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Gisela Torres County FormMIAMIBEACH 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 December 13, 2017 Miami -Dade Clerk of the Board of County Commissioners 111 NW 1St 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 quarter ending September 2017, for the following City of Miami Beach Personnel: • Gisela Torres — City of Miami Beach (Assistant City Attorney) 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, fael E. Granado, City Clerk Attachments REG:cd Sent Certified Return Receipt MIAMI-DADE COUNTY QUARTERLY GIFT DISCLOSURE LAST NAME -FIRST NAME -MIDDLE NAME: `T'oeQ /V/-I-vscx\J STREE ADDRESS: 1100 C t C ptir5e be. CITY: /l4,t iia( /a Aei P4— ZIP: 33/39 COUNTY: MLf ( &Sit kia S NAME OF AGENCY: C `(-(/ t( 3 C/ FL.a% OFFFICE OR POSITION HELD: a �SS'tS+avr t C i �±4-om FOR QUARTER ENDING Check One): ❑ MARCH ® SEPT. 0 DEC. ❑ JUNE YEAR. 20 ( 1 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 GIFT 4.1 I 1444., JFrrST )-'CiCftS y01'T MONETARY NAME OF PERSON ADDRESS OF PERSON VALUE MAKING THE GIFT MAKING THE GIFT y 'Z. 14m -C -5' CO'S AvtrvA- ('s 1 z 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. 0 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 lst 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 Count Signature of Person Making Gift Disclosure COE 02/2010 STATE OF FLORIDA COUNTY OF M olvt _ � Scorn to (or affirmed) and subscribed before me this day of .sl',g1I1&f2, 20 ( 7 by 643 &RAJ< O \) TB)eeES (Name of Person- takillg Gift Disclosure) (Signature of No tic,State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) f(I Personally known to me or 0 Produced Identification Type of Identification Produced: CARMEN B.fERNANDEZ ?r-' •i MY COMMISSION 0 FFI I4720 EXPIRES: August 03, 2010 CD m > m _ t. ED. en 10as o to 0D FD0 00 0 c - E 3 m o m E1) g N 203 a) m a v a) c 8> d v v m N o 2' -2 > crj 2cr m to liO >- to m CO CC to w X Cd o O U £ a) > m .5 .®C o E y 0 • o o ri 55 vs E V .0 m Q Q cd N O a) C C Y O Q r (6m —0) EECS -o m 0 U O 2 m y co Q >„1-4 o c o ■ ■ ■ Article Address Miami -Dade Clerk of the to v 0 N E E O U O V 0 0 O 00 N m M J 11. E ra 2 o Priority Mall Express® 0 Registered MallT ^ ❑ Registered Mali Restricted Delivery o Return Receipt for Merchandise • ❑ Signature ConflrmatlonTM 0 Signature Confirmation Restricted Delivery Domestic Return Receipt co to o 0) (O o ®O .-.- r9 0 r.4 N ti w ru o ®ca -- L7 cam) ti CD y Z tO N- E r- Inn co• ru o —.O w 0 Fa IU > N L 1:3� ®OEzi d' D r ameOJa E • c0 ® 0) Z c7 E Q r• 'R LL N r- a rR 0 N 0002 2744 U.S. Postal Service" CERTIFIED MAIL° RECEIPT Domestic Mail Only • FICIAL USE Certified Mail Fee r- $ n_I Extra Services & Fees (cher* box add tee as appropriate) 0 Return Receipt (hardcopy) $ O0 Return Receipt (electronic) $ 0 Certified Mail Restricted Delivery $ O Ln in a r� $ r- r- Sent Tc ❑ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ Postage Total Pr = - ---"---- r•R 0 P- r - Postmark Here Miami -Dade Clerk of the Board of County Commissioners Street, 111 NW 1st Street, # 17-10 city,st Miami, FL.33128 ructions