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Laura Dominguez Form 9 QRT IOFFICE OF THE CITY CLERK City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139 www.miamibeachf,gov Telephone: 305 673-741 June 27, 2024 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 2024, for the following City of Miami Beach Personnel: • Laura Dominguez - Commissioner Group 2 (City of Miami Beach) Should you have any questions or require any additional information, please contact me at 305.673.7411. Respectfully, Raf~nado, City Clerk Attachment REG:cd Sent Certified Return Receipt Page 1/2 Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LA S T NAM E -- FI R S T NAM E -- MI D DL E NA M E : NA M E O F A G E N C Y : Dominguez -- Laura Citv of Miami Beach M A ILI N G A D D R E S S : O FFIC E O R PO S IT IO N HE LD : 10 Venetian Wav #2101 Commissioner Group 2 C IT Y : ZIP : C O U N TY : FO R Q U A RT ER EN D IN G (C H E C K O N E): Y EA R Miami Beach 33138 Miami-Dade M AR CH I.JUNE □SEPTEMBER □DECEMBER 2024 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 Jan 25, 2024 Bass Ball $2,500 x 2 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 Jan 26,2024 Miami New Drama Event $200 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 3313 9 Feb 18 Jewish Federation Dinner $136x 2 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 Feb24 Shlomo Fest $180x 2 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 9 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 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, sore or p 3 ,A o CouNY OF _Hua Md S orn to (or affirmed) and subscribed before me by means of pony si gal presen ce or [} nine notarization, this { qt- dayo~So ,2o2j ry Public-State of Florida) (Print, Type, or Stamp Commissioned Name Personally Known XO OR Produced Id( 1t Type of Identification Produced 2560 26 surance 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 FORM 9- EFF, 1/2016 (Refer to Rule 34-7.010(1)(g), F.A.C.) (See reverse side for instructions) cJF Page 2/2 Form 9 Q U A R T E R LY GIFT DISCLOSURE (GIFTS OVER $100) LA S T N AM E -- FIRS T N AM E -- M IDD L E NA M E : N A M E O F A G E N C Y : Dominguez-- Laura 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 L D : 10 Venetian Way #2101 Commissioner Group 2 C ITY : Z IP : C O U N T Y : 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 MM4ARCH JUNE □SEPTEMBER □DECEMBER 2024 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 Feb 22 -24 SOBE Wine & Food Events per $1,500 City of Miami Beach 1700 Convention Center Dr sponsorship ticket policy Miami Beach FL 33139 Mar 3,2024 Hebrew Academy Dinner $250 X 2 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 Mar4,2024 Fujisawa Delegate Dinner $100 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 Mar 8,2024 Power Breakfast $257.50 City of Miami Beach 1700 Convention Center Dr Miami Beach FL 33139 □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 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, STATE OF FLORIDA , cooNr or Li ao Dodd Sworn to (or affirmed) and subscribed before me by means of lillp?:1c;4I presence or D online notarization, this I2if rs'son@ (Print, Type, or Stamp Commissioned Name - lie) ALIC~ ij. ;-·-·1 Personally Known _'K) OR Produced taby6jie iii@}3&@ Type of Identification Produced 8(8'}b5 Ihiiunirice 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 FORM 9- EFF. 1/2016 (Ref er to Rule 34-7.010(1)g), F.A.C.) (See reverse side for instructi on s) %° City of Miami Beach City Clerk 1700 Convention Center Dr Miami Beach Fl 33139 I I USPS CERTIFIED MAIL 11 111 9214 8901 9403 8367 6131 36 FLORIDA COMMISSION ON ETHICS PO BOX 15709 TALLAHASSEE FL 32317-5709 Fold Here Return Reference Number: Username: Gabriel Donadio Martins Code Violation # : Court Case #: Property Address : : Permit ID#: Custom 5: Postage: $7.3600