Barry Klein 12/31/19 (2)IBEA<:H
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: J31?-'/ ,(LQt r' v DATE OF APPOINTMENT: Sl/ 71/ (5)-'
BOARD/COMMITTEE: eb Art4S/714/5A/% Appointed by: (, < i % W/1'4!
Scan o ANNER 00OLettter off Appointment TERM END: 1-2-/3/I 3� ! TERM LIMIT: /4%2/3 ���3
FOR SCLERK STAFF
Scan o o Letter of Reappointment
' of e -r of Appointment/Reappointment a_mail to Committee Liaison on
Scan 0
Scan 0
Scan 0
Scan 0
Scan 0
0
o Board and ommittee Application (Completed on S.- t)
o Resume/Curriculum Vitae �,+��
o Diversity Statistics Reporting (Completed onDt4:7 Ct�`-�Y
o Oath
/r
1
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
tt�°v ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
do
r'°_ amended through December 2010)
,; Wit- ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records — Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
>-
o
r.a
Received on:
Processed on:
Scanned on:
o Citywide Permit Application (Parking Department Form)
o Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
O Acknowledgment of Financial Disclosure Require ent
O DIVERSITY STATISTICS REP_
• ' it' G Keep C �► PY in file a i1 INAL for Annual Report.
)/4A I ``, Signed l-/(
/D.i4/
/ l/U¢'
By Employee:
By Employee:
Em to ee:
Date
a a III IIINMMk
City C. Office Staff Initials;
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed
Resignation Letter Date Processed
Removal Letter due to absences Date processed
Initials Scan 0
Initials Scan 0
Initials Scan 0
F:\CLER\BALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
AVt 019 committed to providing excellent pubic service and say t all who live .n -historic • .4 e� p c and pi�;y .rt Our vibrant 6npx:oi hs,,nc communi+'r
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Barry Klein
RE: Board of Adjustment
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 1 have been appointed for a
term ending: 12/31/2019.
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 July lst, followin• the closing
of the calendar year on which I have served.
IP1NBarry Klein
day of4/14-1, 2018
Sworn to and subscribed before e this
-2'(iarle
'Agostin
puty 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.
AMFDiADE
SOURCE OF INCOME STATEMENT
ction 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
every year.
s- closure for Tax Year Ending Last Name First Name Middle Name/Initial
2017 Ct� 0 ??Pd-ckz-Le
a- iling Address — Street Number Street Name, or P.O. Box
ty, State, Zip
your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
3tructions on the following page and check here. 0
ling as an Employee (check one)
❑ Coun ❑ Public Health Trust ❑ Municipal:
epartment
o- sition or Title
Jork address
(Municipality)
iling as aember (check one)
❑ County
Board where serving
1i/or ' • . one
Employee ID Number
Employment began on/ended on
)Srtlunicipal: , i Y7i of MIA -04t- l
(Municipality)
gooe6 of A-6, qs r, eAJ i
Iternate address (if home address is exempt) Work telephone
Term bega on/ended on
1
st below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sourceE
come in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains fr
-operty dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by anotl
erson 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.1
•
Name of Source of Income Address
2,;01 ,6 . M�� ► << ��
herb swear (or affir
that the information above is a true and correct statement.
1
of P 1Disclosing
•317 H3
Description of the Principal Business Activity
tb-95 I --‘41 co s,;(41,4_4_
1
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
E Electronic Copy
MIAMI BEACH
City of Miami Beach
11700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.aov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.6737411 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:
Nick
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.
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Dat
MIAMI BEACH
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
May 17, 2018
Mr. Barry Klein
6356 Alton Road
Miami Beach, FL 33141
RE: Board of Adiustment
Dear Mr. Barry Klein:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
7J4'
Rafael Granado
City Clerk
gcc: Saul Frances, Parking Director
Rogelio Madan, 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.