Jonathan Groff 12/31/2014 t"e-�A A
f,L,�M 1 I B i_-_A C
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
1/3/2013
Jonathan Groff
4294 Nautilus Drive
Miami Beach, Florida 33140
SUBJECT Parks and Recreational Facilities Board
Congratulations! You have been reappointed by Commissioner Deede Weithorn
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.
Sincer ,
Raf el E. Granado
City Clerk
cc: Saul Frances, Parking Director
Kevin Smith
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
OFFICE OF THE CITY CLERK, Rafael Granado,City Clerk
Tel: (305)673-741 1, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
TO Jonathan Groff
RE: Parks&Recreational FaciIities
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.
I 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 year on which I h ve served:
Jonathan Groff
Sworn to and subscribed before me this /9e day of `", 2013.
LC4 hV�G F LAZOq
Aj Silvia Ofieto
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.
�► MIAMI BEACH
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeochfl.Qov
CITY CLERK Office CilyClerkCmiamibeochfl.gov
Tel: 305.673.7-411 , 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 Me
mbar.name: Td M a t�v.,.. �✓� ��-'
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-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 lax 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 f ne not-to exceed
$500.00 or by imprisonment'in the county jail for-a period not to exceed sixty
days, or both.
/.7
Signature: .Date:
MIAMI DADE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
�- 6000 For Tax Year
Name: jdA�' w+ `. �l lc/— Ending: 2
Mailing Address: 2 g ��1��� rl✓%o
City/State/Zip:
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
r e r
Position held or sought: ��.s g /Grc/`6�� � �-iwc�l/�i�` / .,/�/ V, ?'
Board where serving: .� A Term or Employment
Began on: Y CO
c.a
CO
Department where employed: mil/ c
Work Address: �Gf O'/ �L••, /� �,•✓�e' �O4f
If your home address is exempt from public records pursuant to 5-060'.'` �lt-�
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
t✓ -eo t &-z- t<r P .�.� a✓ /✓
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
_ 3 -/Cr
Signature of per ng Date signed
Please Print or Type
Source of Income Information
(Required by the Miami-Dade County Code,Section 2-11.1(i),as amended.)
The term INCOME shall include, but is not limited to, the following items: wages, salaries; tips;
bonuses; commissions & fees; dividends, interest; profits from businesses and professions; your
share of profits from partnerships and small business corporations; pensions, annuities &
endowments; profits from the sale or exchange of real estate,securities or other property,including
personal residence; rents and royalties;your share or estate or trust income, including accumulated
distributions;alimony,separate maintenance or support payments; prizes,awards and gifts;fees as
an Executor, Administrator or Director, disability retirement payments; workmen's compensation,
insurance;damages;etc.
Filing instructions
A Source of Income Form, Financial Statement, Form 1 or copy of the personal Income Tax forms
may be filed to satisfy the filing requirement for County, Municipal employees and advisory board
members.
This form must be filed by July 1St of each year.
This form should not be used as a substitute for Form 1 for those required
to file under state requirements.
Miami-Dade County Personnel and Advisory Board members shall file completed forms with:
Miami-Dade Elections Department
2700 NW 87th Avenue
Miami,Florida 33172
Or
P.O. Box 521550
Miami,Florida 33152-1550
Municipal Personnel and Advisory Board Members shall file completed forms with:
Their respective Municipal Clerk.
For further information contact the
Miami-Dade Elections Department at 305-499-8400 or your Municipal Clerk's Office
Note:The role of our office is to receive and maintain the forms filed as public record. If your home
address appears on the form and you are exempt from public records and you do not wish it to be
made public, you should use your office or other address. The following persons should not use
their home addresses: active and former law enforcement personnel, including correctional and
correctional probation officers; current or former state attorneys, assistant state attorneys,
statewide prosecutors, and assistant statewide prosecutors; firefighters, justices and judges
personnel of Department of Children and Family Services whose duties include the investigation of
abuse, neglect, exploitation, fraud, theft or other criminal activities; and personnel of the
Department of Revenue or local governments responsible for revenue collection and enforcement or
child support enforcement; spouses of the above; and county and municipal code inspectors and
code enforcement officers.
I
Source of Income Statement/dr