Dale Gratz 12/31/2019MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
December 16, 2016
Ms. Dale Gratz
215 E. San Marino Dr.
Miami Beach, Florida 33139
SUBJECT: Cultural Arts Council
Dear Ms. Dale Gratz:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, fora term ending: 12/31/2019.
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.
Respe
Rafael Gra ado
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 Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
TO: Ms. Dale Gratz
RE: Cultural Arts Council
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.
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.
Ms. Dale Gratz
Sworn to and subscribed before me this % Z>sz day of , 201&
'Damon Quezada
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
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
AS
Disclosure for Tax Year Ending
201.4
Last Name
Mailing Address — Street Number Street Name, or P.O. Box
First Name
'bpi V
Middle Name/Initial
City, State, Zip
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. ❑
loyee (check one
Filing as a Board Member (check one)
El County
0 Municipal:
Ca ,
tib e2_10-
(Municipality)
Board wh re serving
Ooukie,d
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. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also; include any source of income received by another
erson for our benefit Hoav� i r the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
P Y
Name of Source of Income
Address
% County Public Health Trust Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
El County
0 Municipal:
Ca ,
tib e2_10-
(Municipality)
Board wh re serving
Ooukie,d
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. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also; include any source of income received by another
erson for our benefit Hoav� i r the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
P Y
Name of Source of Income
Address
Description of the Principal Business Activity
I hereby swear (or affirm) that the information above is a true and correct statement.
l
Signature of Person Disclosing
�/a
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency:
?39 SP -i4 COE2016
Processed Date/Initials:
Scanned Date/Initials:
a
1i1 B E 1
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: `-DQ(IE rt1 z'
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 days in jail or both.
)
Signature
Updated: Monday, April 20, 2015
Page 4 of 4
F.\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Da e
MIAMI BE
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee:
Appointment Date:
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 Ul Female TJ
Race/Ethnic Categories
What is your race?
African-American/Black
L.Z.Caucasian/White
CD Asian or Pacific Islander
LJ Native-American/American Indian
0 Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
arNo
Li Yes
Do you consider yourself Physically Disabled?
No
Yes
CAUsers\CENTFraN\AppData\Loco\Microsoft\Windows\Temoorary Internet Files\Content.Outtook\NP4J9CMASC minority
information form 05-20-13 FINALdoc
Updated: Monday, January 26,2015