Philip Levine Form 9�.� I A„M. I B EAC F�
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)
LAST NAME — FIRST NAME -- MIDDLE NAME NAME OF AGENCY:
i � v' � r��� � I�h � I � � I _ [� t ,� � � �..:t + -I C� �t '�^i � �� 1�1 � � Ci � Ir�
MAILING ADDR SS: � OFFICE OR bOSITiON HELD:
�� o�; C��n�,� �-��t � �� ��,� C�►��' � 1� r, �,'1 C1 �l t� r
CITY ZIP: COUNITY: FOR QUART�R ENDING (CHECK ONE): YEAR
�`��I �� `� I I�CtI ��� �)� � ?'(� ; f�1 t' �-{? UMARCH JUNE ❑SEPTEMBER ❑ DECEMBER 20��
PART A— STATEMENT OF GIFTS
Please list below each gift. the value of which you believe to exceed 5100. 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 ihe gift, the name and address of the person making the gift, and the
date(s) the giit 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
explamed more fully in the instructions on the reverse slde ot the form, you are not reqwred to disclose gifts from relatives or certain other gifts. You
are not required to file this statement for any calendar quaRer 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
I /
�CHECK HERE IF CONTINUED ON SEPARATE SHEET
I/
PART B— RECEIPT PROVIDED BY PERSON MAKING THE GIFT
if any rece�pt for a gitt listed abo�e was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
torm. You may attach an explanation of any differences between the mformation disclosed on this form and the in(ormation on the receipt.
U CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C — OATH
I, the person whose name appears at the beginning of thls form, do STATE OF FI
COUNTY OF
depose on oath or affirmation and say that ihe information d�sclosed Swor t�or �
herein and on any attachm� made by `r,
and total listing of
Florida
a irue accurate.
by
by Section 112.3148.
before me this
20 ('l
\/ ( igna ure of Notary Publio-State of Florida)
r
(Print, TypE r Stamp ~, Na ���R ..�. �C�' .
OFFICIAL �PerspriailyTT7 f�no r� ced� �oCL. t2 �
�b en i ication Pr ����
� � � � �
PART D — FILING INSTRUCTIONS
This form, when duly signed and notarized, must be filed wrth the Commission on Ethics, P.O. Drawef 15709, Tallahassee, FlOrid2 32317-5709; physi-
cal address� 325 John Knox Road, Building E, Suite 200. Tallahassee, Florlda 32303. The form must be fi�ed no later than the last day of the calendar
quarter that folbws the calendar quaner tor which this form is filed (For example, if a gift is received in March, it should be disGosed by June 30.)
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Tallahassee, FL. 32317 - 5709
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