Jose Smith March 2011 COUNTY •
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MIAMI -DADE COUNTY C/ v. 8 I: j
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QUARTERLY GIFT DISCLOSURE •s 0
LAST NAME -FIRST NAME - MIDDLE NAME: NAME OF AGENCY:
Smith, Jose City of Miami Beach
STREE ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Dr., 4th Floor City Attorney .
CITY: Miami Beach FOR QUARTER ENDING (Check One):
ZIP: 35139 ® MARCH ❑ JUNE
COUNTY: Miami -Dade ❑ SEPT. ❑ DEC. YEAR: 2n 11
PART A: STATEMENTS OF GIFTS. List below each gift, or series of gifts, from one person or entity in
excess of $100, accepted by you during the calendar quarter for which this statement is being filed. Describe the gift
and state the monetary value of the gift, the name and address of the person making the gift, and the dates the gifts
were received. If any of these facts are unknown or not applicable, state this on the form. 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
CHECK HERE IF CONTINUED ON SEPARATE SHEET. G)
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 CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM. ❑
PART C: FILING INSTRUCTIONS. The signed and notarized form must be filed no later than the last day
of the calendar quarter that follows the quarter for which this form applies. For example, if a gift is received in March,
it should disclosed the end of the next quarter, i.e., June 30. County personnel-file with-the Clerk of the Board
of County Commissioners, 111 NW 1 St., Suite 17 -10, Miami, FL 33128. Municipal personnel file with their
respective municipal clerks.
. PART D: OATH. • - - - - - --- --
I, the person whose name appears at the beginning of STATE OF FLORIDA
this form, do depose on oath or affirmation and say COUNTY OF Miami -Dade
_ .. _ 1 _ _ . __ _ - that the information _disclosed herein and on any__ _
attachments made by me constitutes a true, accurate, _ -- , S . ,' _ n o ( o r a f f i x d)�:and ubscribed before me this - -- - - -- -' - - --
and total listing of all gifts required to be reported by ,C1 day of af 20 11 ,
Section 2 -11.1 (e)(4) of the Code of Miami -Dade
County. by Jose Smith
(Name of Person M ng Gift Disclosure) '
/i�:. ��
/, (Si, nature of Notary Public, slut of Florida)
S na ; 7f of ' . • I : king Gift Disclosure Y,9,»/eK � Jim / ' � S
(Prin . , or Stamp Commissioned Name of
Notary � a Notary Public)
q Personally known to me or ❑ Produced Identification
Type of Identification Produced:
YRMILEX MORALES
COE 02/2010 s " t Commission # DD _
• • Expires Mlar( i6, 20° 870863 3 =
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BondedllwTreVFabthts /a80048840Js •
Over a $100
Date Description Monetary Name of person Address of person •
Rec. of gift Value making the gift making the gift
1 -20 -11 Jorge Dexler $133.00 City of Miami Beach 1700 Convention Center Dr.
Miami Beach, FL 33139
1 -20 -11 Les Ballet Trocadero $146.00 - CC - - CC - - ti - - CC -
1 -20 -11 Le Ballet Gran Prix $146.00 - 44 - - " - _ CC - _ `C -
2 -17 -11 Bubble Q $700.00 - 46 - - if - - IC - _ -
2 -17 -11 Burger Bash $400.00 - " - - " - - ii - _ it —
2 -17 -11 Grand Tasting $450.00 - " - _ " • 4C
4C • _ « •
2 -25 -11 Wine and Spirits Expo. $450.00 - " - - " _ - _ _ 64 • •
3-2-11 Kevin Hart $444.00 - 4C - _ " • • • « • 64
64 -
3 -2 -11 Gal Costa $146.00 - 4C - - ii - - 46 _ _ « _
3 -2 -11 Amuary Gutierrez $146.00 - "- - " - _ _ _ " _
3 -2 -11 Wanda Sykes $133.00 - 44 - - CC - - CC - _ « _
3-4 -11 Fashion Week $500.00 - 46 - - 44 - _ " _
• CC -
3 -9 -11 Program III Arsht $170.00 - "- - " - - _ « _
. Center
3 -16 -11 Program IV Arsh $178.00 - "- - " _ _ _ _" _
Center