Jose Smith September 2011 STATE ,
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME NAME OF AGENCY
Smith, Jose City of Miami Beach
MAILING ADDRESS OFFICE OR POSITION HELD
1700 Convention Center Dr., 4th Floor City Attorney
CITY ZIP COUNTY' FOR QUARTER ENDING (CHECK ONE) YEAR
LIMARCH LIJUNE E SEPTEMBER LI DECEMBER 2011
Miami Beach 33139 Miami —Dade
PART A — STATEMENT OF GIFTS
Please list below each gift, the value of which you believe to exceed 5100, accepted by you curing the calendar quaver for which this statement is
being filed You are required to describe the gill 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 gilts. 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
Please see attached Exhibit
M 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.
❑ 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 STATE OF FLORIDA
COUNTY OF Miami —Dade
depose on oath or affirmation and say that the information disclosed Swoon 19 affirmed) and subscribed before me this
,;Q I day of September , 2011
herein and on any attachments made by me constitutes a true accurate,
by Jose, Smith , �
and total listing of all gifts required to be reported by Section 112.3148,
/ /k&✓C i I — �
Ida S utes.
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(S'•nature of Notary Public -State of Florida) •
4 / .••'�Y ►v'• YAMILEX MORALES � � (Print, Type, or Stamp i ,"` eerTi . ,! 'I 4l(}-� f� I�?, U bb3 —
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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 5700; physi-
cal address 3600 Maclay Blvd, South, Suite 201, Tallahassee, Honda 32312. The form must be filed no later than the last day of the calendar quarter
that follows the calendar quarter for which this forum is filed (For example, if a gift is received in March, it should be disclosed by June 30.)
CE FORM 9 - EFF 1/2007 (See reverse side for instructions)
I
a •
Over a $10O
Date Description Monetary Name of person Address of person
Rec. of gift Value making the gift making the gift
6/25/11 ABFF $ 130.00 City of Miami Beach 1700 Convention Center Dr.
Miami Beach, FL 3 313 9
7/5/11 Christian Castro $207.00 " - C4 4C -- 44 " - LC 44 -- "
7/15/11 David Sedaris $100.00 " - GC LC -- GC " - 44 LC -- GC
7/15/11 Andres Calamaro $127.00 " - GC " -- GC " - LC GL -- GC
7/22/11 Miami Spice Kickoff $250.00 " -- GC GC -- LC " -- CC CC -- 4C
7/27/11 Chris Tucker $131.00 " - " GC -- CC " - CC C4 -- GC
8/11/11 Camila $197.00 CC - GC GC -- GC GC - GC GC -- GC
8/11/11 Ballet Etudes $120.00 " - ‘, GC -- GC " - C4 4, -- f,
8/11/11 Black Star $ 100.00 " -" " -- CC GC CC GC -- GC
9/16/11 XVI International $117.00 " -- G4 " -- CC " -- GC CC -- GC
Ballet Festival of Miami (Sat.)
9/16/11 XVI International $117.00 " - G4 LC -- CC " - GC GC -- LC
Ballet Festival of Miami (Sun.)
9/16/2011 Wine Festival $140.00 " - GC GC -- GC " - GC GC -- GC
9/19/11 Maria Bethania $160.00 " - GC GC -- " " - LC GC -- "
9/21/2011 Program I $170.00 " - GC GC -- GC " - ‘C CC -- GC
(Arsht Center)