Mark Samuelian Form 9 QTR 2MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-7411
September 27, 2018
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find a Quarterly Gift Disclosure State Form
(9), for the quarter ending June 2018, for the following City of Miami Beach Personnel:
• John Elizabeth Aleman — Commissioner (City of Miami Beach)
• Kristen Rosen Gonzalez — Commissioner (City of Miami Beach)
• Mark Samuelian — Commissioner (City of Miami Beach)
• Daniel Gelber — Mayor (City of Miami Beach)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfull ,
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
7017-1450-0002-2744-0266
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $10y0)
A
�aamuel,an --Fl ark NAME -- MIDDLE NAME:
ty O FMiaTnl each
1 _OnVeenlon'CenterDrive
Fi[RommiQssionerHELD:
CITY: ZIP: COUNTY:
Miami Beach 33139 Miami -Dade
FOR QUARTER ENDING (CHECK ONE): YEA13
❑MARCH Q1JUNE ❑SEPTEMBER Ll DECEMBER 20 1 t3
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
DESCRIPTION
OF GIFT
MONETARY
VALUE
NAME OF PERSON
MAKING THE GIFT
ADDRESS OF PERSON
MAKING THE GIFT
Dinner event or 2 at HOA
Meeting
La Gorce netree
HOA
ton Oa
❑ 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 FLO A
COUNTY OF Mj( Fd l- —bQrL-C
depose on oath or affirmation and say that the information disclosed Swop&r affirmed) ands crib d befQr�e�me_ this
``� day of 120_ L2)
herein and on any attachments made by me constitutes a true accurate, k AA j A/ r , I.A _
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes.
by
� � � � .•�,M►557p-•• "'gyp ��
'O N
(Print, Type, or Stamp Commissioned i f&Wary PubFT�lss ;
REPORTING OFFICIAL Personally Known OR ProduFed lientifica6m, iO ca * w
Type of Identification Produced
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 T'2317-5709; 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)