Comm Rosen Gonzalez Form 9MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.Qov
Telephone: 305.673-7411
March 8, 2018
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 December 2017, for the following City of Miami Beach Personnel:
• Kristen Rosen Gonzalez — Commissioner (City of 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
7017-1450-0002-2744-0174
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
rI `t OF MIAMI I BERCI;
GONZALEZ ROSEN KRISTEN CITY OF MIAMI=BEACH THE CITY CI_FRM
RECEWED
2J18 MAR -8 AM II: 04
MAILING ADDRESS:
1700 CONVENTION CENTER DRIVE
CITY: ZIP: COUNTY:
MIAMI BEACH FL MIAMI-DADE
OFFICE OR POSITION HELD:
COMMISSIONER
FOR QUARTER ENDING (CHECK ONE): YEAR
MARCH JUNE DSEPTEMBER 1 DECEMBER 2017
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
RECEIVED
10/07/2017
10/22/2017
DESCRIPTION MONETARY NAME OF PERSON
OF GIFT VALUE MAKING THE GIFT
NAT'L LGBTQ GALA 500.00
BIKUR CHOLIM OF MIAMI
BEACH DINNER
❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET
CITY OF MIAMI
BEACH
136.00 TEMPLE MOSES
PART B — RECEIPT PROVIDED BY PERSON MAKING THE GIFT
ADDRESS OF PERSON
MAKING THE GIFT
1700 CONVENTION
CENTER DR
1200 NORMANDY DR.
MIAMI BEACH
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
1, 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 attachme made by me constitutes a true accurate,
and total listing of 11
1
Florida Statutes
ed to be reported by Section 112.3148,
STATE OF FLORIDA.
COUNTY OF M1111wAAsi —1\'��
Sworr,_to (or affirmed) a a me this
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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)