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Jason Witrokc 12/31/2014 i 1%At0,I HACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfi.gov OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk Tel: (305)673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov 11/16/2012 Jason Witrock 4779 Collins Ave. #3305 Miami Beach, Florida 33140 SUBJECT:' € Safety Committee Congratulations! You have been reappointed by Commissioner Jorge Exposito to the above referenced agency, board or committee for a term ending: 1213112014. 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, r Rafael . Granado 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, 2-2458, 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. M City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov TO Jason Witrock 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: 12/31/2014. 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 the Florida Commission on Ethics Guide to the Sunshine Amend- ment 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* requirements of Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve)on July 1, following the closing of the calendar ye o which I have served. A j i Jason Witrock Sworn to and subscribed before a this j day of ��'� , 2013 • d Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm for additional information regarding the Financial Disclosure Requirement We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical, historic community. �/1 I Ali BEACH City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww miamibe9chF1.9Dv CITY CLERK Office CityClerkCmiamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 Acknowledgement of fines/.suspension for Board Mem hers for failure to comply with Miami-Dade County Financial .Disclosure Code Provision Code Section 2-11-1(i) .(2) Board Member name: 24 4- 41 �zt;Lp 0 C I understand that no .later than July L 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-ftle,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 14 may subject the.person or firm to a fine not-to exceed $500 or by imprisonment-in the county Jaill for a period not to exceed sixty days, or both. tell ignat. e: Qte: eo M I A M I•DADE SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name: ��� (JlJ l (�. C� Ending: Mailing Address: C.cAI li S' 33© City/State/Zip: P L �`- L b Social Security Number: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: <;- Cass-•,� Board where serving: 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: Street Address 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: Description of the Principal Name of Source of Income Address Business Activity MCZ L.L. t,- MC 2oo S. i-L t-36 (Vy swear(or affirm)that the aforesaid information is a true and correct statement. re of person disclosing Date si ned