Beverly Heller 12/31/2012 ® MIAMIBEACH
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
12/16/2010
Beverly Heller
5916 LaGorce Dr
Miami Beach, Florida 33140
SU J `` '*; Committee for Quality Education in MB
Congratulations! You have been reappointed by Mayor Matti Herrera Bower
to the above referenced agency, board or committee for a term ending: 12/31/2012.
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld
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 safety to all who live, work and play in our vibrant, tropical, historic community.
1
MIAMIBEACH
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl,gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
TO Beverly Heller
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: 12/31/2012.
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 theFlor/da 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.
Bev Heller
Sworn to and subscribed before me this 5 day of&-"n , 2010
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
•
® MIAMIBPACH CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
• NAME: �� i, e-� E J B
Last Name First Name Middle Initial
HOME ADDRESS: ; 1 b LA-& I SLE MIAMI G - EL 33 t `-i O
No. Street City State Zip Code
q
PHONE: 5 S - 1 3 I `
Home Work Fax Email address
Business Name: Position: I") ,,,
--i 00
Address: —C
No. Street City State.) rn 1 Code
r c-)
Professional License (describe) Expires: Wttacire copy the license
tD r71
Pursuant to City Code section 2 -22(4) a and b: Members of agencies, boards, and committees shall be giliatR with` Fie city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the c y fi4 ma of six
months; or b) an individual shall demonstrate ownership /interest for a minimum of six months in a businesastabtl%hedf the city.
t—,
m
• Resident of Miami Beach for a minimum of six (6) months: Yes If or No ❑
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes if or No 0
• Are you a registered voter in Miami Beach: Yes ID or 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, experience. Please list below:
( - - b tmvhv r v • ] N e-STC ( V\V (3\ . 1"" l \ - -oMc Y (Q $;
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
0 Affordable Housing Advisory Committee ❑ Historic Preservation Board*
❑ Art in Public Places Committee 0 Housing Authority*
0 Beach Preservation Board 0 Loan Review Committee*
0 Beautification Committee ❑ Marine Authority*
❑ Board of Adjustment* Miami Beach Commission for Women
❑ Budget Advisory Committee 0 Miami Beach Cultural Arts Council
0 Capital Improvements Oversight 0 Miami Beach Florida Sister Cities
0 Committee on Homeless ❑ Normandy Shores Local Gov't Neigh. Improvement
3 ® Committee for Quality Education in MB ® Parks and Recreation Facilities Board
❑ Community Development Advisory* ❑ Personnel Board*
0 Community Relations Board 0 Planning Board
0 Convention Center Advisory Board ❑ Police Citizens Relations Committee
❑ Cultural Arts Neighborhood District Overlay (CANDO) 0 Production Industry Council
0 Debarment Committee _ 0 Public Safety Advisory Committee
❑ Design Review Board* ❑ Safety Committee
0 Disability Access Committee 0 Single Family Residential Review Panel
0 Fine Arts Board 0 Sustainability Committee
0 Ga Business Development Ad Hoc ❑ Trans•arenc Reliabilit & Accountabilit Committee "TRAC"
'0 Golf Advisory Committee 0 Transportation and Parking Committee
0 Health Advisory Committee 0 Visitor and Convention Authority*
0 Health Facilities Authority Board 0 Youth Center Advisory Board
0 Hispanic Affairs Committee •
* Board Required to File State Disclosure form
F \OLER \SALL \Board E Committees \B &C Application \B &C Appiicatior Revidec ' 11308.00c
Sri
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 I No =: Years of Service:
2. Present participation in Youth Center activities by your children Yes_ No 1. If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
•Have you ever been convicted of a felony: Yes 0 or No ' No 6 If yes, please explain in detail:
N 7 3 C N egidgci Lt- --r1
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No V. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes 0 or No ®. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ® or No 0. If yes; which board?
(\t\ Pi-vv i t9 Vic- ('E cLo .m VY\ ‘SS t b N) 0 fJ W o
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Lf i C 2<- I-aM E- OW NI Ie:
Name: / Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
0 U'A
• I am now employed by the City of Miami Beach: Yes 0 or No::. Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child EL, brother D, or sister ❑ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: CO fi years old Gender: Male 0 Female
Ethnic Origin (Check one)
White iB African - American /Black 0 Hispanic: ❑ Asian or Pacific Islander 0 American Indian or Alaskan Native ❑
"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 and Agency Members."
•eJJ'QJA e_ 19.S1- \ L - 2 S -b S < -- eQ L 4iELL
Applicant's §Lipature Date Name of Aplicant (PLEASE
T
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Employment Status: Employed ❑ Retired ❑ Hom- -maker 0 Other D
Received in City Clerk's Office by /,‘,41 Date / Oy
Na- a .f Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) Entered By �1� Date l /6# vised09/02/08 LH
A NIA,t2./ I()A jb t I I Pe- 1A-s\
�,ar,. .ornminees uuii:...r ;L.._ r r
eir- MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.aov
CITY CLERK Office CityClerk @miamibeachfLgov
Tel: 305.673.7411 , Fax: 305.673.7254
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: eR U 0A- U
i �_� , . U C ci till
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.
You must file one 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.
...,----- ...,) \ jzi
Signature: Date:
i
i
0
MIAMI.
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
l Far Tax Year
Name: ' I . I °�I t Ending t 0
Mailing Address: 5 V' La. a 6--ore-Q--
City /State /Zip: I Y ► '°'"A i -3(_,12, � ''L --- 2 LID
Social .Security Number: aiez145■-..
Filing as a: ® County Employee:
® Municipal Employee of:
I Position held or sought:
Board where serving: Term or Employme t
I
Began an: j i / //
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes 114.07 please check hare (read instructions): 0 Work Telephone:
Home Address:
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 Activity
K e 4-1-7. b c, "C"-e rn it
1 hereby swear (or affirm) that the aforesaid information is -a true and correct statement.
\4 ....e. .
Signature of perso disclosing Date signed