Kristen Rosen Gonzalez Form 9 QTR IVM IA M I BE A C H
O FF IC E O F TH E C ITY C LERK
C ity of M iam i Beach, 17 0 0 C onvention C enter Drive, M iam i Beach, FL 33 13 9
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Telepho ne: 30 5.6 7 3-7 4 11
March 31, 2022
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find an Quarterly Gift Disclosure State Form
(9) for the quarter ending December 2021, for the following City of Miami Beach Personnel:
• Kristen Rosen Gonzalez - City of Miami Beach Commissioner
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Re7&
Ra¿ E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
Rosen Gonzalez Kristen Citv of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Dr Commissioner
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
Miami Beach 33139 Dade □MARCH JUNE ISEPTEMBER ?'DECEMBER 2021
PART A- STATEMENT OF GIFT S
Please list below each gift, the value of which you believe to exceed $100, 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
11/30/2021 (2) Dinner Tickets $200 Culture Magazine 217 5 Sampson A ve Ste
118, Corona, CA 92879
11/25/2021 (2) Design Miami Tickets $200 City of Miami Beach 1700 Convention
Center Dr
11/25/2021 (2) Art Basel Tickets $200 City of Miami Beach 1700 Convention Center Drive
Miami Beach, FL 33139
□CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt fo r a gift listed above w as provided to you by the person making the gift, you are required to attach a copy of that receipt to this
fo rm . You m ay attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
O CHECK HERE IF A RECEIPT 15 ATTACHED TO THIS FORM
PART C- 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 112.3148,
Florida Statutes.
sore or0p)A _De co uN r Y or /Lv\l )MD
Sw orn to (or affirm ed) and subscribed before me by means of
0loop r es one or [ op p orza«on." „ }]
v Pl?" ll 1Zak
(Print, Type, or Stamp
Personally Known
Type of Identification Pr
of Notary Public-State of Flori
public Underwriters
PART D FILING INSTRUCTIONS
This form, when duly signed and notarized, must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709; physi-
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 calendar
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.)
CE FOR M 9 -EFF. 1/2016 (Re fer to Rule 34-7.010(1)g), F.A.C.) (See reverse side for instructions)
City Clerk USPS CERTIFIED MAIL
111111 I
9214 8901 9403 8371 4886 14
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
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