Mark Jacobs 12/31/2012 m MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeochfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
1/19/2012
Mark Jacobs
3605 Flamingo Drive
Miami Beach, Florida 33140
3
C '. k Safety Committee
at.(. .. 4.
Congratulations! You have been reappointed by Commissioner Jorge Exposito
to the above referenced agency, board or committee for a term ending: 1213112012.
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
Clifford 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, 2-2458, 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 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 Mark Jacobs
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: 12/31/2012.
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.
ark Jacobs
J� f
Sworn to and subscribed before me this / day of/r � ' 2012.
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.
MIAMI BEACH
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miamlbeochfl.goy
CTY CLERK Office CityClerkCm i amibeachfl..gov
Tel: 305.673.741 1 , 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:
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.compiy 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 ftie, even though you may have.been
recently appointed.
you must file 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
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 f t t not c exceed
, 500.:00 or by imprisonment'in the county.jail for period nvt#o exceed sixty
days, or both.
h/ - �/��✓
LIZ-
Signature: ote:
6
SOURCE OF INCOME.STATEMENT
Please.Print.or Type First Name Middle Name Initial Last Name Disclosure
S For Tax Year
Ending
Name:
Mailing address;
city/state/Zip:
Filing as a: ® County Employee:
® Municipal Employee of:
position held or sought:
A " � Term or Employment
Board where serving:
F /Y ,yr�l/�£ '.Began.on: j 7�
Departmentwhere empiayed:
Work Address:
-if-your home address is exempt from public records pursuant to Woric Teie hone:
Florida Stmtutes§119.07 please check here(read instructions); p
Horne Address: Street Address
Cif, State. Zip Code
please list below in descending order with the largest source first, time na er salary You
principal business activity of every source of your income includisig public
received or arty person received for your b y .or use during the disclosure period. The
d. If continued an e
income of your.spouse or-any business partner need not be.disclose
separate sheet, check here: [3
-Descrip "on of the Principal
Name of Source of Income
Address gtssirress AcEivi
.7 hereby swear (:or affirm) that the aforesaid information is.a true and .correct statement,
6 2/0
Date signed
Signature of perrP4Isclosinq