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Jorge Exposito September 2011 • Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME—MIDDLE NAME. NAME OF AGENCY. EXPOSITO, JORGE CITY OF MIAMI BEACH MAILING ADDRESS OFFICE OR POSITION HELD. 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY" ZIP. COUNTY FOR QUARTER ENDING (CHECK ONE): YEA MIAMI BEACH, FL 33139 DADE ❑MARCH ❑JUNE SEPTEMBER ❑DECEMBER 2011 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 (—) #v SEE ATTACHED G � ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET Cl) 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 J� COUNTY OF U depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and su scribed before me this C day of "Q�L_r ,20 ()1 herein and on any attachments made by me constitutes a true accurate, by and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. l ��1 y Pub gt (Signature of otarlic- ate of Florida) ( ,I ` • • "IC • • j •e,or Stamp Comjinissioned Na of Notary Public) T OF REPORTING OF ♦� � E> - on y Known ,/ OR Produced Identification . �• CanNligEdOn OD 6:.e of •entification Produced • F I G 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 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)0" FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Jorge Exposito Ticket Distribution for July—September 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Jul. 9 Amencan Black film Fest Awards Ceremony Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2 tickets @ $65.00 ea. $130.00 July 24 Teen Pageant 2011 "Miss Finals" Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $50.00 ea. $100.00 July 28 Miami Spice Kickoff Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2 tickets @$125.00 ea. $250.00 July 30 Teen Pageant 2011 "Queen Finals" Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2 tickets @$50.00 ea. $100.00 Aug. 13 Cristian Castro Provided by City of Miami Beach Miami Beach, FL 33139 2 ticket @$103.50 ea. $207.00 Sept. 17 Int'l Ballet Festival Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2 tickets @ $58.50ea. $117.00 Sept.18 Int'l Ballet Festival Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2.tickets @ $58.50ea. $117.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: ' Commissioner Jorge Exposito Ticket Distribution for July—September 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Sept.24 Chris Tucker Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $65.50ea. $131.00 Sept. 27 Black Star Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach,FL 33139 2 tickets @ $50.00 ea. $100.00