Laura Dominguez Form 9 QTR IM IA M I BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachhl.gov
Telephone: 305.673-7411
June 29, 2023
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 2023, for the following City of Miami Beach Personnel:
• Laura Dominguez - Commissioner (City of Miami Beach)
Should you have any questions or require any additional information, please contact me at
305.673. 7 411.
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
RECEIVED
llIM 90 9n92 -~
Form 9 QUARTERLY GIFT DISCLOSURE CITY OF MIAMI BEACH
(GIFTS OVER $100) OFFI EE CITY CLERK
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
Dominguez, Laura Citv of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD:
10 Venetian Way #2101 Commissioner Group 2
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade 2 ARCH JUNE □SEPTEMBER O DECEMB ER 2023
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
1/12/2023 Play Ticket $100 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
1/27/2023 FOP Dinner $100 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
2/15/2023 Performing Arts CenterTix $100 Harvey Burstein 1775 Washington Ave PH2
Miami Beach FL 33139
2/16/2023 Performing Arts Center Tix $100 Harvey Burstein 1775 Washington Ave PH2
Miami Beach FL 33139
/ CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B - RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
J CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, the person whose name appears at the beginning of this form, do
depose on oath or affirmation and say that the information disclosed
herein and on any attachments made by me constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148,
~"~"
SIGNATLJ ~EPORTING OFFICIAL
stare or ro9a,gr
COUNTY OF /VI
to (or affirmed) and subscribed before me by means of
~~sence or . tarization, this ,......, _t?
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ate of Florida)
(Print, Type, or Stamp Commi
Personally Known _O
Type of Identification Produce
PART D FILING INSTRUCTIONS ?$gs a a rr~icy ow e users
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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) e"
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAM E -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
D om in guez - Laur a Citv of M iam i B each
MAILING ADDRESS: OFFICE OR POSITION HELD:
10 V enetian W ay #2101 Com m issioner, G roup 2
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE). YEAR
M iam i B each 33139 M iam i-D ade 2ARCH □JUNE □SEPTEMBER □DECEMBER 2023
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
2/20/2023 Greater Miami Jewish $200 City of Miami Beach 1700 Convention Center
Federation Dinner Event Drive, Miami Beach FL 33139
2/23/2023 Wine and Food Festival Vendor $650 City of Miami Beach 1700 Convention Center
deal including tix to events Drive, Miami Beach FL 33139
2/25/2023 Wine and Food Festival Vendor $425 City of Miami Beach 1700 Convention Center
deal including tix to events Drive, Miami Beach FL 33139
2/26/2023 Wine and Food Festival Vendor $350 City of Miami Beach 1700 Convention Center
deal including tix to events Drive, Miami Beach FL 33139
9 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,
%% Sl~ORTING OFFICIAL
sweorroy, 7[
COUNTY OF _it'' l' Se "
rmed) and subscribed before me by means of
nce or amine notarzaon. nits )?
tilt 20_Z
-z
Personally Know
Type of ldentificati
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 - EF F. 1/2016 (Refer to Rule 34-7.010(1)g), F.A.C.) (See reverse side for instructions) Cir
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
Dominguez-- Laura Citv of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD:
10 Venetian Way #2101 Commissioner, Group 2
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade 2 ARCH 3 JUNE □SEPTEMBER O DECE MBER 2023
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 w as 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 m ore fully in the instructions on the reverse side of the fo rm , 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 MO NETARY NAME OF PERSON ADDRESS OF PER SON
REC EIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
2/26/2023 SA VE Fundraiser $200 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
3/2/2023 Winter Party Reception $100 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
3/4/2023 Little Lighthouse Foundation $400 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
3/8/2023 Aspen Ideas City Tix $100+ City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
□CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B - RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt fo r 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
fo rm . You m ay attach an explanation of any differences between the info rmation disclosed on this form and the info rmation on the receipt.
□CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, the person whose nam e appears at the beginning of this fo rm , do
depose on oath or affi rm ation and say that the info rm ation disclosed
herein and on any attachm ents m ade by m e constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148,
Flo~tes
SIGATURE ~ING OFFICIAL
STATE OF FLORIDA/) " -
couNTY or /U [Ly
ed) and subscribed before me by means of
e or online notarization, this '°"I 3
oh l ' _.20e
Personally Known
Type of Identification Produc
PART D - FILING INSTRUCTIONS
This fo rm , when duly signed and notarized, m ust be filed with the Com m ission on Ethics , P.O. Drawer 15709, Tallah assee, Florida 32317-5709; ph ysi-
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 fo llows the calendar quarter fo r which this fo rm is filed (For exam ple, 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 instructi on s)
F o rm 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA ST NAM E -- FI R S T NAM E -- MI D DL E NA M E : NA M E O F A G E N C Y :
Dominguez--Laura Citv of Miami Beach
M A ILI N G A D D R E S S : O FFIC E O R PO S ITIO N HE LD :
10 Venetian Way #2101 Commissioner, Group 2
C ITY : ZIP : C O U N TY : FO R Q U A RT ER EN D IN G (C H EC K O N E): YEA R
Miami Beach 33139 Miami-Dade 24ARCH 0JUNE □SEPTEMBER O DECEMBER 2023
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 statem ent fo r any calendar quarter during w hich 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
3/8/2023 HaSalon Aspen Dinner $150 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
3/11/2023 Miami New Drama Vendor Deal $200 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
□CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
□CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, the person whose name appears at the beginning of this form, do
depose on oath or affirmation and say that the information disclosed
herein and on any attachments made by me constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148,
Peg
SIGNATURE OF REPORTING OFFICIAL
ibed before me by means of
·ass» 2$
=h'a''.20_a)
(Print, Type, or Sta
Personally Knowns
Type of Identification Produced
15 ER#Rs: D
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 FOR M 9 -E FF. 1/2016 (Refer to Rule 34-7.010(1)(g), F.A.C.) (See reverse side for instructions) @
City Clerk USPS CERTIFIED MAIL
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FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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