Robert Middaugh - December 2006QUARTERLY GIFT DISCLOSURE
FORM 9 (GIFTS OVER $100)
LAST NAME -FIRST NAME -MIDDLE NAME: NAME OF AGENCY: , ~~ ` $ea~`
itY1 ~ ~~ nu o ~. R n h ~.. RT C ~--
MAILING ADDRE OFFICE OR POSITION HELD: ,
'rI00 CONVeNTioN C~-~-"~ER ~RtV~ RSS1sTPtNT C 1~r
CITY: ZIP: COUNTY: FOR QUARTER ENDING (Check One):
MARCH JUNE SEPTEMBER
M'wmi B~~-h ~ 33t3~1- ~~~>G
PART A -STATEMENT OF GIFTS
rc i~.
YEAR:
20 0~_
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
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 consti-
tutes atrue, accurate, and total listing of all gifts required to be
reported by Section 112.3148, Florida Statutes.
STATE OF FLORIDA ~~
COUNTY OF /LI~/
Sworn to (or affirmed) and subscribed before me this
~~ ,~~ t1 F , 20 ~~
day of
by
(Signature of t ry P tic-State of Florida)
Notary i'ubwc State of Flprid~
~'~ ~ Judith Hernandez-Figueroa
(Pri , to e o otary Public)
Personally or ~ ~~ tification
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. 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. 1/2001 (See reverse side for instructions )
PART B -RECEIPT PROVIDED BY PERSON MAKING THE GIFT