Kristen Rosen Gonzalez June 2016 (2) Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100) 20:6 S=P '?''
LAST NAME– FIRST NAME--MIDDLE NAME: NAME OF AGENCY:
Rosen Gonzalez CI -1y o-F Mla.ry>1 8ta'ch+" i ;•
MAILING ADDRESS: OFFICE OR POSITION HELD:
1-1b18 .4 Rd • COmm- srioner
CITY: ZIP: COUNTY: FOR QUARTE -ENDING(CHECK ONE): YEAR
M t aal t &cat c) 3314 0 M t 0trn (fade. MARCH JUNE USEPTEMBER ❑DECEMBER 20 1b
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is
being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the
date(s)the gift was received. If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED / -T OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
4/$— (.11 /I(o "Tickle-is See A.uncked See 74.14ock
IJiplp...0. •;c -t-r;p is00.o0 Sn•1. Celt-5r 44 Via Ludo v;3
q-/2 0 l �o p:pler".4-ic Rita-tienr 143, 0o194-,2on.o71+14
5/I Z ' 20l(o lo∎Oar..0_ +L Tr; r i500. 00 �' rr
CM4.140. )
Rowland c“-Fe 9290 NW
to /20 I to Co4e a tt'I 6 . 64-
goosirrs 1 t z �1,,e. sue, LS
�� Medley �� 39►�4
5 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 FLOil,PA
COUNTY OF ��i�l�
depose on oath or affirmation and say that the information disclosed Sworrtt•,( ffirmed)and su scribedpefor 'me this
3 / ' day of a�'•1r.L'- -) 20 /C.r7
herein and on any attachments made by me constitutes a true accurate, //�/ 1 /,'?„ / /
by /6//5>r e ) 1S E� LAC/.j 24 I '2_
and total listi • .fa • • required to be reported by Section 112.3148. d
t _ _ �A► 71��!!!rT ..
Florida Stat s. 'l (Sjgnature of - a -� to I�0[e��ff
Pty. i
I i �`�, t duo -State of Florida
's• Ii1N•7.my Comm.Expires Mar 16.20 7 '
1 (Print,Type,or Sta p om !.s-• ;'�`-:t of •': t ".•
SIGNATUREEPO'ING 0 FICIAL Personally Known •) P•.: "t?. Ideklildgt;f4ughNationalNotarykin. '
Type of Identification Produc`. 4
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)c'
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RQVc7LAND. IBUSTELO .,`�
9290 NORTHWEST 112th AVENUE.SUITE 15 • MEDLEY, FLORIDA 33178
PHONE: (305)594-2386 • (305) 594-9039 Date CO (,- 20 10
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ADDP.ESS ACCOUNT Na
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CASH CA.SH CHARGE SALESLIRM NAME ROUTE
II PICASES' UNCTS CODES' PRODUCT A610UNT RICE PRICE FF 006816 MINI ESPRESSO KIT 5 x 6
006809 REGULAR ESPRESSO KIT 8 x 6
006694 COMMERCIAL ESPRESSO KIT 12 x 10
010155 BS 1oz.SUPREME EXTRA FINE 40 x 1
1 017208 IBS 10oz.ERICK 24/10Dz
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I101013 I P110oz.ERiCK 24/10oz.
1 0170^x2 BS 100:..SUPREME ER CK 12/10ez
101119 PI 10oz.GOUP.i.T:RICK 12!10oz.
018021 BS l6oz WE-RJR-321E 8/16oz
I 101211 PI 16oz Y/S SUPREME 8 116oz.
018007 BS 32oz.WB SUPRA 413202
201003 PI 32oz V,3 SU PREME 4!32oz
^2.5x.20 ID 16cz WS PREMIUM 81 16oz
I Xi TA#WC.l7zz W3 CAFE ES? el 17oz
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124,:< t��,r,PII'?,iF:�J:.$ 120 CT
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] . 1412494 I' XE:;F.,«?PC0S 120 CT
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031900 SFLEIDA 1'2000
881021 SUGAR 2/20
681236 SUGAR CANISTER 24!20
881205 CREAM CANISTER 12/12
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879103 CUPS 115000
010141 BS 2oz REG FRACK PACK 30 CT
064741 FG 1.75oz CAF 100/1.75
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UNVOICE'i+O. 313524 . TOTAL `Oli■ MM.
ALL CLAMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL
SIGNED
AUthO'08C