Michael Gongora Form 9 QTRIII MIAMI 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
April 3, 2020
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 2019, for the following City of Miami Beach Personnel:
• Michael Gongora — City of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
.7._\6
Rafael E. Granado,
City Clerk
Attachment
REG:js
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE RECEIVED
(GIFTS OVER $100)
LAST NAME --FIRST NAME--MIDDLE NAME NAME OF AGENCY APR �`� 2020
Michael Gongora City of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD: y/r-)47..... n r., ,
1700 Convention Center Drive Commissioner
CITY: ZIP COUNTY! FOR QUARTER ENDING(CHECK ONE): YEAR
Miami Beach 33137 Dade DMARCH ❑JUNE ❑SEPTEMBER VI/DECEMBER 20 199
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed 5100.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
10/25/2019 Blue Gala Ticket $500 1951 NW 7th Ave.
Miami-Dade DEC Miami FL
12/01/2019 Scope V I P Card $100 Scope 801 Ocean Drive
Miami Beach, FL
12/01/2019 $225 Design Miami 3841 NE 2nd Ave.
Design Miami VIP Card Miami, FL
12/01/2019 $500 Art Basel 300 W 41st St,
Art Basel VIP Card Miami Beach, FL
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.
J 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 STATE OF FLORIDA
COUNTY OF t ttAli1— 17ros°€
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subscribed before me by means of
Jphysical presence or�nlrne notarization.this
herein and on any attachments made by me constitutes a true accurate. p'3 day of J�+'t?1'21 l,. .20 2.c
and to,s l listing of all gifts required to be reported by Section 112 3148. by Rie l'�g L ID . G ftAbr., .61 o
n
A
s
•
F o d� tat es
(Signature o Notary Public-State of Florida)
SIGNAT •E OF R' •ORYINGO,FI, IAL
-- (Print.Type.or Stamp Commissioned Name of Notary Public) 3.�g n i
Personally Known ✓ OR Produced Identification ,d y,
Type of Identification Produced _
,a' 4
PART D— FILING INSTRUCTIONS ; -.!s,1 t
I-1,i
This form,when duly signed and notarized.must be filed with the Commission on Ethics.P.O.Drawer 15709.Tallahassee.Florida 32317-5709.phy I-
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 calen.:r.'"„,.
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.) ' t �
CE FORM 9-EFF 112016(Refer to Rule 34-7 010(1)(g).FAC i (See reverse side for instruct,ons) '' ''+ti s ,
City of Miami Beach USPS CERTIFIED MAIL
City Clerk
1700 Convention Center Dr
Miami Beach FI 33139 II 0
9214 8901 9403 8310 4359 69
FLORIDA COMMISSION ON ETHICS
P O DRAWER 15709
TALLAHASSEE FL 32317-5709
Fold Here
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Username:Jason Salvatore
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