Philip Levine Form 9IAMIBEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673.7411
March 23, 2018
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 December 2017, for the following City of Miami Beach Personnel:
• Daniel Gelber - Mayor
• Michael Gongora — Commissioner — Group 111
• Philip Louis Levine — Former Mayor
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfull
afael E. Granado,
City Clerk
Attachment
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Sent Certified Return Receipt
F:\CLER\$ALL\GIFT DISCLOSURES\MASTER FOR THE STATE - REG.docx
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAMEMIDDLE NAME:
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MAILING ADDRESS:
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CITY: ZIP:
NAME OF AGENCY:
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OFFICE OP POSITION HELD:
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COUNTY: FOR QUARTER ENDIN9,(CHECKOE): YEAR
M I CA/rrl - DIVIARCH LIJUNE F...PTEMBER DECEMBER 24 /
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 DESCRIPTION
RECEIVED OF GIFT
CHECK HERE IF CONTINUED ON SEPARATE SHEET
MONETARY
VALUE
NAME OF PERSON ADDRESS OF PERSON
MAKING THE GIFT MAKING THE GIFT
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.
Li 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
depose on oath or affirmation and say that the information disclosed
herein and on any attachments made by me constit .s a true accurate,
and total listing of all gifts required to be r
Florida Statutes.
SIGNATURE OF RSPORTICIAL
This for
cal address:
quarter that
,Section 112.3148,
STATE OF FLORIDA t) F>6
COUNTY OF
Sworn t9u(or affirmed) and subscribakedleforeme this
1 4i day of fl. Pt e..1.1 , 20 1 g
by Abikm
(Print, Type,
Type,
Personally K
Type of Eden
Signature of NotaryPublic-State of Florida)
PART D — FILING INSTRUC
1,41 y signed and notarized, must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709; physi-
ohn Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The form must be filed no later than the last day of the calendar
ows 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. 6/2016)
(See reverse side for instructions)
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