Comm Rosen Gonzalez County FormMIA/\ABEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
wvvvv.miamibeachfl.gov
Telephone: 305.673-7411
March 8, 2017
Miami -Dade Clerk of the
Board of County Commissioners
111 NW 1st Street, # 17-10
Miami, FL 33128
Pursuant to Section 2-11.1(e)(4) of the Code of Miami -Dade County, attached please find a copy
of the Miami -Dade County Quarterly Gift Disclosure Form, for the quarter ending December
2017, for the following City of Miami Beach Personnel:
• Kristen Rosen Gonzalez — Commissioner (City of Miami Beach)
The original has been filed with the Miami Beach Office of the City Clerk.
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully/
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
7017-1450-0002-2744-0167
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
LAST NAME -FIRST NAME -MIDDLE NAME:
GONZALEZ ROSEN KRISTEN
STREE ADDRESS:
1700 CONVENTION CENTER DRIVE
• CITY: MIAMI BEACH, FLORIDA
ZIP: 33139
• COUNTY: MIAMI-DADE
NAME OF AGENCY:
CITY OF MIAMI BEACH
'OFFICE OR POSITION HELD:
COMMISSIONER
FOR QUARTER ENDING (Check One):
0 MARCH El JUNE •
0 SEPT. DEC. YEAR: 20
PART A: STATEMENT OF GIFTS. List below each gift, or series of gifts, from one person or entity in
excess of $100, accepted by you during the calendar quarter for which this statement is being filed. Describe the gift
and state the monetary value of the gift, the name and address of the person making the gift, and the dates the gifts
were received. If any of these facts are unknown or not applicable, state this on the form. You are not required to
file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE
RECEIVED
DESCRIPTION
OF GIFT
MONETARY NAME OF PERSON ADDRESS OF PERSON
VALUE MAKING THE GIFT MAKING THE GIFT
10/07/2017 NAT'L LGBTQ GALA 500.00
BIKUR CHOLIM 0=-
10/22/2017 DINNER 136.00
I: 04
• CITY OF MIAMI •1700 CONVENTION
RFAr,H CTR DRIVE, MB
• TEMPLE MOSES 1200 NORMANDY DR
M IA11.44-13-E--ACH
CHECK HERE IF CONTINUED ON SEPARATE SHEET. 0
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. 0
PART C: FILING INSTRUCTIONS. The signed and notarized form must be filed no later than the last day
of the calendar quarter that follows the quarter for which this form applies. For example, if a gift is received in March,
it should be disclosed by the end of the next quarter, i.e., June 30. County personnel file with the Clerk of the Board
of County Commissioners, 111 NW 1st St., Suite 17-10, Miami, FL 33128. Municipal personnel file with their
respective municipal clerks.
PART D: OATH.
I, the person whose name appears at the beginning of
this form, do depose on oath or affirmation and say
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate,
and total listing of all gifts required to be reported by
Section 2-1 o the Code of Miami -Dade
County.
Signature o
COE 02/2010
erson Making Gi t Disclosure
STATE OF FLORRA
COUNTY OF M
Sworn to (or aff
day of PY
by \<-,
)--and subscribed before me this
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ift
(Signature of Notary Public State of Florida
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