Karen Edelstein 12/31/2013 MIAMI BEACH
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
1/13/2012
Karen Edelstein
4955 Cherokee_Ave
Miami_Beach, Florida 33140
SU , CJTL*I Miami Beach Commission For Women
Congratulations! You-have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending. 12/31/2013.
If_you are.unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411..
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
ICS .
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Wanda-Geist
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, 22458,2-459
Ordinance 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
Employees
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 oUNlicani Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miarnibeachflgov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
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TO Karen Edelstein
RE. Miami Beach diimmission For Women ,
I do solemnly..'Wear,"or,;affirm to bear true faith,loyalty encr,allepance,tc4he Government of the
_ _
United States thb:Statetof Florida and the City of'MiamiIBeacti,and to 151-e'rf6rM all the duties of
,
a member ofthe,above-Mentioned board or committee of the rCjtil'. of;Mlarni Beach to which I have
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beenap'pointeclkra term'ending 12/31/2013.
I ti'ave beehlissuedi a copy,of Section 2-11 1 of the;Miamiifiade County COd6(ponflict of Interest
and Code of EthicsrslinanCe),-as'well as theplorida Commission on-Ethi&-duidetb-the Sunshine.
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.• • , , ,, ....., -
:Amendment and Code Of,EthiCS for Public Officers lhdEinployees,lanclunders:tand that as a member
jO-fa',City of Miami Beach;Board and/or Committee; I Musticbniply.With the financial require
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;rnentslof Miami Dade County,,Or the State of Florida(depending on'the bdard'Oi.lcOmmittee on which
it serve)op JUly,1"slofollowingllie closing of the calendar year on whicM have served.
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Karen'tdelsiein
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inforn,t0,and subscribed before me this/3 day of 44.11 /112, ,
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SilVia,Prieto
. • , • ,,
Deputy Clerk
*please visit the4Cit9forMiamilBeach.website at www.miamibeachfl.goVunder';City,Clerk/Board and Committees
for additional inforrnitionrebarding.the Financial Disclosure Requirements.
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We are carnmittedkpproviding_eiccellent public service and safety to all who live,,woilc;Cind;Plciyin,our vibrant, tropical,historic community
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Ell M I AM 1 B EAC H . ` CITY OF MIAMI BEACH
ED BOARD AND COMMITTEE APPLICATION FORM
NAME: EDC.�,SiC,nl 1`AR .N S
Last Name First Name a Middle Initial
HOME ADDRESS: L1a9rJ Cherokee A ven O t thew■ Pe i&t 3314. 6
Apt No House No./Street City State Zip Code
PHONE: 30* Tb9 O6$ 3 '05 - 9134-?001 X KEDELSTF/N,0 Oasotrttonef
Home Wefit• eg..(„Q Fax Email address
Business Name; f. Position
Address.
No Street City State Zip Code
Professional License(describe) , :s . ,.J /,`"•_: • 1' Expires ' ' ' 4iidch a copy of the license
I
Pursuant to'City Code section 2L22(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 al business ?established in the city.
• Resident of Miami Beach for a minimum of six(6) months}Yes'or No ❑
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6)months Yes 0 or No ❑
•Are you a registered voter in Miami Beach Yes t r No ❑
• (Please circle one) I am now a resident of -North Beach South Beach (Middle Beac
• I am applying for an appointment because I have special abilities, knowledge and experience. Please lit below:
Keyway 0f.wools WC wtien S
•Are you presently a registered lobbyist with the City of Miami Beach?Yes❑or No XI pYalAni L.Afio vt , 4ts \Nell
a4 No✓t% 13cack Slew. pPR
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)
❑Affordable Housing Advisory Committee ❑Marine Authonty
_0 Art in Public Places Committee XMiami Beach Commission for Women
❑Beautification Committee ❑Miami Beach Cultural Arts Council
❑Board of Adjustment* ❑Miami Beach Human Rights Committee
0 Budget Advisory Committee ❑Miami Beach Sister Cities Program
_❑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 0 Personnel Board
❑Community Development Advisory ❑Planning Board* `_,
0 Community Relations Board ❑Police Citizens Relations Committee
❑Convention Center Advisory Board ❑Production Industry Council
❑Debarment Committee
❑Design Review Board* ❑Safety Committee
❑Disability Access Committee ❑Single Family Residential Review Panel
❑Fine Arts Board ❑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
_0 Health Facilities Authority Board ❑Youth Center Advisory Board
❑Hispanic Affairs Committee
❑Histonc 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 0 Years of Service • -1 -
2 Present participation.in Youth Center!activities byy®ur children YesQ= No 0 If•yes, please`list the names of yourchildren, 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
•Have you ever been convicted of a felony Yes ❑ or No' If yes, please explain in detail
• Do you currently have a violation(s) of Cir-bf Miami Beach codes Yes 0 or NoNg if yes, please explain in detail.
• Do you currently owe the City of Miami Beach any money. Yes 0 or No' If yes, explain in detail _
I -�. f
-r•.�+l.t•)II',i•.1.r l i. _i �,, `0 l l i,. .i , •i,.`� _ ..
• 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 ND 1'01 Fx9w1n Slarne.n-}gr ?� Title.4; ra.n'�'S Chat r
Name: M.B. e. �Ycrc ckOS r't`"� Title LC.O rfA 4) SC3(:e
• List all properties owned or have an interest in, which are located within the City of Miami Beach
c( C Vv‹.rro kere A-ve k a vv., !eakC k 3 3 ki C)
• I am now employed by the City of Miami Beach. Yes 0 or N# Which department?
• Pursuant to City Code.Section 2-25(b): Do you have a parent,❑,, spouse❑,`child 0, brother❑, or sister❑who is employed by the
City of Miami Beach"Check all that apply Identify the department(s) /1/0
The following Information,is voluntary.and is neither part of your application nor has any bearing on your consideration for appointment. It is
bQingasked fo comply,';vvit1federaAl equal opportunity reporting requirements.
Gender: ❑ Male )(Female
Ethnic Origin: Check one only(1)
gWhIte (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.
❑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 Noo
Employment Status. Employed ❑ Retired ❑ Homemakers 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 a .-st to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII— .f the C• Code " ndards of Conduct or City Officers, Employees and Agency Members."
��.<� ✓L/1 / at/3 /Z - past-; .5. ED€l.s t re/n1
App cant's Signature e Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by Date:_/ /2010 Control No Date:_/_/2010
Name of Deputy Clerk
GI M1AMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamlbeachfl goo
CITY CLERK Office CityClerk@m i amibeochfl.gov
Tel 305 673.7411 , Fax: 305 673.7254
Acknowledgement of fines/suspension for Board Mem bers for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11.1(i) (2)
Board Member name: b-„ge-iv
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 toihe 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(orb
3. A Copy of the person's current Federal income Tax Return
Failurpr. 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.
/ /3 /g
Signature: D : --
M I A M I•DADE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
For Tax Year
Name: 16(Yell SCh VW 1+2- t C( Ending:2O
'
Filing as a: ® County Employee:
Municipal M tarvi( *132acln
Position held or sought: M.enriber
Board where serving: l Amin—ISSIOvt on ■ Qwier► Term or Employ ent
Began on: t 2.011
Department where employed: ^ /
Work Address: /v r
If your home address is exempt from public records pursuant to _
Florida Statutes§119.07 please check here(read instructions): •�I Work Telephone:
Home 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 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,
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14* an I'ee an invest Coral blest ' "Vnuestwten-�5
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Inca vt Qe1I VIG v s livten'f'
I hereby swear(or affirm) that the aforesaid information is a true and correct statement.
arA14 leia-e4;1
Signa re of person disclosing ate igned