Michael Gongora Form 9 Quarter IIMIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
WWW.miamibeachfl.gov
Telephone: 305.673-7411
September 30, 2021
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 June 2021, for the following City of Miami Beach Personnel:
• Mickey Steinberg — City of Miami Beach (Commissioner)
• Michael Gongora — City of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
Rafel . ranado,
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:
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): YEAR
Miami 33139 Dade
❑MARCH p'JUNE ❑SEPTEMBER ❑ DECEMBER 20 21
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
MONETARY
NAME OF PERSON
ADDRESS OF PERSON
RECEIVED
OF GIFT
VALUE
MAKING THE GIFT
MAKING THE GIFT
05/17/2021
2 Tickets for WFF Italian
$350
City of Miami
1700 Convention
Bites ($175)
Beach
Center Drive
05/17/2021
2 Tickets for WFF Burger
$450
City of Miami
1700 Convention
Bash ($225)
Beach
Center Drive
05/17/2021
2 Tickets for WFF Grand
$500
City of Miami
1700 Convention
Tasting ($250)
Beach
Center Drive
05/17/2021
2 Tickets for WFF Bubble
$450
City of Miami
1700 Convention
Q ($225)
Beach
Center Drive
ly 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
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 constitutes a true accurate,
and total listing of all gifts req i e o be reported by Section 112.3148,
Flori Ja Sta s. l
S UR O REPOR G OFF CIAL
STATE OF FLORIDA
COUNTY OF /f/1 U J
Sworn to (or affirmed) and subscribed before me by means of
is I resence or ❑ o line notari tion, his .
//day of �`/2�0�y
by /'1 1-7 C-- `07 !126 -
of Florida)
Charles J.
(RriO,, Type Stamp CommissionedMtdGE
IJ OF FLORIC
Personaly nown OR ProduIM 'aw # GG168171
Type of Identification 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. 1/2016 (Refer to Rule 34-7.010(1)(g), F.A.C.) (See reverse side for instructions)
Table 1 4
05/17/2021
I—
05/24/2021
(I
WFF Best of the $800.00
Fest ($400 each)
—_
National Salute to $200.00
America's Heroes
($100 each) I
City of Miami
Beach
City of Miami
Beach
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1700 Convention
Center Drive
1700 Convention
Center Drive
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City
Clerk
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FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
Return Reference Number:
Username: Charles Dagostin
Code Violation #:
Court Case #:
Property Address
Permit ID #:
Custom 5:
Postage: $6.3300