Leslie Coller 12/31/2011i
m- MIAMI BEACH
~ -
City of Miami Beach, 1700 Convenfion Center Drive, Miami Beach; Florida 33139, www.miamibeachR.aov
OFFICE OF THE CIN CLERK, Robert Porcher, Ciy Clerk
Tel: (305( 673-7411, Fax: (305( 673-7254
12/22/2009
Leslie Coller
5301 LaGorce Dr.
Miami Beach, Florida 33140
Miami Beach Commission For Women
Congratulations! You have been reappointed by Commissioner Deede Weithorn
to the above referenced agency, board or committee for a term ending: 72/31/2011.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
~g~f ~~~/S~°
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Wanda Ortiz
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-2458, 2-459
Ordinance 2006-3543 -Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to providing excellent public service and safely ro all who live, work and play in our vibrant, tropical, historic community.
I
m MIAMI BEACH
City of Miami Beaeh, 1700 Convention Center Drive, Miami Beach; Florida 33.139, www.miamibeachR.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk
Tel: 13051673-7411, Fax: 13051673-7254
TO Leslie Colter
RE: Miami Beach Commission For Women
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United States, the State of Florida, and the City of Miami Beach, and to pertorm all the duties of
a member of the above-mentioned board or committee of the Ciry of Miami Beach to which I have
been appointed for a term ending: 12/31/2011.
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officrrs and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure' require-
ments of Miami-Dade County ar the State of Florida (depending on the tward or committee on which
I serve) on July 1st, following the closing of the calendar year o which I have ed.
i
Leslie Coller
Sworn to and subscribed before me this
day of ~~ , ~ ~
~~~~~G
_~ ~,2-Silvia Prieto
Deputy Clerk
'Please visit the Gry of Miami Beach website at www.miamibeachfl.gov under Ciry Gerk/BOard and Committees
for additional information regarding the Financial Disdosure Requirements.
We are committed b providing excellent public service and safey to oll who live, work and play in our vibrant, tropical, historic community.
m i ,~ , ~. ,. ~~ ctiC H
1 ,i t i ) ~ CtTY OF MIAfd! 3E~;CH
~_ /30y,RG AND COIVIMi i i EE APPLIyATbDN =CRM
NAME:
HDME ADDRESS: J ,~
Apt No
PHDNE: ~d~ ~~
Business Name:
Position:
address
Adtlress:
No. Street City State Zip.Cotle
Professional License (describe)
Expires: Attach a copy ol;ne license
Pursuant to Cfty Code section 2-22(4) a and h: Members of agencies, boards, and cpmmittees shall be affiliated with the city; this
requiremerri shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrete ownershiplinterest fora ' ' um of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes r No D
• Demonstrate an ownership/interest in a business in M' i Beach for a minimum of six (B) mon o ^
• Are ybu a registered voter in Miami Beach', Yes No ^
. (Please carcle one): I am now a resident of North Beach South Beach Middle Bsaeh
• I am applying for an appointment because I have special abilities, knowledge and experience, slow:
• Are you presently a registered lobbyist with the City of Miami Beech? Yes ^ or No 0
Please list your preferences in order of ranking (1] first choice [2] second choice, and [3] third choice. Please note that onN three !31
choices will be observed by the City ClerMs Office. (Regular Boards of City)
D Afiorliable Housin Adviso Commitlee D Housfn Arttho
0 Art in Public Places Committee D Loan Review Committee
D Bealttification Committee D M tine Atttho
D Board of Ad'rtstinerrP' semi Beach Commission inr 1NOmen
D Bud Advil CtmtmlCae C Miami Basch Guttural Arts Coundl
D C Ifel Y tttb P reCfa Oversi Committee D Miami Beach Silster Cities P ram
D Committee on the Homeless D Nonnen Shores Local Govemmerrt Ne' h. Imbrrnemerrt
D Committee for float Education in MB D Parks and Recreation Facilities Board
0 Common Davelo meat Adviso D Personnel Board
D Commun Relations Board D Ptannin Board`
D Convenfion Center Adviso Board D Pofi~ Citizens Relations Committee
D Debarment Committee D Production Ind Council
D Desion Review Baerd' D Public 5 Adviso Gommfttee
D Disabil' Access Committee ^ Sa Commit~e
D Fine Arts Board ^ Sin le Fami Residential Review Panel
0 Ga ,Lesbian, Bisexual and Transcender GLBT ^ Sustainabli' Committee
D Golf Advil Committee D Tra ten Reiiabii' & Accountability Committee "TRAC"
D Health Abviso Commitee D Tran ortation antl Parkin Committee
^ Health Faldltties Autho ' Board p Vusitor antl Convert(ion Ar.rtho '
^ His nic Affairs Commitlee D Waterfront Protection Committee
D Historic Preservation Board D Youth Cerrter Advisory Board
"Board Required to Flle State Disclosure Form
Note. If applying for Yputh Advisory Board, please indicate your affiliation with the Scott Rakow Youth Cemer:
1 Past service on the Youth Center Atlvispry Board Yes No ~ Years of Service
2. Presem participation in Youth Center acGvkies by your children Ye=_-~ No _. if yes, please list the names o` your children, their
ages, enC WnICh prpgram5. LIST below'.
Child's name'. Age: progrem:
Cnild's nam= Ac= Prooram~.
,_!=P-,bA!'. wr~RM,$\B7AP.r AND 27MMITTEES\B. AvohvvuvnOG260~ N?~/,-.oo;
/~
3
Name
. wave yo~_ eve' :,ear cow~,-ro° : z telonc •,~< ~ ;~ vas oiease explain v oetair.
. Do you currently have a vio;aiionls, o' Gry of Wuam: Bsapf~~ :ode=_ Yes .. - No _. I' vas please erolalr Ir oe;ai!
. Do you currently owe the City o` fVfiam~, 8sach any money: Yes . or Nom f` ve=_ ezolain In detail
• 4r5 you currently servm~ or any ~ttp Boards or Committees u(es or No ~. I'. ve; w~icr poard~
. What or~y-iaA
Name. ~-( ni~ations Ir. the "it} o'.
~~ ~ Miami Beach oc yo:: currently Hole m=
-itle 1~ m/o~~.,rs/rn~F. Ire
/-i/ug /GC.C~w.-J '
Name Title:
• List all properties owned or have an interest in, which are located within the City o` Miami 8sach
. I am now employed by the City o* Miami Beach Yes ~ or Nom Which deoartment?
. Pursuant to City Code Section 2-Z5 (bj: Do you have a parent ~, spouse C, child L brother C, or sister D who is employes op !ne
City o` Miami Beach? Check all that apply. Iderrtify the departmerrt(s):
The folkowing information Is voluntary and Is neHher part of your apptieetlon nor has any bearing bn your conslderetlon for eppolntmen: I: is
oeing eaketl tp comply with federal equal oppoitunlty reporting requirements.
Gender: D Male D Female
one only (1)
r~' WYfite (Not of Hispanic Urigin)~. All persons having ohgfns in any of Itw_ original peoples of Europe, North Africa or the Middle est.
^ Afrk;an-AmerieanlBkek (Not of FUapanic Origin): All petaons Having ongins in any of the Black, racial groups of Afrtea.
D Hispanic: Ail persons of Mekiwn, Puerto Ri®n, Crfben, Central or South American, or other Spanish culture or odgln. Bgerdless of race
Asian or Paetfie klandar: All persons craving origins in any of the oaginal peoples of the gar cast, Sotrthesst Asia, the fndfen Subtsntinen~.. or
the PacHtc Islands. Tltis eras krCgttles, for etztmple, China, YMia, Jaoan, Koraa, the PMilppine tstentls and Smnoa.
4menean Indian or Alasfren aetlve: All peisoris having origins in any of the original peoples of North America, and vfio maaaein
Cabaret itlerntifrca6pn ttrtough tribal etflgafion or txrnrrturtHy recopnaion.
Yes p or NoC.
Employment Status, Employed fl Refired D Homemaker p ether
NOTE: if appotrrted, you will tre ~requirad fA follow certain laws which apply to city boardleommMtee miambats.
These taws include, btrt are not IimMmd to, the foliowing•.
c Prohibition from directly or indirectly lobbying ~tl' personnel (IJ~iam~ Beach Cm' Code section 2-459)
Prohibition from contracting with the ~Y (Miami-Dade County Code section 2-11.1)
o ProMbition from lobbying befog baenf/committee you have served pn for ceriod of one year after leaving office lMiam
Beach City Code section 2-26).
c Requiremem to disclose remain financial irperests anti gifts (Mrami•Dade Coumy Cade section 2-11.1).
(re'. CMB Community Development Advisory Committee) prohibdion, during tenure and for one year after leaving office
from having any htmrest in or rereiving any benefit from Communtty Development Block Grant funds for eMher voursel'
or those wtth whom you have btmineas or hnmediate family ties (CFR 670.611;. '
Upon request, copies of these laws may be obtained from the Chy CierF;.
"I hereby attest : th see ., a tr hfulneas of the application and hav received, read anC will abide by Chapte~ ;
rticle VII - q e C e ` to ar o` Conduct or C ~ Officers, Em sand ncy Mempers "
lO ~S ~Q ~ L/.p''
o - is igrtature ~ `Jate
ame of App6Cen! (P. .SE °n^fN~;
°Vaese attach a copy o' your resume to tms appilcetlor.
NOTE: Aooheations will mmem pn the for r oerion o' one fL caianoer veal
keoewec Ir the ~ny mien: s~hICB op Uat~ ;20DF :,pntroi Iva Uars -%>^OD<
Name o' Ueputy .~.lerh: -
®~ SOURCE OF INCOME STATEME
Please Print or Type
Name:
Malting Address:
City/State/Zip;
Disclosue
For Tax Year
Ending:
Social Security Number: 2/° Z - ~~' - $l° ~'`~'
Filing as a: ® County Employee:
® Municipal Employee of:
Position iii§Id or sought;
Board where serving; S 7<<t S ~~rnc~ Term or i3mpioymant
Began on:
Department where employed:
Work Address:
2f your home address is exempt from public records pursuant to
Florida statutes § 17.8.07 please cbad: bare (read instructions): ~ Work Telephone:
Home Address:
Street Address
~'
Cc~
Zip Code
Please List below in descending order with the Largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or arty person received far your benefit or use during the disclosure period. The
inrome of your spouse or any business partner need not be disclosed. If continued tm a
separate sheet, shack here:
Name of Source of Income
Address Description of the Principal
Business Asti '
Pte. ~ onS, f' .oi !.9 0 - ~
~. I rXJ ! C
-.2 ~ / Q~.c, .~. ~e
I hereby swear (or affirm) et a aforesaid information is a true ar+d correct statement.
_ __ a 3 io
Signetur person disclosing signed