Rafael Granado Form 9MIAMI BEACH
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 21, 2019
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 December 2018, for the following City of Miami Beach Personnel:
• Rafael Granado — City of Miami Beach (City Clerk)
• Mark Samuelian — City Of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully
�i4
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
9214 8901 9403 8380 3615 33
City of Miami Beach USPS CERTIFIED MAIL
City Clerk
1700 Convention Center Dr
Miami Beach FI 33139
9214 8901 9403 8380 3615 33
FLORIDA COMMISSION ON ETHICS
PO Box 15709
TALLAHASSEE FL 32317-5709
Fold Here
Return Reference#: State Gift Disclosure
Username: Charles Dagostin
Code Violation #
Court Case #:
Property Address
Permit ID #:
Custom 5:
Postage: $5.6000
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME:
NAME OF AGENCY:
Granado, Rafael E.
City of Miami Beach
MAILING ADDRESS:
OFFICE OR POSITION HELD:
1700 Convention Center Drive
City Clerk
CITY: ZIP: COUNTY:
FOR QUARTER ENDING (CHECK ONE): YEAR
Miami Beach 33139 Miami -Dade
❑MARCH ❑JUNE ❑SEPTEMBER la DECEMBER 20,$
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
DESCRIPTION
MONETARY
NAME OF PERSON
ADDRESS OF PERSON
RECEIVED
OF GIFT
VALUE
MAKING THE GIFT
MAKING THE GIFT
12.3.18
Art Miami
$190
City of Miami Beach
1700 Convention Ctr Dr
2 tickets
Miami Beach, FL 33139
12.3.18
Scope Art$150
City1700
Of Miami Beach
Convention Cir Dr
2 tickets
Miami Beach, FL 33139
10.11.18
Claws for a Cause
$500
Micky Steinberg
767 Arthur Godfrey Road
Charity Dinner
Miami Beach, FL 33140
❑ 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
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 r uired to be reported by Section 112.3148,
Florida Stat
3 2.1
SIGNAT E OF REP TING OFFICIAL
STATE OF FLORIDA
COUNTY OF AA 17! /
Swo tQ r affirme ) and subscribeA b fore me this
/ r day of 20
by ��e � G1-�itJf�
of
(Print, Type, or Stamp mio
Personally Known
Type of Identification Produced
PART D — FILING INSTRUCTIONS
NOTARY
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. 6/2016) (See reverse side for instructions) '�'_