Laura Dominguez - Form 9 Q IV 2024City Clerk USPS CERTIFIED MAIL
Ill 11111111 1111
9214 8901 9403 8307 6891 91
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FL 32317-5709
Fold Here
Return Reference Number:
Username:Charles Dagostin
Code Violation #:
Court Case #:
Property Address ::
Permit ID#:
Custom 5:
Postage:$8.1600
MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach,1700 Convention Center Drive,Miami Beach,FL 33139
wwwy_migmibegchf\.goy
Telephone:305.673.7411
March 31,2025
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 December 2024,for the following City of Miami Beach Personnel:
•Laura Dominguez -Commissioner
Should you have any questions or require any additional information,please contact me at
305.673.7411.
77
Rafael E.Granado
City Clerk
Attachment
REG:DM
Sent Certified Return Receipt
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME --FIRST NAME --MIDDLE NAME:NAME OF AGENCY:Dominguez --Laura City of Miami Beach
MAILING ADDRESS OFFICE OR POSITION HELD:1700 Convention Center Dr 4th FL Commissioner Group 2
CITY:ZIP:COUNTY:FOR QUARTER ENDING (CHECK ONE):YEAR
Miami Beach 33139 Miami-Dade □MARCH 0JUNE 0SEPTEMBER 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 thesefacts,other than the gift description,are unknown or not applicable,you should so state on theform.As
explained more fully in the instructions on the reverse side ofthe 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 PERSONRECEIVEDOFGIFTVALUEMAKINGTHEGIFTMAKINGTHEGIFT
10/31/2024 Big Brothers Big Sisters Lunch $100+Commissioner Micky 2124 NE 123 Street #201
Steinberg's office North Miami FL 33181
11/2/2024 Group Dinner at Queen split by $100+David Suarez and DS --2185Meridian Ave 33139
David Suarez and Wayne Roberts Wayne Roberts WR--400Alton Rd 33139
12/7/2024 Art Basel Tickets per $100+City of Miami Beach 1700 Convention Center Dr
City Ticket Policy Miami Beach 33139
12/13/2024 Miami Beach Fire Dept Holiday $100+City of Miami Beach 1700 Convention Center Dr
Event Miami Beach 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 15 ATTACHED TO THIS FORM
PARTC-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 ofall gifts required to be reported by Section 112.3148,
EEA-SIGNATURE OF REPORTING OFFICIAL
sATe OFF0?My D)DEcouNrYorMLH),DHDI>omn to (or affirmed)and subscribed before me by means of
Weyea oresens ojeg@on."s 9<3l day of MR'A 2o_-=
s,oo o Dm3osUe.
~f Notary Public-State of Florida)wwwwuuu»,,,s"MARQyz."o,"[~..···..'Sd ""0,
•Te.o6""PYj"sore@ are oro@@%@"7Us}•Personally Known OR Produced Identificaion;'''.%zTypeofIdentificationProducedg:<
sit'l If
Wow"Ao27'fPARTDFILINGINSTRUCTIONS.EyPIRES4-2 ;s
Thisform,when duly signed and notarized,must befiled with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Flori~~f~W!l;.Rll~~;z1
cal address:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.The form must be filed no later than the lasff[fclnary;]?se
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}'lj34.hf],"""aw
CE FORM 9-EFF,1/2016 (Refer to Rule 34-7.010(1)g),FA.C.)(See reverse side for instructions)@