Jose Smith Dec 2013 l
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
Smith,Jose City of Miami Beach-City Attorney's Office
STREEtADDRESS: OFFICE OR POSITION HELD: C---;)
1700 Convention Center Drive, 4th Floor
City
ty Attorney
CITY: Miami Beach FOR QUARTER ENDING(Check One): r'
ZIP: 33139 ❑ MARCH 0-JUNE—
COUNTY: Miami-Dade ❑ SEPT. IR DEC. YEAR:'- 13'_
--
PART A: STATEMENT OF GIFTS. List below each gift,or series of gifts,from one person or entity-in C
excess of$100,accepted by you during the calendar quarter for w:,hich this statement is being filed.Describe Qe__'gift
and state the monetary value of the gift,the name and address of the person making the gift,and the dates the gets
were received. If any of these facts are unknown or not applicable,state this on the form.You are not requirePo '
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.
CHECK HERE IF CONTLNIUED ON SEPARATE SHEET.
PART P: 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: 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 be disclosed by the end of the next quarter, i.e.,June 30. County personnel file with the Clerk of the Board
of County Commissioners, 111 NW V 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
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, S to(or affirmed)and subscribed before me this
and total listing of all gifts required to be reported b �7, *day of T) 20 13 C q P Y eceinhex >
Section 2-11.1 (e)(4) of the Code of Miami-Dade
County. by Jose Smith
(Name of Peron Making G Discloossuree)) /
(Signature of Notary Public,State of Florida)
i� a r or Making Gift Disclosure
VAI
'-(Print,Type,or Sta C ame of No u is
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NotarAublic•State of Florida
YPersonally known t 6HftS tlP ar 16,2017
Type of Identificati P �r Commission#EE 875420
COE 02/2010
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Over a$100
Date Description Monetary Name of person Address of person
Rec. of gift Value making the gift making the gift
City of Miami Beach 1700 Convention Center Drive
Miami Beach,FL
9-30-13 Vampire $100.00
Circus
9-30-13 Jon Anderson $140.00
9-30-13 Tale of a Graveyard $100.00
Clown
10-18-13 John Legend $123.00
10-18-13 Diego Amador $117.00
10-25-13 MB Antique Jewelry $120.00
& Watch Show
11-6-13 Jorge Ben Jor $107.00
11-14-13 The Nutcraker $107.00
11-14-13 Starship $140.00
11-26-13 Art Basel $210.00
Day pass (5 days)
11-26-13 Art Basel $125.00
Design Miami
11-26-13 Art Basel- Scope $125.00
11-26-13 Art Basel—Untitled $125.00
12-11-13 Dave Chapelle $110.00
12-13 @10:30
12-11-13 Dave Chapelle $110.00
12-14 @11:30 p.m.
12-11-13 Dave Chapelle $110.00
12-14 @ 9:30 p.m.
12-11-13 Dave Chapelle $110.00
12-14 @ 8:00 p.m.