Sheila Duffy-Lehrman 12/31/2012 •
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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
1/5/2011
Sheila Duffy - Lehrman
3090 Alton Road
Miami Beach, Florida 33140
Fti 'a =r, Committee for Quality Education in MB
Congratulations! You have been reappointed by Commissioner Jorge Exposito
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,
ice S,
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.
j
e
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 Sheila Duffy - Lehrman
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 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
serve) on July 1st, following the closing of the - - - : - ear on which I have served.
//
heila Duffy - Lehrman
Sworn to and subscribed before me this /5 day of 2011.
C
reit -- ilvia 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. P �
M 1 AM 1 LA
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Atat
NAME:
Las ame First Name / Middle Initial
HOME ADDRESS. J _ IA N.
Apt House No./ treet City -te Zip Code
PHONE: .� , t '` - - � � . . r . I t erCSalil vdel.
omme Work Email address
Business Name. i / 11 5IVAAV Position:
ce
Address. _ YA,0 - 1
No. Street City State Zip Code
/Li 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 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: Yes 1 or No
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes 0` or No
• Are you a registered voter in Miami Beach: Yesjor No ❑ .�
• (Please circle one): I am now a resident of: North Beach South Beach Beach
• 1 am applying for an appointment because 1 have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach'? Yes ❑ or No K
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 ❑ Marine Authority
0 Art in Public Places Committee 0 Miami Beach Commission for Women
0 Beautification Committee ❑ Miami Beach Cultural Arts Council
❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee
0 Budget Advisory Committee ❑ Miami Beach Sister Cities Program
0 Capital Improvements 'Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
0 Committee on the Homeless 0 Parks and Recreation Facilities Board
;#40Committee for Quality Education in MB 0 Personnel Board
0 Community Development Advisory ❑ Planning Board*
0 Community Relations Board 0 Police Citizens Relations Committee
❑ Convention Center Adviso Board ❑ Production Indust Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
❑ Design Review Board* 0 Safety Committee
❑ Disabili Access Committee ❑ Sin • le Famil Residential Review. Panel
❑ Fine Arts Board D Sustainability Committee
❑ Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Transportation and Parking Committee
❑ Golf Advisory Committee 0 Visitor and Convention Authority
❑ Health Advisory Committee ❑ Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board
0 Hispanic Affairs Committee
0 Historic Preservation Board
❑ Housing Authority
❑ 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 ❑ No 0 Years of Service:
2. Present participation in Youth Center activities by your children Yes0 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:
CLER \$ALL \ciFORMS \BOARD AND COMMITTEES\BC Appiication.doc
*Have you ever been convicted of a felony: Yes ❑ or No .f yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or NCW 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 rently serving on any City Boards or Committees: Yes or No E. If yes; which board'?
4, L _-
• What org. izations i the City of iami Beach do you currently hold membership in?
.. _ ,
Name: frt/LM/L
1 1 • . . _ ►ham _rt1. 4 1 � .r - Title.
Name
• I I p v
it � Title: �
•
• List all properties owned or have an inte -st in which a e located within the City of Miami Beach:
D 1
0
• 1 a 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 0, spouse 0, child 0, brother 0, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
&JO
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 ■ male
Ethnic Origin: Check one only (1)
i White (Not of Hispanic Origin): All persons havin origins in an of the original eo 1
9 any peoples es of Europe, North Africa or the Middle East.
0 African- American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial rou s of Africa.
9 P
❑ Hispanic: AU 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.
0 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 0 or No
•
Employment Status: Employed Y Retired 0 Homemaker ❑ 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 h- - • , a t„, - . Agency ees cura�,- and truthfulness of the application and have received, read and will abide by Chapter pter 2,
rticle VII - o • .fit • • ndards of Co duct f • City Officers, Employees and A Members."
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i ', ./' eld-P; LA- `1) Li FW-1-L,
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` 0 g arr /'Fir •ate Name of Applicant (PL LASE PRINT)
4 PIe - : - - ch a cop of your resume to this application
NOTE: Applic - ns,will re = in on file . for a. period of one. (1) calendar year.
i
Received in the City by Clerk's Office b 'r / / 2
�► (Igj Date:I �
0 . Control No. Date: 1 010 //
ame of • " uty Clerk
6 MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.rniamibeachfl.gov
CITY CLERK Office CityClerk@rniarnibeochfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Merhers far faifure e
=1
to comply f with Miami -Dade County Financial Disclosure Code Provision
Code Section 2 -11.1 (;) (
.- , .
Board Member name: - i t .t i .�.r►J ..It -i A Al
July 1, of each ye • all understand that no later than memb . - Y 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 ith the City Clerk
g ty 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 Code a
g ty a Ch t per 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. jai! for a eriod not to exceed sixty
y
days, or .both.
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M1AMi.
COUNTY E OF INCOME STATEN ENT
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Please. Print .or Type First Name Middle Name /Initial Last Name
fN
Disclosure
For Tax Year
. � � � / . Ending:
Name: 1 !.� L . . _ t �_Jh 0 ,
. _
a � l
Mailing Address. ,� , _ __ . _ t + — AP
9
State gip: : iiCi `a 0
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Social Security Number: _ ,-- - -� - -4 -( .-------,- D=
Filing as a: ® County Employee:
® Municipal Employee of
Position held or sought:
Board pe 0--/
Where serving : `- Term or EmPIo me
.Began an: ----- j .
Department where employed:
A-
I
. Work Address:
If your . home address is exempt from public records pursuant to 'is S
'Florida Statutes § 1.19.07 please check here (read instructions): -0 Wor T e l ep h one
Home Address: - Mk 6,. a h--1.A.
Street Address
City State Zip Code
. PI descending ease list below in descendin 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 p erson 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: 0
Description of the Principal
Name of S • mice of :inco - _ Address Business Activi s
1 Avinnunway-r
, k .1;144„ .3? te,(
, ,
...._
. ,
, ,
h wea - : ., hat the -� ' = e aid information is _a true and correct statement.
``\ r te „ p-
7/
� � � • . t o si n - d
o." person disclosing +�