Jenifer Caplan 12/31/2010 MIAMIB Alt
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miam ibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
08 -18 -2010
Jenifer Caplan
5660 Collins Ave. #9D
Miami Beach, Florida 33140
SUB ECC T Golf Advisory Committee
a a t
Congratulations! You have been appointed by Commissioner Jorge Exposito
to the agency, board or committee named above for a term ending: 12/31/2011.
Pursuant to Ordinance No. 2006 -3543, commencing with' terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305 - 673 -7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
e
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Kevin Smith
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, 2-458 and 2-459
Ordinance No 2006 -3543 - Amendment to City Code Section 222
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 Employee
{
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community
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MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami leach, Florida 33139, www.miamibeachfl.al v
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673 -7254
TO Jenifer S. Caplan
RE: Golf Advisory Board
1 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: 12/31/2011.
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 theF /onda 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 mu t comply with the financial disclosure* require-
ments of Miami -Dade County or the State of Florid- dep: nding on the board or committee on which
I serve) on July 1st, following the closing of the = endar -ar on which I have served.
d d�1Va:
f n r a P Ia
Sworn to and subscribed bef• me thi/ daay o ,
`.a & 11, 1 .41 _ /AI
Silvia Prie o
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 Finandal Disclosure Requirements.
We are committed to providing excellent public service and safety to all who ive, work and play in our vibrant, tropical, hi -toric community
MI�DADE SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
Jenifer Caplan For Tax Year
Name: Ending:
2010
Mailing Address: 5660 Collins Ave Unit 9D
City /State /Zip: Miami Beach, FL 33149
I - �
Social Security Number: !
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: Golf Advisory Term or Employment
ry Began on:
Department where employed: _ N/A
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): ® Work Telephone:
Home Address:
Street Address
I I
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
- Rollashoe, LLC 1688 Meridian Ave #418 MB FL 33139 Distributor
i I
i I
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
5/01/11
nature of person disclosing Date signed
� j
® MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @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 Fina Disclosure Code Provision
Code Section 2- 11.1(i) (2)
Board Member name: Jenifer Caplan
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 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
$500.00 or by imprisonment in the county jail for a period not to exceed 'sixty
days, or both.
06/01/11
Signature: ! Date:
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