Tamra Sheffman 12/31/2012 CD olli
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... A- Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139
www.miamibeachfLgov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673- 7411, Fax: (305) 673 -7254
1/10/2011
Tamra Sheffman
4600 Royal Paim Ave
Miami Beach, Florida 33140
,z: Bog-, 1 Fine Arts Board
Congratulations! You have been reappointed by Commissioner Dee Wei
thorn
de We�thorn
to the above referenced agency, board or committee for a term endin : 12/31/2012. C
g 12.
If you are unable to accept this appointment, lease notify the City Clerk's p y ty Clerk s Office at
(305) 673 -7411.
Please read the enclosed material carefully. .A Again, congratulations g g s and.good luck.
Sincerely,
o -
jeit,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
'
g Y, m ittee
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 '
e of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
\ Booklet Guide to the Sunshine Amendment and Code of Ethics for Public
Employees
blic Officers and
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
p t. y
ISI t. 1 ,
........
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 Tamra Sheffman
RE: Fine Arts Board
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.
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 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 wh' h I have served.
Tamra Sheffman
Sworn to and subscribed before me this day of , 2011. _
6 0-t--te -
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.
Y p ty .
c- /V\1/---\/\/\.1 btAL h CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: R A- A
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Last Name .----- c p., First Name . Aliddle Initial
al
HOME ADDRESS: t +Loo NOIAL_ re--(2.4÷- A QE..- ) 9 I ii'M / e-14. tt- . 3" j )
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Apt No. House No./Street City State Zip Code
PHONE 0 .5 ( 9 - 0 9r -.:-/-S. - -.-i'l - ''''/ — 7 - 74 evt 424
,. ...H.ole Fax Email addres
Business Name: f< 01 At- Q L cek t8,-(ki Position: DU) 0 ete.,..
ANeFI
Address: P‘ 1_ ..- 4-P ----
Street City State Zip Code
Professional License (describe) C_:7 --- 0 R. 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 city 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: YeeKor No 0
• Demonstrate an ownership/interest in a business in Miami Beachior a minimum of six (6) months: Yes r or No 0
• Are you a registered voter in Miami Beach: Yes ''or No 0
• (Please circle one): I am now a resident of: North Beach South Beach Clk
• 1 am applying for an appointment because I have special abilities, knowledge and experience. list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or No pi.,..
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 0 Marine Authority.
0 Art in Public Places Committee D Miami Beach Commission for Women
0 Beautification Committee 0 Miami Beach Cultural Arts Council
0 Board of Adjustment* 0 Miami Beach Human Rights Comm'. - -
0 Budget Advisory Committee Miami Beach Sister Cities Progra ,ff
0 Capital Improvements - Projects Oversight Committee 0 Normandy Shores Local Govemmen ,- • . provement
0 Committee on the Homeless 0 Parks and Recreation Facilities Board
0 Committee for Quality Education in MB 0 Personnel Board
0 Community Development Advisory 0 Planning Board*
0 Community Relations Board 0 Police Citizens Relations Committee
0 Convention Center Advisory Board 0 Production Industry Council
0 Debarment Committee 0 Public Safety Advisory Committee
0 Design Review Board* 0 Safety Committee
0 Disability Access C. .. ittee 0 Single Family Residential Review Panel
. 1 Fine Arts Board 111M 0 Sustainabili Committee
0 Ga , Lesbian, BiseM and Trans. ender GLB 0 Trans.ortation and Parkin. Committee
0 Golf Advisory Committee 0 Visitor and Convention Authority
0 Health Advisory Committee 0 Waterfront Protection Committee
0 Health Facilities Authority Board 0 Youth Center AdvisorvBoard
0 Hispanic Affairs Committee
0 Historic Preservation Board
0 Housing Authority
0 Loan Review Committee *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 0 Years of Service:
2. Present participation in Youth Center activities by your children Yeso No 0. 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: ..
i- . \CLER\SALL\aFORMS\BOARD AND COMM1TTEES\BC Application.doc
*Have you ever been convicted of a felony: Yes 0 or No r; yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No . if yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ 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?
F i 10 6._. A, ....
• What organizations in the Cit of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned o - have an inter st in, whic are located within the City of Mia ' Beach:
¥( 0 O r o 6N A L. vn - ,- t l c 0 --►..'
• 1 am now employed by the City of Miami Beach: Yes 0 or No 4lhich department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, 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: 0 Male YF&hale
Ethnic Origin: Check one only (1)
A.-Er-White (Not of Hispanic. Origin): All persons having origins in any of the original peoples of Europe, e, North Africa or the Middle East.
P P
❑ African- American /Black (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.
0 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 affiliation or community recognition.
Physically Challenged: Yes ❑ or NIL
Employment Status: Employed g Retired ❑ Homemaker 0 Other
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.
"1 hereb •--st to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
A e VI — • th City Code "Standards of ondu t for City Officers, Employees and • ency. Members."
_--� _ __. 1( L, ( MA t4 C ,ni A eL)
Applicant's Si • 1 . ur- Date Name of Applicant (PLEASE PRINT)
Please copy of your resume to this application
NOTE:. Applications- will. red • in on Ile for a= period of one. 1). calendar. year.
FM, - ir Received in the City Clerks Office by �! Date: if 2 Control No. Date: / /2010 ( l g 1/
Name of Deputy Clerk
•
C-- M I AM I B EACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerkC m i amibeachfl. ov
Tel: 305.673.7411 , Fax: 305.673.7254 8
• Acknowledgement of fines/suspenson for Board Members ' 9 for failure
to comply with Miami -Dade County Financial Disclosur Provision p Y Disclosure Code
Code Section 2- 11.1(11) (2)
____.,,)
;---------
Board Member name: ( A v•A P L±E
1 understand that no later than Jul 1, of each year a y all members of .Boards and -
Committees of the City of Miami Beach, including those of a urei advisory nature, are
p .Y ry ,
required to comply with Miami -Dade County Disclosure Requirements. This means-that the
members of City Advisory Boards, whose .sole or primary .•resporisibili is to recommend
legislation or give advice to the City Commission, must file, even though you may have been
recentty appointed.
You must file one ofithe following ith the ..C' i
g City Clerk of Miami Beach, .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 C
9 ty ode Chapter 't, General
Provision, Section i-5 may subject the erson or firm to a fine not to exceed
xceed
$500.00 or by imprisonment in the county ail for period not to exceed _si
tY.� p sixty
days, or both.
_........ \
- N ) t t t
Signature: .
Date.
•
COUNTY OF INCOME STATEMENT
SOURCE /
•
Please. Print .or Type First Name Middle Name f initial Last Name
hiQSUre
Far isc Tax Year
T �1 En di n (�
Name:
WI e g
Marling Address. ��--
Mate : Zi
C�ty/ / P
Social .Security Number: -
Piling as a: ® County .Employee:
Ei Municipal - Employee of:
Position held or sought: �' vii .r- -' e
where serving: ,� Terra or. Employment
Board tat 3 �.. � � ..._ G..� ors:
. .Began
•
Department .employed:
Work Address: Q=0
If your home .address .is exempt from public records pursuant to .
Florida Statutes § 119,07 please check here (reed 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
P
rincipal business activity of every source of your income including public salary y ou
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 .disciased. If continued on .a
separate sheet, check here:
Description of the Principal
ame of Source of Income Adclr ss Business Activi
c ti AL csi...-4L. 12..coLat (ro _ _ _ • um -
•
:Z hereby swear (or affirm) that the aforesaid information is :a true :and correct statement.