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Jerry Libbin - December 2011 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME-FIRST NAME-MIDDLE-NAME: NAME OF AGENCY: LIBBIN, JERRY CITY OF MIAMI BEACH MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 CONVENTION CENTER DRIVE COMMISSIONER CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR MIAMI BEACH, FL 33139 DADE ❑MARCH ❑JUNE ❑SEPTEMBER DECEMBER 201— 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 SEE ATTACH D C'l N O ►V ' 71 n ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET _ < PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT '7 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 thatZ ceipt 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 FLORID JJ COUNTY OFnQ depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and sub ribed before me this _2n f" day of Gh 20 herein and on any attachments made by me constitutes a true accurate, by f •,I b' y lA and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. ` (Signature of Notary.. bli - tat of Flor' a) , N ROW RODRIGM "dv(Print,Type,or Stamp Cora o SI ATUREX REPORTING OFFICIAL Personally Known Type of Identification Produc toll R 0�1929q 7941W IRMUR in.; 11�1;1 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:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.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. 1/2007 (See reverse side for instructions) FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Jerry Libbin Ticket Distribution for October—December 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Oct. 2 Camila Provided by City of Miami Beach 1700-Convention Center Dr. Miami Beach, FL 33139 .2 tickets @ $98.50 ea. $197.00 Oct. 8 Andres Calamaro •Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $63.50 ea. $127.00 Oct. 15 Giselle Provided by City of Miami Beach 17,90 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $60.00 ea... $120.00 Oct. 22 Miami Arts Gala Provided by City of Miami Beach Miami Beach, FL 33139 2 ticket @ 300.00 ea. $600.00 Oct. 22 Miami City Ballet Program I Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $85.00 ea. $170.00 Oct. 28 Miami International Auto Show Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 10.tickets @ $10.00 ea. $100.00 Nov.I David Sedaris Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tsckets @ $50.00 ea. $100.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Jerry Libbin Ticket Distribution for October—December 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Nov.l l Maria Bethania Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $80.00ea. $160.00 Nov.12 Sting Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $86.50ea. $173.00 Nov.13 Sting Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $86.50ea.. $173.00 Nov.18 Bikini Physique Prejudging Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $53.50ea. $107.00 Nov.19 Bikini Physique Finals Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $78.50ea. $1 57.00 Nov.23 Tigger(short film) Provided by City of Miami Beach •1700 Convention Center Dr. J Miami Beach, FL 33139 2 tickets @ $55.00ea. $110.00 Nov.26 Tracy Morgan Live Pravided by City of Miami Beach 1,700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $63.50ea. $127.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Jerzy Libbin Ticket Distribution for October—December 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Nov.27 -.The Kings of Salsa Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $58.50ea. $117.00 Dec.02 Sleepless Night Cafe Bustelo box Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 1 box @ $l 00.00ea. $100.00 Dec.03 Daniel Levi Provided by City of Miami Beach .1700 Convention Center Dr. Miami Beach, FL 33139 .2-tickets @ $50.00ea. $100.00 Dec.03 Jean Carlos Canela Provided by City of Miami Beach 1700 Convention Center Dr. Mimi Beach, FL 33139 2 tickets @ $78.25ea. $156.50 Dec.05 Janet Jackson Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $116.50ea. $233.00 Dec.10 Bikini & Masters Prejudging Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $60.00ea. $120.00 FORM 9 QUARTERLY GIFT DISCLOSURE (ATTACHMENT) RE: Commissioner Jerry,Libbin Ticket Distribution for October—December 2011 City of Miami Beach Mayor and Commission Office DATE EVENT VALUE Dec.10 Showdown Provided by City of Miami Beach 1700.Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $l 00.00ea. $200.00 Dec.16 Ce.line Dion Event Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $1000.00ea. $2000.00 Dec.17 The Nutcracker Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 .2 tickets @ $58.00ea. $116.00 Dec.20 Woody Allen Jazz Band Provided by City of Miami Beach 1700 Convention Center Dr. Miami Beach, FL 33139 2 tickets @ $125.00ea. $250.00