Dr. Ronald Shane 12/31/2013 � IANAIBEACH
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
12/27/2011
r;
Dr. Ronald Shane
2522 Fisher Island
Miami-Beach, Florida 33109
4
S,.IJJ:' ` a Debarment.Committee
Congratulations! You have been reappointed by Commissioner Jerry Libbin
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,
Gli S�
Robert Parcher
.City Clerk
cc: Saul Frances, Parking Director
Gus Lopez
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 safely to all who live, work and play in our vibrant, tropical, historic community.
MIAMIBEACH
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
TO Dr. Ronald Shane
RE: Debarmant Committee
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 theFlorida 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.
�y
Dr. Ronald Shane
Sworn to and subscribed before me this day of , 201 jaw
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.
I\AIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.Aoy
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ;Fax:305.673.7254
Acknowledgement of fines/suspension for Board lean hers for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11.1(i) ;(2)
Board Member name:. RO
I understand that no .later than July L of each ear 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 fora period not to exceed.sixty
days, or-both.
l
Signature: Date:
M I A M hDADE
SOURCE OF INCOME STATEMENT
Last
Please Print or Type First Name.,` Middle Name Initial Name_
Disclosure;
For Tax,Year
Name: 4``c? fE-ll/ kndingc
Mailing Address: Z S".L.Z rt�At ��
:City%State/Z p:
. Social Security Number:
Filingas.a ® County�Employeec
-® Municipah Employee of:
Position held or sou ht:
9
Board where serving: M e Term or Employment
/,' a►_;.,�:.� _S-ea,�c:_�.i Began on:
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): ® .Work Telephone:
Home Address: L�
Street Address
f 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 continue on a,
separate sheet,check here: _
lz
Description of the Principal
Name of Source of Income ="Address Business Activity
e S H�e.w .� t-
e �` s -
n zr,
I hereby swear(or affirm)that the.aforesaid information is a true and:correct statement.
Sign"ature of person disclosing ate si ed.