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Jeffrey Cohen 12/31/2011m MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33.139, wvrw.miamiheochA as^v OFFICE OF THE CITY CLERK, Robert Porcher, Ciy Cierk - ~ .. Tel: (3051 673-7411, fax: 1305) 673-7254 1 /4/2010 Jeffrey Cohen 880 Lakeview Drive Miami Beach, Florida 33140 SIUBJECT: Golf Advisory Committee Congratulations! You have been reappointed by Commissioner Jerry Libbin to the above referenced agency, board or committee for a term ending: 1213712011. 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, obert Percher City Clerk ce: Saul Frances, Parking Director Kevin Smith 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 ore committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. m- MIAMI BEACH City of Miami Beach, 1700 ConvenKon Center Drive, Miami Beach; Flbrida 33139, www.miamibeachA.aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk _ ,. _ ~. , „ , _. - , Tel: (305i 673-7411; Fax: i305) 673-7254 , TO Jeffrey Cohen RE: Golf Advisory Committee 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 io perform all the duties of a member of the above-mentioned board or committee of the City 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 Officers 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 or the State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing of the calendar year on which I have served. /J Sworn to and subscribed before me tfiis ~~day of ~, 20t7~~ ~~~L~~ /Fq+Z_Silvia Prieto Deputy Clerk *Please visit the Gty of Miami Beach website at www.miamibeachFl.gov under Gty Gerk/BOard and Committees for additional information regarding the Finandal Disclosure Requirements. We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic communiy. 1 V 1~f`~l Y 11 ~ ~ CE`t'YC3F ifliRh~6i9 CiL:,~4.:Q-# ~3~"'h4~,~i11[) &{:7h~s~]3"'T~E.~P~"L]<:ATiC?Po) ~~t~Mp NAME: Cohen Jeffrey M Last Name First Name Middle Initial HOME ADDRESS: 880 Lakeview Drive, Miami Beach, Florida 33140 No. Street City State Zip Code ~eF~C ~.1QF'FC©bQN•Ct~'t PHONE: 305-867-3345 305-534-5333 305-534-9805 ~l Home Work Fax Email address Business Name: Real Estate Enterprises Position: Owner Address: 419 Arthur Godfrey Road. Miami Beach. Florida 33140 No. Street City State Zip Code Professional License (describe) Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement 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 demonstrate ownershipfinterest for a minimum of six months in a Expires: kVJ,tarhr z~ ecrpzg~ of d4tr> Ur, E>a~b9e Please list your preferences in order of ranking [1] first choice [2J second choice, and [3j third choice. Please note that only three (31 choices will be observed by the Citv Clerk's Office. (Regular Boards of City) Affordable Housing Advisory Committee Historic Preservation Board Art in Public Places Committee Housing Authority Beach Preservation Board Loan Review Committee Beautification Committee Marine Authority Board of Adjustment Miami Beach Commission for Women Budget Advisory Committee Miami Beach Cultural Arts Council Capital Improvements Projects Oversight Committee Miami Beach Sister Cities Program Committee on the Homeless Normandy Shores Local Gov't Neigh. Improvement Committee for Quality Education in M8 Parks and Recreation Facilities Board Community Development Advisory Personnel Board Community Relations Board tanning Board' Convention Center Advisory Board Police Citizens Relations Committee Cultural Arts Neighborhood District Overlay (CANDO) Production Industry Council Debarment Committee Public Safety Advisory Committee Design Review Boartl' Safety Committee Disability Access Committee Single Family Residential Review Panel Fine Arts Board Sustainability Committee Gay Business Development Ad Hoc Transparency Reliability & Accountability Committee "TRAC" Golf Advisory Committee Transportation and Parking Committee Health Advisory Committee Visitor and Convention Authority Health Facilities Authority Board Youth Center Advisory Board Hispanic Affairs Committee ` Board R aired to File State Disclosure form ~~ Macintosh I-ID:UseisjefEcohen:Documents:MiQOSOft User Data:Saved Attachmedts:BC Application 21109.doc Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: Yes No Years of Service: ~ave you ever been convicted of a felony: No If yes, please explain in detail: Do you currently have a violation(s) of City of Miami Beach codes: Yes or~ If yes, please explain in detail: Do you currently owe the City of Miami Beach any money: Yes explain in detail r No !f yes, Are you currently serving on any City Boards or Committees: Yes or~. If yes; which board? What organizations in the City of Miami Beach do you currently hold membership in? Name: Name: Title: List all properties owned or have an interest in, which are located within the City of Miami Beach: Residence at 880 Lakeview I am now employed by the City of Miami Beach: Yes o No .Which department Pursuant to City Code Section 2-25 (b-: Do you have a parent ,spouse ,child ,brother , or sister who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): q/o Gende : ale Female Ethnic Origin: Asian or Pacific Isl der African-American/Black American Indian or Alaskan Native Hispanic: t~jte~lot Hispam Employment Status: m o e ome-maker Other "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees a A ency Members L Received in City Clerk's Office by r~ :~/~ ~~ ~ U ' " "_ _` / /~Q -r•~"x- Date Name of Deputy Clerk the City Clerk's Office) ~~58 Entered By Macintosh HD:Usersjeffcohen:Documents:Mivosoft User Da[a:Saved Attachments:BC AppGcaflon 21109.doc ~ v ~~ SOURCE OF INCOME STATEME Please Print or Name: Malting Addre, City/State/ZiE Disclosure For Tax Year Ending: Social Security Number: a(O a ~ ~~ _ ~y`37 Filing as a: ® County Employee; ® Muniapal E~mp,~~opyee of: Position ~ii3ld yr sought; _~~~ ~~/Sd'~/ ~ ' h~s~`~~ /( Board where serving: Term or Employment Began on Department where employed; ~~ Work Address; y/ 9 /`f! //IO ~ G23~~~ /T b 2f rout home address b: exempt from public records tarrmsarrt to Piorida statutes § iiB.G7 please cbed: bare (reed instruetionsj: ®. Work Teieiphone; Home Address; S ~~ Street Aridness ~l~i~ ~~ _~~-'cam-~'~ City State Zip Code Please list below in descending order with the iar~est source first, the name, address and prindpal business aeLivity of every sou-ee of your income including public salary you received or any person received for your benefit or use during the d'esclosure period, The income of your spouse or arty business partner need not be disclorsed. If txntinued rm a separate sheet, check here: ~] of Sources of Income I hereby swe r (or trm) th the aforesaid information is a true and correct statement. 2 Signet of arson disclosing Date sgnad