Samuel Rabin, Jr. 12/31/2019MIAMI 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
Email CiyClerk@miamibeach.gov
December 16, 2016
Mr. Samuel Rabin, Jr.
9 Island Ave. #2101
Miami Beach, Florida 33139
SUBJECT: Cultural Arts Council
Congratulations! You have been reappointed by City Commission to the above referenced, board or
committee named above, for a term ending: 12/31/2019.
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 I Granado
City Clerk
cc: Saul Frances, Parking Director
Max Sklar, 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.
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
Email CityClerk@miamibeach.gov
TO: Mr. Samuel Rabin, Jr.
RE: Cultural Arts Council
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: 12/31/2019.
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 1st, following the closing
of the calendar year on which I have served.
Mr. Samuel Rabin, Jr.
Sworn to and subscribed before me this
�rd
day of /14h1-2 201.
-R TTmr'Quezeda- __I,tmoN
Deputy Clerk 541...v471,4
*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 BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
CityClerk@miamibeachfl.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 Member's Name:
cc6Ismx_e
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 Tater than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
2. A "Statement of Financial Interests (Form 1)"
3. A Copy of your latest 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.
�rm
I\
Signature ;. Date
Updated: Tuesday, October 04, 2016
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
M IA M I•DADE
COUNTY
SOURCE OF INCOME STATEMENT
Disclosure or Tax Year Ending `Last Nam
I First Name Middle Name/initial
�`� i UUI , :
Mailing Ad ress —Street Nur, Stre� or P.O. BJ�x
E
City, State, Zip
) 1tifd, 614, 39
ID Number
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. 0
Filing as an Employee (check one
Filing as a Board Member (check one)
County Board
O Municipal:
(Municipality)
Board where serving
Alternate address (if home address is exempt)
!Work telephone
Term began on/ended 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. ❑
Nance of Source of Income
Address Description of the Principal Business Activity
County/Public Health Trust 0 Municipal:
(Municipality)
Department
Position or Title
Work address
Work telephone
Employment began on/ended en
Filing as a Board Member (check one)
County Board
O Municipal:
(Municipality)
Board where serving
Alternate address (if home address is exempt)
!Work telephone
Term began on/ended 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. ❑
Nance of Source of Income
Address Description of the Principal Business Activity
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I hereby sw "- it affirm) th the infon .. on above is a true and correct statement.
♦f .
RECEIVED BY ELECTIONS DEPARTMENT
L Hardcopy
❑ Electronic Copy
Signature s erson Disclosing
111`.11 e
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency;__".
"130_SP•14 COE 2015
Processed Date/Initials:_.
Scanned Date/Initials:
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.741 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 Member's Name: a WA l7 (A ct b(h r
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"
2. A "Statement of Financial Interests (Form 1)"
3. A Copy of your latest 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 da s in jail or both.
Signatu� ' Date
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\SC APPLICATION REVISED 06022014.docx
I\AIAt\A BEAC
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee: 0J (Id f a.'4 -c- u dl
Appointment Date: t I /(P
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: Mal Female _ is
Race/Ethnic Categories
What is your race?
African-American/Black
CaucasianAAlhite
Asian or Pacific Islander
l 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 you consider yourself Physically Disabled?
Flo
Yes
C:\Users\CFNTFraN\AppData\LOCa\MiCrOSOft\Windo`MS\Temoorar! Internet FIles\\Content.outIOOk\!NP J9CiN.<\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26, 2015