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Dolores M. Mejia - March 2010 ECL lVE MIAMI-DADE COUNTY r 201 ITY t`MAR t...,•-8 P� ; 3 Iu • QUARTERLY GIFT DISCLOSURE 1ijy OFF t: LAST NAM&FIRST NAME-MIDDLE NAME: NAME OF AGENCY: 11106714 l 2b0 L 01 E S M. d./Ly OF M/Any!I B eacf') MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 eenvei ioq eent.er,bri v - s/ eiA L PROJE TS doeM DI/14Too CITY: ZIP: COUNTY://4Ml-.DAB FOR I. •RTER ENDING(Check One): YEAR: Ia�)'l! �� C �C.. 33, 4 ARCH JUNE SEPTEMBER DECEMBER 20/D PART A -STATEMENT OF GIFTS Please list below each gift,or series of gifts of$100 or more,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 RECEIVED OF GIFT VALUE MAKING THE PERSON MAKING GIFT THE GIFT cl3eae h Welled i/pbo AtE tip ay. a1 as(11 Bubble Q $700. ©o IoD Festival num,cL. ❑ 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 PART C -OATH I,the person whose name appears at the beginning of this form, STATE OF FLORIDA COUNTY OF M.I AIVI I do depose on oath or affirmation and say that the information Sworn tc2 or affirmed)and subscribed before me this disclosed herein and on any attachments made by me consti- � day of I�f-4C-0■ ,20 11 by oa 1.pr-e C j`k• tutes a true,accurate,and total listing of all gifts required to be IY�.( 1iL4� (Signature of Notary Public-State of Florida) reported by Section 2-11.1(e)(4)of the Code of Miami-Dade County. Y .-.#. •dew GrAll'SUOIN DD 5121h? r,".%• • I iiFi_5..:r>>�fiiJEf 2e, %y' �it'` {{r' n�fns, FI3�v. �..i h1iC llil: +i��::•: SIGNATURE OF REPORTING OFFICIAL (Print.,. ��ie :.oY.Siatn�C`bi��tti�S�sioned i�arg�giutitublic) Personally OR Produced Identification Type of Identification Produced PART D-FILING INSTRUCTIONS This form,when duly signed and notarized,must he filed with the Clerk of the Board of County Commission, I l l NW 1"Set, Suite 17-202,Miami,Florida 33128. 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.)