Laura Dominguez Form 9 QTR IVM IA M I BE A C H
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-7411
March 26, 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 December 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.
Respectfu I ly,
7# Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE
{GIFTS OVER $100)
LA S T NAM E -- FIRS 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 ITIO N HELD :
1700 Convention Center Drive Commissioner, Group 2
C ITY : ZIP : CO U N TY : FO R Q UA R TER EN D IN G (C H E C K O N E ): YEAR
Miami Beach 33139 Miami-Dade □MARCH JUNE OSEPTE MBER /DECE MBER 2023
PART A- STATEMENT OF GIFT S
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
10 /14 /2023 National LGBTQ Task Force $450 City of Mi ami Beach 1700 Convention Center Dr,
Event bought table Miami Beach, FL 33139
10 /30 /20 2 3 G ift of L ife E vent at Q ueen $20 00 City of Mi ami Beach 1700 Conventionn Center Dr.
bought table Miami Beach, FL 33139
□CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B RE CEIPT 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.
O 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,
Florida Statutes._ f
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srE e OF FLORIDA ), _ ),/
COUNTY OF ,hm7- Ufr'
Sor to (or affirmed) and subscribed before me by means of
09eon or [ %pp7 %997 " 4/ 26 aoyoi 1/&ch ,ao2/
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(Print, Type, or Stam~L missio
Personally Known OR PA A\TCHELL
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EXP IRE S: April 13, 2025
Bonded Thru Notary Public Underwriters 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 -EF F. 1/2016 (R efer to Rul e 34-7.0 10(1)(g ), F.A.C.) (See reverse side for instructions) <iF'
City Clerk USPS CERTIFIED MAIL
1111 111111
9214 8901 9403 8354 6125 24
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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eturn Reference Number:
sername: Charles Dagostin
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□stage: $7.3600