Commissioner Rosen Gonzalez Form 9 QTR II,./1:I IL�JI_`r•�� 1 BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673.741 1
September 30, 2022
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending June 2022, for the following City of Miami Beach Personnel:
• Alex Fernandez — Vice -Mayor
• Steven J. Meiner — Commissioner
• Kristen Rosen Gonzalez — Commissioner
• David L. Richardson — Commissioner
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfull
Ra ael E. Granado
City Clerk
Attachment
Sent Certified Return Receipt
City Clerk USPS CERTIFIED MAIL
1700 Convention Center Drive
Miami Beach FL 33139
9214 8901 9403 8391 4193 60
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FLORIDA 32317-5709
Fold Here
Return Reference Number:
Username: Patrick Camm
Code Violation #
Court Case #:
Property Address
PermitlD #:
Custom 5:
Postage: $6.8100
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 Miami -Dade
❑MARCH p'JUNE ❑SEPTEMBER ❑ DECEMBER 20�
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 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
April 7 2022
Miami City Ballet "Swan
$2500 ea x 2
Lisa Pollack
2200 Liberty Ave Miami
Ball" Gala Tickets
Beach, FL 33139
May 6 2022
Carbone Beach Activation
'4000 x 2
✓Ua-6o � hod
AI V /uy
hosted by Major Food Group
6T
t
May 10 2022
Aspen VIP Reception hosted by
$150 ea x 2
City of Miami
1700 Convention
Major Food Group
Beach
Center Dr
May 9 2022
Aspen Institute
$500 x 2
City of Miami
1700 Convention
Conference
Beach
Center Dr
Lje 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 — OATH
I, the person whose name appears at the beginning of this form, do
STATE OF FLORI
`3) i�OL
depose on oath or affirmation and say that the information disclosed
COUNTY OF I iai
Sworn or affi emr d) and subscribed before me by means of
LJi5fTysical presence or J online notarization, this
herein and on a att ments made by me constitutes a true accurate,
day of
C
and total li ling f I gift) r q�ired to be reported by Section 112.3148,
by (2 -tiEr4 P'-j Cc-X
Florida S I
(Sign ure o ary Public -State of Florida)
SIGNA UR)07IG OFFI IAL
(Print, Type, or Stamp mmissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Identification Produced
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; ph
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 cater
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 FORM 9 - EFF. 1/2016 (Refer to Rule 34-7.010(1)(g), F.A.C.) (See reverse side for instructions) O '
Date Received Description of Gift Monetary Value Name of Person Address of Person
Making Gift Making Gift
June 4 2022 Miami Beach $325 x 2 = $650 City of Miami 1700 Convention
Chamber Annual Beach Center Dr
Gala