Jose Smith December 2012 MIAMI-DADE COUNTY 2012 DEC 21 FM 1. 47
QUARTERLY GIFT DISCLOSURE
CI 1 Y CLEF " 0FI= 1 C F
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
Smith, Jose City of Miami Beach
STREETADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Drive,4th Floor City Attorney
CITY: Miami Beach FOR QUARTER ENDING(Check One):
ZIP: 33139 ❑ MARCH ❑ JUNE
COUNTY. Miami-Dade ❑ SEPT. IR DEC. YEAR:2012
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 atta hed Exhibit
CHECK HERE IF CONTINUED ON SEPARATE SHEET. Ell
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 I"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-Dade
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, Sworn to(or affirmed)and subscribed before me this
and total listing of all gifts required to be reported by k4l_day of December 20 ,
Section 2-11.1 (e)(4) of the Code of Miami-Dade Jose Smith
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of Person Making Gift 'sclosure)
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/ Signat a of Notary Public,State of Florida)
S`- 'ur erso-Making Gift Disclosure
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Type of Identificati n e gmje`uuTro;,Ewj=an6e°o"w aa5_-7o1s
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Over a$100
Date Description Monetary Name of person Address of person
Rec. of gift Value making the gift making the gift
9-28-12 SOTB Expo $109.90 City of Miami Beach 1700 Convention Center Drive
Miami Beach,FL
9-29-12 SOTB Expo $109.90 "—" " -- " "—" " -- "
9-30-12 SOTB Expo $109.00 "—" -- " "—" " -- "
10/20/12 Miami City Ballet $170.00
Program I
Fire&Ice
10/30/12 Hombres G y Miguel $177.00
11-12-12 Auto Show $100.00
11-28-12 Rick Ross $165.00
11-29-12 M. Olympia $167.00
&IFBB
11-29-12 The Nutckraker $107.00
1212 Art Basel $168.00
12-14-12 Life in Color $120.00