Dolores Hirsh 12/31/2015 `
L1 �
` ' '
� City of Miami Beach 1700 Convention Center D Miami Beach, Florida 33139,
OFFICE OF THE cn,CLERK, Rafael smno6o City Clerk
Tel: (30J) m73-74ll' Fax: (305)673-7254
' 1/10/2014
Dolores Hirsh
1365 N. Biscayne Point Road
Miami Beach, Florida 33141
Tennis Advisory Committee
Congratulations! You have been reappointed b« Commissioner Jonah M. Wolfson
to the above referenced agency, board or committee for a term ending: 12/31/2015.
If you one unable to accept this oppointnnmnt, please notify the City Clerk's Office at
(3O5) 673-7411.
Please read the enclosed material carefully. Agoin, congratulations and good |uck.
Sincerely,
Raf88/ E. GraOado
City Clerk
| cc: Saul Frances, Parking Director
JoUoK8agrisso
ATTACHMENTS:
Letter ofAppointment
�
Oath
City Coda (]n1|nanoa oection, applicable to ogenoy, board or committee
City Code Section 2-22' 2'23, 2-24, 2-25, 2-28, 2'2458. 2~458
Ordinance 2OO6-3543-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 Porn)
Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We ore committed to providing excellent public service and safety to a//who live, work and play in our vibrant,tropicol, hi5toric community.
M I AM.1 BEACH
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: Dolores Hirsh
RE: Tennis Advisory Committee
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: 12/31/2 01S.
have been issued a copy of Section 2-11.1 of th4 Miami Dade County Cod e:(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 Officers 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 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.
Dolores Hirsh
Sworn to and subscribed before me this; day°' of F&ZAI*1, 2014
d
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�pmmitted to rovidin excellent public ervice and safgty to al who ive, wo an la in our.vibrant,r i al historic communi
V1'e are corr�m;Ped to Pr' rdinq c>xcall�nt puf,ic se!vrce and sat�1y to o�w?io f ve, wor anc�p�ay �our v;brcmr trop;r ;s�onc comrnun;ly. ry
��A A
I " 1:ACH
I V\1 , v k I TB L_
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33 139,
rrr�,v.miamib�achfl.co�
CF 1Y CLERK Ofcice. CiryClerk@m lam ibeachR.9ov
Te!:305.673.741 1 ,rcx:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11 .1(i) (2)
K
Board Member name:
I understand That no later than JULY i OF EACH YEAR all members oil 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
Iegislation or give advice to the City Commission, must fiie,even though you may have 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.
1. A`'Source oil Income Statement(a Lached)or
2. A"Fina��cial Statement(2t ached( or]
I 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
8500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
Si - Dare:
M®°ADE SOURCE OF INCOME STATEMENT
Disclos a for Tax Year Ending Last Name First Name Middle Name/Initial
3 �r
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
❑ County Board Member XM unicipal 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.❑
Name of Source of Income Address Description of the Principal Business Activity
F 2l �o!1��- 5 t47 1�
� U r s rA
1A rn , n4---.::,
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT.
❑ Hardcopy
' ❑ Electronic Copy
Sign to of person disclosing
-1fC1
Print name Date signed
OFFICE USE ONLY Accepted: Y/ N Oeficiency: Processed Date/Initials: Scanned Date/Initials:
133 SP-14 2/13