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Qualifying documents M.Góngora AAIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 3313 ,i www.miamibeachfl.gov 2013 SEP _6 0110: 36 CITY CLERIC'S OFFICE CITY rLC. ;"=i` (J F F I C Tel: 305-673-7411. Fax: 305-673-7254 Email: RafaelGranado @miamibeachfl.gov STATE OF FLORIDA COUNTY OF MIAMI-DADE Before me, an officer authorized to administer oaths, personally appeared to me well known who, being sworn, says that he/she is a candidate for the office of City Commissioner (Group No. (or Mayor) for the City of Miami Beach_ , Florida; that he/she is a qualified elector of said City residing within the City at least one year before qualifying for City of Miami Beach elected office; that his/her legal residence is: .50 6I #:3k- , Miami Beach, Miami-Dade County, Florida; that he/she is qualified under the ordinances (including Miami Beach City Code Chapter 38 governing "Elections") and Charter of said City to hold such office; and that he/she has paid h required qualification fee. Michael G6ngora Candidate ignature of Candidate Sworn to and subscribed before me this 6A day of 1..2013. 4)3 Authorized Offic svle-rtsr`Ism Co., L6%3 Signatur of Notary NOTARY SEAL UUAMM K HAMEW MY COMMISSION#EE 844865 Date EXPIRES:February 18,2017. foaled hru Wary public Wder*ters F:\CLER\CLER\000_ELECTION\0000_2013 General Election\MISCELLANEOS WORD DOCS\CANDIDATE'S OATH.Docx CANDIDATE OATH — NONPARTISAN OFFICE 2013 SEP -6 AN 10: 36 V 0 1 1_ ICE (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021,Florida Statutes) r6-- (PLEAS PRINT NAMt AS YOU WISH IT TO APPIQ!-10 THE BALLOT"— NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of 01� Kk" , (office) (district#) Mr in I am a qualified elector of �,j�j County, Florida; (circuit#) (group 4r-seat#) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. lro)4 M'CLcej @ ML-�Ve I db,) Signature o Ca didate Telephone Number Email Address Ay,4f j y4D Address city State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): * Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities(see instructions on page 2 of this form): STATE OF FLORIDA COUNTY OF�ggd4y c: - Sworn to(or affirmed)and subscribed before me this (oL day of Ak�c .l./ , 20�. Personally Known: or Signature of Notary Public Produced Identification: ✓ Print,Type,or Stamp Commissioned Name of Notary Public UUAM R.HATFIELD Type of Identification Produced: MY COMMISSION#EE 844865 • o� EXPIRES:February 18,2017 � pf�v51 Bonded Thru Notary Public Underwriters DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. FORM 1 STATEMENT OF 2012 Please print or type your name,mailing FINANCIAL INTERESTS r,�. d address,agency name,and position below: 9'�I.° . h E'"FOR'OFRICE USE ONLY: LAST NAME--FIRST NAME--MIDDLE NAME: Gdn tr 1 P� 2013 SE 6 AN 10: 36 MAILING ADDRESS): I= 56--3b 6,v11; 3 kCflal Rl aV14 11-bmic, CITY: ZIP: COUNTY C ©� r NAME OF AG NCY: B 4!�7\�q () NAME OF OFFICE OR POSITION HELD OR SOUGHT: You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE **** BOTH PARTS OF THIS SECTION MUST RE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR,WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER(must check one): LJ� DECEMBER 31, 2012 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER CALCULATIONS, OR USING.COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING: ❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,you must write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY St i z_r-1C FA I2- Ill 0#= F I aA- Corrd abes, L_ :3-;-' 134' C,t-+ u� 6m; Bea,C,gw ooGn r o PART B-- SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE N PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] (If you have nothing to report,you must write"none"or"n/a") FILING INSTRUCTIONS for when and where to file this G 11 S ��, form are located at the bottom .5839 of page 2. INSTRUCTIONS on who must cloa A-� 0,VI( file this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. (Continued on reverse side) PAGE 1 PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions] (If you have nothing to report,you must write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES �s L+O1 PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,you must write"none"or'Wa") NAME OF CREDITOR ADDRESS OF CREDITOR �3S57 Ackkc-m�� 6%ecJe. Cwrn 1 r=37,- 1es --F7 - -3,z 13 PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,you must write"none"or"n/a") BUSINESS ENTITY#1 BUSINESS ENTITY#2 BUSINESS ENTITY#3 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY - OWNERSHIP INTEREST IF ANY OF PARTS A THROU F ARE CONTINUED ON A SEPARATE SHEET PLEASE CHECK HERE ❑ SIGNATURE re wired : DATE SIGNED (required): FIUSG INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, If you were mailed the form by the Commission Initially, each local officer/employee, including signing and dating it, send back on Ethics or a County Supervisor of Elections state officer, and specified state employee only the first sheet(pages 1 and 2)for filing. for your annual disclosure filing, return the must file within 30 days of the date of form to that location. his or her appointment or of the beginning If you have nothing to report in a particular Local officers/employees file with the of employment. Appointees who must be section,you must write"none"or'Wa"in that Supervisor of Elections of the county in confirmed by the Senate must file prior to section(s). which the confirmation, even if that is less than 30 (s) y permanently reside. (If you do not days from the date of their appointment. permanently reside in Florida, file with the NOTE: Supervisor of the county where your agency Candidates for publicly-elected local office MULTIPLE FILING UNNECESSARY: has its headquarters.) must file at the same time they file their Generally, a person who has filed Form 1 State officers or specified state employees qualifying papers. for a calendar or fiscal year is not required file with the Commission on Ethics, P.O. Thereafter, local officers/employees, state to file a second Form 1 for the same year. Drawer 15709,Tallahassee, FL 32317-5709. officers, and specified state employees However, a candidate who previously filed are required to file by July 1st following Form 1 because of another public position Candidates file this form together with their each calendar year in which they hold their must at least file a copy of his or her original qualifying papers. positions. Form 1 when qualifying. To determine what category your position falls Finally, at the end of office or employment, under,see the"Who Must File"Instructions on each local officer/employee,state officer,and page 3. specified state employee is required to file a final disclosure form(Form 1 F)within 60 days Facsimiles will not be accepted. of leaving office or employment. However, filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if he or she was in their position on December 31,2012. CE FORM 1-Effective:January 1,2013.Refer to Rule 34-8.202(1),F.A.C. PAGE 2 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY: GONGORA, MICHAEL CITY OF MIAMI BEACH MAILING ADDRESS: OFFICE OR POSITION HELD:&arac� M4 � 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR MIAMI BEACH, FL 33139 DADE ❑MARCH 1$JUNE ❑SEPTEMBER ❑DECEMBER 20J3 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 ATTACHED r., '7i L 1 e ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET �, I Ti PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT If any receipt fora 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 depose on oath or affirmation and say that the information disclosed Sworn to or armed)and sub cribed before rjre this day of_ 20 4�5 herein and on any attachments made by me constitutes a true accurate, by ! Old• � / � and total listing of all gifts re uired to be reported by Section 112.3148, Florida utes. (Signature of Notary Public-St of Florida) (Print,Type,or Stamp Commissioned Name of Notary Public) IGNATURE OF REPORTI G OFFICIAL Personally Known O Xt . i ti Type of Identification Produce MY COMMISSION#EE 844865 PART D—FILING INSTRUCTIONSEXPIRES:February 18,2017 nded Thru Notary Public Underwriters 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) i FORM 9 QUARTERLY GIFT DISCLOSURE VC F) (ATTACHMENT) 7013 SEP -6 AN 10: 36 RE: Commissioner Michael Gongora _ �, .:`�; Ticket Distribution for April - June 2013 � M1, City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 4/21/13 JAMEL DEBBOOZE SB COMEDY FEST Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $55.50 ea. $111.00 4/26/13 FONSECA Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $55.00 ea. $110.00 5/17/13 RAPHAEL Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.50 ea. $107.00 5/25/13 CUBAN CLASSICAL BALLET Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $68.50 ea. $137.00 6/1/13 Miami Beach Chamber of Commerce Annual Gala Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 1 tickets @ $300.00 ea $300.00 6/6/13 PAM ANN "COCKPIT" Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $50.00 ea. $100.00 FORM 9 QUARTERLY GIFT DISCL6W ��� ? (ATTACHMENT) CI i�,f C` `;`5 OF ICS RE: Commissioner Michael Gongora Ticket Distribution for April -June 2013 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE 6/14/13 CESAR MILLAN Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $56.00 ea. $112.00 6/22/13 Miami Dade Gay & Lesbian Annual Gala Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 1 tickets @ $200.00 ea $200.00 6/23/13 MARISA MONTE Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $88.50 ea. $177.00 6/24/13 MARISA MONTE Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $88.50 ea. $177.00 6/29/13 DANIEL TOSH (7:OOPM) Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $59.75 ea. $119.50 6/29/13 DANIEL TOSH (9:30PM) Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $59.75 ea. $119.50 l