Dale Stine 12/31/2012 MIAMI EACH
City 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
1/10/2011
Dale Stine
645 Michigan Ave. Apt. A
Miami Beach, Florida 33139
a4, Gay, Lesbian, Bisexual and Transgender (
Congratulations! You have been reappointed by Commissioner Michael Gongora
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,
/647/1124-P
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Rebecca Wakefield
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 to all who live, work and play in our vibrant, tropical, historic community.
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) 673 -7411, Fax: (305) 673 -7254
TO Dale Stine
RE: Gay, Lesbian, Bisexual and Transgender
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 theFlorida Commission on Ethics Guide to the Sunshine
Amendment and Code ofEthics 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 whit have served.
6 611
Dale Stine
Sworn to and subscribed before me this 11 day of , 2011.
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',Iive, work and play in our vibrant, tropical, historic community.
CA / 5 ,,L--„, � �� ; CiTY OF MlAidl! BEACH
0 • RD AND COIVIMI i i EE PPLICATION FORM:
NAME: ( 4/2.L Qutf._, j
Last pi s- th 1 „J i 1 , `^ il t Name a 1 ii die Ini -
HOME ADDRESS: J�'�
Apt No. Ouse No. /Stree / y State ip Code
PHONE: 3O5%L32f? '�b . 99 / ' LI 8
Horn- Work i Fax Email address
Business Name: �� r iii _/ C, Position: A lifir,4 :r (1 0 ;09 • .0 A'
Address • 1 I. �/ ' �� , Oi ' �/ i _� � � 1 , •
Street ' • . ' City , .. 4 , , ... , tate Zip Code
Professional License (describe) Expires: Attach a copy of the license
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'dity'for a minimum of six
months; 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: Yesytor No ❑
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes 'gor No 0
• Are you a registered voter in Miami Beach: Yes for No 0
• (Please circle one): I am now a resident of North Beach outh Bead' Middle Beach
• I am applying for an .appointment because I have special abilities, kno^ _•,._ - d experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or No %
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Please list your preferences in order of ranking [1] first choice [2) second choice, and [3) third choice. Please note that only three f3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Housing Advisory .Committee 0 Housing Authority
(R h in Public Places Committee 0 Loan Review Committee
eauttficafion Committee 0 Marine Authority
0 Board of Adjustment' 0 Miami Beach Commission for Women
0 •Budget Advisory Committee 0 Miami Beach Cultural Arts Council
D Capital improvements Projects Oversight Committee 0 Miami Beach Sister Cities Program
D Committee on the Hometess 0 Normandy Shores Local Government Neigh. Improvement
0 Committee for Quality Education in MB 0 Parks and Recreation Facilities Board
D Community Development Advisory 0 Personnel Board
0 Community Relations Board 0 Planning Board"
❑ Convention Center Advisory Board 0 Police Citizens Relations Committee
. D Debarment Committee 0 Production industry Council
0 Design Review Boar 0 Public Safety Advisory Committee
D Disability Access Committee 0 Safety Committee
ine Arts Board 0 Single Family Residential Review Panel
ay, Lesbian, Bisexual and Transpender (GLBT) 0 5ustainabiiity Committee
cif Adviso Committee D Tran .aren Reliabil & Accountability Committee "TRAC"
O Health Adviso Committee 0 Trans•ortation and Parkin- Committee
Cl Health Facilities Authority Board 0 Visitor and Convention Authority
❑ Hispanic Affairs Committee 0 Waterfront Protection Committee
❑ Historic Preservation Board 0 Youth Center Advisory Board
*Board Required to File State Disclosure Form
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 0 No ( Years of Service:
2. Present participation in Youth Center activities by your children Yes`' No =. If yes, please list the names of your children, their
i ages, and which programs. List below.
Child's name_: Age: Program:
Child's name: Aoe: Prograrn:
=LEP ssAL'_'\o=DRM„ AND :3MMITrE6c\B: Anoiicoton06260c N•\/■.00:
•riavE yoi eve :,eer..o- ,v:• �' a ie,on\ `'es It No ' "es please ' tr detail:
• Do you currently have a viotationtsj of City of Miami B acv: codes Yes No __ I` vex. please exolair tr. detail.
• Do you currently owe the City of Miami Beach, any money: Yes Dc' No if yes. explain it detail -
• Are you currently servinc or anv. :its Boards or Committees Yes v No -. V yes whirr noardr
• What organizations it the City of Miami Be h d^ a :urrentl nolo membprsnt; In?
Name:l /1 /6A I) (leA 1 cr., Q A r '/ nher itie 7U
Name: Title.
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
�/i
• i am now employed by the City of Miami Beach: Yes or N. Which department?
• Pursuant to City Code Section 2 -2s (b): Do you have a parent spouse _^, child ., brother C, or sister 0 who is employes p■' the
City of Miarnt Beach? Check all that apply. Identify the department(s):
The foftowing information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. L• is.
being asked to comply with federal equal opportunity reporting requirements.
Gender: Xe Male 0 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 - American /Stack (Not of Hispanic Orighn): All persons having origins in any of the Black racial groups of Africa.
❑ Hispanic: All persons of Mexi an, Puerto Rican, Cuban, Central or South American. or other Spanish culture or origin, regardless of, race
1 0 Asian or Pacific islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent. or
- - -the Pacific islands. =This area includes, for exertrpie, China, India, Japan, Korea, the PMlippine Islands and Samoa. _
❑ American todian or Alaskan Native: All persons having origins in any of the original peoples of North America. and who maintain
Cultural idertttftcationthrough tribal affiliation or community recognition.
Physically Challenged: Yes 0 or Ng.
Employment Status: EmptoyedX Retired ❑ Homemaker 0 Other ❑ - , — , I id • , �
NOTE: if appointed, you will be required to follow certain taws which apply to city boardicommtt ee m embers.
These taws include, but are not limited to, the following:
1
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2 - 459).
• Prohibition from contracting with the city (Miami - Dade County Code section 2 11.1). - .
o Prohibition from lobbying before board /commtttee you have served on for period of one year after leaving ,office (Miam
Beach City Code section 2 -26).
o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2-11.1).
(re: CAM Community Development Advisory Committee): prohibition, during tenure and for one year atter leaving ofnoe
from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourset'
Cr 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.
1
"' hereby atte t to a accuracy and truthfulness of the application and have received, read and will abide by Chaote
Arti cVII — e i Code "Standards of Con uct for City Officers. Employees an- Age- y
Appftcan 's Signature U e N.m o /kook:. 7 ! • (P LI-av, PRINT)
Please attach a copy of your resume to this application.
NOTE: Aopfications wilt remain on flie tor a oerion of one f1i calendar year
Reoervec ir. the Cite Diertrs Office oy v
c �eSL"""r 'w i� ? irate I $2Or ;,ontroi No th2T2 f 2 4 l a
Name o` Deputy Clerk ((
i 1
DALE STINE
photographer
Dale Stine views the photographic lens through his creative, academic and
professional experiences in the performing arts. A North Carolina native who
obtained a Master's Degree in Opera from the world - renowned Juilliard School
(NY), Dale enjoyed a 16 -year run in many off-Broadway productions. Never
one to pass up an opportunity to flex various muscle groups, Dale
simultaneously pursued a dual career in personal training and fitness
instruction.
Self - taught in the fine art of digital photography, Dale quickly established
himself as one of the most sought -after photographers in Miami. Since 2001,
his photographs and images have graced countless magazines, cd covers and
websites, including Wire, Ocean Drive, Men's Journal, Medesthetics, Home,
DAYSPA and Genre. Internationally- acclaimed DJ's, drag personas and his 18
year -old cat Reba are among his favorite clients.
Dale is one of the official photographers for the internationally - acclaimed
South Beach Wine and Food Festival as well as Aqua Girl for the Aqua Girl
Foundation, the Miami -Dade G/L Chamber of Commerce and for six years, the
Miami G/L Film Festival. Just last fall, Dale was hired to shoot
the New York City Wine and Food Festival, the only photographer from
Florida to do so.
Exhibitions have included The Diva Collection: Illusion Series, featured at the
historic Royal Palm Hotel during White Party, The Starlet Series
at Miami Beach Cinematheque, Communion Celebrates Art at the Bakehouse
Art Complex, Decline in Civilization for Art Basel 2006
and A Different Angle for Art Basel 2008.
"Whether I am photographing a person, an animal or a building, I do my best
to connect with the essence of the subject. By allowing the "now" to unfold, I
trust the intimacy of the moment to flourish for all to see."
dalestine.com
305.761.3253
dale @dalestine.com
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachFLpov
CITY CLERK Office CiiyCIerk @miamibeachfl.gov
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: aki
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 Miaml -Dade County. Disclosure Requirements. This meansTthat 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 Return
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. or by imprisonment in the county jail for a period not to exceed sixty
days, or :both.
I1 II
Signature: D te:
•
MlAMND
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
DOLe For Tax Year
Name: l ��
Ending :9,01 0
Mailing Address: 6 I 1 0 • 4.1,0 f�-
City/State/Zip: 641/ (ate] 16�, J 23/3/
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: L e 1� 17 Term or Empio an
Cin F, Began on: 1 1
Department where employed:
Work Address: 2'YtL 3b? v i
If your home address is exempt from public records pursuant to 3 63 ` 2 ` 53
Florida Statutes § 119.07 please check here (read instructions): D 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 . f So rce of Income , Addr - B sines Acti "
{ I hereby swear (or affirm) t the aforesaid information is a true and correct statement.
1 2 a,7
Signature of pe son disci sing Date signed