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Mayor Gelber State Form 9M IAMI BEACH OFFICE OF THE CITY CL ERK City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139 www.miamibeachfl,gov Telephone: 305.673-741 l December 22, 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 September 2021, for the following City of Miami Beach Personnel: • Daniel Gelber - City of Miami Beach (Mayor) Should you have any questions or require any additional information, please contact me at 305.673. 7 411. Res76 Ratai' 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: Gelber, Daniel, Saul Citv of Miami Beach MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive Mavor CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR Miami Beach 33139 Miami-Dade □MARCH OJUNE SEPTEMBER O DECEMBER 2021 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 8/30/2021 Miansai Leather Folder. Notebook & $188.00 Style Saves Pen D 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. D CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM PARTC-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 112.3148, SIGNATURE OF REPORTING OFFICIAL STATE OF FLORIDA COUNTY OF PLAl- AO E om ,Jó (or affirmed) and subscribed before me by means of ul ysical presence or [] online notarization, this 2 day ot Dg +I n ,201 I i g. i ±5; 52 i; 9 ä 32 ±} ooe-E. A?s Nllg"E%. (Print, Type, or Stamp Commissioned Name of Notary Public) j%éz Personally Known OR Produced Identification {@ lii Type of Identification Produced [9%·; " 4{" · Dy gr IN7 by _,L , (Signature of Notary Public-State of Florida) 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) @" City Clerk USPS CERTIFIED MAIL I I 111 1 1 1111 I 9214 8901 9403 8362 2925 27 FLORIDA COMMISSION ON ETHICS PO BOX 15709 TALLAHASSEE FL 32317-5709 Fold Here Return Refere nce Num ber: Usern am e: Charles Dagostin Code Violation # : Court Case #: Pro perty Addre ss : : Perm it ID #: Custom 5: Postage: $6 .1300