Robin Schwartz 12.31.2017 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
December 18, 2015
Ms. Robin Schwartz
7315 Byron Avenue
Miami Beach, Florida 33141
SUBJECT: LGBT Advisory Committee
Congratulations!You have been reappointed by Commissioner John Ateman to the above referenced,
board or committee named above,for a term ending: 12/31/2017.
Pursuant to City of Miami Beach Code Section 2-22 (5) a, "Notwithstanding any other provision of the
City Code or of any resolution, commencing with terms beginning on or after January 1, 2007,the term of
every board member who is-directly appointed by a member of the City Commission shall automatically
expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or
upon the appointment/election of the successor City Commission member."
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.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Daphne Saba, 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: Ms. Robin Schwartz
RE: LGBT Advisoy 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: 12/31/2017:. ,._ .,r� .
.;.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 olio .'ng the closing
of the calendar year on which I have served. w
ILA.
Ms. chwa Trir
Sworn to and subscribed before me this l 2..t4- day of AA)) , 2015.
V ra
•
Deputy Clerk �' '�
S�LUIU
*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:.-
t
•
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
MIAMIDADE
COUNTY SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
20145el, .ivGe f z .266(I�• zr.
Mailing Address®Street Number,Street Name,or P.O.Box
Z- ( 0c7 Av -fit n `F
City,State,Zip ID Number
(r-L 33 `3 `�
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 --
E 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
fi
County Board Member _ Municipal Board Member, Name of Municipality: ( ovvt k r6,e_ec
Board where serving
►� — c501 mwtftee
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
C Al kV&I OVk1 V .r ,e - (
I hereb . 'ir at the/� . r �;.::•is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
/ ��`� ❑ Hardcopy 0/ .
WI Electronic Copy
Signature of person di. losing
12-0 13 i•J W- I 1
Print name Dat sign d
OFFICE USE ONLY Accepted: Y r N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
SCHWARTZRobin
NAME:
First Name
Last Name
Middle Initial
Florida33141
HOME ADDRESS
:
7315 BYRON AVEMiami Beach
Home No./StreetState
Apt No.City
Zip Code
rjs100@gmail.com
3057941864
PHONE
:
WorkEmail Address
Home
LICENSED MORTGAGE LOAN ORIGINATOR
Business Name:
Position:
1825 West Ave #12
Miami BeachFlorida33139
Address:
State
CityZip Code
Street
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated
requirement shall be fulfilled in the following ways: a) an indi
months; or b) an individual shall demonstrate ownership/interest
No
Yes
Yes
circle one): I am now a resident of: North Beach
I am a LGBTQ activist and leader in the community as well as a b
No
123Please note that only three (3)
Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice.
choices will be observed by the City Clerks Office.
(Regular Boards of City)
Choice 1:LGBT Advisory Committee
Choice 2:Miami Beach Human Rights Committee
Choice 3:
Miami Beach Commission For Women
Note: If applying for Youth Advisory Board, please indicate your aff
1. Past service on the Youth Center Advisory Board:
No
Years of Service:
if yes, please list the names of your children, their
No
2. Present participation in Youth Center activities by your chil
ages, and which programs. List below:
No
Have you ever been convicted of a felony:If yes, please explain in detail:
Do you currently have a violation(s) of City of Miami Beach code No If yes, please explain in detail:
Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail:
No
Are you currently serving on any City Boards or Committees:If yes, which board?
What organizations in the City of Miami Beach do you currently h
NameTitle
Gay and Lesbian Chambermember
List all properties owned or have an interest in, which are loca
No
I am now employed by the city of Miami Beach:Which department?
The following information is voluntary and is neither part of yo
being asked to comply with federal equal opportunity reporting r
Gender:none
Race/Ethnic Categories
What is your race?
Mark one or more races to indicate what you consider yourself t none
Other Description:
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani No
Physically Challenged:No
NOTEIf appointed, you will be required to follow certain laws which
:
These laws include, but are not limited to, the following:
Prohibition from directly or indirectly lobbying city personnel
o
Prohibition from contracting with the city (Miami-Dade County Co
o
Prohibition from lobbying before board/committee you have served
o
Beach Code section 2-26).
Requirement to disclose certain financial interests and gifts (M
o
(re: CMB Community Development Advisory Committee): prohibiti
from having any interest in or receiving any benefit from Co
or those with whom you have business or immediate family ties
Upon request, copies of these laws may be obtained from the
I hereby attest to the accuracy and truthfulness of the applica
VII of the City Code Standards of Conduct for City Officers,
I Robin SCHWARTZ agreed to the following terms on 7/15/2015 4:3
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No.Date
tv\ tvA\ L,
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: R0101 v1 G a-1 kh 'e fra
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.
w
lipapr 111
Signa re D e
. Updated:Wednesday,April 09,2014
Page 4 of 4
F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
M, I AAA I EACH
DIVERSITY STATISTICS REPORTING
Name: AD 6 �►
G IAA.
2. g 40/11/507 �s'n� f �e�hoard / Commattee. ��
Appointment Date: / Z /V /
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 Female�.
Race/Ethnic Categories
What is your race?
P5r-ican-American/Black
Cauc
asian/White
LD Asian or Pacific Islander
LD Native-American/American Indian
L3 Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No
Yes
Do you c sider yourself Physically Disabled?
No
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