Jacquelynn Powers 12/31/2015 MIAMMEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.pov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
01-21-2014
Jacquelynn Powers
3171 Sheridan Avenue
Miami Beach, Florida 33140
SUBJECT Miami Beach Sister Cities Program
Congratulations! You have been appointed by Mayor Philip Levine
to the agency, board or committee named above for a term ending: 12/31/2015.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1, 2007., the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the
City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
Rafa I E. Granado
City Clerk
cc: Saul Frances, Parking Director
Desiree Kane r
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, 2-458 and 2-459
Ordinance No. 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 Employee
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
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MIAMIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www rniamibeachfl.nov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO Jacquelynn Powers
RE: Miami Beach Sister Cities Program
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 the board or committee on which I serve)on
July 1, following the closing of the calendar year on which I hav served.
4acquelynn Powers
Sworn to and subscribed before me this 5 day of I rug x014.
• 1
Maria E. Martinez
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.
MI®°ODE SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
Mailing Address—Street Number,Street Name,or P.O.Box
31 �-7 ( S 41r,d v-r--
City,nState,Zip ID Number
j
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: Al
Board where serving
M C 5; //d 2 0
L.
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
( cam
e e W►' I M ( 1 ACC
P l 33 1.4 U
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY E!ECTIONS DEPARTMENT:
❑Hardcopy
❑ Electronic Copy
Signature o erson disclosing
Print name Date signed
OFFICE USE ONLY Accepteld. Y/ N De icienc,,: Processed Date/Initials: Scanned Date/Initials:
138 SP-1 2/13
%I E b L_ACP
City of Kcrni Beach,
1700 Ccnvention Center Drive,
Miami B_acn,Flcridc 33139,
r
"PHW.Micnlibeccn;19.ccv
CI (CLERK Orrice CiyClercC�ricmi�each'l.gov
i=I-305.673.7411 ,Fax:305.673.725'
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 cll members of Boards and
Committe.es 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 unatthe
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation orgive advice to the City Commission,must file,even though you may have been
recently appointed.
You must file one of the folloaving l.vith the City Clerk of Mi-2mi; Beach, 1700
Convention Center Drive.. iMiami Beach. Florida, by July 1; 2010.
1. Al`Source of I n c o m e Statem-a nt(a-cached) or
2. A`F ina<<ciai Statement (a-ached' orj
3. A, Copy of the person's current Federal Income Tax Retum
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
5500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
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