Rafael Paz County FormOFFICE OF THE CITY CL ERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachll.goy
Telephone: 305.673-7411
March 14, 2022
Miami-Dade Clerk of the
Board of County Commissioners
111NW 1Street, # 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
2021, for the following City of Miami Beach Personnel:
Rafael Paz - City Attorney
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
LAST NAME-FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
Paz. Rafael City of Miami Beach
STREE ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Dr., 4th Floor City Attorney
CITY: Miami Beach FOR QUARTER ENDING (Check One):
ZIP: 33139 DJ MARCH □JUNE
COUNTY: Miami-Dade □SEPT. ) DEC. YE AR: 20 21
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
Two VIP Tickets- $120.00 Robert Goodman Art Basel U.S. Corp.
12/01/2021 Art Basel - MBCC Art Basel Miami Beach I 76-180 Grand St,, # 60 I
New York, NY 10013
CHE CK HE RE IF CONTINUED ON SEPARA TE SHE ET. 0
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 ro 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. 0
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, 11 NW I st 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.
~~
STATE OF FLORIDA
COUNTY OF Miami-Dade
Swqrn to (or affirmed) and subscribed before me this
ll_ day of March ,2022. •
Signature of Person Making Gift Disclosure
COE 02/2010
by Rafael Paz
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City Clerk USPS CERTIFIED MAIL
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9214 8901 9403 8369 1336 63
MIAMI-DADE CLERK OF THE BOARD OF COUNTY COMMISSIONERS
111NW 1ST ST UNIT 17-10
MIAMI FL 33128-1902
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