Rafael E. Granado Dec 2015i
MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-7411
December 24, 2015
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending December 31, 2015, for the following City of Miami Beach Personnel:
• City Clerk Rafael E. Granado
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
Rafael E. Granado,
City Clerk
Attachment
REG:rq
Sent Certified Return Receipt
F:CLERI$ALLIGIFT DISCLOSURES1201512nd QuarterlMayor Philip Levine Quarter lll.docx
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY:
RAFAEL E. GRANADO City of Miami Reach
MAILING ADDRESS: OFFICE OR POSITION HELD:
888 134scayne Boulevard#5901 City Clerk
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
Miami FL 33132 ❑MARCH ❑JUNE ❑SEPTEMBER Id DECEMBER 20j5_
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
Art Basel Miami Beach-2 1700 Convention
12/04/2015 tickets $94 City of Miami Beach Center Drive, MB, FL
12/16/2015 Miami Beach Bowl-4 tickets $268 City of Miami Beach 1700 Convention
Center Drive, MB, FL
12/16/2015 FitBit Surge $250 Mayor Levine 1700 Convention
Center Drive, MB, FL
❑ 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,do STATE OF FLORJPA
COUNTY OF it.Lr[ U66
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subsc ibed befor me this f
day of �=4– ,20 /S
herein and on any attachments made by me constitutes a true accurate,
by
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes. (Signature of Nota Public-State of Florida)
(Print,Type,or Stamp Commissioned Name of Notary Public)
SIGN'A'TURE OF REPORTING OFFICIAL Personally Known ✓ OR Produced Identification
Type of Identification Produce
PART D—FILING INSTRUCTIONS °" `r Cc ;►4'ss!o-N#EE 844W5
February 18,2017
i_
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 1 ,`1Vt WdW—,M0-n - ;p ysi-
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)
I