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Osvaldo Ramos County FormMIAMI 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 March 14, 2019 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 2018, for the following City of Miami Beach Personnel: Osvaldo Ramos - Police Department Sergeant (City of Miami Beach) Adrian Chamberlin - Commission Aide (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, Ra ael E. Granado, City Clerk Attachments REG:cd Sent Certified Return Receipt 9214-8901-9403-8380-1195-61 City of Miami Beach City Clerk USPS CERTIFIED MAIL 1700 Convention Center Dr Miami Beach FI 33139 9214 8901 9403 8380 1195 61 FLORIDA COMMISSION ON ETHICS PO Box 15709 TALLAHASSEE FL 32317-5709 Fold Here Return Reference#: Gift Disclosure Username: Charles Dagostin Code Violation #: Court Case #: Property Address Permit ID #: Custom 5: Postage: $5.6000 MIAMI-DADE COUNTY QUARTERLY GIFT DISCLOSURE LAST AME -FIRST NAME -MIDDLE NAME: .�A%�s ✓�%LDO AME OF AGENCY: C _ml D F FAG/ • /,Oat cE Pf "TAM ._ ,e Mff v STREE ADDRESS: OFFICE OR POSITION HELD: G•A,B.A GALA 72 ©0 ,r�o.vtS� a CITY: FOUR QUARTER ENDING (Check One): ZIP: ��/�� /' //9 2 Ei MARCH ❑ NNE COUNTY: /�� ❑ 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 VALUE NAME OF PERSON MAKING THE GIFT ADDRESS OF PERSON MAKING THE GIFT G•A,B.A GALA 72 ©0 ,r�o.vtS� a G✓.t[ sf�/ w f CHECK HERE IF CONTINUED ON SEPARATE SHEET. ❑ ;,x cE.r s T 3. Y fo 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: 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 V 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 2-11.1 e 4) of the Code of Miami -Dade County Signature of Person Making Gift Disclosure COE 02/2010 STATE OF FLORIDA /] COUNTY OF Sworn to (or affirmed) and subscribed before me this Z 8 day o * A/ , 201 , by 16 JORGE GMCIA 6AMMISSION # GG 049860 iaa EXPIRES: Febrwry 14, 2021 Bonded Thru Notary Public Undew iters (Print, Type, or p COMMi . I� Personally known to me or 11Produced Identification Type of Identification Produced: