Elaine Soffer 12/31/2015 MIA/MIBEACH
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
TO Elaine Soffer
RE: Parks and Recreational Facilities 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, a understand that as a member of a City
of Miami Beach Board and/or Committee, I must comply wit financial disclosur * requirements of
Miami-Dade County or ithe State of Florida (depending o oard or comm' which I serve)on
July 1, following the closing of the calendar ye c I rued:
Elaine ffer
Sworn to and subscribed befor me this day 014.
JV
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.
B AC
City of Miami Beach,
1700 Conven ion Center Drive,
Micmi Beech,Flcridc 33 139,
v.�v.miemibscchR.ccv
CI IY CLERK Office Ci�Clerk@micmibecch,9.gov
Te1:305.673.7d11 ,Fax:30_.673.723?
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 • �
er name.
1 understand that no later than JULY i OF EACH YEAR all members of Boards and
Commi Lees 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 thatthe
members of City Advisory Boards, whose sole or primary responsibility is to recommend
I-ngislation orgive advic;,to the City Commission, mustfile,even though you mayhave been
recently appointed.
You must file one of the follo,;ving with the City Clerk of Miami Beach, 1700
Convention Center Drive, Miami Beach, Florida, by July 1, 2010.
r, 'S ource Oi Income Statement(a+_cached) or
2. A`Financial Statement(a«ached(orl
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
Prevision, Section -5 mays the person or firm to a fine not to exceed
$500.00 or b: imprisonment in the county jail for a period not to exceed sixty
days, or both.
� L
Sianatu Date:
~;
- BO>L,P~~ ,4tJu CCfVI[ti/!iT T ~E ~;PPLIC~;TIOh =CR1~
NAME : ~,~- ~ .~-~-~J` ~
Las? Name -ire+. Name IVuodie InrtEal
' ~~ c.3
Ap No. House Nc./Street City Q Stale Zip ~odE
PHON! :~ ® . O~ l O ~- ~~~~ ~ ~ +~ ~ ~ ~ ~ !`. ~.. (fit ~C B i ~~ ~W4_~- - C~
Home
Business Name' _
Address:
No.
Professional License (describe) _
City
State Zip Code
Expires ~ Attach b copy of .fhe license
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the fioliowing ways: a) an individual shall have been a resioent 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.
• Resident of Miami Beach for a minimum of six (6) months: YesNo ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No 0
® Are you a registered voter in Miami Beach: Yes ^ or No D
. (Please circle one): I am now a resident of: North Beach South Beac Middle Bsach
. I am applying for an appointment because I have special abilities, knowledge and experience. Please list below,
® Are you presentl}~ a registered lobbyist with the City of Miami Beach? Yes ^ or No
Please fist your preferences in order of ranking [1j first choice [2j second choice, and (3j third choice. Please note that only three C3)
choices ~-HI tie observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Housin Adviso Committee D Housin Autho '
D Art in Public Places Committee D Loan Review Committee
0 Beauttficatian Committee D Marne Autho
D g~~ of p-d~ustrne~ D Miami Bsach Commission for 1Nomen
D Budget Adviso Committee D Miami Beach Culture( Arts Councll
0 C ftel lm rovements Pro~ects Oversight Committee 0 Nfiami Beach Sister Cifies Pry ram
Committee on the Nameless D Normandy Shores Local Government Nei h. imerovemertt
0 Committee for Quai' Education in MB D Parks and Recreation i=aciifties Board
0 Commun' Develocment Adviso D Personnel Beard
Commun' Retafions Board D Ptannin Board"'
^ Convention Center Advtso Board 0 Police Citizens Retations Committee
D Debarment Committee D Production industry Council
D Design Review Baardr` D Public Safe Advi o Committee
D Disability Access Committee D Safe Committee
D Fine Arts Berard D Sin ie Famit Residential Review Panel
D Ga ,Lesbian, Bisexual and TransQender GLBT ^ Sustainabil' Committee
^ Goff Adviso Committee D Trans area Reiiabil' 8~ Accauntabiitty Committee "TRAC"
0 Health Adviso Committee D Trans ortation and Parkin Committee
D Health i=aciltties Autho ' Board D Visitor and Convention Autho
His anic Affairs Committee ^ Waterfront Protection Committee
D Historic Preservation Board D Youth Center Advisory Berard
"Board Required to File State Disclosure Form
2
Mote: If applying for Youth Advisor~~ Board, please indicate your affiliation with the Scott P~akow Youth Center:
'~ Past service on the Youth Center Advtsory Beard: Yes = No~ Years or Service:
Z Present participation in Youth Center activities by your children Yes_ No L, if yes, please
ages. and which programs List beto~~.
~hi1d`s name: Age: Program:
j Chitd'~ name Aa= Program:
,: L.P .~AL'_ ~a=~Rr1~,5~6~.ARG tiN~- ~~MMiri'~=~\B~ H,~nii~ai~onU62609 N~N .oo,
V
Email address
Work
Street
Fax
Position:
li l the names o` your children, their
~'-ia'Je yp~~ av~' J~a,- ~~' ~%I~i°~ .., c T°i:~'1' ~' oc ~. ~V.i I V°;, al@?5~. °X~iali ~'
it ~ gal:
~ :J. you ~Urr?'ltl~- ~BV~ c Vlo~atlorl;5 C~ ~I?\% O- C~iami ~~aC` ;OdeC YgS .. C NO ~' Vc~c o Q- i
~I,aSc Y,piair I. :2.,~a1,.
• JG VOU currently CWe t'lo ~;liv O' I1~liam; 3°aCi''~ any' rnaney Yes 0"`..=.~" ~` v°S eXOiatr Ir~ aetall
~ .y r° VoU currentiv s]r~~Ir1C C~ ~n\' ~ Its' 3C8r~E C"~lr"litt~°S Yes C NO ~' ;r6S VN'"1lSi 708rG~'
• Wriat or~,anization5 ir'. ,nom '..I?1 ~~ iJiiami ~°a^i"' ~C ;JJL CUrr°"iiiV r>CI~ ^"I~'rt'iC)°rSnl~; Ir:
Name: ~ ftiG
Name: ~ itie
• List all properties owned or have an interest in, which are located within the City of ,Viami Beach:
• i am notir erTZpfoyec by the amity o' f~iiam~ Beach: Yes ~~ or Nou. Which deoartment~
: Furstlant.to C[ty Code Section 2-Z5 (bj: Do you have 2 parent D, spouse _, child ~; brother ~, or sister D who is employsc a~~ t~~.
:. it}~ of Niiami 3~act-~ % Check al that apply. Identify the department(s):
The folkowing intorrr~atton is voiuntan~ and es neither part of your application nor has any bearing on your considerattan for appointment
being asked to comply with federal equal opportuntty reporting requirements..
Gender: D hhale ~ Female
Ethnic Origin: Cheri: one only ;1}
D White (Nat of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Mtctdle Gast.
D afri.:an-American/Stack (Not of Hispanic Originj: AIf persons having origins in any a` the Blaci; racial groups of Africa.
Hispanic: all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race
J t~stan or Pacfftc istantier: All persons having origins in any of the original peoples of the =ar mast, South+rast Asie, the Indian Subcontinent. or
~ the Patftc lstartcls. This area includes, far example, ChirtE, India, .iapan, Korea, the Philippine Islands and Samoa.
D American i~clten or ,4taskan Native: All persons having origins in arn~ of the original peoples of North Arneri.:a, and who maintain
~ Guttural irlet*tttfCCafion through tribal affi{fiaflan or commtmlty recognition.
~.
~hysicatby Chaliengect: Yes ^ or o~
Employment Status =mployed D Retired ^ Homemakers ether D
N6TE: ff appoettted, ycu wilt be reQubt+sd to fotiow certain iavrrs which apply to ctt:y baardicommtttise members.
These havers bnciude, beat are not titratted tn, the following:
c Prohibition from directly or indire:;fly lobbying cit}~ personnel (ftliiami Beach City Code section 2-49)
Prohibition from contracting with the city (Niiam+-Dade County Oode section 2-'I '~ .1).
Prohibition from lobbying before beard/commtttee you have served on fob period or one year after leaving office lNlcam
Beach City Code section 2-z6}.
Requirement to disclose certain financial interests aria gifts ({vi~am+-Dade County Lobe section 2-~ i .1 ).
(re: CMB Community Devetoprnent Advisory Committee): prohibition, during tenure and for one year after leaving offl~~
from having any interest in or receiving any benefit from Community Development BIoc4< Grant funds for either voursef
or thQSe with whom you have business or immediate family ties (CcP 570.61'') "
Upon request, copies of these laws may be obtained from the City Cierl;.
"'. her 1' a f to c % and truthfulness of the application and have received, read and wi{( abide b}~ Crartte~
to V{{ City C d 'Sf;.ant4ards of Gonciuct for Git}~ Officers, =mptoyees and Agency Memb rs."
~`
Apolic nt`s SYgr~e mate Name of HoDl~can~ (~'~~G,S~ ~~ i
pr se attar; 2 cop, o" vottr resume tr, this appltcat~on
~ NO7E: Applccatiortr will remain file for a Deriod ~' DnP ! i ; ~at,endar vea-
Recewec it the ~ t~, ~ieri~<. ~ffto< o~,; ~ - : ~ ~~ mate ~ ~ ;'20 tJ :,ontro~ No ~` 3~j .irate X200;
Name o` ~enuty ~-ert: _ -
M®°�'DE 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
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
r
❑ County Board Member Municipal Board Member, Name of Municipality:
Board where serving
1
s r2��nJS
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
i
I hereby swear ,r affirm)that the informatio, above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑Hardcopy
X ❑ Electronic Copy
Si Xature of person ding. -,_-. isclos
L.
Print name Date sig d
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/Initials:
138 SP-14 2/13