Rafael Paz Form 9MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl,goy
Telephone: 305 .673-7411
March 14, 2022
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 2021, for the following City of Miami Beach Personnel:
• Rafael Paz - City Attorney
Should you have any questions or require any additional information, please contact me at
305.673. 7 411.
Respectfully,
7
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA S T N AM E -- FI R S T N AM E -- MI D DL E N A M E : N A M E O F A G E N C Y :
Paz. Rafael Citv of Miami Beach
M A ILI N G A D D R E S S : O F F IC E O R P O S IT IO N H E LD :
1700 Convention Center Dr., 4th Floor City Attorney
C IT Y : Z IP : C O U N T Y: FO R Q U A R T E R E N D IN G (CH E C K ON E ): Y E A R
Miami Beach 33139 Miami-Dade □M A R C H O JUN E ISEPTEMBER ?'DECEMBER 2024
PART A- STATEMENT OF GIFTS
P le a se list be lo w ea ch gift, th e va lue of w hich you believe to exceed $100, accept ed by you during the ca lendar quarter for w hich this statem ent is
be in g fil e d . Yo u are re q u ired to de scrib e the gift and state the m onetary value of the gift, the nam e and address of the person m aking the gift, and the
da te(s ) th e gift w a s re ce ived . If an y of the se facts, other than the gift description, are unknow n or not applicable, you should so state on the form . As
exp la in e d m o re fully in th e in structio n s on the reverse side of the fo rm , you are not required to disclose gifts fr om relatives or certain other gifts. You
are no t req u ire d to fil e th is state m e n t fo r an y ca le n d ar quart er during w hich you did not receive a report able gift .
D AT E D E S C R IP T IO N M O N E TA R Y N A M E O F PE R S O N A D D R E S S O F PE RS O N
RE CE IVE D O F G IFT VALU E M A K IN G TH E G IFT M A K IN G TH E G IFT
12/01/2021 Two VIP Tickets - $120.00 R obert G oodm an Art Basel U.S. Corp.
Art Basel - MBCC A rt B asel M iam i Beach 176-180 Grand Street, Suite 60 I
N ew Y ork NY 10013
a CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If an y re ce ip t fo r a gift liste d a b o v e w a s pro vid e d 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 a y att a ch a n exp la n a tio n of any diff ere n ces betw ee n the info rm ation disclosed on this form and the info rm ation on the receipt.
O CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, th e pe rso n w ho se na m e ap p e a rs at the beginn ing of this form , do
de p o se on oa th or affi rm a tio n an d sa y that the inform ation disclosed
he re in an d on an y atta ch m e nts m a d e by m e constitutes a true accurate,
an d to ta l listin g of all gifts re q u ire d to be repo rt ed by S ection 112 .3 14 8,
Flo rid a S tat~
S IG N A T U R E O F R E P O R T IN G O F F IC IA L
STAT E O F FLO R ID A
C O U N T Y O F Miami-Dade
Sw orn to (or affi rm ed) and subscribed befo re m e by m eans of
~phy~ca l presence or O online notarization, this
I'± day ot March 2 022
(Pr int , Typ e, or St amp/C om m i
Personal ly Kn own OR ' Id@ det jiationa; ¿m-
Typ e of Iden tification Produced
,a3: °' s PART D FILING INSTRUCTIONS ",G;···;'
"hi]" ow
Th i s for m , wh en dul y si gn e d an d not a ri zed , m ust be fil ed wi th th e C omm i ssi on on Ethic s, P.O. D raw er 15709, Tallah ass {/{4 )p9 }b%317-5709; ph ysi-
ca l ad d re ss: 32 5 Jo h n K n o x R o a d , B u ild in g E , S u ite 200, Tallahassee, Florida 32303. The fo rm m ust be fil ed no later than the last day of the calendar
q u a rt e r th a t fo llo w s th e ca le nd a r q u a rt e r for w hich this form is fil ed (F or exam ple, if a gift is received in M arch, it should be discl osed by June 30.)
CE FORM 9 -EFF, 1/2016 (Refer to Rule 34-7.010(1)9), FA.C.) (See reverse side for instruction s) @0'
City Clerk USPS CERTIFIED MAIL
I 11 11 1
9214 8901 9403 8369 1335 57
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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Usern am e: Charles Dagostin
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