Annette Cannon 12/31/2012 MIAMIBEAC
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
07 -19 -2011
Annette Cannon
103 -7 Terr /Dilido Island
Miami Beach, Florida 33139
UB "JEµCT r Youth Center Advisory Board
Congratulations! You have been appointed by Commissioner Ed Tobin
to the agency, board or committee named above for a term ending: 12/31/2012.
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 cal( the City
Clerk's Office at 305 - 673 -7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely, /
/c1 r Cilaligycl
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ellen Vargas
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 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 Employee
We are committed to providing excellent public service and safety 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.miamibeachfi.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
TO Annette Cannon
RE: Youth Center Advisory Board
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 theF /orida 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 which I have served.
nette Cannon
01� /
Sworn to and subscribed before me this? day of , 2011.
34c 2 a F ,
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
er 1 CITY OF MIAMI BEACH
MIAMI BOARD AND COMMITTEE APPLICATION FORM
NAME: Cannon Annette E
Last Name First Name Middle Initial
HOME ADDRESS: 103 -7 Terr /Dilido 103 -7 Terr /Dilido
Island Island Miami Beach FL 1 33139
Apt No House No. /Street City ! State Zip Code
i
PHONE: 305 613 2244 305 892 1577 305 531 - 8603 1 annettecannonpa @bellsouth.net
Home Work Fax Email Address
1
Business Name: Annette E. Cannon, PA Position: MEDIATOR/ ATTORNEY
Address: 103 - 7 Terr /Dilido Island Miami Beach FL. 33139
No. Street City State Zip Code
Professional License (describe): 858196 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 I
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: No
• Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: South Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
I grew up on the beach including working for the Parks and Recreation while in college.; My children are active
participants of the Beach Programs. 1
• Are you presently a registered lobbyist with the City of Miami Beach? No
I
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)
I
I
Af(uldadle Huuainy Adv6u1y Cumiti llee Mal ii Authulity
Art in Public Places Committee Miami Beach Commission for Women
Beautification Committee Miami Beach Cultural Arts Council
Board of Ad'ustment* Miami Beach Human Rights Committee
Budget Advisory Committee Miami Beach Sister Cities Program
Capital Improvements Projects Oversight Committee Normandy Shores Local Gov't Neigh. Improvement
Committee on the Homeless [21 Parks and Recreation Facilities Board
Committee for Quality Education in MB Personnel Board
Community Development Advisory Planning Board* 1
Community Relations Board Police Citizens Relations Committee
-
Convention Center Advisory Board Production Industry Council
Debarment Committee Public Safety Advisory Committee
Design Review Board* Safety Committee
Disability Access Committee Single Family Residential Review Panel
Fine Arts Board Sustainability Committee I
Gay, Lesbian, Bisexual and Transgender (GLBT) Transportation and Parking Committee
Golf Advisory Committee Visitor and Convention Authority
Health Advisory Committee Waterfront Protection Committee
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee I
Historic Preservation Board I
Housing Authority I
• • . ft:Ig1 glib/ nnu1♦t • : • . • • • • • t • • fiu linty'( iali ilialfaiii+tafr ' -
1
1 Past service on the Youth Center Advisory Board: No Years of Service:
2. Present participation in Youth Center activities by your children Yes If yes, please list the names of your children, their
ages, and which programs. List below
Child's name: HAILEY CANNON Age: 13 Program: ICE SKATING, X- TREME,
f
TUM 1 /
C;
Child's name: HERSHEL CANNON Age: 16 Program: HOCKEY A
I • I
• Have you ever been convicted of a felony: No If yes, please explain in detail.
1
I
• Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail
Miami Beach
• Do you currently owe the City of Miami Beach any money No If yes, explain in detail
Miami Beach
• Are you currently serving on any City Boards or Committees: No If yes; which board?
Miami Beach
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: NAUTILUS MIDDLE SCHOOL Title: PTSA BOARD MEMBER
Name: Title: 1
1
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
103 7TH TERRACE, DILIDO ISLAND, MIAMI BEACH, FL 33
I
• I am now employed by the City of Miami Beach. No Which department? i
1
• Pursuant to City Code Section 2 -25 (b): Do you have a who is employed by the
City of Miami Beach? Check all that apply Identify the department(s):
i
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: Female Race: White
Ethnic Origin: Check one only (1)
Hispanic I
Physically Challenged: No
Employment Status: Employed 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.
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
1 Annette Cannon agreed to the following terms on 5/26/2011 12:31:22 AM (( //
Cl/t/ �i�
Received in the City Clerk's Office by ��e U � � Z Date: 6 L7 /(Control No. g t( Date: 1 / 7 //
Name of Deputy Clerk
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.aov
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 Financial Disclosure Code Provision
Code Section 2- 11.1(i) (2)
Board Member name: A#k'
1 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 havebeen
recently appointed.
You must file one ofthe 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 Statemenf (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 fora period not to exceed sixty
days, or both.
Signature: Date:
li
A
MIAMI•
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
For Tax Year
Name: rleite ep -Pi Iccr u r)- ego y-z) Ending /e
Mailing Address:
Cit /State /zip: iriCAvr►C ��'1 1�— 33/3 7
•
Social Security Number: -
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought
Board where serving: Term or .Employment
Began.on:
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes §1.1.S.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 induding public salary you
received or any person received fur 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
hind f: Cohnb,r i oA /C5-- Te y r Ce P1 a( o4 re- /
d £vi
I hereby swear ( affirm) thatthe aforesaid information is a true and correct. statement.
7 /3 - 0/ohJ ti
Signature of person disclosing Date signed