Kristen Rosen Gonzalez June 2016 Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME—MIDDLE NAME: NAME OF AGENCY: AA � ,Q �
Cron IP2 <r134en, RnSe n C;41 O? (v1 ) Cf,l I &'Card+
MAILING ADDRESS: OFFICE OR POSITION HELD:
L (o A Ho C omm, ssioner
CITY: ZIP: COUNTY: FOR QUART�S�NDING(CHECK ONE): YEAR
M I' ' /! r I�� U 1 ❑MARCH L+!'JUNE SEPTEMBER ❑DECEMBER 20 NO-A
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
(.DI. >P ) / i 3 co (04' Rorrw
Ian d of 2 O NW
I O (Ohre �� II Z oti✓rn`) try �s
L/ Cor-trcn C.c. ?"n4 . eJ'�rr- Via udovI`,;
lip ( C Or r Ion.r4Ari.- o -Ge Dipt tf„- `I 3 j 0018'x- R,-.r•. 1.
5IZbI L Ma )4a Cdry race sit ISa0
Se c. A Git‘ TE L Iz.c-1-",, Stec gr- ck) -5 e fk,d -5-4c r`../
Ed' 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.
L� 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 FLORIDA M�
/E
COUNTY OF LI( nti VQG(
depose on oath or affirmation and say that the information disclosed Sworn to(Qr affirmed)and sub=ibe d before me this
. L day of c_l iC/1 ,20 /
herein and on any attachments made by me constitutes a true accurate,
by kri s fe4 leDs€ /
n. Goh ZLc e
and total list g .f II`gifts required to be reported by Section 112.3148,
'�_�• a``���� r�'
Florida St utes. ( mature of . , o _
P , _ '(1'j j„_D
ES
� Nohr Public- M Raft
(Print, tamp om 'Tr .PS TIP
�-';,,;oaf it 2017
SIGNATUR OF REPORTING OFFICI Personally Known ■ °, +:.. .entill9t1R8100 o EE 070421
Type of Identification Product ''!" Bonded Three National footiffyissi.
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)
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R°W.L iE - 3L#USTE ® Gou 7
9290 NORTHWEST 112th AVENUE.SUITE 15 • MEDLEY, F ORIDA 33178
PHONE: (305) 594-2886 • (305) 594-9039 Date( CO 1,j 20 I‘O'V
/*SOLD TO _ Y V� 15.1217..4 JV_ PURCHASE ORDER No. N
ADDRESS - ACCOUNT No.
IN
CITY STATE ZIP PHONE
S ,O_AG
CASH CHARGE SALESMAN NAME ROUTE
CASES UNITS CODES PRODUCT CASE UNFf` ' AMOUNT
PRICE PRICE
006816 MINI ESPRESSO KIT 5 x 6
006809 REGULAR ESPRESSO KIT 8 x 6
006694 COMMERCIAL ESPRESSO KIT 12 x 10
010155 BS toz SUPREME EXTRA FINE 40 x 1
017208 BS 10oz.BRICK 24 1 10oz
101013 Pi i Ooz ERICK 24/10oz.
P0170521 SS 1Ocz SUPREME BRICK 12!10oz.
101119 PI 10oz Gam. ET BRICK 12!10oz.
018021 BS 16oz WE St: E.ME 8!16oz.
I • 101211 PI 16oz WE SUPREME 8/16oz.
1 018007 BS 32o_z.WB SUPREME 4132oz.
1 201003 PI 32oz WB SUPREME 4/32oz .
I , 2S 201 ID l6.z'NS PREMIUM e/16ez
{ x141 M C 17rz.W3 CAFE=ESP El/17oz
d I:12 84 FES 22 FREIE FOES 120 CT
1 11249` I SS?' EE E y PCOS 120 CT
I ,
031900 Sr LENDA 1 12000
L
1881T1 SUGAR 2/20
661236 SUGAR CANISTER 24/20
881205 CREAM CANISTER 12/12 I
879103 CUPS 1 15000 1
010141 BS 2oz.REG FRACK PACK 30 CT
064741 FG 1.75oz.CAF 100/1.75
-- - F11,• E , . . _v
man (fpo? ; . 2, k R.f 4 . _. 0
INVOICE No. 313524 TOTAL
ALL CLAMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL -
SIGNED
Authorized ewe 1