Jeff Gordon 12/31/2013 m MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miomibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
02-13-2012
Jeff Gordon
4535 N. Michigan Ave
Miami Beach, Florida 33140
Safety Committee
Congratulations! You have been appointed by Commissioner Jonah M. Wolfson
to the agency, board or committee named above for a term ending: 12/31/2013.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1 st, 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,
U Sv
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Clifton Leonard
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.
• •
m 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
TO Jeff Gordon
RE: Safety 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 whic I have served.
Jeff Gordon
Sworn to and subscribed before me this day of 1 012.
c
1 D
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.
M I AM BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miaml6eachfl.pov
CITY CLERK OFFice CityC{erkC�m i amibeachfl.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 name:
I understand that no later than Jul '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, 17D0 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.}ail for a period not to exceed sixty
days, or both.
Signature: Date:
MIAM FDADE
SOURCE OF INCOME STATEMENT
Please Print or T'Vpe First Name Middle Name/Initial Last Name
Disclosure
For Tax Year
Name: c;0 r�� Ending:
Mailing Address: q,5--3-5- /CiI.
City/State/Zip:
Social Security Numaer: - - --
Filing as a: 0 County Employee:
® Municipal Employee of: _
Position held or sought:
Board where serving: �TC�—` Term or Employment
— Began on:— Q Z
Department where employed: _
Work Address:
If your home address is e;t?mpt from public records pursuant to
Florida Statutes§119.07 please check.here(read instructions): 13 Work Telephone:
r
Home Address: , M4.4 2911-le-
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity c4 every source of your hicome 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 hers;:
Description of the kl#* "
Name of Source of Income _ Address Business Activity
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Si of person disclosing _--- --Da a sic3ed