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Jose Smith - June 2013 L 0-- - • ti . �i � g. _ ,� .. 1� ,,:' V- - _ MIAMI-DADS COUNTY 2� 5� QUARTERLY GIFT DISCLOSL ..0 Z1 _ - C 1`� u'--L��'\. LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY: Smith, Jose City of Miami Beach STREETADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive, 4th Floor City Attorney CITY: Miami Beach FOR QUARTER ENDING(Check One): ZIP: 33139 ❑ MARCH C JUNE COUNTY: Miami-Dade ❑ SEPT. ❑ DEC. YEAR:2013 PART A: STATEMENT 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 atta:hed Exhibit CHECK HERE IF CONTINUED ON SEPARATE SHEET.El 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: 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 1St 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, Sworn to(or affirmed)and subscriimd before me this and total listing of all gifts required to be reported by ,2-711- day of :Li/IL ,20 , Section 2-11.1 (e)(4) of the Code of Miami-Dade County. by Jose Smith (N. .f Person Ma:,n• ift D:.c.sure) (Signal re of Wry y Pu. c,St\t�iligiliiii/t/A , /1/ I[ -� 1 ,VI IW 14 Signatu - ",rson A•orGift Disclosure w�� r••�OMM/ssi••.F�% (Print,Type,or Stamp CommissidlQVame�i grbf�r:- .S Personally known to me or ORr®duccd IlentifiCitOA Type of Identification Prod44r FFr4 ® "�' G ••��ei •.•' ante•••• •ON'' c ,9 COE 02/2010 yJ" TA tEr0��opQ`\\\� 4 Over a$100 Date Description Monetary Name of person Address of person Rec. of gift Value making the gift making the gift 3-26-13 Yaakov Shwekey $100.00 City of Miami Beach 1700 Convention Center Drive Miami Beach,FL 3-28-13 11 Volo $159.00 "—" " -- 44 "-44 44 -- LC 3-28-13 Il Volo $159.00 " " " -- 44 "-LC 44 -- 44 3-28-13 Pam Ann $100.00 "-44 CC -- 44 " " " -- LL 4-17-13 Bill Burr $113.00 "—" 44 -- " "-64 44 -- 44 5-3-13 Raphael $107.00 " " " -- GC "-44 CL -- GC 5-3-13 Cuban Classical Ballet $137.00 " " " -- 44 " " " -- 44 5-31-13 Victor Manuelle $127.00 GC—C4 44 -- 44 44-44 44 -- C4 6-4-13 Cesar Millan $112.00 "-44 GC -- 44 "-44 44 -- GC 6-4-13 Marisa Monte $177.00 " " " -- 44 " " " -- GC 6-4-13 Daniel Tosh $119.50 "-44 44 -- 44 "-44 GC -- 44 6-4-13 Daniel Tosh $119.50 "—" " -- " " " " -- 44 6-3-13 Belly Dance Evolution $100.00 "-44 64 -- 44 " " " -- 44 6-27-13 Air Supply $177.00 "—" " -- " " " " -- 44 6-27-13 Maria Gadu "Mais $138.00 " " " -- " " " 44 -- 44 Uma Pagina" 6-27-13 Julio Sabala $127.00 " " " -- 44 " " " -- 44 Form 9 QUARTERLY GIFT DISCLOSURE r" (GIFTS OVER $100) 2013 JUN 27 PM 2: 56 LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY: Smith,Jose City of Miami Beach C I T�' (; �,i r E �("'� MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive,4th Floor City Attorney CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR Miami Beach 33139 Miami-Dade ❑MARCH JUNE ❑SEPTEMBER ❑DECEMBER 2013 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 Please see attached 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 PARTC—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 Sworn to(sir affirmed)and subscribed before me this 2- day of June ,20 13 herein and on any attachments made by me constitutes a true accurate, by Jos: Smith 4 r ttlll1« and total listing of all gifts required to be reported by Section 112.3148, / �/ Florida Atig St. • - (Signature of Not�y Pt�#9� •t�g :;'•a) : s • _ (Print,Type,or Stamp C,ommisatfle1 Name f Q ry Pt, £ SIGH ATU: 0 RE %'TING OFFICIAL Personally •Known ✓ ORgceditgrCion off` Type of Identification Produced eatded0 •' 4/4/8L/C,SZ P �e PART D FILING INSTRUCTIONS sglli1l,ea.a 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) Y w 1 Over a $100 Date Description Monetary Name of person Address of person Rec..• of gift Value making the gift making the gift 3-26-13 Yaakov Shwekey $100.00 City of Miami Beach 1700 Convention Center Drive Miami Beach,FL 3-28-13 Il Volo $159.00 "—" " -- CC " " " -- CC 3-28-13 Il Volo $159.00 CC CC " -- " 66 CC GC 66 3-28-13 Pam Ann $100.00 "—CC -- CC "—GC CC -- GC 4-17-13 Bill Burr $113.00 "-" CC -- 66 CC CG CC -- CC 5-3-13 Raphael $107.00 " " " -- CC "—CC CC -- CL 5-3-13 Cuban Classical Ballet $137.00 " " " -- CC " " " -- GC 5-31-13 Victor Manuelle $127.00 " " " -- CC " " " -- CC 6-4-13 Cesar Millan $112.00 "-44 64 -- CC "-LL G4 -- CC 6-4-13 Marisa Monte $177.00 "-GC 46 -- GC " " " -- 44 6-4-13 Daniel Tosh $119.50 " " " -- 64 " " " -- " 6-4-13 Daniel Tosh $119.50 "—" " -- " " " " -- LC 6-3-13 Belly Dance Evolution $100.00 " " " -- CC " " " -- GC 6-27-13 Air Supply $177.00 " " " -- CC " " " -- 44 6-27-13 Maria Gadu "Mais $138.00 " " " -- " " " " -- C, Uma Pagina" 6-27-13 Julio Sabala $127.00 " " " -- GC " " " -- GC I