Laura Dominguez Form 9 QTR IM IA #BE A CH
O FFIC E O F TH E C ITY CL ERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeach[l,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.
Reji]ly,
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
RE C EIVED
•IN 99 2n22 -
Form 9 QUARTERLY GIFT DISCLOSURE CI T Y CF MIAMI BEA CH
(GIFTS OVER $100) OFFICE EE CITY CLERK
LAST NAME -- FIRST NAME -- MIDDLE NAME NAME OF AGENCY:
Dominguez, Laura City 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 2ARCH JUNE □SEPTEM BER O DECE MB ER 2023
PART A- STATEMENT OF GIFTS
P le ase list be lo w ea ch gift , the value of w hich yo u be lieve to exceed $100, accepte d by you during the calendar quarter for w hich this statem ent is
being fil ed . Y ou are req uired to describe the gift and state the m onetary value of the gift, the nam e and address of the person m aking the gift, and the
date(s) the gift w as received. If any of these facts, other than the gift description, are unknow n or not applicable, you should so state on the fo rm . As
explaine d m o re fully in the instru ctions on the reverse side of the fo rm , you are not required to discl ose gifts fro m 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.
D AT E D E S C R IP T IO N M O N ETAR Y NA M E O F PER SO N AD D R ESS O F PER SO N
R E C E IV E D O F G IFT VALU E M AKIN G TH E GIFT M AKIN G THE GIFT
1/12/2023 Play Ticket $100 City of Miami Beach 1700 Convention Center
D rive, M iam i Beach FL 33139
1/27/2023 FOP Dinner $100 City of Miami Beach 1700 Convention Center
D rive, M iam i Beach FL 33139
2/15/2023 Performing Arts CenterTix $100 Harvey Burstein 177 5 W ashington A ve PH2
M iam i Beach FL 33139
2/16/2023 Performing Arts Center Tix $100 Harvey Burstein 1775 W ashington A ve PH2
M iam i Beach FL 33139
9 CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B - RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any re ce ip t fo r a gift listed abo ve w a s provided to yo u by the person m aking the gift , you are required to attach a copy of that receipt to this
fo rm . Y ou m a y att a c h an exp la n atio n of an y differe nces betw een the info rm ation discl osed on this fo rm and the info rm ation on the receipt.
D CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, the perso n w h o se na m e appe ars at the be ginning of this fo rm , do
depose on oath or affi rm atio n and say that the info rm ation discl osed to (or affi rm ed) and subscribed befo re m e by m eans of
~~sence or arization, this I""") _'7
her ei n an d on any atta chm en t s m ade by m e con stitute s a tru e accurate, ll) dayof t 20_z )
and total listing of all gifts req uired to be rep o rt ed by Section 112.3148, by [__ Z.,
soreor}1
C O U N TY OF ,
late of Florida)
(Print, Type, or StamX:m m i
Personally Know n 0
Type of Identification Produce
PART D - FILING INSTRUCTIONS %is$$ a ss ~ioy wo e usinmers
a
T his fo rm , w h e n du ly sig n e d and notarized , m u st be filed w ith the C om m ission on Ethics, P.O . D raw er 15709, Tallahassee, Flo rida 32317-5709; ph ysi -
cal add ress : 325 Jo h n K n ox R oad , Buildi ng E, Suite 200, Tallahassee, Florida 32303. The fo rm m ust be filed no later than the last day of the calendar
qu art er th at fo llo w s the cale nd ar qua rter for w hich this fo rm is filed (For exam ple, if a gift is rece ived in M arch, it should be discl osed 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) @
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA S T N AM E -- F IR S T NAM E -- M IDD L E NA M E : NA M E O F A G E N C Y :
D om in gu ez - L au ra C itv of M iam i B each
M A ILI N G A D D R E S S : O FFIC E O R PO S IT IO N HE L D :
10 V en eti an W ay #2 10 1 C o m m ission er, G rou p 2
C ITY : Z IP : C O U N T Y. FO R Q U A R TE R E N D IN G (C H E C K O N E ): Y EA R
M iam i B each 3313 9 M iam i-D ad e 2ARCH 0 JUNE □SEPTEM BER O DECEMBER 2023
PART A- STATEMENT OF GIFTS
Please list below each gift, the value of w hich you believe to exceed $100, accepted by you during the calendar quarter for which this statem ent is
being filed. You are required to describe the gift and state the m onetary value of the gift, the nam e and address of the person m aking the gift, and the
date(s) the gift was received. If any of these facts, other than the gift description, are unknow n or not applicable, you should so state on the fo rm . As
explained m ore fully in the instru ctions 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 DESC R IPTIO N M O N ETARY NAM E OF PER SON AD DRESS OF PERSO N
REC EIV ED OF GIFT VALU E M AKIN G THE GIFT M AKING THE G IFT
2/20/2023 G reater M iam i Jew ish $200 City of Miami Beach 1700 Convention Center
Federa tion D inner Event Drive, M iam i Beach FL 33139
2/23/2023 W ine and Food Festival V endor $650 City of Miami Beach 1700 Convention Center
deal incl uding tix to events Drive, M iam i Beach FL 33139
2/25/2023 W ine and Food Festival V endor $425 City of Miami Beach 1700 Conven tion Center
deal including tix to events Drive, M iam i Beach FL 33139
2/26/2023 W ine and Food Festival V endor $350 City of Miami Beach 1700 Convention Center
deal including tix to events Drive, M iam i Beach FL 33139
9 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 w as pro vided to you by the person m aking 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 rm ation discl osed on this fo rm and the info rm ation on the receipt.
D CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C- OATH
I, the person w hose 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,
Fl~tes
siAT&ePORTtNG OFFICIAL
STATE OF FLORI] )
CO UNTY OF 1'' 'e< th
irm ed) and subscrib ed before m e by m ean s of
e ol cine notarza on . mis 9-<
t /II .20_z
(Print, Type, or Stam
Personally Know n
Type of Identification Pro du
PART D FILING INSTRUCTIONS
This fo rm , w hen duly signed and notarized, m ust be filed with the Com m ission on Ethics , P.O . Dra wer 15709, Tallaha ssee, Flo rida 32317-5709; phy si-
cal address: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The fo rm m ust be filed no later than the last day of the calendar
quarter that fo llow s the calendar quarter fo r w hich this fo rm is filed (For exam ple, if a gift is received in M arch, it should be disclosed by June 30.)
C E FO RM 9 - EFF, 1/2016 (Re fer to Rul e 34-7.010(1)(g), F.A.C.) (See reverse side for instruction s) @
F o r m 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA ST NAM E -- FI R S T NAM E -- M IDD L 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 IT IO N HE LD :
10 Venetian Way #2101 Commissioner, Group 2
C ITY : Z IP : C O U N TY : FO R Q UA RT E R EN D IN G (C H E C K O N E ): Y EA R
Miami Beach 33139 Miami-Dade 2ARCH @ JUNE □SEPTEM BER □DECEM BER 2023
PART A STATEMENT OF GIFTS
Please list below each gift, the value of w hich 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 m onetary value of the gift, the nam e 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 m ore fully in the instru ctions 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 DESC R IPTIO N M ONETARY NAM E OF PERSO N ADDRESS OF PER SON
RECEIVED OF GIFT VALUE MAKING TH E GIFT MAKING THE GIFT
2/26/2023 SA VE Fundraiser $200 City of Miami Beach 1700 Convention Center
Drive, M iam i Beach FL 33139
3/2/2023 Winter Party Reception $100 City of Miami Beach 1700 Convention Center
Drive, M iami Beach FL 33139
3/4/2023 Little Lighthouse Foundation $400 City of Miami Beach 1700 Convention Center
Drive, M iami Beach FL 33139
3/8/2023 Aspen Ideas City Tix $100+ City of Miami Beach 1700 Convention Center
Drive, M iam i Beach FL 33139
D 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 pro vided to you by the person m aking 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 rm ation disclosed on this fo rm and the info rmation on the receipt.
O CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C- 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, Floites
s1cATURE ~ING OFFICIAL
swe orro9»)' tf/)E
couNnY or /UL[Ar t ulU
ed) and subscribed befo re me by means of
e or online notarization, this ..-, 3
h l '' _,20--
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 Eth ics , P.O. Drawer 15709, Tallahassee, Florida 32317-5709; physi-
cal address: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The fo rm m ust be filed no later than the last day of the calendar
quarter that fo llow s the calendar quarter fo r which this fo rm is filed (For exam ple, if a gift is rece ived in March , it should be disclosed by June 30.)
CE FORM 9- EFF 1/2016 (Ref er to Rule 34-7.010(1)(g), F.A.C.) (See reverse side for instructions) CJr
F o r m 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
D omi nguez--Laur a C itv of M iam i Beach
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 Mi am i-D ade 2ARCH JUNE 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 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
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 $200 City of Miami Beach 1700 Convention Center
Drive, Miami Beach FL 33139
a CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
D CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C OATH
I, the person whose name appears at the beginning of this form, do
depose on oath or affirmation and say that the information disclosed
herein and on any attachments made by me constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148, 372
SIGNATURE OF REPORTING OFFICIAL
ibed before me by means of
·ass 2$
h'. ,20_z)
(Print, Type, or Sta
Personally Known
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.)
C E FO R M 9 - EF F . 1/20 16 (R e fer to R ul e 34-7.0 10 (1)g ), F.A.C .) (S ee revers e si d e for instruction s) @°
C it y C le r k USPS CERTIFIED MAIL
lll111111111111111
9214 8901 9403 8320 8967 81
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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