Fernandez, Hilda March 2008F~~~'~~~r"~
M
QUAR IAMI-DADE COUNTY
TERLY GIFT DISCLOSURE ~ ~ ~ `~ t ~- ~-' '
LA T NAME~FIRST NAMIrMIDDLE NA
r ~ Id a ME: NAME OF AGENCY:
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MAILING ADDRESS:
0o ven~7~'
~ ter
~ ve, OFFICE OR POSITION HELD:
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~(C~ITY: //~~ZhP:
/1r1 aMl 1../C:c7C COUNTYQ:
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/y/11,~ FO DARTER ENDING (Check One): YEAR:
ARC JUNE SEPTEMBER DECEMBER 20Q$
DART A l"1'A'1'li'MN'N~1- I IH~ I~IN 1
~ I, ('. F
~~
Please list below each gift, or series of gifts of $
being filed. You are required to describe the gift
the gift, and the date(s) the gift was received. I
you should so state on the form: As explained
disclose gifts from relatives or certain other gift 100 or more, accepted by you during the calendar quarter for which this statement is
and state the monetary value of the gift, the name and address of the person making
f any of these facts, other than the gift description, are unknown or not applicable,
more fully in the instructions on the reverse side of the form, you are not required to
s. You are not required to file this statement for any calendar quarter during
which you did not receive a reportable gift.
DATE
RECEIVED DESCRIPTION
OF GIFT MONETARY
VALUE NAME OF PERSON
MAKING THE
GIFT ADDRESS OF
PERSON MAKING
THE GIFT
~ 2 ~ mC~i ; t: ~ 15 ~ . o o ~~~~ ~,~y.13~-~Er M~M~EyAgc i F~
3
p~ ~~r~yy
~etn6-~To~~
~ 50,0o . S I~r n
MCd~1nl- Ctw~fi'
I11 Ntnl l5Ti~7
^ CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B -RECEIPT YKUV1llLll 13Y Y1~K,V1V Iviaiul~~ ins sir i
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, STATE OF FLORIDA
COUNTY OF ~ ~~('~ f~11 L` L~k~e
do depose on oath or affirmation and say that the information
disclosed herein and on any attachments made by me consti-
tutes atrue, accurate, and total listing of all gifts required to be
reported by Section 2-1 ].1 (e)(4) of the Code of Miami-Dade
County. ~~'
Sworn to (or affirmed) and subscribed before me this
_~' day of ~. ' 20~
by - ,. 1
( ~gnature of No e of Florida)
~__.__
Cornrn# ppp8g8e183
Expires 9/28/2011
Ftcxlde Nq~ly Aean., Inc
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CARLA GOMEZ
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SIGN TURF OF REPORTING OFFICIAL '~ .=(Print, Type, ~' Stamp Commissioned Name of Notary Pubhc)
CPerso nown OR Produced Identification~
Type of IdenUficauon Produced-
PART D -FILING INSTRUCTIONS
This form, when duly signed and notarized, must be filed with the Clerk of the Board of County Commission, 111 NW 1'Sttect,
Suite 17-202, Miami, Florida 33128. The form must be filed no later than the last day of the calendar quarter that follows th
calendar quarter for which this form is filed. (For example, if a gift is received in March, it should be disclosed by June 30.)