Mark Samuelian Form 9 QTR IMIAMI BEACH
OFFI CE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl,goy
Telephone: 305.673-7411
June 15, 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 March 2022, for the following City of Miami Beach Personnel:
• Mark Samuelian - Commissioner (City of Miami Beach)
Should you have any questions or require any additional information, please contact me at
305.673. 7 411.
Respectfully,
-71 '
/
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LA S T NAM E -- FI R S T N AM E -- MI D DL E N A M E : NAME OF AGENCY
Samuelian - Mark Citv of Miami Beach
M A ILI N G A D D R E S S O FF IC E O R P O S IT IO N H E L D
10 Venetian Way #2101 City Commissioner Group 2
C ITY : Z IP : C O U N TY FO R Q U A R T E R E N D IN G (C H E C K O N E ): Y E A R
Miami Beach 33139 Miami-Dade 2ARCH Q JUNE □S EPTEM BER □DEC EM BER 2022
PART A- STATEMENT OF GIFTS
Please list below each gift, the value of which you believe to exceed $100, accepted by you during the calendar quarter fo r which this statem ent is
being filed. You are required to describe 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
date(s) the gift w as rece ived. If any of these facts, other than the gift description, are unknow n or not applicable, you should so state on the fo rm . As
explained m ore fully in the instru ctions on the revers e side of the fo rm , 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 DESC R IPTIO N M O NETARY NA M E O F PERSO N AD D R ESS O F PERSO N
RECEIV ED O F G IFT VA LUE M A K ING THE G IFT M A KIN G THE G IFT
2/24/2022 Sobe WFF Tix G ave to aide Julio $300 FIU Ch aplan School of 3000 NE 151 St,
R odriguez H ospitality M anagem ent N Miami, FL 33181
2/25/2022 Sobe WFF Burger B ash gave to $550 FIU Ch apl an School of 3000NE 151 St,
aide Ju lio R odriguez H ospitality M anagem ent N M iam i, FL 33181
2/26/2022 Sobe WFF Tequilas & Tacos $500 FIU Chaplan School of 3000 NE 151 St,
H ospitality M anagem ent N M iami , FL 33181
2/27/2022 Sobe WFF Bacardi gave to aide $270 FIU Chaplan School of 3000 NE 151 St,
Julio Rodriguez H ospitality M anagem ent N M iami , FL 33181
□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 pro vided to you by the person m aking 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 betw een the info rm ation discl osed on this fo rm and the info rm ation on the receipt.
□CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-OATH
I, the person w hose nam e appears at the beginning of this form , do
depose on oath or affi rm ation and say that the info rm ation discl osed
herein and on any attachm ents m ade by m e constitutes a true accurate,
and total listing of all gifts required to be reported by Section 112.3148,
Florida Statutes.
STATE O F FLO R IDA
CO UNTY O F M iam i-Dade
Sw orn to (or affi rm ed) and subscribed befo re m e by m eans of
(]I physical presence or D online notarization, this
16in dayof une 2o
(Print, Type, or Stam p
Personally Know n
Type of Identification Produce d _
PART D FILING INSTRUCTIONS
This fo rm , when duly signed and notarized, m ust be fil ed w ith the Com m ission on Ethics , P.O . Draw er 15709, Tallahassee, Florida 32317-5709; physi-
ca l address: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The fo rm m ust be fil ed no later than the last day of the calendar
quarter that fo llow s the calendar quarter fo r w hich this fo rm is filed (For exam ple, if a gift is rece ived in M arch, it should be disclosed by June 30.)
C E FOR M 9-EF F, 1/2016 (R efer to Rul e 34-7.010(1)g), F.A.C.) (S ee reverse side for instruct ions) qr
City Clerk USPS CERTIFIED MAIL
I I 11 1111
9214 8901 9403 8379 7338 46
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
F old Here
Return Reference Number:Mark Samuelian Gift Disclosure
Usemame: Charles Dagostin
Code Violation # :
Court Case #:
Property Address : :
Permit ID#:
Custom 5:
Postage: $6.1300