David Richardson County FormMIAMIBEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.aov
Telephone: 305.673-7411
September 28, 2021
Miami -Dade Clerk of the
Board of County Commissioners
111 NW 15' 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 June 2021, for
the following City of Miami Beach Personnel:
David Richardson — City of Miami Beach (Commissioner)
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
MIAMI-DADE COUNTY
QUARTERLY GIFT DISCLOSURE
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SEP 2 7 ?®21
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LAST NAME -FIRST NAME -MIDDLE NAME:
Richardson - Lance - David
NAME OF AGENCY:
City of Miami Beach
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STREE ADDRESS:
FFICE OR POSITION HELD:
RECEIVED
1700 Convention Center Drive
City Commissioner, Group 6
MAKING THE GIFT
CITY: Miami Beach
FOR QUARTER ENDING (Check One):
(2n—teat3175. BWneFestl,
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ZIP: 33139
❑ MARCH
� JUNE
COUNTY: Miami -Dade
❑ SEPT. ❑ DEC.
YEAR: 202t
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
05/20/2021
(2n—teat3175. BWneFestl,
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@
$350.00
City Miami Beach
on, 3313 Dr.,
MiamiB1700 Beach,
Miami Beach, FL., 33139
05/21/2021
SoutM1 at$2aeaBWnadntt l
$500.00
City Miami Beach
1700 Convention Center Dr,
mn ;":na gives oWlooe msbe:eo�owmaa i-
Miami Beach, FL., 33139
105/21/2021
BoutM1 Beach FooaB Wine Fesgval
(6 ticket, � W;On,n °
$3,600.00
Cit Miami Beach
y
1700 Convention Center Dr.,
given a oadN,
Miami Beach, FL., 33139
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. CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM. ❑
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 lst 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.
6V
kig,ature of Pe on Making Gift Disclosure
COE 02/2010
STATE OF FLORIDA
COUNTY OF Ni 14A I / - D426
S orn to (or affirmed) and subscribed �efore me this
day of S?�{� , 20 pV ,
by L4,, C& Qq -v! D/ l i Ltam p S -,J
(Name of Person Making Gift Disclosure)
(Signature of Notary Public, State of Florida)
J�so>,1 S�-�✓mob <<-Cs►
(Print, Type, or Stamp Commissioned Name of Notary Public)
� Personally known to me or ❑ Produced Identification
Type of Identification Produced:
EI.
JASON SALVATOREOMMISSION # HH 000062RES: September 14, 2024
Tt ru Notary P,.W
City Clerk
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9214 8901 9403 8351 2011 10
MIAMI-DADE CLERK OF THE BOARD OF COUNTY COMMISSIONERS
111 NW 1ST ST UNIT 17-10
MIAMI FL 33128-1902
Fold Here
Return Reference Number:
Username: Charles Dagostin
Code Violation # :
Court Case #:
Property Address
Permit ID #:
Custom 5:
Postage: $6.1300