Patricia Deann Walker- June 2014 Form 9 1
Form 9 QUARTERLY GIFT DISCLOSURE 0 P y
(GIFTS OVER $100)
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY:
WALKER -PATRICIA-DEANN CITY OF MIAMI BEACH M.B. EMP PENSION BOARD
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 CONVENTION CENTER DRIVE CFO/MBEPB
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
MIAMI BEACH 33139 MIAMI-DADE ®MARCH ❑JUNE ❑SEPTEMBER ❑DECEMBER 2014
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
JAN 2014 MIAMI CITY BALLETTKTS* 335. MIAMI CITY BALLET 2200 LIBERTY AVE
MIAMI BEACH FL,33139
FEB 2014 MIAMI CITY BALLET TKTS* 335. MIAMI CITY BALLET 2200 LIBERTY AVE
MIAMI BEACH FL 33139
*RECEIVED IN MY GOVERNORS MEMBER FOR
CAPACITY AS BOARD OF MIAMI CITY BALLET
❑ 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 tile receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM X_ .rte
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA
COUNTY OF /YJI !/'64 nif
depose on oath or affirmation and say that the information disclosed Swor Vor affirmed)and s bscribed before me thiscD 1 `
day of �
herein and on any attachments made by me constitutes a true accurate,
UAL-
and total listing of all gifts required to be reported by Section 112.3148,
Florida St S. ignature of Notary Public-State of Florida)
(Print,Type,or Stam Co m 'i me o �'
SIGNATURE OF REPORTING OFFICIAL Personally Known r AIdWftaTj'Aic S!,:il urila
Type of Identification Prod . My C)rnm_ Expires,iu;2" is
z`l` Iu r7 L; I"
B000ed Through haiiooal Notary Assn.
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 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)