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John Woodruff County form Dec 2015 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY: Woodruff, John City of Miami Beach MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive Budget Direct CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK O YEAR f�MARCH ❑JUNE ❑SEPTEMBER ECEMBER 201_1 Miami Beach 33139 Dade 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 12/23/15 Gift Card 200.00 Philip Levine 1700 Convention Center Drive ❑ 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 ,.•z �'►i:�•, K11THEgINEGON7ALEZ myeemmissimiings ; : EXPIRES:November 20,2018 PART C—OATH � ;o;�. Bonded Thru Notary public Underwriters I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA COUNTY OF \�'�� depose on oath or affirmation and sa y that the information disclosed SwSworn to or affirmed)and s4 � n�bed before me this day of VX Ce–IyA�lf ,20 1 S herein and on any attachments made by me constitutes a true accurate, and total listing of all gifts required to be reported by Section 112.3148, Florida S ignature of Notary ubli State of Florida) Y (Print,Type,or Sta Co missioned Name of Notary Public) SIGN URE O REPORTING OFFI L Personally Known OR Produced Identification Type of Identification Pro ced 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:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.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(Refer to Rule 34-7.010(1)(g),F.A.C_)(Rev.9/2014) (See reverse side for instructions)cc� scanned Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY: Woodruff, John City of Miami Beach MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive Budget Director CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR AMARCH ❑JUNE ❑SEPTEMBER ❑DECEMBER 2016 Miami Beach 33139 Dade 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 12/23/15 Gift Card 200.00 Philip Levine 1700 Convention Center Drive ❑ 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 ,.i��.►i;% KATHERINEGON7ALEZ My PART C—OATH ' EXPIRES:November 20,2018 ',p, 4`� Bonded Thru Notary Public Underwriters I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA COUNTY OF \C"' depose on oath or affirmation and say that the information disclosed Swom to or affirmed)and s nbed before me this LQ ' V 20 S herein and on any attachments made by me constitutes a true accurate, b W O^ r Y and total listing of all gifts required to be reported by Section 112.3148, Florida S ignature of Notary ubli State of Florida) (Print,Type,or Sta Co missioned Name of Notary Public) SIGN URE O REPORTING OFFI L Personally Known OR Produced Identification Type of Identification Pro ced 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:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.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(Refer to Rule 34-7.010(1)(g),F.A.C.)(Rev.9/2014) (See reverse side for instructions)