Britta Hanson 12/31/20BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ��,-- �5��1 DATE OF APPOINTMENT: V1-/9-/5
BOARD/COMMITTEE: LAC, Appointed by: C -A iY COAA—M 167
FOR SCANNER FOR CLERK STAFF l /
Scan o o Letter of Appointment TERM END: / 3 TERM LIMIT:
Scan o o Letter of Reappointment
o Copy of Leiter of Appointment/Reappointment-mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on )
Scan o o Resume/Curriculum Vitae i-��/� d
o Diversity Statistics Reporting (Completed on . Q )
Scan o o Oath '
N IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
c ✓ City Code Ordinance Section applicable to the agency, board or committee
✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
+k- ✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
— amended through December 2010)
Lij ch :!StXj ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
LLJ co '— ✓ Highlights of the Miami -Dade County Ethics Code
�r C) ✓ Sunshine Law and Public Records — Frequently Asked Questions
CC '/ '--
C= r-�j ✓ Memorandum - Solicitation by City Board and Committee Members
o Citywide Permit Application (Parking Department Form)
o Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosur quire nt
o DIVERSITY STATISTICS REE/PORT G eep Yin file and ORIGINAL for Annual Report.
Received on: Q� Signed by /�
Date Board r C mi e Member
Processed on: Y Employee:
B Em to ee:
d�
Date I �/ .v""' er ' Office Staff Initials
Scanned on: �`� / 0 By Employee: _
Date Ity e 's Office StafftFiNED
CONCLUDED & RESIGNATIOY TERS
Term Expired Letter Date Processed
Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed
Initials Scan o
F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
VVe ore comm!tfed to providing exceiieni public service and safety to ani who live, work and ploy in our vibrant, tropico!. historic cornmundy
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
January 19, 2018
Ms. Britta Hanson
100 Jefferson Ave
Miami Beach, Florida 33139
RE: Cultural Arts Council
Dear Ms. Britta Hanson:
Congratulations! You have been reappointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2020.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
/RafaelYanaclo
City Clerk
cc: Saul Frances, Parking Director
Brandi Reddick, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
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 vvvnv.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Britta Hanson
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: 12/31/2020.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a public servant.
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 JulyIlowing the closing
of the calendar year on which I have served.
✓' Mg. Britta Hanson
Sworn to and subscribed before me this _X-4, day of� 2018
Deputy Clerk 5At Vq�
*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.
City of (Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.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: PAI +,/✓ 14&V5.::DtJ
I understand that no later than July 1, of each vear 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 moren $500, 60/days in jail or both.
cure
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Date l
MIAMI -DADS 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.
Disclosure for Tax Year Ending Last ame First Name Middle Name/Initial
�gl;46 OL
0500
Mailing Address — Street Number, Street Name, or P.O. Box
10 0 .� �ll;+�soto Av
City, State, Zip
AA(AAAI RbAe.AO
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)
County Public Health Trust r: "
(Municipality)
Department
Position or Title I Employee ID Number
Work address I Work telephone Employment began onlended on
Filing as a Board Member (check one)
0 County Municipal: Ic/e'i't 1 /3E-A7C.I.l'
(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. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRP. 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 I Address I Description of the Principal Business Activity
I here s pie or off that the information above is a true and correct statement.
RECEIVED BY ELECFiO DEfTMENL.,
_
❑ Hardcopy
❑Electronic CoA24— -
-+ N
S ature f ers n Di�ciosing
X,
Daze sig ed
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OFFICE ! SE ONLY Accepted: Y / N n_ficienry: Processed Date/Initials:
Scanned Date/Initials:
133 SP -1: COE 2016
MIAMI BFACH
DIVERSITY STATISTICS REPORTING
Name:
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 U Female
Race/Ethnic Categories
What is your race?
' 'Gn-American/Black
Caucasian/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, Latinos.
0
Yes
Do you consider yourself Physicaliy Disabled?
Nc
Yes
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informarion form 0520-13 FiN.'.L'doc '
Updated: r;tancZy, .!anu:: ,% _.:C1