Tiffany Heckler 12/31/12 • •
CD M\A I /-\\N, I B E AC H
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
10 -20 -2011
Tiffany Heckler
435 West 51st Street
Miami Beach, Florida 33140
.SUBS,E`CvT , Committee for Quality Education in MB
Congratulations! You have been appointed by Corpmissioner Michael Gongora
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 call the City
Clerk's Office at 305 - 673 -7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
- 2/
, .q , Je/S -1
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld
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
• •
MIAMI BEACH
Cit of Miami Beach, 1700 Convention Center Drive, Mic mi Beach, Florida 33139, www.miamibeachfl.wy
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305j 673-7411, Fax. (305) 673 - 7254
TO Tiffany Zientz Heckler
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 :o 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 /onda Commission on Ethics Guide to the Sunshine
Amendment and Code ofEth /cs for Public Officers and Employees, and understand that as a member
of a City of Miami Beach Board and /or Committee, 1 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 1 have served.
� T , l � ff y a � ny Zientz Heckler
Sworn to and subscribed before me thisaClS" dray of hy� , 2A11.
Silvia Prieto
Deputy Clerk
I �
*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.
I I
I I
We are committed ro rovidin excellent public service and safe to all P 9 P y a who live, work and play in our vibrant, tropical, historic community.
r' V 11 A V 11 BE H CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPL: rION FORM
NAME: f
Last Name Fir t Namee / fu Initial
9 2. 7 \\/17\ HOME ADDRESS: - 1
q � 7 l �1 a ' ett Vl1 l JJ I 0
Apt No House No. /Street City State Zip Code
PHONE: 1 70 . c W 10�s �10� )5 ?(, I07 0 L P, C1(1.2 NPitt2TNe
Home Work Fax Email address (.,0rn
Business Name: G i jU ? )KTt' f 5 ti-e_ Position• G
Address. 9 ( JO` J� ( .S t icLc h'i I t vv 144 PL.- > 3! 'tU
No. Street City State Zip Code
Professional License (describe) Expires: `r> t> a copy of the 1
•
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 el or No
• Demonstrate an ownership /interest in a busirtesl in Miami Beach for a minimum of six (6) month. Y or No
• Are you a registered voter in Miami Beach es or No
• (Please circle one) I am now a resident of North Beach South Beach id le Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please lis below
• Are you presently a registered lobbyist with the City of Miami Beach? Yes o
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice Please note that only three (31
choices will be observed by the City Clerk's Office. (Regular Boards of City)
Affordable Housing Advisory Committee 0 Marine Authority
❑ Art in Public Places Committee 0 Miami Beach Commission for Women
❑ Beautification Committee ❑ Miami Beach Cultural Arts Council
0 Board of Adjustment* ❑ Miami Beach Human Rights Committee
❑ Budget Advisory Committee 0 Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement
❑ Committee on the Homeless ❑ Parks and Recreation Facilities Board
)(Committee for Quality Education in MB ❑ Personnel Board
❑ Community Development Advisory ❑ Planning Board*
❑ Community Relations Board ❑ Police Citizens Relations Committee
❑ Convention Center Advisory Board ❑ Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
D Design Review Board* ❑ Safety Committee
D Disability Access Committee ❑ Single Family Residential Review Panel
0 Fine Arts Board D Sustainability Committee
❑ 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
0 Hispanic Affairs Committee
❑ Historic Preservation Board
❑ Housing Authority
❑ 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 Youth Center Advisory Board: Yes No Years of Service:
2 Present participation in Youth Center activities by your children Yes No If yes, please list the names of your children, their
ages, and which programs List below.
Child's name. Age Program
Child's name. Age Program
F \CLER \$ALL \afORMS \BOARD AND COMMITTEES \BC Application doc
• .
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. m lam i b ea c hf l. g ov
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)
I A .
! aW� f �
Board Member name: t
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 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.
„ l — f} ( 27J 1 I
Signature • Date:
F \CLER \$ALL \aFORMS \BOARD AND COMMITTEES \BC Application doc
MI A M FDADE
� SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
r -7, Disclosure
1 C�Uh'\ G� P V�fiZ I 1 L�C� e�Z For Tax Year
Name:
Social Security Number: --
i
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought: -6131i4 P M,t lA e,ir
Board where serving: Q c\ is \ Oat ( - {, I , " Term or Employment
Began on: ) 0�\ _a
Department where employed:
Work Address: 0 t U� 6O 1 +�-`� e-�1 * 40) CV11�M t i ac i- i ) 'I0
If your home address is exempt from public records pursuant to �
/ G J O
) C ,—
Florida Statutes § 119.07 please check here (read
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 disdosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
s. separate sheet, check here: p
Description of the Principal
Name of Source of Income Address Business Activity
11 -C XP.v At x. kVt Lkki P A Elk( Cal ( k t k # `1 A C t o
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signatu of person disdosing Date signed