 32312. 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 (See reverse side for instructions) °'
•
Over a $100
Date Description Monetary Name of person Address of person
Rec of gift Value making the gift making the gift
4/7/11 La Fille Mal Gardee $133 00 City of Miami Beach 1700 Convention Center Dr
Miami Beach, FL 33139
4/7/11 La Fille Mal Gardee $133 00 " " " -- " " " -- it
4/7/11 The Beach Boys $296 00 " — " " -- " " " " -- 4,
5/4/11 Aumary Gutierrez $113.00 " - " " -- " " — " " -- "
5/19/11 Exxxotica $210.00 f t " -- " " — " -- CC
5/19/11 Diego Torres $113.00 " — " -- it
46 — " " -- GC
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MIAMI -DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME -FIRST NAME - MIDDLE NAME. NAME OF AGENCY
Smith, Jose City of Miami BeachC
STREE ADDRESS. OFFICE OR POSITION HELD
1700 Convention Center Dr. 4th Floor City Attorney'
CITY Miami Beach FOR QUARTER ENDING (Check One)
ZIP. 33139 ❑ MARCH El JUNE
COUNTY Miami — Dade ❑ SEPT ❑ DEC. YEAR. 2d -
PART A: STATEMENT OF GIFTS. List below each gift, or series of gifts, from one person or entity in
excess of $100, accepted by you during the calendar quarter for which this statement is being filed. Describe the gift
and state the monetary value of the gift, the name and address of the person making the gift, and the dates the gifts
were received. If any of these facts are unknown or not applicable, state this on the form. 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
Please see attached Fxhihjt
CHECK HERE IF CONTINUED ON SEPARATE SHEET. El
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: FILING INSTRUCTIONS. The signed and notarized form must be filed no later than the last day
of the calendar quarter that follows the quarter for which this form applies. For example, if a gift is received in March,
it should be disclosed by the end of the next quarter, i.e., June 30 County personnel file with the Clerk of the Board
of County Commissioners, 111 NW 1 St., Suite 17 -10, Miami, FL 33128. Municipal personnel file with their
respective municipal clerks.
PART D: OATH.
I, the person whose name appears at the beginning of STATE OF FLORIDA
this form, do depose on oath or affirmation and say COUNTY OF Miami —Da rle
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, Sworiq to (or affirmed) and subscribed before me this
and total listing of all gifts required to be reported by 9 of June , 20 11
Section 2 -11 1 (e)(4) of the Code of Miami -Dade
�.- C -ount . by Jose Smith
(Name of Person Making Gift Dis re)
L . .4 .L -� - /- . / 9 L.._l�
' (Signature ,of otary Public, Sta'e of Flon
ignature of Person Making Gift Disclosure ' L d i b I C aindS
IF (Print, Type, or Stamp Com ssioned Name of Notary Public)
i 1 - Personally known to me or ❑ Produced Identification
Type of Identification Produced.
NOTARY PUBLIC STATE OF FLORIDA
COE 02/2010 " '''''''. Guadalupe C. Ramos
al. -;, ; Commission #DD807512
r Expires: SEP. 08, 2012
BOND THRU ATLANTIC BONDING CO., INC.
Over a $100
Date Description Monetary Name of person , Address of person
Rec of gift Value making the gift making the gift
4/7/11 La Fille Mal Gardee $133 00 City of Miami Beach 1700 Convention Center Dr
Miami Beach, FL 33139
4/7/11 La Fille Mal Gardee $133 00 " it it -- " " " -- if
4/7/11 The Beach Boys $296 00 " — " " -- it
it " " -- it
5/4/11 Aumary Gutierrez $113.00 " — " " -- " " -- it
5/19/11 Exxxotica $210 00 — " " -- it it
5/19/11 Diego Torres $1 13.00 " " 44 CC " -- it
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