David Smith 12_31_18MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.g_ov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
January 17, 2017
Mr. David Smith
4538 Sheridan Ave
Miami Beach, Florida 33140
SUBJECT: Affordable Housing Advisory Committee
Dear Mr. David Smith:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2018.
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.
RespelGrando
Ra el
City Clerk
cc: Saul Frances, Parking Director
Richard Bowman, 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.g_ov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
TO: Mr. David Smith
RE: Affordable Housing 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: 12/31/2018.
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.
David Smith
J Z-' �—I —
Sworn to and subscribed before me this�day of�./�'t-� , 2017.
� 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.
MIMI®- SOURCE OF INCOME STATEMENT
Section 2-11.1(1) 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.
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2016 �J Wytwt �� QV tGi .
Mailing Address — Street Number, Street Name, or P.O. Box
City, State, Zip
If vnnr hnme addrass`is vnnr mai Iinn address. and vnnr home address is exemnt from nublic records Dursuant to Fla. Stat. 6119.07, read
instructions on the following page and check here. ❑
Filina as an Emolovee (check one)
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)
County Municipal: U (a !!!�j' f) t:u C� -
(Municipality)
Board where serving
Alternate address (if home address is exempt) \3 lWork4blephone I 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
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
Description of the Principal Business Activity
2Address c1
affirm) that the inforAation above is a true and correct statement.
of
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP -14 GOE 2016
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. m iami beachfl.aov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@miamibeachfl.gov
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: lJ cf U f 4 GW tf�
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.
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 Date
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\6C APPLICATION REVISED 06022014.docx
MIAMI BFACH
DIVERSITY STAT15TICS REPORTING
Name: a I'd es wt (�
Board / Committee: D c1 1_J12 U 5 'T Qj U1 so
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Appointment Date: t
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 L'�T Female
Race/Ethnic Categories
What is your race?
Alf '.can-American/Slacr:
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other -- Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Marl, the ".No"box+f not
Spanish, Hispanic, Latino/a.
�No
Yes
Deo you consider yourself Physically Disabled?
No
Q Yes
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information form 05-20-13 FtNAL.doc v Y
Updated: PAondav, J2nuaty 20.:=015