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Patti Hernandez 12/31/2015 NMAMd BEACH 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 1/28/2014 Patti Hernandez 1720 Bay Dr Miami Beach, Florida 33141 SUBJECTi 3 Hispanic Affairs Committee Congratulations! You have been reappointed by Commissioner Deede Weithorn to the above referenced agency, board or committee 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. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, Raf el E. Gra ado City Clerk cc: Saul Frances, Parking Director Nannette Rodriguez 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.miamibeachfi.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Patti Hernandez RE: Hispanic Affairs 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 the Florida Commission on Ethics Guide to the SunshineAmendrr�entand Code of Ethics for Public Offl'cers and u n d e rsta n d 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. Patti H rnandez Sworn to and subscribed before me this /0 day of F (�, 014 � 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 mr itt��l tQ vi ��r�x�ellen�� li�,,s c�,a�d s e �o Ill► hQ l vet r&W,F��la�r in out v�r�n�;tr�piiry�l�i��c��r�mmunity. (fie ci c r mrtro c> r rn c.x o.r�n, u rc �c nd s nor t a„w.o,n c �c� r Uur w,r�r o c r,s. r u r. MI DADS SOURCE OF INCOME STATEMENT 0 Disclosure for Tax Year Ending Last Nam a Pml_Name Middle Name/initial Mailing Address—Street Number,Street Name,or P.O.Box City,State,Zip ID Number L4 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 ®Gr.V/W46/1"_ 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 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.❑ pao of Source of Inco a 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 Signatu a 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 IMIAMI City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, w,vw.m i o m i beach Fl.acv CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.741 1 ,Fox:305.673.7254 i 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. � l® Signature: Date: