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Michael Gongora Form 9MIAMI BEACH 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 June 29, 2018 Florida Commission on Ethics P.O. Drawer 15709 Tallahassee, FL 32317-5709 Pursuant to Sec. 112.3148, Florida Statutes, please find a Quarterly Gift Disclosure State Form (9), for the quarter ending March 2018, for the following City of Miami Beach Personnel: • Michael Gongora — Commissioner (City of Miami Beach) • Ricky Arriola — Commissioner (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 7017-1450-0002-2744-0259 Form 9 QUARTERLY GlFT DISCLOSURE (GIFTS OVER $100) LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY: Gongora, Michael City of Miami Beach MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive Commissioner CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): Miami Beach 33139 Dade �MARCH ❑JUNE ❑SEPTEMBER ❑ DECEMBER PART A— STATEMENT OF GIFTS YEAR 2o�y Please list below each gift, the value of which you believe to exceed $100, accepted by you during the caiendar 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 02/ 14/2018 DESCRIPTION OF GIFT VIP Art Wynwood Tickets (4) ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET MONETARY VALUE $220 NAME OF PERSON MAKING THE GIFT Art Wynwood PART B— RECEIPT PROVIDED BY PERSON MAKING TNE GIFT ADDRESS OF PERSON MAKING THE GIFT Art Mia�ni. LLC 48 N W 29th Street Miami, FL 33127 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 TH15 FORM PART C — OATH I, the person whose name appears at the beginning of this form, do STATE OF FLORIDA COUNTY OF M�M1' �ADC�' depose on oath or affirmation and say that the information disciosed Sworn to (or affirmed) and subscribed before me this Z9 day of Tv N� , 20 18 herein and on any attachments made by me constitutes a true accurate, by �lC(-�AG� GOt�cGo.;LrA and total listing of al� gifts required to be reported by Section 112.3148, %� � / Florida Stat es. � (Signat�re of Notary Public-State of Florida) � � �,t�.,�,Rt#� �"- GTLAnr�OG �� (P , , tamp Commissioned Name of Notary Public) S NATURE OF REP Ri�NG O ICIAL P nally Known OR Produced Identification Type o�Identitication Produced 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 last day of the calendar quarter 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. 6/2016) (See reverse side for instructions) � D � 0 � Z � � � 1] N � d � y U� � � � o � ozO � m p f1J m til '_ � � -- - - - � Cn .� O � � � � O = N vi W � �('�, � �V v — �� rn — � �� — q _ � R: — � � � � O � � u, .� �00000r�w �OOOODD oommao.(n � � � � m �.�q.��ommvi�. .o o afl-�� m .>>�3>> —=oomc,wm—i � m ��m 3 �2 � � m m � � s a N a o � o O �a _ �n m o `m o- � m_ � m � � m `� � ■ s � �� ° D o 'D C� ('\ � � � n S .�-« � �<.:) D s p) .� 'O 7'.+ "O (D �YJ �a � � � � � 7 � � � � � � ! � N � n n � � ��a�� o � p �j 1 � N � 3 Q. 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