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Carol Housen 12.31.2016 MIAMI = EAC H • 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 1/16/2015 Carol Housen 7330 Ocean Terrace #2001 Miami Beach, Florida 33141 iSU701ACTl;° Design Review Board Congratulations! You have been reappointed by the City Commission to the above referenced agency, board or committee for a term ending: 12/31/2016. 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, Ra ael E. Granado City Clerk cc: Saul Frances, Parking Director Deborah Tackett 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.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Carol Housen RE: Design Review 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 have been appointed for a term ending: 12/31/2016. 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 1st, following the closing of the calendar year on which I have served. g_ed //t,, / Carol Housen Sworn to and subscribed before me this day of - , 2015 06AA".1 fOirr -Ol q S luia-Pto'c?.v.--n 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�ommitted tQ��v dinRAT eller�RIfiblfc�.service anc�sa lty to Pll,�v �eve v o► ,fir yl Ql�y i�9 r��pr,P 11c-trpli ich�s�P �r9Rmmunity, are cxmirru .c. c> >r me e:xce,.c.� U J!C;56r�9CE'arlC sae o o <. vc.. ��lor ,c r i rr.r MIAMWADE SOURCE OF INCOME STATEMENT COUNTY Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2014 kôos CrO ( A iu Mailing Address-Street Number,Street Name,or 7,P 0.Box City,State,Zip ID Number 6 M' P 111 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 fl Mu '.`sal Employee, Name of Mu pality: Position held or sought Department where employed r Work address Work telephone Term began and `) co = 0 �— Filing as a Board Member -Yi -7-1 ❑ County Board Member El Municipal Board Member, Name of Municipality: (Y\t ►M I3ic2J2-L__7 Boa where serving -�S ►'�� GP Ocam.r Work address Work telephone Term began on 2-O 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.❑ ,M Name of Source of Income �1 Address CO /� Description of the Principal Business Activity ► I a �` C 1.1-Y RJ. US q b /'t 1 Yvt-��; l. r''C�l C�,/ i -� �s� .-2 Sodid_g, R -raj ti\Jccyyy.e— 5 - 6 9 S Jz.o t(7_ 1' ' �1 5 - Cp q s r—y- 1 L 1 (v1 0 �--� it 'O`CQ O 5 5 SeC r sg-a) t i 1 8- 55 G 'a/h-A-) I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy df-Le Ayt - ❑ Electronic Copy Signature of person disclosing • (!'a rd• / ////t) #e 05,.01J c>7 Print name I ate si ned OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _ 138 SP-14 2/13 MIAMI City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.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: 'r6C 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.pdf 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.html 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. ,2AAS Signature Date Updated:Wednesday,April 09,2014 Page4of4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx