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Ivette A. Birba - 06/30/2014 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)673-7,411, Fax: (305)673-7254 August 29, 2013 Ivette A. B i rba 1830 Cleveland Road Miami Beach, FL 33141 SUBJECT: Committee for Quality Education in Miami Beach Congratulations! You have been appointed as a Representative of the PTA for Fienberg-Fisher K-8 to the above referenced agency, board or committee for a term ending, 06/30/2014. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411 . Sincerely, ZE.dGra`raclo City Clerk cc: Saul Frances, Parking Director Leslie Rosenfeld, Liaison 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 Granada,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 TO Ivette A. Birba RE: Committee for Quality Education in Miami Beach 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: 6/30/2014. 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 year on which I have served. Ivette A. Birba Sworn to and subscribed before me this day of �, , 13. Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.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. AM I BEAC H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miamibeachfl.QOv CITY CLERK Office City Clerk CmiamibeachfLgov Tel: 305.673.741 1 , Fax: 3 0 5.673.725A 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: 7,e 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,mustfile,-even-though you may have been recently appointed. Y®u must file one ofthe-following-with the City Clerk of Miami Beach, 1700 C.onventon Center.Drive, Miami Beach, Florida,.by.July 1 each-year. 1. A°Source.of.Income.Statement" (attached).or 2. A"Financial Statements (attached(or] 3. A Copy of the person's current Federal income Tax Return Failure to-file., according to the Miami.®ade :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 couinty jail for-a period not to exceed sixty days, or.both. a,4,S .Signature: .Date "'®°MADE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial b '-Z'VI. Mailing Address—Street Number,Street Name,or P.O.Box j':--6' 3 D C e ve C-coa City,State,Zip ID Number If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here. Filing as an Employee dblWnty Employee Municipal Employee, Name of Municipality: Position held o ught O'Q a t(7,-14 q Cab"O A Department where Oployed Work address Work telephone Term began on Filing as a Board Member County Board Member unicipal Board Member, Name of Municipality: cY�` E i Board where serving /i / �e Work address Work telephone Term began on List below every source of income you received,along with the address and the principal activity of each source. Include your public salary.Place the sources of income in descending order,with the largest source first.Also, include any source of income received by another person for your benefit.However,the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here.❑ Name of Source of Income Address Description of the Principal Business Activity I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing e 4 k2 11,3 Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13