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Mark Samuelian County FormA HEACH OFFICE OF THE CITY CLERK City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139 www.miamibeachfl.aov Telephone: 305.673.7411 March 26, 2018 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: • John Elizabeth Aleman — Commissioner — Group VI O Cilia Maria Ruiz -Paz — Commission Aide • Gloria Salom — Commission Aide • Mark George Samulian — Commissioner Group!! The originals have 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:rq Sent Certified Return Receipt 0 0 ' 0 z c N 0 N ❑❑• T .. N 0 2 cp 0_ 0 > co N•0 'L7 -C3 illi F co - Lu D U •%cc. 012MccC ar 52?o -0 0 ti 0 cD <<o000. ,cz❑❑{❑❑CDC n6nV `Gee 1a0d Sd ABS :..N,Odi lou s! stud eye 00 )psua sod Il a j„ luewosaopue tins s,o0ssoappO lompps us Joh M �p�ati;bei r R i lel eioo!ld ip L ai :ion sd)claoo� cera v �. �... = rn 'Ago of .kiaAllop °' r' U0!Y3PPO UI3 aod, �,— o c. ® _. _ ,, ru o NV ilSNl ON NI �0 cam. •� v t 1=1cp CO 1:3. > V3' 13 �" '�=. as �. .,.... . 0, ,.._ >- �a..0 : co E 8 0CL.cn<OQ- . r° N CL j0 !mow V uep3 enblun v 11000.1 § 11]! OW V - �,.. 1. 9fli.l;dl d,Gidl41,.Y:l,.d�il. „I.hdiw:...�L ..daniq.l„Liu J..I li�s'isiwi{4�.�,Ao�.a I�'�IlIS'.'mLZom:�m�J:: �I�IISiillifilJLylfmli dWi_df:Y”:IYJI�r«m4.rrdW.muHL1�ILYfdL.LC,WL�Y�.Y I a,i. I:alia'd.,_miuumi .nma l:m��immi Ill llpuls: mn:.lx un «.L. YW�dIY��I�'.i10®.9Y��MiY�I.—�.:mmlbm�Ys"I'm'k'�`L'uLE.. i.ni::JJdJi.Bili.dah.L=•,i°-"— "�11'Y.iWiJLL.'a 2,11141:11,1.&!u _hll!!Jth,1�tr1ssVl'J�aL'iS.Uda.IkSa!l CY") J CO CLQ w -o - � U o >- LL U LU 0 Z an F- w © .2 w � EL: • v © c- - L 115v c O d U 0 0 a > c • 0 a 0o ._ V 13 1-q rq> r m D C 11.1 Postage Certified Fee E3 © © Return Receipt Fee Q Qi (Endorsement Required) ED ED Restricted Delivery Fee (Endorsement Required) ru Total Postage & Fees Sent To5a8 Q r- r - Street, Apt. No. "-_---- or -_por• PO Box No. I City State, Z1P' 4 Postmark Here UaRk4e korJ /Cowl- Coy,ii,_ ---------- .761 MIAMI-DADE COUNTY QUARTERLY GIFT DISCLOSURE = LAST NAME -FIRST NAME -MIDDLE NAME: Samuelian, Mark George STREE ADDRESS: 1700 Convention Center Drive CITY: Miami Beach ZIP: 33139 COUNTY: Miami -Dade NAME OF AGENCY: City of Miami Beach OFFICE OR POSITION HELD: C TY F 7 R26 AM 9: 3 6 I 3H1 OF T CLERK Miami Beach City Commissioner FOR QUARTER ENDING (Check One): 0 MARCH 0 JUNE _ 0 SEPT. P DEC. YEAR: 20_17 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 11/15/17 12/212017 12/2/2017 DESCRIPTION OF GIFT Dinner for two NWS Concert Tix for 2 Prvate dinner for about 22 ppple after the show MONETARY VALUE $115.00 $240.00 NAME OF PERSON ADDRESS OF PERSON MAKING THE GIFT MAKING THE GIFT 101 Ocean Dr, Santorini Rest. Miami Beach, FL 32139 New World Symphony 500 17th St, Miami I3each 33139 $200.00 New World Symphony 500 17th St, MimiFt-h 7317 CHECK HERE IF CONTINUED ON SEPARATE SHEET. El 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 lst St., Suite 17-10, Miami, FL 33128. Municipal personnel file with their respective municipal clerks. PART D: 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 attachments made by me constitutes a true, accurate, and total listing of all gifts required to be reported by Section 2-11.1 (e)(4) of the Code of Miami -Dade County. Signature of Person Making Gift Disclosure COE 02/2010 STATE OF FLORIDA COUNTY OF k1, Swo!-5 to (or at -firmed) and subscribed before me this 011"v'day of , 20 I by i\lcurAC VV»&j (Name of erson Ma ift Disclosure) (Sign ure of Notary Public, State of Florida) M) 0 116 Ael4jpJ (Print, Type, or Stamp Commissioned Name of Notary Public) LieKeisonally known to me or 0 Produced Identification Type of Identification Produced: STEVONNIE M. BROWN Notary Public - State of Florida Commission # FF 996465 My Comm. Expires Jun 3, 2020 Bonded through National Notary Assn.