Keith Menin 12/31/2013 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)673-741 1, Fax: (305)673-7254
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02/28/2012
Keith Menin
1100 West Ave TS
Miami Beach, Florida 33139
SBIJB�'� - Visitor and Convention Authority
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12/31/2013.
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Grisette Roque
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.
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk@miami6eachfi.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Members 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 -,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. 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 for a period not to exceed sixty
days, or.both.
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Signature: Date:
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am SOURCE OF INCOME STATEMENT
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Please Print or Type First Name Middle Name Initial Last Name
Disclosure
For Tax Year
Name: � n I Ending: /
Mailing Address:
City/State/Zip: �� c
Social Security Number: ---
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: <I 'Term or Employment
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: ` AV , c4
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Street Address
G ,
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 continued on a
separate sheet,.check here: -®
of-the Principal
'Name:df:Source.of1ncorne Address Business Activity
n,.
ear(or a that the aforesaid information is a true and correct-statement,
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Signature of person disclafing Date_si.gned