Mark Samuelian Quarter I 2020OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673.7411
June 26, 2020
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending March 2020, for the following City of Miami Beach Personnel:
• Mark G. Samuelian - Commissioner
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Records Management Specialist
Attachment
Sent Certified Return Receipt
F:\CLER\$ALL\GIFT DISCLOSURES\MASTER FOR THE STATE - REG.docX
M IA MI -D A D E C O U N T Y
Q U A R T E R L Y G IFT DI S CL O SU RE
LA ST N A M E -FIR ST N A ME-M IDD L E NA ME : N AM E OF AGENCY:
S am uel ían --M ar k --G . C ity of M iam i Beach
ST REE ADDRESS: FTICE OR POSITION HELD:
17 0 0 C o nventio n C ente r D rive C om m issioner G roup 2
CITY:Miami Beach FOR QUARTER ENDING (Check One):
71P: 33139 ] M A R C H DJ JUNE
C O UNT Y : Miami-Dade J SEPT. O DEC. YE A R : 20 20
PART A: STATEMENT OF GIFTS. List bel ow each gift, or series of gifts, from on e per son or entity in
excess of $100 , ac cepte d by you during th e cal en dar quarter for which thi s state m ent is being filed. Describe th e gi ft
an d stat e th e monetary value of the gi ft, th e nam e and addre ss of th e person m aking the gi ft, and the dates th e gifts
w ere received. If any of th ese facts are unkn ow n or not ap plicable, state this on th e form . You are not required to
file thi s statem ent for any calendar quarter duri ng which you did not receive a reportabl e gift.
DATE DESCRIPTION MONETAR Y NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
1100 Wash ing ton Avo.
1/18/2020 Dinne r $17o FO P G ala Miami Beach FL 33139
220 W 42 St
1/28/2020 Pop up event $1,400 Wheels Up New York, NY 100 36
02/16/2020 Group Up Music 7275 Collins Ave
Tickets $152 Festival Miami Beach, FL 33141
02/20/20 tickets to give away s1.1so DJ SobeWFF 11200 SW8 St
MIami, FL 33199
CHECK HERE IF CONTINUED ON SEPARATE SHEET.
PART B: RECEIPT PROVIDED BY PERSON MAKING THE GIFT. If an y re ceipt fo r a gift
listed ab ove w as provi ded to you by th e pe rs on m aki ng the gift, you are require d to attach a copy of that receipt to this
form . Y ou m ay attach an expl an ation of an y di fferences betw een th e inform ation disclosed on th is form an d the
info rm ation on th e receipt. CHECK HERE IF A RECEIPT IS A TI ACHED TO THIS FORM. 0
PART C: FILING INSTRUCTIONS. The sign ed an d not ari zed form m ust be filed no later than th e last day
of th e cal en dar quart er th at fol low s th e quart er for which th is form ap plies. For exam pl e, if a gift is received in M arch ,
it sh ould be di sclosed by th e end of th e next quart er, i.e., June 30. Count y pers on nel fil e with th e Clerk of th e Boar d
of C ounty C omm issioners, II N W I" St., Site I7-10, M iami , FL 33128. M unicipal personn el file with th eir
respective m unicipal clerks . STATE OF FLORIDA
COUNTY OF _DAD> PARTD:OATH.
I, th e pe rs on w hose nam e app ears at th e be ginn ing of
thi s for, do depose on oath or affirm ation an d say
th at th e inform ation disclosed herei n an d on any
atta chm ent s m ade by m e constitutes a tnu e, accurat e,
an d tot al listing of all gifts req uire d to be re po rted by
Section 2-11.I (e)4 ) of th e Cod e of M iam i-D ade
2ai.A
Signature ~M aki ng Gi ft D isclosure
Sw orn to (or affirm ed) an d subs cribe d before m e this
2@day of )2Ara.,202O_.
/z re4 64 w,la_AJ
('%- lure of Notary Public, Sale of Florid3)
\hI >rip a re-Oe,
(Print. 'Type, or Stamp C'ommi iored Name of Notary Public)
)efi,crsonally known to mc orâ–¡Produced ldcntilicution
Typ e of Identification Produced:
COE 02/2010
psi!'http, Kistima airos §~~l:~ COMMISSIOII lff98867~ r ? EXPIRES: August 23, 2020
%3.2?gs oonded Thru Aaron N0lay
.Ii,fl"
City Clerk
1700 Convention Center Drive
Miami Beach FL 33139
II
USPS CERTIFIED MAIL
11 111
9214 8901 9403 8315 2756 07
FLORIDA COMMISSION ON ETHICS
PO Box 15709
TALLAHASSEE FL 32317-5709
Fold Here
Return Reference#:
Username: Patrick Camm
Code Violation # :
Court Case #:
Property Address : :
Permit ID#:
Custom 5:
Postage: $5.7500