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Sofia Emuriel 6/30/2011m ,MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) b73-7411, Fax: (305) 673-7254 .September 8, 2010 Sofia Emuriel 6900 Bay Drive Apt 9B Miami Beach, FL 33141 SUBJECT: COMMI'Y'7"EE O:OR QUALITY EDUCATION Ild .MIAMI BEACIi Dear Ms. Emuriel, Congratulations! You have been -appointed as a Representative of the PTA for Treasure Island Elementary School to the above-referenced agency, board or committee for a term ending, 6/30/2011. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-741 1. Sinpcerely, n - ~~~~~~ s1' Robert Parcher City Clerk cc: Saul Frances, Parking Direcbr Leslie Rosenfeld, .Liaison 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 2-1 1.1 -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 ro providing excellent public service and safely to all who live, work and play in our vibront, tropical, hisroric community. VdP OIL' commired iu providutp exceiierd pu~fic service and safer~~ t, ; ei! who live, utinn:, and piov in our viurant, tropical, historic comm:.~nrry. m MIAMIBEACH City of -Miami Beach, 170o Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: j305) 673-7411, Fax: (305) 673-7254 TO Sofia Emuriel RE: Committee for Quality Education in MB 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 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 ~cters and Employees, and understand that as a member of a City of Miami Beach Board and/or Committee, 1 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. n Sofia Emuriel ` Sworn to and subscribed before me this L day of , 2010. r 6 Fx~ Silvia rieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City perk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed ro providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. NAME: ~~V ~/,~ ,~ ~ Last Name "',+ HOME ADDRESS: ~~©O 7 /Apt No/ us PHONE: ` ~l0 7~j~.~D83 7 Home W~,~ Business Name: ~1'-iy~C yn(~ %~ ~GYti_-B-X~- Address: ~~/~-l / ~ ~~~ ~i! ~4~ No. Professional License (describe) _ e No./Street 86 3 / Street i~~+€~~3 ~N~ ~t.7['~`C~ ~P~'LtCATl~3~1 FIr,31~# ~/ ~ _ First Name Middle Initial City State Zip Code ~~ ~~ - E'SAlJSO ~Z~ XoTwo~7 cow. Fax Email address Position:.~/'2~~`(,1Q~l7'" ~ ~ ~JC~ ` ~ ~~ol ~~ ~/~~ ~ ~ ~ City State Zip Code _ Expires: Attach a copy of the ticerrse 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 ~moriths; or b)~an individual shall demonstrate ownership%interest for a minimum of six months in a business established in the city. -, • Resident of Miami Beach for a minimum of six (6) months::Yes ~'or No ^ • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes~or No ^ • Are you a registered voter in Miami Beach: Yes for No ^ • (Please circle one): I am now a resident of. North Beach South Beach Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No ^ Please list your preferences in order of ranking [1) first choice [2) second choice, grid j3] third choice. Please note that only three (3) choices will be observed by the Citv Clerk's Office (Regular Boards of r~fin [.. ___.. ,W, ,,,,. ,U, ~~,.. .~. •.Di7HKii ±j~vts =.:t1~r'~tv;i7T~~ :l3C fi,~~~;i utioa~0626t~~ ~lE`~t` uo;: .Have you ever been convicted of a felony: Yes :: or~ ^' If yes, please explain in detail: • Do you currently have a violations} of City of Miami Beach codes: Yes G or No~lf yes, please explain in detail: ~~t t • Do you currently owe the City of Miami .Beach any money: Yes i= or No~Q If yes, explain in detail .. • Are you currently serving on any City Boards or Committees: Yes =: or No~,lf yes; which board? ; • What organizations in the City~of~Miami Beach do you currently hold membership in? Name: Name: Title: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: r ,~, . _ . •..~ : ~_~~•~- '~~twH c.L ~ ST_ ~'~ c o tit h S 8 S S ~ ' `I F • I am now employed by the City of Miami Beach: Yes ^ or 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): The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. Gender: ^ Male ; Female Ethnic Origin: Check one only (1) ^ White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East. ^ African-AmericanBlack (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. ^ Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa. ^ American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Cultural identification through tribal affili`at~ion or community recognition. oF...c:~~lly Chaltenaed: Yes ^ Or Ng4l. _ . ~ Employment Status: Employed ^ Retired ^ Other ^ c~~ ~~ NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami Beach City Code section 2-26). o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). (re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself , or those with whom you have business or immediate family ties (CFR 570.611). Upon request, copies of these laws may be obtained from the City Clerk. "I hereby ttest to t e accuracy truthfulness of the application and have received, read and will abide b Chapter 2, e Hof the ty Code "Sta d rds of Conduct for City Officers, Employees and cy Members." Applica is Signature Date al~me of Applicant (PLEASE PRIN Please ~~ch•a:copy of your resume:to this:application ~ { NOTE:.Applt'cations=will:r~,lnaino~jfile:fora;period of.one (1) calendar year. f Received in the City Clerk's Office by : Date: _I /2010 Control No.~ ~ Date: _/_/2010 ~ f'J Name of D putt' Clerk F:\CLER\$ALL\aFORMS\BOARD AND C MMITTEESIBC Application oc ~- MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww.m iam ibeachfl.aov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2) Board Member name: ~~~~~ ~U~l.~?l/ I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though you may have been recently appointed. YOl! ml1St file' 011@ of the following with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami .Beach, -Florida, by July 1 each year. 1. A "Source of Income Statement" (attached) or 2. A "Financial Statement" (attached( or] 3. A Copy of the person's current Federal Income Tax Retum Failure to file, according to the Miami-Dade County Code Chapter 1, General Provision, Section 1-5 may subject the person or firm to a fine not to exceed $500.00 or by imprisonment in the county jail for a period not to exceed sixty days, or both. ~~ Signature: ~~ _ ~ ~ ~, Date: '® SOl1RCE OF In1COME STAl'Et~IEtVT Please Print orType First Name Middle Name initial iaszjtlO11O Disclosure For Tax Year Name: 1 Q ~ ~ i~~ ~ Ending: ~~O Cit. ~~~~e Pik =8 ~ Mailing Address: ~ i~e City/State/Zip: 1"~b~.~1~ C ~~~ Social Security Number: `"~ ~~ r.. ~ 6 _ ~ ~ / Filing as a: ® County Employee: - ® Municipal Employee of: Position held or sought: Board where serving• Term or Employment Began on: Department where employed: Work Address: if your home address is exempt from public records pursuant to Florida Statutes § 119/07 please check here (read instructions): ® Work Telephone: Home Address: l~~~ Street Address City State 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 any person received for your benefit or use during the disclosure period. The income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here: Description of the Principal Name of Source of Income Address Business Activ' ~~ ,,~ ~. ~ -Leoi ~ ~-Q; _ awu~e ~ ~. A ~~ swear {or a~irm) that th~ aforesaid information is a true and correct statement: of person disclosing Date signed