Dale Stine 12.31.2016r
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
January 05, 2016
Mr. Dale Stine
1573 Pennsylvania Ave. #1N
Miami Beach, Florida 33139 •
SUBJECT: LGBT Advisory Committee
Dear Mr. Dale Stine:
Congratulations!You have been reappointed by Commissioner Joy Malakoff to the above referenced,
boa r d o r co mmittee named above, for a term ending: 12/31/2016.
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,
Raf el 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: Mr. Dale Stine
RE: LGBT Advisory 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* requirements of Miami-Dade County or the
State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
0%'_11 1 :J.4, _
Mr. Dale Stine
Sworn to and subscribed before me this 1O 1-'' day of-Y , 2015.
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
CO SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2014 • `5�c vi ctle._ . 6 •
Mailing Address—Street Number,Street Name,or P.O.B x
. t Ri,) Pe __,
. f\k,4,-, 't IN)
City,State,Zip ID Number
1Y\idmu ge Ft 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__of Employee —
County Employee n Municipal Employee, Name of Municipality:
Position held or sought
Department where employed
Work address Work telephone Term began on
Filing as a Board P4lelmber
-- , is � .
_
County Board Member n Municipal Board Member, Name of�rlunicipality; Lct ✓�-(
Board where serving
IL CD 6 r 0 d()iSb/7 - • 00 i.,,, -i9,,,014e)
Work address Work telephone I 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.7
Name of Source of Income • Address I Description of the Principal Business Activity
• . , I ei n - ( ,e r, --,'�J1c ,' _ e /vvtu, C
e . IN4
i i. , 111 I 1 OUc IS
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
I ❑ Hardcopy
IEl EElectronic Copy
____....—..=..Signature of person w—►sclosi ____....—..=..
Thi 1 r? 2.0it
Print name to sig ed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Dateilnitials: Scanned Date/initiais:
!3&SP-14 2/13
t t 1—\ ! a_ rL �as?C
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
,vww.mlam ibeachFl.gov
CITY CLERK'S OFFICE CityClerkCmiamibeachFl.gov
Telephone: 305.673.741 1 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 Members Name: �C
5/-/ .A,8
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 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.
/ cP" /)0(C
Signature Date
Updated:Wednesday,April 09,2014
Page 4 of 4
F:\CLER\SALL■aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
TI t\t) M I t EAC H
DIVERSITY STATISTICS REPORTING
Name
r d
Board / Committee: of s
br C i m � �i
Appointment Date: 1 /b
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?
1I,African-American/Black
L�A! C aucasian/White
Asian or Pacific Islander
Native-American/American Indian
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 yo . consider.yourself Physically Disabled?
re No
D Yes
C:\Users\CENTFraNWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015