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Max Sklar December 2008QUARTERLY GIFT DISCLOSURE FORM 9 (GIFTS OVER $100) LAST NAME -FIRST NAME -MIDDLE NAME: ~- NAME O AGENCY: • 8 MAILING AD RESS: OFFICE R POSITION HELD: ' 2 ~.~ ~ brY ~ ~ CITY; ZIP: COUNTx: ; , ,-~ -)~ ( ~? ~,,, ~U F ER ENDING (Check One): Z.d~ YEAR• MARC JUNE SEPTEMBER DECEMBER 20 Q,~_ ~~. PART A - STATEM~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 fads, 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 ffiis statement for any calendar quarter during which you did not receive a reportable gift. DATE RECEIVE D DESCRIPTION OF GIFT MONETARY VALUE NAME OF PERSON MAKING THE GIFT ADDRESS OF PERSON MAKING THE GIFT D 0 ` J ~~~ ` ~~~u-w~ µr^c~%t CHECK HERE IF CONTINUED ON SEPARATE SHEET C' ~ o -r, ~v PART B -RECEIPT PROVIDED BY PERSON MAKING THE GIFTc~--, ~~v ~1 r-- -~+ ,~ ,, ff 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 reoe~t to tOl!< fomi~ol u may attach an explanation of any differences between the information disclosed on this form and the information on the receipt. x~ A~ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM ~ ~ 'Yl PART C -OATH r`~'., I, the person whose name appears at the beginning of this form, STATE OF FLORID ~\ am ~ _ ~de do depose on oath or affirmation and say that the information COUNTY OF ~ ( _ -r ~ Sworn to (or affirmed) and subscribed before me this lU disclosed herein and on any attachments made by me consti- f ~ t ~ 20 day o , totes a true, aa:urate, and total listing of all gifts required to be S ~ X ~ a r . by reported by Section 112.3148, Florida Statutes. a) f+lodryPubic-sa.a % ~xp+les lN.r z1, zoos SIG RE OF REP ING OFFICIAL (Pri m to Public) Personally n Type of Identifiption Produced PART D -FILING INSTRUCTIONS This form, when duly signed and notarized, must be filed with the Commissron 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.) E F M 9 - EFF. 1/2001 (Ses reverse skis for Instruc ons )