Erick Chiroles County Form QTR 4 MIAMIBEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfI.gov
Telephone: 305.673-741 1
March 29, 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:
Erick Chiroles — City of Miami Beach (Commission Aide)
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,
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
9214 8901 9403 8380 7815 46
City of Miami Beach USPS CERTIFIED MAIL
City Clerk
1700 Convention Center Dr
Miami Beach FI 33139
9214 8901 9403 8380 7815 46
MIAMI-DADE CLERK OF THE BOARD OF COUNTY COMMISSIONERS
111 NW 1ST ST UNIT 17-10
MIAMI FL 33128-1902
Fold Here
Return Reference#:County Gift Disclosure
Username:Charles Dagostin
Code Violation#:
Court Case#:
Property Address::
Permit ID#:
Custom 5:
Postage:$5.6000
MIAMI-DADE COUNTY -
QUARTERLY GIFT DISCLQSURE 29 pf`1 (i•: ( 0
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY: 09 f/t14kL
C-h;ireles 1 C,�tc�, a
STREE ADDRESS: OFFICE OR POSITION HELD:
/573 a Merlie an e A pJ 1/Da C o rv.w4 I's s%ori +b��
CITY: Kt_
m% 6 t c FOR QUARTER ENDING(Check One):
ZIP: -5-5(z 01 0 MARCH ❑ JUNE
COUNTY: M Arm —Dade 0 SEPT. "DEC.eYEAR:20 /5
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 DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
/0 h5lif e m;-Vih) in kris 1 c OO M' M u w� r�i /Dyo ! Rai
14m� �� +a >• rcI &min Kam;��iott�►i`L
CHECK HERE IF CONTINUED ON SEPARATE SHEET. 0
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 Conunissioners, 111 NW 1st 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 STATE OF FLORID /l I'
this form, do depose on oath or affirmation and say COUNTY OF //'J F-���J` I �LJ�
that the information disclosed herein and on any
attachments made by me constitutes a true, accurate, Sworn to(or affirmed)and subscribed�before me this
and total listing of all gifts required to be reported by day of LAA P - , 0 / ( ,
Section 2-11.1 (e)(4) of the Code of Miami-Dade
County. by _7/� t/d /PS
/(N .e of et, gG' I•sclosure)
t� otaryf NoPubli Florida
(Sign. l
Charles J.DAgostin
Signature of Person Making Gift Disclosure �ot� NOTARY PUBLIC
(Print,Type,or Sta 9 Otter`btORIDA
Personally known to'&.1''l o e f ica
Type of Identification 'f.,.11Ped: Expires 12/1412 21
COE 02/2010