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Rebeka Cohen 06/30/2012 . , E AC 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 August 04, 2011 Rebeka Cohen 5500 Collins Ave. #1804 Miami Beach, Fl 33140 SUBJECT: Committee for Quality Education in MB Dear Ms. Cohen, Congratulations! You have been appointed as a Representative of the PTA for North Beach Elementary School to the above referenced agency, board or committee for a term ending, 06/30/2012. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Sincerely, /2e-k - Vsi• Robert Parcher City Clerk cc: Saul Frances, Parking Director Leslie Rosenfeld, Liaison 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 -1 1.1 - 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 arq,,committed to x cel to c, 911 Whq live, wo andpia,' in our vibrant, tropical historic community. an loo tt e , w O k, a . x.. OU' Vi/3 C . !) r ti'J�iico tod is C:? ?,'o corn S • M IAMIBEACH 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 Rebeka Cohen 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: 6/30/2012. 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. ebeka Cohen / Sworn to and subscribed before me this 2 ( day of oc , 2011. / 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. 0U r SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name /Initial Last Name Disclosure For Tax Year Name: � �� �l v Ending: l7 n r Mailing Address: T ICv 1:. Ave- (2 e City/State/Zip: \-Atal-tt eat L 33( -tu Filing as a: ® County Employee: Municipal Employee of: Position held or sought: Board where serving: 4 g2A44,"(4,,,,/i Term or Employment Began on: Department where employed: Work Address: t)0 0 tA1cL■ctac■ mac r -'lC� 6c 1 3305 If your home address is exempt from public records pursuant to _ ►7 Florida Statutes § 119.07 please check hare (read instructions): L Work Telephone: 3 Home Address: V'7 S A-'c C Street Address FI 4c. v-1 t ck_c 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 NtrC+Pr S��.� - C , " Stio ��.�� Cie. -�-cc. � �aS (:, f -t � . C'‘" . ri � Pry pc;� �►- c.c`�1•�a�J�� M t , �'1 e' ( ) es(J). hereby swear (or affirm) that the aforesaid information is a true and correct statement Signature of p on di c losing Date signed • • on /V\!A MIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www. rniamlbeochf(.gov CiTY CLERK Office CityClerk© i amibeachfl.8ov Tel: 305.673.74 11 , Fax: 305.673.7254 Acknowledgement of fines /suspension for Board Mem hers for failure to comply with Miami -Dade County Financial Disclosure Code Provision Code Section 2 -1 1.1 (1) (2) Board Member name: R .i- . i3 4 e4,1_1.1,01 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 Df 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 been recently appointed. . YOU must 'file One of the following with the .City Clerk of Miami .Beach, 1 700 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 nat to exceed sixty days, or bath. - Signature: pate: •