Adrian Gonzalez & Margaret Benua Gift DisclosureMIAMIBEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-7411
June 13, 2017
Miami -Dade Clerk of the
Board of County Commissioners
111 NW 1" Street, # 17-10
Miami, FL 33128
Pursuant to Section 2-11.1(e)(4) of the Code of Miami -Dade County, attached please find a copy
of the Miami -Dade County Quarterly Gift Disclosure Form, for the following City of Miami Beach
Personnel:
• Adrian Gonzalez — Visitor & Convention Authority Board Member
• Margaret Benua — Visitor & Convention Authority Board Member
The original has been filed with the Miami Beach Office of the City Clerk.
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME -FIRST NAME -MIDDLE NAME: NAME OF AGENCY:
STREE ADDRESS: OFFICE OR POSITION HELD:
S7voo LRK-eVlew D2tV-e- 1 0AZ� k7\-e-6'—
CITY: ` R m� t :2�(_ FOR QUARTER ENDING (Check One):
ZIP: ARCH JUNE
COUNTY: vrj SEPT. ❑ DEC. YEAR: 20 t
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
RECEIVED
DESCRIP'T'ION MONETARY
OF GIFT VALUE
NAME OF PERSON
MAKING THE GIFT
ADDRESS OF PERSON
MAKING THE GIFT
�nM\'�^�.
Ir�A�1 13t �n��
"�;d% 9W 4G L100 00
f
Ii01
9.Su4rg03 M
3 , 11
c,`1'ie )� I UC (0!50 • 00
rA S V e 1r
►Jo i r�n:d r C. rtw
CHECK HERE IF CONTINUED ON SEPARATE SHEET. ❑
1.9
Z73
PART B: RECEIPT PROVIDED BY PERSON MAKING THE GIFT. If any receipt for a gift 1
listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to thi
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 1st 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
this form, do depose on oath or affirmation and say
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate,
and total listing of all gifts required to be reported by
Section 2-11.1 (e)(4) of the Code of Miami -Dade
County.
6?F��
Sign toe Person Making Gift Disclosure
STATE OF FLORIDA
COUNTY OF A -1i
Sworn to (or affirmed) and subscribed before me this �
13' -"day of jl lam_, 20 %__7
by Ad ria y� ion za.1e z
(Name of Person Making Cift Disclosure)
(Signature of Notary Public. State of Florida)
Elle -m -/a /,�(- Grit vva- Set v4
(Print. Type. or Stamp Commissioned Name of Notary Public)
Personally known to me or ❑ Produced Identification
Type of Identification Produced:
..........
1 P ��/� EILEEN DE LA CUESTA-SELVA
COE 02/2010 ; g'. Notary Public - State of Florida
Commission # FF 904384
�rF OF FL ���•' My Comm. Expires Oct 1 B, 2019
"rttrrr� 8prdedthroughNationa WaaryAssn.
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME -FIRST NAME -MIDDLE NAME:
lvrJA ktC.ir �T" nC
NAME OF AGENCY:
M
STREE ADDR SS:
OFFICE OR PO ITION HELD:
ADDRESS OF PERSON
MAKING THE GIF -7
Mc,.,�6�/
CITY:
Vv\,,,, ��L�
FOR QUARTER ENDING (Check One):
ZIP: g's 13I
T$ MARCH ❑ JUNE
COUNTY: fvN,
❑ SEPT. ❑ DEC. YEAR: 20%-%
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
RECEIVED
DESCRIPTION
OF GIF"I'
MONETARY
VALUE
NAME: OF PERSON
MAKING THE GIFT
ADDRESS OF PERSON
MAKING THE GIF -7
Z 4-ic 6,6
0)6141-A
I—+M YY1 ti, j
CHECK HERE 1F CONTINUED ON SEPARATE SHEET. ❑
h
.L -e_
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 ATTACHEDTO THIS FORM. ❑
PART C: FILING INSTRUCTIONS. The signed and notarized form must be tiled 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, I I 1 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
this term, do depose on oath or affirmation and say
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate,
and total listing of all gifts required to be reported by
Section 2-11.1 (e)(4) of the Code of Miami -Dade
County.
Signa re of Person Making Gift Disclosure
EIIE �N DE LA CUE A 0ELVA
Notary Public - State o1 Florida
•= Commission #r FF 904384
My Comm. Expires oct 16, 2019
Banded through National Notary Assn.
COE 02/2010
STATE OF FLOR DA a
COUNTY OF 1&M1 L
Swop, to (or affirmed) and subscribed before me this
6 — day of AtA e_ . 20 1-7
one S'Maa
v(Nmurol Pr- m%I:kme Oti ni. Im�luc•i
kilo
ISignm urr of Nomn, Puhk. Slide nl Flmnda)
_04 -em Ala Guesfa-,SPlva
(Prim. Tape. (1r Scatlp C'omminioned Name of Nuhn') Puhho
personally known to me or ❑ Produced Identification
Type of Identification Produced:_-
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