Kristen Rosen Gonzalez Form 9 1. � � . �r��, I � E:� � �
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
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending June 2017, for the following City of Miami Beach Personnel:
• Kristen Rosen Gonzalez — Commissioner, City of Miami Beach
• Michael Grieco — Commissioner, City of Miami Beach
• Micky Steinberg — Commissioner, City of Miami Beach
• Rafael Granado — City Clerk, City of Miami Beach
• Philip Levine — Mayor, City of Miami Beach
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
�
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSUR R�������
(GIFTS OVER $100) �Q�� S�P 29 �� ��; _
3b
LAST NAME -- FIRST NAME -- MIDDLE NAME:
GONZALEZ ROSEN KRISTEN
MAILING ADDRESS:
NAME OF AGENCY: � St °;= , � � .r �§,;�� ��t-�
CITY b�1v11'f�MIP��I�,�-�i,
OFFICE OR POSITION HELD:
1700 CONVENTION CENTER DRIVE I COMMISSIONER
CITY: ZIP: COUNTY: � FOR QUARTER ENDING (CHECK ONE):
❑MARCH ❑JUNE �SEPTEMBER ❑ DECEMBER
MIAMI BEACH 33139 MIAMI-DADE
PART A— STATEMENT OF GIFTS
YEAR
2017
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
expiained 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
RECEIVED
04/13/2017
06/03/2017
DESCRIPTION
OF GIFT
LEAGUE OF CITIES GALA
MIAMIBEACH CHAMBER OF
COMMERCE
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
MONETARY
VALUE
150.00
325.00
NAME OF PERSON
MAKING THE GIFT
CITY OF MIAMI
BEACH
CITY OF MIAMI
BEACH
PART B— RECEIPT PROVIDED BY PERSON MAKING THE GIFT
ADDRESS OF PERSON
MAKING THE GIFT
1700 CONVENTION
CENTER DRIVE
1700 CONVENTION
CENTER DRIVE
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 expianation of any differences between the information disclosed on this form and the information on the receipt.
u i.nE�.i� ri�nc i� i+ ri�i.ci�T i� r+i ii�i.ricv iv i riia �vtrtivi
PART C — 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
Flor
�[�
to be reported by Section 112.3148,
�IAL
�
STATE OF FLORIDA
COUNTY OF � AEU�c
Sworn to (pr affirmed) ribe efore me this
����' d , 20 ��'l
by K C��" �-"`ON2A-1.E2
�
(Signatura - ' ?�
,�'M�•,• GLORfASALOM
: i ••h:!�,�:
(Print, Type, or Stamp � �jis ¢�Name � � � f� �
Personally Known �§ c� i r� u�n
Type of Identification Pr '•��'F�"'��� o PublicUndenKi6era
n_.! u_. eieie!i i�!i.is�i�iuuoi�iim iu�i�unr—.
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: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The form must be filed no later than the Iast day of the calendar
quaRer 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 (Refer to Rule 34-7.010(1}(g), F.A.C.)(Rev. 9/2014) (See reverse side for instructions) ``T
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� �- Certified Mail Fee
� N-EXt�a SeNiCes 2 FE2s (check bar, add fee as appropnate)
❑ Retum Receipt Q�ardcop� $
� � ❑�RetumReceipt(elecUonic) $ Postmal'k
�� ❑ Certfied Mail Resficted Deiivery $ Here
� � ❑ Adutt Signature Required $
O O ��ult Signature Restrictetl Delivery $
p p Postage
�7 u7 $
�� T� Florida Commission on Ethics
� P.O. Drawer 15709
a a 5 Tallahassee, FL. 32317 - 5709 _________________
O O S
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