Jay Dermer 07.31.2015r
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1915.2015
MIAMI B E AC
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK'S Office
Tel: 305-673-7411 , Fax: 305-673-7254
October 17, 2014
Jay Dermer
4195 North Bay Road
Miami Beach, Florida 33140
SUBJECT: AD HOC CENTENNIAL COMMITTEE
Congratulations! You have been appointed by Commissioner Jonah Wolfson to the board or
committee named above for a term ending: 07/31/2015.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1st,
2007, the term of board members who are directly appointed by a member of the City Commission
shall automatically expire on December 31 of the year the appointing elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City Clerk's
Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
i,Sincerely,
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
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.
- Id Mil. 411111111111k. 0
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1915•2015
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk @miamibeachfl.gov
TO: Jay Dermer
RE: AD HOC-CENTENNIAL 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 07.31.2015.
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Code of
Ethics Ordinance), as well as the Florida Commission on Ethics Guide t the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, and unde'stand that as a
member of a City of Miami Beach Board and/or Committee, I must comply . ith the financial
disclosure* requirements of Miami-Dade County or the State of Florida__.(de.pe.._ •i on the board or
committee on which I serve) on July 1, following the closi_ng--of-t -ndar =.r'on i h I have
served. ,,�
�i'//I
------ w
V Jay Dermer
Sworn to and subscribed before me his /� day of. ok-ArtI A, 2014.
i —G- -
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 Requirement.
MIAMMADE SOURCE OF INCOME STATEMENT
COUNTY
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2014 bE12- e,e.. -MI .
Mailing Address—Street Numb,Street N me,or P.O.Box
O9 fa c o.�v.A(v. o.Ce.
City,St tate Zip a--- ID Number
,M7 OANA' QD,C.V\ L 331 LI 0
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 ❑ Municipal Board Member, Name of Municipality: la V K t 6ectak -
Board where serving
owe ni 1' ee ot. • (4 UL. Ge'1/1 e NN1 1 4
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
.w_-w ! 4-,1-W-.---,
QAe , , 161 . 1 , • ' 3-/)y o
Qc ft 3
I hereby_swear-(or affirm)_t ut fh?information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
` - ❑ Hardcopy
❑ Electronic Copy
RI Moir y
_'•nature o pe son disclosing°'-j Q—kr tWAr ha / (
Print m Da a sign d
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,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 name: t.T Gi Og tw) e. Pe.
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 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 1 each year.
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.
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Signs D te: