David Wieder 12/31/2013 IM MIAMI BEACH
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
02/28/2012
David Wieder
1390 Bay Dr.
Miami Beach, Florida 33141
1�JCT._ Historic Preservation Board
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12131/2013.
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,
�D
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Thomas Mooney
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.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO David W ieder
RE: Historic Preservation 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 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 committee on which
I serve)on July 1 st,following the closing of the calendar year ich served
vid Wieder
Sworn to and subscribed before me this day of 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.
From.David Nader Fax:+1(305)866-7621'2 To:City of Miami Beach Cie Fax: +1 (305)673-7254 Page 1 of 2 12/27/2011 6:05
M i.*.0 BEArH CIT`(OF MIAMI BEACH
BOARDS AND COMMITTEE APPLICATION FORM
NAME:
;Lpt Name J� /J First Name %�� /] / Middle Initial
HOME ADDRESS: 'l �W 0 `�� Y,,_4� 111�I 1 11it%yT(ff 1 C.�--- `7 Z T
No, r Street City T State Zip Code
_ —.
PHONE: 7�i [ 1 �C C /1'( /�(�� T ( /1.Jd ,
Home. : Work Fax Emaif address
Business Name: i�:�f� ` Position:
Address: y � 1Ii!1.41�1 13 # EL
i' No..�- �- rr ,Q /Street City // State Zip Code
Professional License(depribe) ✓�'/� iC � Expires:1 Jirtacn a copy of the license
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 ownership/interest for a minimum of six months in a business established in the city.
. Resident of Mlami Beach for a minimum of six(6)months:YesXor No 0
• Demonstrate ah ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes or No ❑
r
,.j
•Are you a registered voter in Miami Beach:Yes�l or No ❑
. (Please check due): I am now a resident of: North BeachSouth Beach❑Middle Beach❑
a'
. I am applying fo.',an appointment because l havespecial abilities, knowledge, experience. Please list below:
fi71 ,17 W I' ; �/�,��y,�v ,-��- J2r4 ffikTx1W1 -,7-6 H,,o�_g
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 obseived by the City'Clerk's Office.(Regular Boards of City)
❑Art irwF!ublic Places Committee O Housing Authority*
0 BeactORreservation Board O Loan Review Committee*
0 Beautification Committee 0 Mayor's Green Ad-Hoc Committee
0 Board bf Adjustment* ❑Marine Authority*
0 Budget Advisory Committee ❑Miami Beach Cultural Arts Council
0 Committee on Homeless 0 Miami Beach Commission on Status of Women
❑Committee for Quality Education in MB 0 Miami Beach Florida Sister Cities
0 Community Development Advisory` ❑Normandy Shores Local Gov't Neigh. Improvement
0 Community Relations Board 0 Oversight Committee for General Obligation Bond
❑Convention Center Advisory Board 0 Parks and Recreation Facilities Board
❑Deba6ent Committee ❑Personnel Board"
0 Des! n Review Board` 0 Planning Board*
❑Disatt�llty Access Committee ❑Police Citizens Relations Committee
0 Fine Arts Board 0 Production Industry Council
0 Golf Advisory Committee ❑Public Safety Advisory Committee
0 Health Advisory Committee ❑Safety Committee •, DEC 3 0
❑Healllt :Facilities Authority Board ❑Transportation and Parking Committee 2011
0 Ispa ip Affairs Committee ❑Visitor and Convention Authority
Histoi�c Preservation Board* ❑Youth Center Advisory Board
S C
" Board Require to Flue.State Disclosure form
11
� 1
CTocurnents and Setup�\compurbrrnlLocal.Settingstientporary Internet Filos%0LK1CS'd3C Fy)p!icatirm Pevisec July iE 200,;.doc
iti
F 7deFax:+1(305)966-7621 '2 To:City of Miami Beach Cle Fax: +1 (305)673-7254 Page 2 of 2 12/27/2011 6:05
hl!
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 D No U Years of Service:
2. Present participatipn in Youth Center activities by your children Yes- No n. If yes, please list the names of your children, their
ages,and which programs. List below:
Child's name: Age Program:
Child's name: i` Age: Program:
•Have you ever be.'en convicted of a felony: Yes D or Noxlf yes,please explain in detail:
• Do you currently!, ave a violation(s)of City of Miami Beach codes: Yes D or No . If yes, please explain in detail.
• Do you currently Qwe the City of Miami Beach any money: Yes F1 or No If yes, explain in detail
•Are you currently.;serving on any City Boards or Committees:Ye s, l or No❑. If yes;which board?
• What organizab si in the City of Miami Beach do you currently hold membership in?
t),
Name: ;'t Title:
Name: Title:
• List all properties)owned or have an interest in,which are located w5*the City of iami Beach:
• 1 am now employed'.by the City of Miami Beach:Yes❑or No)(Which department?
• Pursuant to City bde Section 2-25(b):Do you have a parent D,spouse D,child 0, brother D,or sister n who is employed by the
City of Miami Beach ,11 heck all that apply. Identify the department(s):
This section is"riot<<equired"but desired:Age: years old Gender: Mall_. Female❑
Ethni dgin(CheclC�+one)
White African-AM encan/Black O Hispanic: D Asian or Pacific Islander D American Indian or Alaskan Native D
Employment Statugi;Employed 0 Retired❑Home-maker D Other❑
"I here attest to.`':th curs y and truthfulness of the application and have received, read and will abide by Chapter 2,
Aj e VI of I I ode" andards of Conduct for City Officers,Employees and Agency Members."
App Icant's Sig L.'Sure Date Name of Applicant(PLEASE PRINT)
Please attach a copy;of your resume to this application
NOTE:Applications±will remain on file for a period of one(1)calendar year.
Received in City Clerk's':C)ffice by Date
Name of Deputy Clerk /
Document Control Numltr(Assigned by the City Clerk's Office) Entered By � Date
Rev.se 125587 jo
dtk5
'ar
fE 2
C:\Documents and Settip sl compurbmlLocal'otittingslTemperary Inte-met FilestiOLKIC.r1BC Application Revised July'18 200T W;:'
I
ID 1\A I AM I B EAC H
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miamlbeachfl.aov
CfTY CLERK Office CRyClark miamibeachfl..gov
Tel: 305.673.7411 , Fax:305.673.7254
Acknowledgement of fines/suspension for Board Merry bars 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 comply with Miami-Dade County Disclosure Requirements. I This means that the
members of City Advisory Boards, whose soie 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 r ustf le One of the following with the City Clark 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 lax Return
Failure to file, according to the Miami-Dade .County Code Chapter 1, General
Provision, Section 1 Z may subject the person or firm to a ft ne not to.exceed
$500.00 or by imprisonment in the county,jail for a period not to exceed sixty
days, or both.
A. Dote:
H
"® SOUR OF INCOME STATEMENT
Pi ease.Print.or Type First Name Middle Name/Initial Last Name
Disclosure
For Tax Ysar
Name: �/ U Ending;
D
Mailing Address: 0,0
City/State/Zip: AA
Filing as a: ® County Employee;
Municipal Employee of:
Position held or sought: L4 _
Board where serving; Term or EmPftvymanCt/
---/// '.Eagan on:
Department'-where employed:
Work Address;
if your home address is exempt from public records pursuant to 3D 7
hone:
Fiaride Statutes 1 11.9.07 pia a check here(read instructions); Voric Tela
i-one pdjre9 5; Iq
t?
S eat Address I
City State. Zip Code
Piease list below in descending order with-the largest source first,then name, address and
principal business activity of ovary source of your income including public salary you
Teceived or any person received for your beneriit or.use during the disclosure period. The
income of your spouse or an business partnar need not be disciased. If continued on e
separate sheet, check hare:
Description of the Principal
a of SD"r e f Income Address Business Activjty
Z h by s; ar (o i to at a aforesaid information Wa tr rrect statement.
Date signed
ature of.parson disciQsing