Meryl Wolfson 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
1/18/2012
Meryl Wolfson
5055 N. Bay Rd
Miami Beach, Florida 33140
SlJ!B�JEC� Parks and Recreational Facilities Board
Congratulations! You have been reappointed by Commissioner Jorge Exposito
to the above referenced agency, board or committee for a term ending: 1213112013.
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Kevin Smith
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 2-11.1 - 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.
IM MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411,Fax: (305)673.7254
TO Meryl B. Wolfson
RE: Parks and Recreational Facilities 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: 12/31/2013.
1 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 theflonda 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 1 st,following the closing of the calendar year on which I have served.
Meryl B.19olfson
Sworn to and subscribed before me this S day of Tom, 2012.
Z
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.
NAME: S/�
Last Name // �p First N e y Middle Initial
HOME ADDRESS: �`t (�-�C g ck r�-
Apt No. House NoStreet City State Zip Code
PHONE: �� jam/ 07,AQ M I ccKI/I
Home n Work Fax mail address
Business Name: /v A Position:
Address:
No. Street City State Zip Code
Professional License{describe) Expires
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 mvnershipinterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six(6)months:YesXor No ❑
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minimum of six(6)months:YesX or No ❑
•Are you a registered voter in Miami Beach:Yes'Kor No ❑ �---�_
e (Please circle one):I am now a resident of: 'North Beach South Beach full ,d1eiei-a
• I am applying for an appointment because I have special abilities.knowledge and experience.Please list below:
•Are you presently a registered lobbyist with the City of Miami Beach?Yes❑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(31
choices will be observed by the City Cleric's Office.(Regular Boards of City')
❑Affordable Housing Advisory Comm ittee ❑Marine Authority
❑Art in Public Places Committee ❑Miami Beach Commission for Women
❑Beautification Committee ❑Miami Beach Cultural Arts Council
❑Board of AdLstment" ❑Miami Beach Human Rights Committee
❑Budget Advisory Committee ❑Miami Beach Sister Cities Program
❑Capital Improvements Projects Oversight Committee ❑Normandy Shores Local Government Neigh. Improvement
❑Committee on the Homeless Warks and Recreation Facilities Board
❑Committee for Quality Education in MB ❑Personnel Board
n 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
❑Design Review Board' ❑Safely Committee
❑Disability Access Committee ❑Single Family Residential Review Panel
❑Fine Ads Hoard ❑Sustainability Committee
❑Gay,Lesbian, Bisexual and Trans ender GLB'T) ❑Transportation and Paridng 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
❑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:
aHave you ever been convicted of a felony: Yes u or NOX If yes, please explain in detail:
o Do you currently have a violation(s) of City of Miami Beach codes.- Yes u or No)KIfyes, please explain in detail:
s Do you currently owe the City of Miami Beach any money: Yes u or No if yes, explain in detail
® Ar you currently serving on any City Boards or Committees: Yes or No u. if yes;which board?
a What organizations in the City of IAami Beach do you currently hold membership in?
Name: Title:
Name: Title:
o List all properties owned or have an interest in, which are located within the City of Miami Beach:
5S MY 00 AD RlAkL _R EACAL F1�3514 0
* I am now employed by the City of Miami Beach: Yes u or Nd/�.Which department?
® Pursuant to City Code Section 2-25(b):Do you have a parent ❑,spouse❑.child❑,brother❑,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)
"9white (blot of Hispanic Origin). All persons having origins in any of the onginal peoples of Europe,North Africa or the Middle East_
❑African-Ammericanisiaek (Not of Hispanic Origin): All persons having origins in any of ff+p Buck racial groups of Africa.
❑Hispanic: All persons of tvl wcan,Puerto Rican,Cuban,Central or South,American,or other Spanish culhrre or oriain,roaardless of race.
❑Asian or Pacific Islander:All persons having origins in any of the original peoples of the Far East,Scutheast Asia,the Indian Subcontinent.on
the Pacific Islands. This area includes-,for example,China,India,Japan,Korea,the Philippine Islands and Sornoa.
❑American Indian or Alaskan Native: All persons having origins in any of the oridnal peoples of North America.and M. o maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes D or No .
Employment Status: Employed❑ Retired ❑ Homemake l-K 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:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before board/committee you have served on for period of one year after leaving office Qjliami
Beach City Code section 2-26).
• 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%,%jhorn you have business or immediate family ties (CFR 570.611).
!Upon request; copies of these laws maybe 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,
le lilt—of the City Code"Standards of Co duct for City Officers,Employees and regency Members."
,e /Z
Applicant' Signature ate flame of App'car:: EASE RINT)
Please attach.a copy:ofyour;resumE tothis application
NOTE:Applications uvill_remain on,file-for a_pe'r.iod of one(1}ea.lendar year:
Received in the City Clerk's Office by: _Date:_f 12010 Control No. Date:_/_12010
Narne of Deputy Clerk
MIAMI BEACH
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miamibeachil.aov
CITY CLERK Office CityClerk @m i omibeochfl.gov
Tel:305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines/suspension for.Board Mern hers for.failure
to comply with Miami-Dade County Financial .Disclosure Code Provision
Code Section 2-11.1(i) .(2)
Board Member n®r>11te:
I understand that no later:than July L of each year all members of.Boards and
Committees of the .City of Miami Beach, Including those of a purely advisory nature, sire
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-fiie,even-though you may havebeen
recently appointed.
You must flie 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.Statement" (attached)or
2. A"Financial Statement' (attached(-or]
3. A Copy of the person's current Federal Income Tax Retum
Fisilure to-fie,according:to the Miami-Dade .County Code Chapter 1, General
Provision, Section 1-5 may subject the:person or firm.to a f eye not to exceed
.$500.:00 or by imprisonment*in the county.jall fora period n®.t to exceed sixty
days, or both.
Signature: ,Date:
SOURCE OF XNCOME STATEMENT
i
Please Print or Type First Name Middle Blame Initial Last Name
Disclosure
For Tax Year
Nerves: j'vc L Q Ending:
Mailing address:
1 City/State/Zip- 3 L Y(Z)
5
Social Security Number:
Filing as a: 13 County Employee:
® Municipal Employee of:
i Position held or sought:
Board :-where serving: 1�Ct,�GS d ate, D oard Term or Employment
Began on:
Department where employed:
Work Address:
If your home address is exerrrpt front pcL.h!ic records pursuant to
Florida Statutes§ 119.07 please check here(react ii55structions): 13 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 including public salary you
received or any person rived 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:
Pesce€ption of the Principal
Name of Soierce-of..Incorvme Address Business Activity
WOkfSO L ec C c&
I hereby swear(or affirm) that the aforesaid information is a true and correct statement.
Z
Signatrsre person disc sing ®a e s geed