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Scan o o Letter o' Reappointment ,�
o ? of Lett r of Appoin me-nl/Reappoin'lnfl�ni �-mailed to L1oi'iin'i1l'1�;� L ld1�C}ii on
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iM_1AM,.BEAC
City ®f Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachf.l.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel- 305,673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
TO: Mr. Mark Sinnreich
RE: Health Facilities Authority Board
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: 06/19/2020.
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 I st, following the closing
of the calendar year on which I have served. Jul71 _41"I
r,
A-1
Sworn to and subscribed before me this day of`
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.
MIIAMMA�D3E
1k41UWM SOURCE OF INCOME STATEMENT
0 1111 e%+
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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 y 10L
of every year.
Disclosure for Tax Year Ending Last Name First Name miame Narne/inmai
20-16
Mailing Address — Street Number, StreetN ame, or P.O. Box
(tj
City, State, Zip
3 1
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 (check one)
E] County [] Public Health Trust
Department
Position or Title
Work addressA
0
Filing as a Board Member (check one)
i
Num
(Municipality)
Employee ID Number
Work telephone Employme6t began on/ended on
e
6?
(Municipality)
Board where serving
t It 0 rw 1 6 0 a ro
11K-11 4a a Fk) CA U �i
Alternate address (if home address is exempt) Worytelephone 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.E]
Name of Source of Income Address Description of the Principal Business Activity
t
6z 1. Cot, too�
I her - eby sUearr affir that the infor ation above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
F-1 Hardcopy
Electronic Copy
Signage of Person Disclosing
3'j rof
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/initials:
138 SP -14 COE 2016
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ity of Miami 13each
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfi.gov
CITY CLERKfS OFFICE
Telephone: 305-673.7411 Fax: 305.673.7254
Cit,vClerk@miamibeachfi.gov
Acknowledgement of fines1sus pension for Board/Committee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Provision Code Section 2-11.1 (1*) (2)
7
Board Member's Name:
I understand that no later than J * ul ' V ' I ` ''o ' f ' e ' a ' ch 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.
allowinri forms must -be f Wi h. the L4_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 {Foran 1) 11
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.
Sign
�V `� �� / Z /3 0%�'
�kure Date
Updated: Monday, April 20, 2015
Page 4 of 4
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