Virgilio Fernandez - December 2014 Form 9 r
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME—FIRST NAME—MIDDLE NAME: NAME OF AGENCY:
Fernandez,Virgilio City of Miami Beach Fire Department
MAILING ADDRESS: OFFICE OR POSITION HELD:
80 SW 17 Road Fire Chief
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ON�ES)�. YEAR
Miami 33129 Miami-Dade ❑MARCH JUNE ❑ it�
SEPTEMBER DECEMBER 20,
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
❑ 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 t Q ( - (�'t
depose on oath or affirmation and say that the information disclosed Sworn to tgr rmed)and subscrib d beforeime this
j day of ()tr C-i 1 20 1
herein and on any attachments made by me constitutes a true accurate; p
by c 4 I D ��rfr,�,fl (i l
and total listing of al :14s required to be reported by Section 112:3148,
7:'NA
Florida Statutes / (Signa'tn - . - . • .-•• •-
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/1.5.'"' ". k cc 41/4.4.1.,-.4.(Print,Type,or Stamp Co' a ¢;f ∎ (ar ptQigtAysi jiq}xpires
SIGNATURVOF REPORTING OFFICIAL Personally Known. ... 1 b ced Ider9tigrb. 2017
Type of Identification Pro I,
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)°'
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Granado, Rafael
From: Sam,Yarily
Sent: Monday, March 09, 2015 3:43 PM
To: Granado, Rafael
Cc: Fernandez, Virgilio
Subject: RE: Quarterly Gift Disclosure
Attachments: Form.pdf
Ralph,
Please find attached the Miami Dade County form for the Fire Chief and second document is just for your FYI.
Thanks.
..
NNW lag IMMINIONINKOZIWIEW194
1915-.21115.
[ tt j �: y x�
Yarily Sam-Gamil, Executive Office Associate
Fire Department
2300 Pine Tree Drive, Miami Beach, FL 33140
Tel:305 673-7000,ext.2800/Fax:786 394-4546/www.miamibeachfl.cjov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
From: Granado, Rafael
Sent: Monday, March 09, 2015 10:12 AM
Subject: Quarterly Gift Disclosure
Importance: High
Good morning,
_ Please be reminded that Quarterly Gift Disclosures forms are due on or before March 31, 2015, for the period
of October, November and/or December 2014. You must report any gift received from an individual or single
entity during October, November and/or December 2014 in excess of$100. No reporting is required if no gift(s)
were received.
I have attached herewith a form entitled "Financial Disclosure Filing Requirements" to assist you in determining
whether you are required to file the State Quarterly Gift Disclosure (Form 9) or the Miami-Dade County
Quarterly Gift Disclosure Form.
Where to file?
• Form 9 must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-
5709.
• Miami-Dade County Quarterly Gift Disclosure must be filed with the City Clerk, 1st Floor City Hall.
If you have any questions, please feel free to contact me.
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..Regards,
MIAMI
Rafael E. Granado, Esq., City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,
historic community.
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