Kristen Rosen Gonzalez March 2016 Form 9 • QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100) L�;Ji SFJ 30 r'i'` ": 2�
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY: ,.i..
Rosen Gonzalez j kn s4en CS 4y of Minrrt,-`•00ci►i '
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MAILING ADDRESS: OFFICE OR POSITION HELD:
H t I S A I-I-on Rd. Comm;ssi One r
CITY: Q ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
M IaMr 3cctG1• 33140 M:aMr,—Dade Er6ARCH JUNE SEPTEMBER ❑DECEMBER 20 Me
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
rid' 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 FLORIDA J
COUNTY OF t_t W
depose on oath or affirmation and say that the information disclosed Swor to(or (firmed)and subscribed fore,lne this
Gj r". day of 7. .iu-L'`Z7 ,20 iCle
herein and on any attachments made by me constitutes a true accurate,
by /K L./) 60n2qk Z� 7; KJS.k n
and total lis, g o • efts required to be reported by Section 112.3148, D n G�-�o
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Florida St:I te. 1 (Signature` ,,a4��nn,,' YAMILEX MORALES
1 1 ,'/f s Notary Public-State of Florida
�/ (Print,�yge;or Sta 96i4 ill ' 'ii, d;dttmpt�ar 16.2017
SIGNATUR".1 RTIN OFFICIAL Personally Known 11 ` .:.:,:::"'f e .• • IdClilftfli&®lan#EE 875428
Type of Identification Protce•,ter;2
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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)0-
The Form 9 (Quarterly Gift Disclosure) for quarter ending in March is being resubmitted with the tickets
that correspond to that time period. They were originally included in Commissioner Rosen Gonzalez's
Form 9 for quarter ending in June, which is now being submitted at the appropriate deadline. Thank
you.
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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
September 30, 2016
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find "an amended" Quarterly Gift Disclosure
State Form (9), for the quarter ending March 2016, for the following City of Miami Beach
Personnel:
• Commissioner Kristen Rosen Gonzalez
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
afael E. Granado,
City Clerk
Attachment
. REG:rq
Sent Certified Return Receipt