Rachel Umlas 12.31.2016 MIAtAIEJ' CH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.dov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
March 03, 2015
Rachel Umlas
1424 S. Biscayne Point Rd
Miami Beach, Florida 33141
SUBJECT: Miami Beach Human Rights Committee
Dear Rachel Umlas:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2016.
If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk
at 305.673.7411.
Please read the enclosed materials carefully. Congratulations and good luck.
Respectfully,
R/ /(
afael Granado
City Clerk
cc: Saul Frances, Parking Director
Marcia Monserrat, City Liaison
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, 2-458 and 2-459
Ordinance No. 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.
MIAMI BEACH
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: Rachel Umlas
RE: Miami Beach Human Rights 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: 12/31/2016.
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 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*requ' - is of Miami-Dade County or the
State of Florida (depending on the board or committee on which I - - i n July 1st, following the •'osing
of the calendar year on which I have served.
A (4 LA
Rachel Umlas
Sworn to and subscribed before me this rc". day of ittrr,4 2015.
.. ■_ -
Deputy Clerk :, 1,q- Be?r4,0,1
*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 committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
MIAMI•DADE
COUNTY SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2014 I vYN Li.S t dI ei �.
Mailing Address—Street Number,Street Name,or P.O.Box
(. if 2 4 - . Pori- C-6(k: vut PO
City,State Zi ID Number
Alk 1 / CO .
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 Empioyee .
0 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
M P)e. a❑ County Board Member Municipal Board Member, Name of Municipality: t4 Mit a •
Board where serving
NA la wt,I lbeack V o/h 02-vtt :A 00 i'M�l E�
V4lo 7k address I Work telephone Term began i
L-3 II 2___ AI ?NI (P--d r--(45 0 30S---S 32-022
, . •
• -List belo -vefry source of income you rec a,along with the address and the principal activity of each source.Include your pudic 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 i ddress Description of the Principal Business Activity
LS
Oar IWO=Mt ' S P D - —T II ' 1 4
_ a "Al '
' AA -C-) 7% a 1 itair.arMIIIIIMI di i
I h reby swear(o.affirm)tha.the infor tion above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
. ) , \
❑ Hardcopy
•t ❑ Electronic Copy
nature of person disclosing
(c4VAA(C/ V vIA a > _5__. (14[_>
int me Dat s
OFFICE USE ONLY Accepted: Y I N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
MIAMIE.: EACH
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: KAGI^J 1,611A5 .
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 -o file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no re than $500 60 days in jail or both.
3 to 1S
Sig re D to
Updated:Wednesday,April 09,2014
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
I
MIAMI EACH
DIVERSITY STATISTICS REPORTING
Name: get
Board / Committee: wury
Appointment Date: i
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male Fema
Race/Ethnic Categories
What is your race?
A frican-American/Black
-4! Caucasian/White
•l Asian or Pacific Islander
Native-American/American Indian
Lal Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
JA,No
Yes
Do you consider yourself Physically Disabled?
&f No
La Yes
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015