Walter Lucero 12/31/2016 M [AMIBEACH
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
3/13/2014
Walter Lucero
919 Michigan Ave.
Miami Beach, Florida 33139
SUBJECT° = Police Citizens Relations 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. Gr nado
City Clerk
cc: Saul Frances, Parking Director
Chief R. Martinez
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.miamibeachfl.ciov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO Lucero Walter
RE: Police Citizens Relations 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: 12/31/2015.
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 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 the 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 have served.
cero Wall ;er
Sworn to and subscribed before me this day of �� , 014.
X
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
I �
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
1 MIAAAI BEACH BARD AND COMMITTEE APPLICATION FORM
LU C_CL_r0 0 U(
Last Name First Name ' Middle Initial
Home Address City State Zip Code
Home Telephone Work Telephone Cellular Telephone Email addr
�Ueumac—r IL.QiG�� E�1V-:; \Ci \C�L�d` 6,AakQ+ A c0
Business Name Occupation
lb"r=b Li
Business Address ` City State Zip Code
Professional License (describe): Lic_r ZA`ZA (4- �SS ¢ Expires:
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a&b: Members of agencies, boards and committees shall be affiliated with the
City; this requirement shall be fulfilled in the following ways: a. An individual shall have been a resident 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 for a minimum of six months.
• Resident of Miami Beach for a minimum of six(6) months: Yes or No ID
® Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes Z3 or No
s Are you a registered voter in Miami Bea : Yes�J or No
• 1 am now a resident of: North Beach South Beach IZI Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
e Are you presently a registered lobbyist with the City of Miami Beach? Yes or No
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that
only three (3) choices will be observed by the City Clerk's Office.
❑Ad Hoc Charter Review and Revision Board ❑Disability Access Committee ❑Miami Beach Human Rights Committee
❑Ad Hoc Committee Centennial Celebration ❑Gay, Lesbian, Bisexual and Transgender ❑Miami Beach Sister Cities Program
Enhancement Committee(GLBT)
❑Affordable Housing Advisory Committee ❑Health Advisory Committee ❑Normandy Shores Local Government
Neighborhood Improvement
❑Art in Public Places Committee ❑Health Facilities Authority Board ❑Parks and Recreation Facilities Board
❑Board of Adjustment' ❑Hispanic Affairs Committee ❑Personnel Board
❑Budget Advisory Committee ❑Historic Preservation Board ❑Planning Board
❑Committee on the Homeless ❑Housing Authority ❑Police Citizens Relations Committee
❑Committee for Quality Education in MB ❑Marine&Waterfront Protection Authority ❑Production Industry Council
❑Convention Center Advisory Board ❑Miami Beach Commission for Women ❑Sustainability Committee
❑Design Review Board* ❑Miami Beach Cultural Arts Council ❑Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
❑Visitor and Convention Authority
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review
Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the
following information:
Type of Professional License License Number
License Issuance Date License Expiration Date
Page 1 of 4
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°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board:Yes I.J No Dates of-Service:
2. Present participation in Youth Center activities by your children:Yes No 4�
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes or No 4D If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes IZI or No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes or No If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No If yes,which board/committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
•Are you now employed by the City of Miami Beach?Yes or No
All
Which department and title?
• Pursuant to'City Code Section 2-25 (b): Do you have a parent 0, spouse �, child brother, or sister who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s)and department(s):
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for
appointment. It is b g asked to comply with City diversity reporting requirements.
Gender: Male'LM Female
Race/Ethnic Categories
What is your race?
ID African-American/Black -
I�Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other-Print Race:
Page 2 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
0
Yes
Do you consider yourself Physically Disabled?
No
Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
• Prohibition from directly or indirectly lobbying City personnel (Miami Beach City Code section 2-459).
• Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office (Miami Beach
City Code section 2-26).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
• CMB Community Development Advisory Committee: prohibition, during tenure and for one year after leaving office, from having
any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom
you have business or immediate family ties (CFR 570.611).
• Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
• Voting conflict—Form 813 is for use by any person serving at the county,city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
Upon request,copies of these laws may be obtained from the City Clerk.
I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS- OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE.MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
j� Lc��c�
Applican Dat Name of Applica PLEASE PRINT)
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date(
PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A
COPY OF ANY APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
i `
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfi.gov
CITY.CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:
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 required to comply with Miami-Dade County
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than-12:00 noon of July 1, of each year.- -
1. A "Source of Income Statement"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pd
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fl.us/ethics/forms.htmI
3. A Copy of your 2013 Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
Signat- D to
Updated:Thursday,March 13,2014
Page 4 of 4
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MI O ODE SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Vame 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
❑ County Board Member 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
I hereby slivear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
ign ure of per n disclos3 g _~
a ��t 2b,.
Print name Date sig ed
OFFICE USE ONLY Accepted: Y / N De iciency; Processed D2te!Iniiia!s: Scanned
u
138 SP- ' 2/13
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miomibeachfl.gov
Tel:305.673.741 1 ,Fax: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)
Board Member na me.
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
required to complywith Miami-Dade County Disclosure Requirements. This means thatthe
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 follo'Ning 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.
YZ /y
Sign a re: Date:
c