Janes Hayes 12.31.2015 pending oath CO• I AM I A t 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
05-15-2014
Jane Hayes
3001 Prairie Ave
Miami Beach, Florida 33140
-5,00.0EOPIEi Affordable Housing Advisory Committee
Congratulations! You have been appointed by Commissioner Jonah M. Wolfson
to the agency, board or committee named above for a term ending: 12/31/2015.
--Pursuant--to Ordinance No.. 2006=3543 commencing with-terms-beginning-orror-a er--
January 1, 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.
Sincerely,
Raf el E. Granado
City Clerk
cc: Saul Frances, Parking Director
Richard Bowman
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 Employee
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
MIAMFCaADE SOURCE OF INCOME STATEMENT
COUNTY
Disclosure for Tax Year Ending Last e First Name Middle Name/Initial
2013 ( �e6 3 G,\L� P
Mailing Address Street Number,Street Name,or P.O.Box
2710 rak
City,State,Zip ID Number
Nif\r) C‘ \r\ be_aeiA L- r2D/\ 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 fl Municipal Employee, Name of Municipality:
Position held or sought
Department where employed
Work address Work telephone Term began 9 an on
Filing as a Board Member
❑ County Board Member ❑ Municipal 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
cti\v\-e S Coc -kc,i :�L,0 0 ,c 4e_ eaA ) o C' eav
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
jrA 4,W-
❑ Electronic Copy
Sig al tune person disclosing
I
Print name
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
__
MIAMI BEAC
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeachfl.aov
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 2-1 1 .1(i) (2)
Board Member name: 9/E S
I understand that no later than JULY 1 OF EACH YEAR.aII 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 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 following 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.
I
4 5 — IR -A
Sign,• Dote: