Gloria Salom County FormMIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.aov
Telephone: 305.673-741 1
September 29, 2017
Miami-Dade Clerk of the
Board of County Commissioners
111 NW 1 St 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:
• Gloria Salom — City of Miami Beach Aide
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.
Respectfull ,
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME-FIRST NAME-MIDDLE NAME:
SALOM, GLORIA J.
STREE ADDRESS:
1700 CONVENTION CENTER DRIVE
cITY: MIAMI BEACH, FL
Z�'� 33139
COUN'rY: MIAMI-DADE
NAME OF AGENCY:
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CITY OF MIAMI BEACH
OFFICE OR POSITION HELD:
AIDE
FOR QUARTER ENDING (Check One):
❑ MARCH ❑ JUNE
C� 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
RECEIV ED
06/03/2017
DESCRIPTION
OF GIFT
MB CHAMBER GAI.A
MONETARY NAME OF PERSON ADDRESS OF PERSON
VALUE MAKING THE GIFT MAKING THE GIFT
325.00 CITY OF MB 1700 Convention C,�tr.,Dr.
MIAMI BFACH FL
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 the receipt. CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM. ❑
PART C: FILING INSTRUCTIOI�TS. The signed and notarized farm must be iiled 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 Couiity Coiilrnissioners, ll 1 N�' 1" St., Suite 17-10, Miami, FL 33128. Municipal personnel file with their
res}�ective 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, aecilrate,
and total listi.'1 of all gifts required to be reponed by
Sectiorl��-}��(e)(4) oi'��ie`Code of Miami-Dade
of Person Making Gift Disclosure
COE 02/2010
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Sworn to (or affirmed) and subscribed before me this
29t171ay of September , 20 17 ,
bv Glori Salo
am Person a c Gifl Disclosure)
l�^�+� .
(Sie��ature of Not ub 'q State of Florida)
C�� �. ,���r,--���—
, ype, or Stamp Convnisiioned Name of Notary Public)
Personally known to me or ❑ Produced Identification
Type of Identification Produced:
M+Nvw
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