Kathie Brooks State Form�an� ►.� !���! I B E A C H
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.aov
Telephone: 305.673-741 1
�� s ��i�
�
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 June 2017, for the following City of Miami Beach Personnel:
• Kathie Brooks — Assistant City Manager, Miami Beach
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:cd
Sent Certified Return Receipt
Form 9
QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
BROOKS, KATHE CITY OF MIAMI BEACH
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 CONVENTION CENTER DRIVE ASSISTANT CITY MANAGER
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
MIAMI BEACH 33139 MIAMI—DADE �MARCH �JUNE ❑SEPTEMBER ❑ DECEMBER �I�J I�
s
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
6-12-17
6-12-17
6-13-17
6-14-17
Collectors Preview Desib Miami
VIP Opening Art Basel
Art Basel First Choice
Canton of Basel Brunch
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
$200.00
$200.00
$200.00
$200.00
Robert Goodman
Robert Goodman
Robert Goodman
Robert Goodman
PART B— RECEIPT PROVIDED BY PERSON MAKING THE GIFT
300 41 st Street, Suite 214
Miami Beach, FL 33139
300 41 st Street, Suite 214
Miami Beach, FL 33139
300 41 st Street, Suite 214
Miami Beach, FL 33139
300 41st Street, Suite 214
Miami Beach, FL 33139
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 > "//�/�9 "` �'��
depose on oath or affirmation and say that the informaiion disclosed Sworp to � affirmed) and sub cribe bef e me this r�
��� da . �? � , 20 / /
herein and on any attachments made by me constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes. •
�
SIGf�CTURE OF REP RTING OFFICIAL
by
�4PRY,PUB��� CYNTHIA L. NEVES '
=; .�a�u�e dP�khYaP�WG�I�ii�1@t�c�f4ft@�d�
;r. : e? My Comm. Expires Apr 30, 2016 a
; E„�„�:� Commission # FF 118240 �
(Print,
Type of Identification Produced
PART D — FILING INSTRUCTIONS
uced Identification
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. 6/2016) (See reverse side for instructions) �
� T
� O
�
v Q
� � v
N
N O n
0
� 0 3
LL
r � �.
W � �"
N � O
W �
F� v O
J p�
m
l!'� r*
J �
O n
� N
. ■ ■■
�D-.°D��o
o ��'��� �
3
D 3h''O m '
a co�i� m
�p N
N O C/ n A1 fD �
w
a �a�m N
O N '� � � :'
0
� � _ � N
Q. �
�a c�caa
� � o N w
w
O � 0
N rt
3 � ,3.�,
a�i � � ,
<
�. �n
m N
c� �
��
7�0�0009' • �' � X �
- p n p p D D
mm��'ca� — 9 G�
� N m �
�-�^QQ�'�'c; mm m �
�>> �3`�`3� m � m
��8m`=�°'�� ,� a W
< < � � m � m � y� Q
`'��� m ` aa �
� o ; m � �
� � � < N j.
m m y
� Q ,.��.
� o o � 4
O. G� m a� G
� � � a � m
< 'z N �
� N
� m3
❑❑ ❑ ❑�❑ o m
tncn�mmm�y � 3 n
t� t� m'. =tL] co O .
>>�c�-�--�
c c �i ��� m�p� - � �
m(� O: � O. O. m ❑❑ m ❑❑
��y� � z{ o D D
>>m
a m c_�i, S"c a m ¢ cQ
-� =+ ' �o �+ 0 0. �
3� a 7� i m m m
?; m y `� '<' tn
>> � � � m
—; _— a__ — —_____--_—_— —.
-..., :.1.
m
�`
� • �n ��. �p I� ���
. � �,� �W �a f A� o
� � - r a,
� � I • - : �•JJI�'I'"`" i' ..F_r; %7.-tc'!�� f. � �
m m - � .. -i:a �.,��a
f`- f` .r' _ r' .r -'.�ss, a s' ;�;._;,
f�- I`- -
� ..o �:; �� _
� � Postage $
m m
n� ru
Certified Fee
(1J R_I
0 � Retum Receipt Fee
O O �Endorsement Required)
� 0 Restricfed Oelivery Fee
(Endorsement ReGuired)
O �
� � Total Postage & Fees �
(1_I �tJ
Sent To
ra r-i
I'� f'� """""'"'"""'_"""""'"""'"""'""""'
Street, Apt. No.;
0 � or PO Box No.
� � '____________�"'������.�..."_'���.'�'��'���
C�ty, State, ZIP+4
a
M
M
Y
� o
U o
� �
U �
w °
= m
~ •-
� E
� _o
w �
V �;
� >
O o
s "�
V C
�
d U
m �
� Q
� C
� �
>
'� O
O U
O
� O
V—
Postmark
Here
I�II L'n ��'I,.i«,II I- Wli II II
�'�'��''�'�'.° �'�`l:41`iW,'11'�9'!�.'i�iwl. �:�'-".l:{�i=1�:.-�Y't:lif��4�'��4:�it:'��kJIY
'i —
O iv
L.L �