Ariel Sosa County form Dec 2015 MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME-FIRST NAME-MIDDLE NAME: AME OF AGENCY:
rl e I Cif W I,.O�vH. Be acJ�
STREE ADDRESS: FFI OR POSITION HELD:
g We �v►e t T �D i re�fio r
CITY: VA%q,V.*.t VL4WL FOR QUARTER ENDING(Check One):
ZIP: 3 313 G, ❑ MARCH ❑ JUNE
COUNTY: At ❑ SEPT. g DEC. YEAR:20
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
fi le this s state m nt for any calendar quarter during which you did not receive a re po rtable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
64 Car �� �tli �..ei�'lJ� 1 pD CDAv iQc.
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: 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 I st 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 ��t�N1� --b
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, Sworn to(or a rmed)arld subscribed before me this
and total listing of all gifts required to be reported by day of 20 /6— ,
Section 2-11.1 (e)(4) of the CocWof Miami-Dade
County. by
(Name erson Maldn t ' los
( ign ure of Notary Ptlic,State of Florida)
Signature of'Pe son NjAdng Gift Disclosure i
(Print,Type,or Stamp Commissioned Name of Notary Public)
Personally known to me or❑Produced Identification
Type of Identification Produced:
v'�'%,/ ISABEL SATCHELL
COE 02/2010 ;_ %; Notary Public-State of Florida
•= Commission#EE 876384
My Comm.Expires Apr 13,2017
OF f��P` Bonded through National Notary Assn.
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