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Delvin Fruit 12/31/2015 MIAMIBEACH 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 January 31 , 2014 Delvin Fruit 4590 N. Jefferson Ave. Miami Beach, FL 33140 SUBJECT: Transportation and Parking Committee Congratulations! You have been re-appointed *by virtue Of your being a Representative for the Mid-Beach Community Association to the agency, board or committee named above for a term ending 12/31/2015. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411 . Sincere) R Bert Parcher ity Clerk cc: Saul Frances, Parking Director We are ycommitted mo prpviding qncelXe��publi�iservlcevand�saf�ety,t�o ail v og1l vex work apdiplay in our vibrant;tr�9prcal historic community. d p g p on,; ) F ) r Y I MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.4ov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Delvin Fruit RE: Transportation and Parking Committee 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: 12/31/15 I 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 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. Delvin Fruit � z . pp Sworn to and subscribed before me this✓ day of ELX4 /� , 2014 U 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��ppmmiged to p viding.gxcellent publiF service and saf0ty to ail�yhq live, work a d,play in out vibrant, trgp'cal,historic community. b1'e are corr;mitted!o pra4rdr'nG exce!lant p�.blic service and safely to crl vrha I,ve, work,anc�ptay rr,UUr ri�r�rnt, trOp;cal,. �rstarr'c communiiy. N !I APO I B EAC H City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, w,/W.miarnibeachfl aov CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade County disclosure Code Provision on Code Section 2-1 1 .1(1) (2) Board Member name V//y 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 4. 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 (aLLached( 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. q- 1 Signature: at �a MI °ADE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial .:201 3 ���✓� �� ��� Mailing Address—Street Number,Sthet Name,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 an Filing as a Board Member ❑ County Board Member Municipal Board Member, Name of Municipality: Board where serving OXX 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.❑ n J Name of Source f I come 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 Print name Date signed OFFICE USE ONLY Accepted: Y /-N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138-SP-14' 2/13