Rosalie Pincus 12/31/2015 8
City of Miami Beach, l0O Convention Center D��.Miomi Beach, Florida 33139'
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
TeL (3051673-7411, Fax: (305)673-7254
2/14/2014
Rosalie Pincus
11 Isl8OdAVe ACt.1512
Miami Beach, Florida 33139 ' '
Personnel Board
Congratulations! You have been reappointed by the City Commission b} the above
referenced agency, board or Committee fora term ending: 12/3112018.
If you are unable to accept this appointrnmnt, please notify the City Clerk's Office at
(3O5) 873-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
SiOCenGlV'
/ae _- ��[� . [���/wmdO
City Clerk
cc: Saul Frances, Parking Director
Sy|vimneo�o-Taba�
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ATTACHMENTS:
Letter ofAppointment
Oath
City Code/Ordinance section applicable ho agency, board orcommittee
City Code Section 2-22, 2-23' 2'24' 2'25, 2-26, 2'2458. 2-450
Ordinance 2U08-3543 -Amendment to City Code Section 2-22
W4|onli-Dode County Code Section 2-11.1.1 -Conflict of Interest and Coda 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 m our vibrant, tropical, historic community.
'
MIAMIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.pov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO: Rosalie Pincus
RE: Personnel Board
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 Amendment and Code of Ethics for Public Officers andunderstand 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.
Rosalie Pincus
- Sworn to and subscribed before me this day of , 2014
a
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 p�pvidin excellent ubli, service and salt to a I hQ live, w rk and la in ou vibrant.t ical historic community.
Vl%e ore c;oand ed!o pr gidrng F>xcolrp!p�lblic 5ervrce and Ids. to a w io live, worT,Uric p, y rn our vrCranr, troy;M, rustdr,c commumny. ty
ZZ AI'Ai
Vfi 6EAi_',H
B 0 A R 7"1-Z'1 C,_'.) 19,4 ;1"1 E A .A
'�_NAME: Ak L)S R U e—
Last Name First Name Middle Initial
HOME ADDRESS: 11 -Tsla VA &0e.
No. ' '8treet city .J State — 9p Code
PHONE: (3e->t;) va.41 �kl SZ&
Home Wgrk Fax Email address
Business Name: Position:
Address:
No. Street City State Zip Code
Professional License(describe) Expires: Attach a copy of
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 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.
• Resident of Miami Beach for a minimum of six(6)months:Yes R�®r No ❑ 1
•Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes❑or No
•Are you a registered voter in Miami Beach:Yes 9;.dr'No ❑
•(Please check one): I am now a resident of: North Beach ❑South Beach �e Beach ❑
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
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. (Regular Boards of City)
11 Art in Public Places Committee 0 Housing Authority*
0 Beach Preservation Board 0 Loan Review Committee*
❑Beautification Committee ❑Mayor's Green Ad-Hoc Committee
❑ Board of Adjustment* 0 Marine Authority*
❑Budget Advisory Committee D Miami Beach Cultural Arts Council
:3 committee onHomeless [I Miami Beach Commission For Women
0 Committee for Quality Education in MB 0 Miami Beach Florida Sister Cities
❑Community Development Advisory* ❑Normandy Shores Local Gov't Neigh. Improvement
0 Community Relations Board 0 Oversight Committee for General Obligation Bond
D Convention Center Advisory Board 11 Parks and Recreation Facilities Board
D Debarment Committee $Personnel Board*
❑ Design Review Board* D Planning Board*
D Disability Access Committee ❑Police Citizens Relations Committee
0 Fine Arts Board D Production Industry Council
0 Golf Advisory Committee 11 Public Safety Advisory Committee
0 Health Advisory Committee 0 Safety Committee
%Health Facilities Authority Board 0 Transportation and Parking Committee
0 Hispanic Affairs Committee 0 Visitor and Convention Authority*
0 Historic Preservation Board* 0 Youth Center Advisory Board
Board Required to File State Disclosure form
-scanned
I
• Note: If applying for Youth Advisory Board,please indicate your affiliation with the Scott Rakow Youth Center:
►. Past service on the Youth Center Advisory Board:Yes L7 No❑ Years of Service:
2. Present participation in Youth Center activities by your children YesD No P. If yes, please list the names of your children, their
ages, and which programs. List below:
C Age: Program:
Child's name:
Child's name: Age: Program:
•Have you ever been convicted of a felony: Yes❑or No&, yes, please explain in detail:
• Do you currently have a violations)of City of Miami Beach codes: Yes❑or Nom 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 Boards or Committees: Yes or No❑. If yes; which board?
•What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned or have an interest in,which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach:Yes❑or No .Which department?
• Pursuant to City Code Section 2-25(b):Do you have a parent 0,spouse 0,child 0,brother 0,or sister 0 who is employed by the
City of Miami Beach?Check all that apply. Identify the department(s):
This section is"not required"but desired: Age: years old Gender: Male❑ Female pig
Ethnic O ' in (Check one)
White African-American/Black❑Hispanic: 0 Asian or Pacific Islander❑American Indian or Alaskan Native❑
Employment Status: Employed ❑ Retired 1*111-0`me-maker❑Other❑
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII—of the City Code"Standards of Conduct for City Officers, Employees and Agency Members."
4--�#w au-t- :EJ_C 9-A c) ?9,VCfjJ0 C, 1 v
Appli nt's Signature Date Name of Applicant(PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE:Applications will remain on file for a period of one(1)calendar year.
Received in City Clerk's Office by Date
Name of Deputy Cleric .
Document Control Number(Assigned by the City Clerk's Office) Entered By Date
Revised 1/25107 jo
i=:`•i>L��!��-1L.E�c.,.ip,�iir.;r? .x� � :,�;_>nd ,..cic �_
ROSALIE B. PINCUS
11 Island Avenue Apt. # 1512 Miami Beach,Florida 305-532-4247
WORK EXPERIENCE
Miami Beach Senior High School, Miami Beach,Florida
■ Counselor,College Assistant Program, 1982-2002
VOLUNTEER EXPERIENCE
Minority and Women Owned Business Advisory Board Miami-Dade Countv
Appointed 2003
Personnel Board -City of Miami Beach,Member and Past Chairperson
Appointed 1999
Mount Sinai Medical Center Board of Trustees,Miami Beach,Florida
Appointed 1977,Appointed Life Trustee 1993
Miami Jewish Home and Hospital for the Aged,Miami,Florida
Board of Director's Appointed 1986
Douglas Gardens Community Mental Health Center
Boars!of Directors,Appointed 1982,Past President
Fine Arts Board,City of Miami Beach
Member 1981-1995
Community Relations Board,City of Miami Beach
Member 1995-1997
Miami Beach Commission on the Status of Women,Miami Beach,Florida
Board of.Directors 1997-1998
AWARDS RECEIVED
Unsung Heroine Award City of Miami Commission on Status of Women
1995
Key to the City of Miami Beach Presented by Mayor, 1994
EDUCATION
Rollins College Winter Park,Florida, Bachelor of Arts
e
MI D E SOURCE OF INCOME STATEMENT
0
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
GUS f�OSQ!lcL
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
F-1 County Board Member Municipal Board Member, Name of Municipality:
Board where serving
So [/�
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 swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
ignature of person disclosing
Print are D to sign d
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
133 SP-14 2/13
Rosalie Pincus
11 Island Ave Apt.1512
Miami Beach Florida 33139
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.gov
City Clerk's Office
Telephone: 305.673.7411 FAX: 305.673.7254
CityClerk @miamibeachfl.gov
Date: May 1, 2012
To: Members of City of Miami Beach Advisory Boards
Subject: Financial Disclosure - Section 2-11.1(i) (2) Code of Miami-Dade County
All Boards and Committees of the City of Miami Beach, including those of a purely advisory
nature, are required to comply the 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 2, 2012.
1. A "Source of Income Statement" (form attached), or
2. A "Statement of Financial Interests (Form1) (form attached), or
3. A Copy of the 2011 Federal Income Tax Returns
Failure to file, pursuant to the Miami-Dade County Code, may subject the person to a fine of no
more than $500, or 60 days in jail, or both.
Should there be any questions, please direct them to Ms. Silvia Prieto at (305) 673-7000 ext.
6269.
Rafael E. Granado
City Clerk
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