Michele Burger County FormMIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeach[l,gov
Telephone: 305.673-7411
March 27, 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:
Michele Burger - City of Miami Beach (Chief of Staff/Office of the Mayor)
Joshua Carden - City of Miami Beach (Art in Public Places & Cultural Affairs Coordinator)
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. 7 411.
Respectfully,
l
Rafael E. Granado,
City Clerk
Attachments
REG:cd
Sent Certified Return Receipt
M IAM I-DADE CO UNTY
Q UARTERLY G IFT DISCLO SURE
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
/R &G Y? MICH Cir or Mt 14M y c l
STREE ADDRESS: OFFICE OR POSITION HELD:
1700 Coa«eh o efc p e CHer or ST4 F E /oFE 0E MA on
CITY: MA#mn» 9ct FOR QUARTER ENDING (Check One):
ZIP: 33/39 □MARCH □JUNE
COUNTY: MA4AA - DA □SEPT. DEC. YEAR: 20_17
PART A: STATEMENT OF GIFTS. L ist below each gift, or series of gifts, fr om one person or entity in
excess of $100, accepted by you during the calendar quarter fo r w hich this statem ent 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
w ere received. If any of these fa cts are unknow n or not appli cable, state this on the fo rm. 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
Mu(- Dae, fle $2 2 £e° Dest9n Mta, 3841 / 2#Ac
/2.3. (9 S u / 4 o o
Mam», P 3337
/ul-day cleek soot± #-1 Base/
3oo 41± Sheet
/2.4.19 6e 2t4 um 8cae 33)/
CHECK HERE IF CONTINUED ON SEPARATE SHEET.□
PART B: RECEIPT PROVIDED BY PERSON MAKING THE GIFT. If any receipt for a gift
listed above w as pro vided to you by the person m aking the gift, you are required to attach a copy of that receipt to this
fo rm . Y ou m ay att ach an exp lanation of any differences betw een the info rm atio n discl osed on this fo rm and the
info rm ati on on the receip t. CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM.□
PART C: FILING INSTRUCTIONS. T he signed and notarized fo rm m ust be fil ed no later than the last day
of the calendar quarter that fo ll ow s the quart er fo r w hich this fo rm applies. F or exam ple, if a gift is received in M arch,
it shou ld be disclosed by the end of the next quarter , i.e., Jun e 30. C ounty personnel fil e w ith the C lerk of the B oard
of C ounty C om m issioners, 111 NW 1 St ., Sui te 17-1 O, M iam i, F L 33128. M unicipal personnel fil e w ith their
respective m unicipal cl erks.
PART D: OATH.
I, the person w hose nam e appears at the beginning of
this fo rm , do depose on oath or aff irm ation and say
that the information disclosed herein and on any
att achments made by me constitutes a true, accurate,
and total listing of all gifts requ ired to be reported by
S ecti on 2-11.1 (e)(4 ) of the Code of Miami-Dade
C ounty.
sr 1E or PL.o 19 A., ' D)4p)/
coUNTY OF /l LHN L,
Sgrn to (or a~nd subscribed before me this
O lhaayor (4 ,o2o,
». MALAele [urea?
ATE OF FLORIDA
ct. Tr!3? tÈEj ooh»sonsowroe»
1.. =,pair9s 12114/2921 'STsonally known to me or T Pröducd Identification
Type ofldentification Produced: _
COE 02/2010
City of Miami Beach
City Clerk
1700 Convention Center Dr
Miami Beach Fl 33139
USPS CERTIFIED MAIL
I 11111 II
9214 8901 9403 8310 0794 15
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#:
Usemame: Charles Dagostin
Code Violation # :
Court Case #:
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