Stephanie Rosen 12/31/15 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
11/12/2013
Stephanie Rosen
325 N. Hibiscus Drive
Miami Beach, Florida 33139
SUBJECT: Youth Center Advisory Board
Congratulations! You have been reappointed by Commissioner Deede Weithorn
to the above referenced agency, board or committee for a term ending: 12/3112015.
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,
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Ellen Vargas
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.
MIAMI BEACH
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 Stephanie Rosen
RE: Youth Center Advisory Board
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: 12/31/2015.
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 e*requirements of
Miami-Dade County or ithe State of Florida(depending o e board or committee o hich I serve)on
July 1, following the closing of the calendar year on i
Stephanie�/Rosen
Sworn to and subscribed before me this `/�1 l�ay of�'Y�1� , 2013.
Maria E. Martinez
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.
I V \I V I I LJ L—, .Vr
_0ArZn *,far? A001 lf`n Apr ZAR Pr)Rnn
Q
s_?
FL
!-tUl!IC HUUIC,J Ss!LV J�LC L!U LUU*r
ME 1111 It' !H117!1)!IUIle.. '!`!t)!it. !t7tiHU1101It, il"111JIM! !Y.IY.UIIt)!It- ri1!=!!l Atltl!t:»
[lt1..N111"Sh Imili!!F' SJ[:t:L1Url!IUi!
rJUti!!ICS�hSUt!!C'N JIiitC L!U%-UUC
Professional License(describe): _ _ Expires:
Piaaca attach a rnnv of r/lrranthi afforrtiva rimfoccinnai liranca
- - L
Pursuant to City Code sections 2-22(4;a & fb: Members of agencies, boards and committees shall be affiliated with the City; 9
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; or b. An individual shall demonstrate ownership/interest for a minimum of six months in a business established in the City
for a minimum of six months.
o Resident of Miami Beach for a minimum of six (E) months: Yes,6 or No
® Demonstrates ownership/interest in a business in P iarni Beach for a Minimum of six months- Yes C1 or No
•Are you a registered voter in Miami Beach: Yesr,&or No U
® I am now a resident of: forth Beach ZI South Beach 11 Middle Beach
® I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
-- - ---- -- - 1�' --- -- �` —, --- - — `— --� � --
e Are you presently a registered lobbyist with the City of IVirarl^r Beach?Yes U or No)61
Please fist your preferences in order of rankinq I'll first choice [21 second choice. and [31 third choice_ Please note that
only three(3)choices will be observed by the City Clerk's Office.
Ad Hoc Charter Review and Revision Board "Debarment Committee `?Miami Beach Human Rights Committee #
Ad Hoc Committee Centennial Celebration Design ReV1eMd Board* - Miami i Beach Sister Cities Program
Ad Hoc Committee Flooding Task Force F!Disability Access Committee _ Normandy Shores Local Government
Neighborhood improvement {
Affordable Housing Advisory Committee Fine Arts Board Parks and Recreation Facilities Board
Art in Public Places Committee Gay, Lesbian;Bisexual and Transgender Personnel Board {
Enhancement Committee(GLBT) i
Beautification Committee "'Golf Advisory Committee j Plannin Board
Bicycle-Pedestrian Advisory Committee ! _ Health Advisory Committee _Police Citizens Relations Committee
Board of Adjustment` '?Health Facilities Authority Board "Production Industry Council
Budget Advisory Committee Hispanic Affairs Committee Safety Committee
Capital Improvements Projects Oversight f!Historic Preservation Board r;Single Family Residential Review Panel
Committee
Committee on the Homeless U Housing Authority -Sustainability Committee
Committee for Quality Education in MB =_:Loan Review Committee Tennis Advisory Committee i
Community Development Advisory Committee ! s Marine Authority �.,, Transportation and Parkina Committee j
Commu ity Relations Board Miami Beach Commission for Women j Visitor and Convention Authority `
Convention Center Advisory Board - Miami Beach Cultural Arts Council "ouch Center Advisory Board
Waterfront Protection Committee
i
C
f I
IYfd LIlfVJJlI I IIJ.VJCI.7-1111•_•Ilarlr.i`r11.VVYS1Ift 3!7.1 C.7Ir VIIG.I rfCl V.�rL!,L)1�IZ!'r L[E.jf?!fL'•O"_ __,-,-_ "�• •..-�
00 Note: If applying for Youth Center Advisory Board, please indi. t o r affiliation with th S ft Rakow Youth Center
service on the Youth('.Pn \?4dvisory Board:Ye
2. Present participation in Youth Center activities by your children'. Yes X-3 No
Child's name: Age: Program:
Child's name.- Age: Program.-
* Have you ever been convicted of a felony?Yes or No I Q11 If yes, please explain in detail:
4_6 wou you ou,nonnvhave amu�uun�)uYonvuYxxxami Beach Code?Yes�=�u, n yes,please explain indetail:
�_�
wouvouou,nanuv owe the Cuvufx8iami Beach any money?Yes�=�orNm�e�p�_�
if yes, explain indutoW:
9 Are vou currently servinq on any City Board or Committee?Yes or No If yes,which board/commi ee?
9mv,o all uwun-Iu:un'u/mu/eu�u/ m/um/ uuvuuj.;ununuvnumxx*mu"/uo/u�
o
e Are you now employed by the,City of Miami Beach?Yes LA or No
vvnmnnwpmnmcmmnnnne/
|
" Pursuant to � v Code Section 2'25 (b): Do you have a paoaru L=J. spouse r—'' child L-J b/otha, r-� or uister --` vvho is
emp|oyedby the City of Miami Beach?Check aU that opp|v.
K^Yau'^ identify pemun(u)and dapartment(m �
`me novppmnq /n/mnnauqm is vo/unwnry wno is wm/mmer Part pr your wpmucwupn nor nam any mmmnng on yowrcons/nemnion Tpr
appointment. /r/mmm/ma ammeO
Africa n-America n!B lack
Asian or Pacific Islander
Native-American/American Indian
Other–Print Race:
.3o you consider yourself to-be-Spanish,Hispanic or Latinola?Mark the"No"Cox if not Spanish, Hispanic, LatOW& f
No
Yes
Pin unto r_-nmidpr vnumPif phuniraiiv nicahipd?
No
Yes
i NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE I
MEMBERS.THESE LAWS INCLUDE,BUT ARE NOT LIMITED TO: I
o Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459).
o Prohibition from contracting with the City (Miami-Dade County Code section 2-11.1).
Prohibition from lobbying before the 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).
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). l
! c Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open p
` government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities. l
o Voting conflict-Form 8B is for use by any person serving at the county,city or other local level of government on an appointed or I
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies j
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. i
Upon request, copies of these laws may be obtained from the City Clerk.
i HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION: AND i HAVE RECEIVED. READ AND
WILL AS WE Y CHAPTER 2. Aid LH�i:L! i►ii_ Vii= THE difii �i fil 3�ait:iri iri 1 I �;i�lit, EN-1 f i Li I biiiiU�RU!t OF i,:QNUU(; FQR
CITY OFI=i .� �. _. . _ FES�Iu�i Ar�Enic4i�iUlEi�nBF�rS di�iD di 1 tlTi•iE,i-ie bPf+i iCii F COUNTY AND/OR ST®YF- i QVif ei�iY'i
ST S t°C:[7i�F�IMM V;;
III laJ
I3
.ippiiCant's egnature a Name of Ap iicant(NLt=HSt PRINT)
Received in the City Clerk's Office
Name of uepuiv t;ierk Controi No. uaml<
e a :JQk a r�a l r a 3■0%V6=%L =r s-- A- ! A■ • ! �1■•r-91% !!T t_ t%- ■ewr !1• ■/\TA/1!1 !1■• !L or%
——----—----——— - - - --IT__r--- — -- -
!°�ii_i-��Tr� il�Gilr i iiG�iri�e�. d'r��i 1 V�Si�i�►�i-i f1i�f✓ ti
-Vrir UP ANT lr t—r �i;v►irt e_ i�f c.UrrZ)0%A.UsNAL LILr-114 C>
!TT! A■ ■ ! 611ft?1 ■! !?" ! ■ ! ■ A■ -o-0% ■■'_ \■■-10%W_AA ! r\\f r.'Oft a%IM Al/■!%r r\rOft ■■F%r—V%
a l l
r�aae 3 of 4
?,Ifar_.intogh Hn:lig erg:rnichaeirog en�Downloa d-s:re$tenhanierngPn:R('APPL II ATIQN 46 BOARDS 82813.&)C.
MIAMI®" SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/initial Last Name
Disclosure
� For Tax Year
Name: Ending: 4�/
Mailing Address:
City/State/Zip: ( '
— I 1
ial Security
hoc ty Number:
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§114.07 please check here(read instructions): ® Work Telephone:
Nome Address:
Street Address
City State Zip Code
Please fast 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 Activi
c
1 C�
Pt
? hereby, swe a irm) tha foresaid information is a true and correct statement.
1
Sign it Date si ned
MIAMI BEACH
City of Miami Beach
i7oo Convention Center Drive,
Miami Beach,Florida 33139
www.miamibeachfl.,qov
CITY CLEWS OFFICE CityClerk@miamibeachfL_qov
Telephone:3o5.673.7411 Fax:3o5.673.7254
iq i r
iz i
i3oara
M h--Arc e-%r- W^-arric -ano-4 eNT thom 'N -1*
I wn.dzenkrstand t hat Inc. iCnA ti%e Ir 1+6 th Ca%I to W!t At l'tUr 16 o Is '.e.4-A,cff oft Vie e--LA%r a.if it I I ern....I%J W I L-#W CA I%A IJ 641 I%A %.0%.0 A 1 4 1 1 1 LIL%l W& Use (.;. .. %04
Miami beach. incluaina those of a Durelv aavisory nature. are reauirea to core o1v with Miarni-Uacle Gountv
Or
I loasA %.-&%As %49%1 1 awardarments. a nes rneav
primary resoonsinioty is to recommend JeQislation or rive acivice to the utv Uommission. must me. even
tnouqn they may have open recently appointea.
f-imm r%-r 1rhzi *r%ilotittanri trwrrw ff"Iest &%,m V's-6,4mors %allij, the (AW veer r%* ANA8*14-A Irons 1. f-f%n%jqnfir%n U42h 42hr i lriwr-
%08 &&A%, Awas go 1 84%4 swoodelp 5841%4 a#%_ a eve& &Is%- %06 W%f %,nir
I.%,
Miami beach. t-lonaa. no later than 1 Z:UU noon ot July 1. of each vear.
1. A "Source of Income Statement"
For your convenience. the form is attached. The form can also be downloaded at.
hftp://www.miamidade.gov/elections/Library/source—of—income—statement.pdf
2. A"Statement of Financial Interests (Form 1)"
For your convenience. the form is attached. The form can also be downloaded at:
hftp://www.ethics.state.fl.uslethics/forms.html
J. A L;ODV of vour 1u11 i--ecierai income i ax Keturn
FnifUrgm te% fibas r%ncm r%i-thcaQga tr%rmc. ni ii-42t i--2nfr tr% thoms f%fi&-3Mi-i✓kafj= i'r%i ant%# i-r%eida rn-a%t ci&%icif-t ir--- - --r-on tr% t3
164410 1— 46%# onoi%, wil%, %08 1%01801,P &0%A1�P%A%AIIL 16%0 1,91*� NWAI%A L.0%.A%A%l %.0%0%A9ILV %.f%0%A%— 6&5%.AV a rine
of no more than iouu. tju aays in iaii or Dom.
6ionature L
Adhfn r.nftj!ftfi!T-rP r:Q%Mr. '71A I C!"A!
Uodated:Wednesday.November 13.2013
Paoe
Macintosh H D'.Users:michaelmsen:Downloads:resteDhanieroren:BC APPLICATION 46 BOARDS 82813.doc