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Sofia Emuriel ifp tit, i it tAlopA ii- . i ,v \ i t--,,,, v ‘,1 1-,) L.— f t - 4 t \,....., i . 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 06/01/2011 Sofia Emuriel 6900 Bay Drive Apt 9B Miami Beach, FL 33141 SUBJECT: COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH Dear Ms. Emuriel, Congratulations! You have been re- appointed as a Representative of the PTA for Treasure Island Elementary School to the above referenced agency, board or committee for a term ending, 6/30/2012. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Sincerely, Ka, / , Robert Parcher City Clerk cc: Saul Frances, Parking Director Leslie Rosenfeld, Liaison We ar committed to o prviding excellent public nd af iy to g 1 h live, wok d plat n our vr, op communit '_Ii'e .__'i71i'l;+t�ct . ci Ci;�v',a ug ex ouo c Se! ce. a 7nd s sv i " to a ;; no l;v w r ork ai i.;� an 7 ( ,. Li (ir ibantt trical historic ' �• o; R MIAMI BEACH 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 Sofia Emuriel RE: Committee For Quality Education In Miami Beach 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 o► hich I serve) on July 1st, following the closing of the calendar year C, which I h. e served. t Sofia Emuriel eft Sworn to and subscribed before me this,' day of C- Abe/ 2011. )110 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. 1 fi lypA�06,t,L,. � �; � AME: TL ( ' u e, Fi e 4,- Last Name First Name Middle Initial HOME ADDRESS: G O 9/Y , ��� 9 © p. /` 2 .1 �_ Apt No. House N / " 4 �, 4-` �� �' � ,� / � \� +p Z o. /Street City State Zip Code PHONE: a ? 761.20 `J 786 3 1176, 9'- C'j/'fitiso Z Home Wo � �4 Viorigail • COk.I• Fax Email address Business Name: l�N eYiC? / / f Jc, C. „ P I�V � i(/��77 --- A ,�[/ VISO Y ' Address: / "� �/ • �aC AI cfa,6- /rive 7 No. �" �' Street City State Zip Code Professional License (describe) Expires: Attach a c p,y 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 'or No Y • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: YesXor No L • Are you a registered voter in Miami Beach: Yes C; or No ❑ • (Please circle one): I am now a resident of: North Beach South Beach iddle Beach • I am applying for an appointment because I have special abilities, knowledge and experienc Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes I' or No :, 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) E Affordable Housing Advisory Committee ❑ Art in Public Places Committee ❑Housing Authority ❑ Beautification Committee ❑Loan Review Committee ❑ Board of Adjustment" ❑Marine Authority 0 Miami Beach Commission for Women ❑ Budget Advisory Committee ❑Miami Beach Cultural Arts Council 0 Capital Improvements Projects Oversight Committee ❑ Miami Beach Sister Cities Program 0 Committee on the Homeless Committee for Quality Education in MB VNormandy Shores Local Government Neigh. Improvement 0 Parks and Recreation Facilities Board ❑ Community Development Advisory 0 Personnel Board $ Community Relations Board ❑Planning Board* 0 Convention Center Advisory Board ❑ Police Citizens Relations Committee ❑ Debarment Committee 0 Production Industry Council ❑ Design Review Board* 0 Public Safety Advisory Committee ❑ Disability Access Committee ❑ Fine Arts Board ❑ Safety Committee 13 Gay, Lesbian, Bisexual and Transgender (GLBT 0 Single Family Residential Review Panel 0 Golf Advisory Committee ) ❑ Sustainability Committee ❑ Health Advisory Committee ❑ Transportation and Parking Committee 0 Health Facilities Authority Board ❑ Visitor and Convention Authority ❑ Waterfront Protection Committee 0 Hispanic Affairs Committee 0 Youth Center Advisory Board 0 Historic Preservation Board *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 L No I. Years of Service: 2. Present participation in Youth Center activities by your children Yes` No L. If yes, please list the names of your children, and whicl .programs. List below Y en, their Child's name: G Le /'<, r 0 vrr eL Age: ,S Programl.Q.060re 15kpwld Etehcesylbvi stl%ao Child's name: Age: Program: F. SOAR f AND CQMM£•'r£E,::$ C Applicofion062609 `l es � •Have you ever been convicted of a fe ony: Yes or )i4 If yes, please explain in $1: • Do ou currently have a violation(s) of City of Miami Beach codes: Yes or No )eIf yes, please explain in detail: Y • Do you currently owe the City of Miami Beach any money: Yes 1 or NoS If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes - or No/ If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: Name: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: ef '‘ la evesu vovA L\ i TO TO c. o tlr v\ S ES ST `i F 400 cao1 & tvi iii • I am 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 ria., spouse child Li, brother I, or sister who is employed by the City of Miami Beach'? Check all that apply. Identify the department(s): 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 Female Ethnic Origin: Check 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 any of the Black racial groups of Africa. S Hispanic: All 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. ❑ 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 or NI< � C ld ❑ Retired ❑ Homemaker Other ❑ 1? £i & \O `� - Employment Status: Employed 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 -ttest to t accuracy . truthfulness of the application and have received, read and will abide b Chapter 2, i •le ,of the • Code "Sta • : rds of Conduct for City Officers, Employees and cy Members." Applica is Signature Date ame of Applicant (PLEASE PRINT) Please . ch a copy of your resume to this application NOTE: App 'cations will ain oi file for a period of one (1) calendar year. / • Received in the City Clerk's Office by : _ ∎!W Date: Date: _/ /2010 Control No..2 M �v Date: //20107 0 ` 0 Name of D-puty Clerk F: \CLER \$ALL \aFORMS \BOARD AND C MITTEES \BC Application oc MAM BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , 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 -1 1.1(i) (2) 1,4 Board Member name. 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 fife, 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. • (D Signatu . Date: I I A r 1 MIAMb COUNTY SOURCE OF INCOME STATEMENT I Please Print or Type First Name Middle Name /Initial Last Name I Disclosure For Tax Year Name: { 4 Q Ending Mailing Address: • •CCACK _ / i. lab L a . City /State /Zip: Lice I • . ° • • _,. - 1 , i _SeriteetW4tY4kunber-i- . i County Employee: Filing as a: ty ® Municipal Employee of: Position held or sought: I Board where serving: rki I A) / /a4 () D 4 T:rmorEmP1oYment /_ / /" Department where employed: Work Address: If your home address is exempt from public records pursuant to Florida Statutes § 119.07 please check here (read instructions): 0 Work Telephone: Home Address: - 4 (oO\ £ ---c�.E � x.. .. c ll &Q f\ft 1 Q,05, r St -t Addre Vol. CV ( U t ' City Sta 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: 0 Description of the Principal Name of So rc= 0 Income Address _ ,Business Activity * to . 6 • b r • . , ' ` • , .. f 1, ' •_I►.. fer ° s i reb swear (or . ffirm) that the foresaid information is a true and correct statement. � 1 ' ‘ \O- 2- Signatu e of person disclosing Date signed