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Rafael Granado Form 9:^.n ! ��:^�.�^ ! B EAC H 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 DISCLOSURE �� (GIFTS OVER $100) �� q p� �: OS LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY: GRANADO, RAFAEL CITY OF MIAM BEACH ;��';` �7i= E' ��i'ii ��;Gi� MAILINGADDRESS: OFFICE OR POSITION HELD: ��1C� ��~ �� 4! �� 1700 CONVENTION CENTER DRIVE, 1ST FLOOR CITY CLERK CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR MIAMI BEACH 33139 MIAMI-DADE ❑MARCH �JUNE ❑SEPTEMBER ❑ DECEMBER 2017 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 RECEIVED JUNE 16, 2017 DESCRIPTION OF GIFT SAVE DADE - CHAMPIONS OF EQUALITY RECEPTION ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET MONETARY VALUE $100 NAME OF PERSON MAKING THE GIFT CITY OF MIAM BEACH OFFICE OF CITY ATTY PART B— RECEIPT PROVIDED BY PERSON MAKING THE GIFT ADDRESS OF PERSON MAKING THE GIFT 1700 CONVENTION CNTR DRIVE, MB, FL 33139 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 - OATH I, the person whose name appears at the beginning of this form, do STATE OF FLORIDA ;� ` COUNTY OF ��M I' Jd4'S� I depose on oath or affirmation and say that the information disclosed Swor�,(or a�rmed) and s scribed before me this `1 day of�iEa+�g6Q- , 20 i ,.,,•"' herein and on any attachments made by me constitutes a true accurate, +�` .•; 3 by 1in JiHDO i": and total listing of all gifts required to be reported by Section 112.3148, d�/Y..- C�cT`--`— ,�, � , �� Florida Statutes. /(Signature of Notary Public-State of Florida) �� = ron � � i �•,– �1�o1�J Sl�t,l//QTo�6 ' m^ i / � �- �� {� 1 C�' � (Print, Type, or Stamp Commissioned Name of Notary Public) ; Z SIGNATUF� OF� �ORTING OFFICIAL Personally Known � OR Produced Identification � �� Type of Identification Produced PART D - FILING INSTRUCTIONS � � i � �� This form, when duly signed and notarized, must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-:_ .; 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 caler�`, . 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) � N D n � m C3� � c O � Q � — m � _ � � O 41 1 � m O �� . � � 1 m � — � � - � � � m � � rn� � u, — w = 7O�O�o�� - oOQOODD 0 o m m a a U� - a.�c c N _ � 1•�•� �N V1fn � '» > � 3 `� `� nm °�owmcc,� < < � � m m � �� s` N $ n � o a � m z m m m � m` m � � ❑❑ ❑ ❑OO` mcn��o�� n� m W m m m . J 7 C "(O (� O C.t pl 5 s �� N�. c c p�.� m m`< `m m a� nmam C� C7 m � m m >> �a m —_x o � 3� � N y � 0 0 � > > � � � � T O v Q � � � flJ N � n � � � � T � � r � W � v+ N � � w � � V V O O � � m lri ,� J S 0 � � O � y mm (n � m 3 `� �a a �- � m N y ,� g' � a �D � � ya Q3 �_ �3 -J ❑ ❑ o � N --.. �.yy _, W �( D � 'J7 � m m - a ; Q � � � a w � i P M M M Y d' O w � U O } � H U � w � 2 � � m � � 0 .� w � U LL j � � � � S � v `c O a� d U m � r Q � C � N tic ] i Q O U � o 0 � � V '-- f1J fU � . • ri r� r� ri _ � � O O • �� • � � � � �- � Certified Mail Fee I � r" � � � E)ctra Services & Fees (check box, add �ee as app/opriate) ❑ Retum Receipt Qiardcop� $ � N ❑ aewm qeceiPt �e�ectror,ic) S p�� O O � Certified Mail qesMctad Dglivery g Here � � ❑Adutt Signature Requtred $ � � ❑ Adu!t Slgnature Restricted Delivery $ O O Postage u� u� � �� T Florida Commission on Ethics g P.O. 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