Karen Edelstein 12/31/2014 /\AJAAA1 BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
12/18/2012
Karen Edelstein
4955 Cherokee Ave
Miami Beach, Florida 33140
SL_U$JEC, Miami Beach Commission For Women
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12131/2014.
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 ael E. Granado
City Clerk
cc: Saul Frances, Parking Director
___ Wanda_Geist —
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.aov
OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
TO Karen Edelstein
RE: Miami Beach Commission for Women
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 th board or committee on which I serve)on n z 4"�
July 1, following the closing of the calendar year on which I ve s
Karen Edelstein
Sworn to and subscribed before me this day of Q_Q►1 • , 201?J
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.
ED MIAMI B*%CH ; ® CITY OF MIAMI BEACH
C BOARD AND COMMITTEE APPLICATION FORM
NAME: GD�LST�]� KAR>:N S
Last Name AA . First Name Middle Initial
HOME ADDRESS: `igsr" Cherokee /' yen U L _1,f ew r Beotck VL- 331 . d
Apt No. House No./Street City State Zip Code
PHONE: 3 oci V.r. 049 3 pr? - g KED ELSrC-/N4 Be11 Si0A n&
Home WeNt Ct.0 Fax
Email address
Business Name: •'' Position:
Address:
No. Street City State Zip Code
Professional License(describe) Expires''` "'"'''�' "' fiach a�c'o'py 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; orb) an individual shall demonstrate:ownershipfinterest-for,a minimum 9f six months"in a-businessiestablished iri the city.
• Resident of Miami Beach for a minimum of six(6) months:%Yes Boor No ❑
• Demonstrate an ownershiprnterest in a business in Miami Beach for a minimum of six(6) months:Yes❑or No ❑
•Are you a registered voter in Miami Beach:Yes SKor No ❑
• (Please circle one): I am now a resident of: North Beach1 South Beach fiddle Beac
• I am applying for an appointment because I have special abilities, knowledge and experience. Please lit below: Wo vttie %
•Are you presently a registered lobbyist with the City of Miami Beach?Yes❑or No Mebev 0 �/gvtOVS
OY�gvl�La1'�o r1 , AS WCIr
44 MOU- ► fieaeti Star-. rTpk
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 observed by the City Clerk's Office (Regular Boards of City)
0 Affordable Housing Advisory Committee ❑Marine Authority
0 Art in Public Places Committee Miami Beach Commission for Women
❑Beautification Committee ❑Miami Beach Cultural Arts Council
0 Board of Ad'ustment* 0 Miami Beach Human Rights Committee
0 Budget Advisory Committee ❑Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
❑Committee on the Homeless ❑Parks and Recreation Facilities Board
❑Committee for Quality Education in MB 0 Personnel Board
0 Community Development Advisory ❑Plannin Board*
❑Community Relations Board 0 Police Citizens Relations Committee
0 Convention Center Advisory Board ` ❑Production Industry Council
0 Debarment Committee
❑Design Review Board* ❑Safety Committee
❑Disability Access Committee 0 Sin le Family Residential Review Panel
0 Fine Arts Board ❑Sustainability Committee
❑Gay, Lesbian, Bisexual and Trans ender GLB 0 Transportation and Parking Committee
❑Golf Advisory Committee 0 Visitor and Convention Authority
0 Health Advisory Committee ❑Waterfront Protection Committee
0 Health Facilities Authority Board ❑Youth Center Advisory Board
❑Hispanic Affairs Committee
0 Historic Preservation Board
0 Housing Authority
❑Loan Review Committee *Board Required to File State Disclosure Form
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❑ No 0 Years of Service:
2. Present participation,in Youth.Cenfer.'activities by"you�-children YesO''>No 0'-'.If ryes, please list the dames-of youf children,,their
ages, and which.programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc
r�
*Have you ever been convicted of a fEe: Yes ❑ or No)( If yes, please explain inail:
• Do you currently have a violation(s) of 6 ` 6 miaml Beach codes: Yes ❑ or No`!if yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No�g If yes, explain in detail
-+.;;li.���..a'�P: l: '�` j fit. :i u;:! •�- � ..J - .1, w:i• .. .. (, .. ... .. J '1 ,.
• Are you currently serving on any City Boards or Committees: Yes ❑or No)5(If yes; which board?
• What organizations in the City of Miami Beach do you currently
. ho_ld;membership in?
Name: No 04A � Title:46A v% G%a
t r
Name: . Q �IA �LV_6 r QW VA Title: R1L L 0Y'6kt h !!)
sL V"�C Yn
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
y`(55 C V%-e vo �ze.e ,fie M t a w•. J�eac k 3
3140
• I am now employed by the City of Miami Beach: Yes ❑or Nq Which department?
• Pursuant to City Code Section 2-25(b): Do you have a parentp, spouse 0,°6hild❑, brother❑, or sister❑who is employed by the
City of Miami Beach?,Check all that apply. Identify the department(s):
AID
The following Information.is voluntary.and is neither part of your application nor has any bearing on your consideration for appointment. It is
b @ingasked fo_com`ply-with;federl equal opportunity reporting requirements.
Gender: ❑ Male XFemale
Ethnic Origin: Check one only(1)
Xwhite (Not of Hispanic Origin):All persons having origins in any ofthe original peoples of Europe, North Africa or the Middle East.
❑ African-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa.
❑Hispanic: All persons of Mexican, Puerto Rican,Cuban,Central or South American,or other Spanish culture or origin,regardless of race.
❑Asian or Pacific Islander.All persons having origins in any of the original peoples of the Far East,Southeast Asia,the Indian Subcontinent,on
the Pacific Islands. This area includes,for example,China, India,Japan,Korea,the Philippine Islands and Somoa.
❑American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America,and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes❑or No .
Employment Status: Employed ❑ Retired ❑ HomemakerK Other❑
NOTE: If appointed,you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to,the following:
• Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
• Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself,
or those with whom you have business or immediate family ties (CFR 570.611).
Upon request, copies of these laws may be obtained from the City Clerk.
M t to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
he C' y Code " ndards of Conduct or City Officers, Employees and Agency Members."
-164zlC. J S. f-Z f_l-s►rc i n1
App cant's Signature ate Name of Applicant(PLEASE PRINT)
I
Received in the City Clerk's Office by: Date:—/ /2010 Control No. /y/ Date:_/_/2010
Name of Deputy Clerk
MIAMI BEACH
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miomibeochfl.gov
CITY CLERK Office CityClerk @miarnibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Mern bers for.failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11.1(i) (2)
Board Member name: -r--- �
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,mustffie,: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 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.
2
Date:
S-
Signature:
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: Ending:
Mailing Address:
City/State/Zip:
m er:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
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
/W,490 E_DF7L5M 1N yqss Che'-C'Aee i9-ve ma o v S-e-
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Signat re of person disclosing Date signed