Esther Egozi Choukroun 12/31/2014 !
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)673-7411,Fax:(305)673-7254
1/24/2014
Esther Egozi Choukroun
21 LaGorce Circle
Miami Beach, Florida 33141
SUBJECTa Youth Center Advisory Board
Congratulations! You have been reappointed by Commissioner Joy Malakoff
to the above referenced agency, board or committee for a term ending: 12/31/2014.
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,
fael anado
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.
I\AIAMI BEACH
DIVERSITY STATISTICS REPORTING
Name.
Board 1 Committee: �v �! ✓�
Appointment Date:
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male E.-D Female
Race/Ethnic Categories
That is your race? Mark one or more races to indicate what you consider yourself to be.
Afrioan American/Black
I [ ucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
E:1N
es
Do you c 'nsider yourself Physically Disabled?
No
Yes
F:ICLERI$ALL1aF0RMS180ARD AND COMMITTEESIBC minority information form 05-20-13 Revised by Mr.
°aPy.doc
MIAMIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.Qov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO: Esther Egozi Choukroun
RE: Youth Center Advisory Board
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.
.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 Amendment and Code of Ethics for Public Ofcersandunderstand 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 the State of Florida (depending on the board or
committee on which I serve) on July 1 st, following the closing of the calendar year on which I
have served.
Esther Egozi Choukroun
f e4
Sworn to and subscribed before me this day of Jv� , 2014
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
VVe ore commuted to providing excellent public service and safely to all who live, work',and play in our vibroni,tropica,historic communily.
1\A I AM BEAC H
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeachfi.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel:305.673.741 1 ,Fax:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-1 1.1(i) (2)
Board Member name.
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 file, even though you may have been
recently appointed.
You must file One of the following with the City Clerk of Miami Beach, 1700
Convention Center Drive, Miami Beach, Florida, by July 1, 2010.
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 fine not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
LQ . 2,8 JA-rJ 2-v
Signature: Date:
MI®°ODE SOURCE OF INCOME STATEMENT
a
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
"Q0 / 3 Eq O-o)w I 'e*V\A I qzcw4 a-r- \j �cto n
Mailing Address—Street Number,Street N me,or P.O.Box
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
❑County Employee Municipal Employee, Name of Municipality:
Position held or sought
Department where employed
Work address Work telephone Term began on
Filing as a Board Member
❑ County Board Member Municipal Board Member, Name of Municipality:
Board where serving
Work address ork 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
l&e r f IA-P�1
�r
0 M -
I hereby swear(or affir that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Signature of person disclosing 0i AV%
C X4r- 4-%rl e 20 i
Print name Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13