Erick Chiroles County FormM IA M I BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl,gov
Telephone: 305 .673-7 411
March 26, 2020
Miami-Dade Clerk of the
Board of County Commissioners
111NW 1°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
2019, 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,
7«
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
M IA M I-D A D E C O U N T Y
Q U A R T E R L Y G IF T D IS C L O S U R E
RECEIVED
MAR 26 2020
CIT OF MIAMI BEACH
OF+r Or HE CITY CLERK
LAST NAME-FIRST NAME-MIDDLE NAME:
Ccoles. E:
AME OF AGENCY:
Cr' /a• Bah
STREE ADDRESS:
700 eon
CITY: Maw! ea
z1: 3 131
COUNTY: e
FFICEORPO
Co \
16$1O
FOR QUARTER ENDING (Check One):
□MARCH
□SEPT. YbE C.
□JUNE
YEAR: 20_/7
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 !ADDRESS OF PERSON
MAKING THE GIFT MAKING THE GIFT
$2,) o° A [ Ü rilsss
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 A TT ACHED 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 I st 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.
d.
Signature of Person Making Gift Disclosure
STATE OF FLORIDM . • 1 A \.L"'
coUNTY OF l/kt-- ttt
Swor),O (or affirmed) and subscribed before me this
2f ay or nuK ,2o2 ,
CL,olo
(Name of Person Making Gift Disclosu
€ '_(/0.> int, Type, or Stamp Commissioned Name of Notary Public)
i Personally known to me or DO Produced Identification
Type of Identification Produced.
COE02/2010 g;y:t%2, GUADALUPE C Rios ''[E'""~-- '% $6: Notary Public - State ot Fiona3
·{ )j commission w Fr 992as
%3j g w comm. Exes se 8, 2
6ff" Bonded through National Notary4a
City of Miami Beach
City Clerk
1700 Convention Center Dr
Miami Beach Fl 33139 I
USPS CERTIFIED MAIL
II 111
9214 8901 9403 8310 0348 03
MIAMI-DADE CLERK OF THE BOARD OF COUNTY COMMISSIONERS
111NW 1ST ST UNIT 17-10
MIAMI FL 33128-1902
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Return Reference#:
Usern am e: Charles Dagostin
Code Violation # :
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