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Leslie Graff 12/31/2012
t'a AA I f\A , ;'' E A' � x ./ 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 1/27/2011 Leslie . Graff 5080 Alton, Rd Miami Beach, Florida 33140 rr� V Parks and Recreational Facilities Board Congratula ions! You have been reappointed by Commissioner Ed Tobin to the abov6 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- 411. Please rea the enclosed material carefully. Again, congratulations and good luck. Sincerely, (Wotag k Robert Parcher City Clerk cc: Saul Frances, Parking Director Keviri Smith ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency, board or committee City Code Section - ty 1 2 -22 , 2 - 23, 2 2 -25, 2-26, 2-2458, 2-459 Ordinance 2006 -3543 - Amendment to City Code Section 2 -22 Miami -Dade bounty ' ty Code Section :2 11.1. - Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application i ty pp i ton (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. i tp A A t k 1 I f' I\ HB E1AC= [nil . i g k Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF T HE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673 - 7411, Fax: (305) 673 -7254 TO Leslie Graff RE: Parks and Recreational Facilities Board I do solemnly swear ©r affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Florida n a d the City of Miami Beach, and to perform all the duties of a member of the abo e- 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 Cod of Ethics for Public Officers and Employees, and understand that as a member of a City of Miami Bech 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 boar. • c• mittee on which serve) on July 1st, f llowing the closing of the calendar year on whit - - s= : d. 11 A 4,41W. ..■liavvAlli , e slie G alf Sw rn to and subscribed before me this day of - ' 11. r /_- /- , .4 „NIS 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. } r----1-. / / tAL 11 CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: a / � . 7 Last Name First Name Middle Initial f / vo HOME ADDRESS: ESS . Apt No House No./Street City State Zip Code .-7 PHONE: 5-4/ ie'P '' net I-A? a �7 c----I: Home Work Fax E mail address Business Name: Position: Address: No. Street City State Zip Code Professional License ( describ Expires: Attach a copy of the license 4 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 fu filled in the following ways: a) an individual shall have been a resident of the city for a minimum of six months; or b) an individdial shall demonstrate ownership /interest for a minimum of six months in a business established in the city. • Resident of Miami Bech for a minimum of six (6) months: Year No ❑ • Demonstrate an owne ship /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: Yew No ❑ �---�, • (Please circle one): 1 a m now a resident of: North Beach South Beach ' • 1 am applying for an aipointment because I have special abilities, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes ❑ orikr A Please list your preferencs 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) ❑ Affordable Housing Advisory Committee ❑ Marine Authority ❑ Art in Public Places Committee 0 Miami Beach Commission for Women ❑ Beautification Committee ❑ Miami Beach Cultural Arts Council ❑ Board. of Adjustment* ❑ Miami Beach Human Rights Committee ❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement ❑ Committee on the Homeless rks and Recreation Facilities Board ❑ Committee for Quality Eiducation in MB ❑ Personnel Board ❑ Community Development Advisory ❑ Planning Board* ❑ Communit Relations Board ❑ Police Citizens Relations Committee } ❑ Convention Center Advisory Board ❑ Production Industry Council ❑ Debarment Committee 0 Public Safety Advisory Committee ❑ Desi• n Review Board* I ❑ Safet Committee ❑ Disabilit Access Committee ' ❑ Sin • le Famil Residential Re view Panel ❑ Fine Arts Board 1 0 Sustainability Committee ❑ Gay, Lesbian, Bisexual 4nd Transgender (GLBT) ' ❑ Transportation and Parking Committee ❑ Golf Advisory Committee ❑ Visitor and Convention Authority ❑ Health Advisory Committitee ❑ Waterfront Protection Committee ❑ Health Facilities Authority Board ❑ Youth Center Advisory Board ❑ Hispanic Affairs Committee ❑ Historic Preservation Board ❑ Housing Authority j ( 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 You h Center Advisory Board: Ye Years of Service: 2. Present participation in Youth Center activities by your children Yes❑ No 0. If yes, please list the names of your children, their ages, and which programs List below: Child's name: 1 Age: Program: Child's name: Age: Program: i : \CLER \$ALL \cFORMS \BOARD AND C` MMITT=ES \BC Application.doc t •Have you ever been convicted of a felony: Yes ❑ or No Iii■ ,' s, please explain in detail: 1 • Do you currently havL a violation(s) of City of Miami Beach, codes: Yes ❑ or es, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ❑ or No yes, explain in detail • Are you currently serving on - - , - 'ty Boards or Committee • 4+ o 0. If ye which board? .4_ ___ a „,--/ c(s - • What organiz- • - f the City of Mi i Beach do you currently hold membership in? I 7 Name: c- .. Title: Name: 1 Title: • List alt ro erties owned or have an interest in, whic are located within i p p the i owned � City of Miami .Beach. 5 -0 All" r f- - { • I am now employed ii )y the City of Miami Beach: Yes ❑ or N .. .Which department? • Pursuant to City Cod Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister. 0 w ho is employed by the City of Miami Beach? Check all that apply. Identify the department(s): Ci � � I PL YA The following nformation Is voluntary and i neither application bearing i i g ry s ether part of your appl�cat�on nor has any bearing on your for appointment. It is being asked to comply with federal equal opportunity reporting requirements. Gender: 0 Male Ca4male Ethnic Origin: Che a k 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 /Black (Not of Hispanic Origin): All persons having origins in a Pe g any of the Black racial groups of Africa. ( Erl ispanic: All persons Lf 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 affiliation or community recognition. Physically Challenge : Yes 0 or. Na Employment Status: Employed ❑ Retired ❑ Homernake Other 0 NOTE: If a ointed, you will be required to follow board/committee Y q llo certain laws which apply to city boardlcommittee members. These laws include, but are not limited to, the following o ( Prohibition fro I directly or indirectly lobbying city personnel (Miami Beach City Code section 2- 459).; O Prohibition fropi 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: OMB Co munity Development Advisory Committee): prohibition, during tenure and for one year after leaving office from having Whom 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) f Upon request, copies of these laws may be obtained from the City Clerk. "i hereby _;, to �e! accuracy and truthfulness of the application and have will • �� a pp received, read and writ rde by C ap r 2, A ' = Tlr ' f t - 1 A . Code "Standards of Condu • t for Ci y Officers, Employees ffid Agen y Membe il l r... f I s l Fe O 1 #1-----r Appiica is Si! ature � Dat Name of Applicant PLEASE PRINT) 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. Received in the City Clerk's Office by : 6 f / t'/ 4- / � / c` Date: / /2010 Control - 3 1 7 �/ ._. o No . Date: / /2010 �/ Name of Deputy Clerk - -` L ...\ 5,P//92,5 ; i i - I , -4-4 M I AM 1 B EAC H - _ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, . www.miarnibeachfl.pov CITY C JERK Office Ci ClerkC m i arnibeochfl. ov h' s Tel: 3051.673.7411 , Fax: 305.673.7254 Acknowledgement of fines/suspension for Bocard Members for failure wi h Miami -Dade Coun Financial Disclosure Code Provision to coply t ty - 2 -11.1 (1) Cade Section • , • r /0 1e ke l "m ber name: . r Board Me • - v i . 1 derstand that no Iater than .Jul 1, of each year all members of :Boards and - Com of the City of Miami Beach, including those of - a purely advisory nature, :are -requir d comply with .Miarni -Dade County Disclosure Requirements. This means'that the members of City Advisory. *Boards, whose sole or primary responsibility is to, recommend �ie 9 isla or give advice to the City Commission, must file, even though you may have been recen .y appointed. You must ff Ie one of the following with the City Clerk of Miami Beach, 1700 Convention -Center Dive, 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 Miami -Dade .County Code Chapter;1, General Rrovr ion, - Sec • 1- may - subject the person or firm to - a fine not to .exceed - . $500,00 or • onment in the county jail for a period not to exceed sixty - days, A r it . / l r // r :r , / , • i 3 . ure: Dat -: ., , . 1 • i ...._—_,.._ } 11 MIAMI. COUN SO OF INCOME STATEMENT i Please. Print .or Type First Name Middle Name /Initial Last Name ‘ EEj;Q ur 4- ..� l � Name: Mailing Address: 6ogo /911 20 , 1 33/V62 -City/State/Zip: � M 6 ___..... _ ,,, i _ , .... - , . .Social Security Number: - - - Filing s .a: County Employee: : 1 0 Municipal Employee of or sought: I'1a..rn 4 ""l) , Position held 9 Board where serving: Term or Employment .began an: . Depa , snent where employed: Work Address: If your home address is exempt from public records pursuant to • 1 'Florida § lorida Statutes 115.07 . please .check here (read instructions): 0 Work Telephone: Home Address: 4 , P 6 , Street Address j , 6 City State Zip Code • T - --- -- descending order with . the largest `source - rst, the name, address and . please lest below in Iles 9 g � salary you rince al business activity of every source of your income including public ry y P - received .or .any .person received for your ben efit sir . .use during the disclosure period. The i come of your spouse or an our s p ouse business partner need not be disclosed.. If continued on a n I X p separate sheet, check here: _� Description of the Principal Name of Source of Income Address ,_ mess Activity . 1 _10)r t" _ _ - ... ,,' r - _ i - ___ 1 • ..,....p.r., _ ,,,,_MCr!Rre __ .^'b _,..w.., - ..._,..... +r.+.+r. 1 tIeT b. :swear (or affirm) that the aforesaid information is.a true and correct statement. • :Signature of .person disclosing Date Signed