Laura Dominguez Form 9 QTR IV (2)M IA M I 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
March 29, 2024
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending December 2023, for the following City of Miami Beach Elected Official:
• Laura Dominguez, Commissioner Group II
Should you have any questions or require any additional information, please contact me at
305.673. 7 411.
e
KEILA MENA Ry(Rafael E. Granado
City Clerk
Attachments
REG:rq
Sent Certified Return Receipt
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:
1700 Convention Center Drive Commissioner, Group 2
CITY: ZIP: COUNTY: FOR QUARTER ENDING {CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade OMARCH 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
10/14/2023 National LGBTQ Task Force $450 City of Miami Beach 1700 Convention Center Dr,
Event bought table Miami Beach, FL 33139
10/30/2023 Gift of Life Event at Queen $2000 City of Miami Beach 1700 Conventionn Center Dr.
bought table Miami Beach, FL 33139
12/5/2024 $500 City of Miami Beach 1700 Convention Center Dr
Art Basel ticket policy Miami Beach FL 33139
12/5/2024 Normandy Arts LLC 1255 Marseilles Dr.
Nicole Henry Concert $125 Miami Beach 33141
□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.
O 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,
FloMda Stawte,. , ~
SIG~INGOFFICIAL
STATE OF FLORIDA .
couNTY or }CQL__DcQ3
Sworn to (or affirmed) and subscribed before me by means of
[Bl physical presence or [} onine notarization, this ,q
Z1 dayof loch zoZl
» Lago Tc Y«.2
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wet,,
(Signature of Notai [Slj ~te of Flori&A/LI GUTIERREZ
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(Print, Type, or Stamp Commiss" El'ii#kiss#id
Personally Known OR P
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), FA.C.) (See reverse side for instructions) @°
City of Miami Beach
City Clerk
1700 Convention Center Dr
Miami Beach Fl 33139 II I
USPS CERTIFIED MAIL
II 1111 I
9214 8901 9403 8354 9803 02
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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Username: Keila Mena Caceres
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