Richard Segal 12.31.2015 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
May 12, 2015
Mr. Richard Segal
1450 Stillwater Dr.
Miami Beach, FL 33141
SUBJECT: Board of Adjustment
Dear Mr. Richard Segal:
Congratulations!You have been appointed by the City Commission to the agency, board or committee
named above 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 again and good luck.
Regards,
afael Grana.o
City Clerk
cc: Saul Frances, Parking Director
Michael Belush, 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
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: Mr. Richard Segal
RE: Board of Adjustment
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*requirements of Miami-Dade County or the
State of Florida (depending on the board or committee on which I serve)on July 1 sit, following th,closing
of the calendar year on which I have served.
.• (
j
Mr. Richard Segal‘"
G 4.1- I
Sworn to and subscribed before me this
/ , day of �I/6 , 2015.
Clara La Rosa
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 committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
MIAMI-DADE 1_ SOURCE OF INCOME STATEMENT
COUNTY
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2014 Se_GAiti Ri ci i►ce rd r
Mailing Address—Street Number,Street Nae,or P.O.Box
ZD I 54-L 6,5 CG`pi e 6 / vd t/414 2-7 !Art,' , ft
,
City,State,Zip ID Number
3 I 3 1
, .
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 Empl®yee- --
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
t
❑ County Board Member ❑ Municipal Board Member, Name of Municipality: H-(4 yee, N
An
ame where serving
( ,c cP 61 0 a did u c � ,24
Work address Work telephone Term began on
4 ,s Give, cs 4 tzrzsvy, 0 ' 3C- ,ax)
List below every source of income you received, along with the address and the principal ac ivity 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.0
Name of Source of Income Address Description of the Principal Business Activity cifi4 ,...eii,, e...--
I hereby swear(or affirm)that the information above is a true d correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
A__ ❑ Hardcopy
❑ Electronic Copy
-/
Si nature of perso isclosing
12 t ;e.;5`-1,- 1 3---- ,s - /J
Print name Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
I
t\/\IA/V\i MIA/MB—Li nCH
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: \l ct rm L
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.qov/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.
///, / 7_
Signature Date
Updated:Wednesday,April 09,2014
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