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BOARD, AND COM MITTEE CHECKLIST
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FOR SCANNER
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RECEIVED
JAN 1 0 2020
FOR CLERK ST AFF
o Letter of Appointment
o Letter of Reappointment
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o Dversty statistics Reporting (completed on. ,[O_,32)O
o Oath
Liaison on
IMPORTAN T INFORMATION FOR BOARD AND COMMI TT EE MEMBE RS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
Y 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
amended through December 201 O)
✓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 CITY OF MIAMI BEACH
OFFICE "! +E CIT CLERK
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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 Requirement
O DIVERSITY STATISTICS REPORTING
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Signed by A kt :t" -
/ Date:J.a -- ,r ~------~- ••-- , _
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ate cc Or ce Sa iiials,
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CON CLUD ED & RE SIGNATION t¡Rs d ·
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
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F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safely to all who live. work, and ploy in our vibrant, tropical, historic community
MIAM I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florida 33139 www .miamibeachflgav
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. John "Jake" Aleman
RE: Youth Commission
i
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: 06/08/2020.
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 July 1st, following the closing
of the calendar year on which I have served.
Mr. John "Jake" Aleman
sworn to and subscribed before me I) «_San, 201s
*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 BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www .miamibeachfl gov
OF FICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityC lerk@miamibeachfl.gov
December 20, 2019
Mr. John "Jake" Aleman
5824 Alton Road
Miami Beach, Florida 33140
RE: Youth Commission
Dear Mr. John "Jake" Aleman:
Congratulations! You have been appointed by Commissioner David Richardson to the above-
referenced Board or Committee, for a term ending: 06/08/2020.
Pursuant to City of Miami Beach Code Section 2-22 (5)a:
Notwithstanding any other provision of the City Code or of any Resolution, commencing with
terms beginning on or after January 1, 2007, the term of every board member who is directly
appointed by a member of the City Commission shall automatically expire upon the latter of:
December 31 of the year the appointing City Commissioner leaves office or upon the
appointment/election of the successor City Commission member.
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.
Reg'1
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Dr. Leslie Rosenfeld, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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)
We areooktest ecuide itdóthe c@(ensbiné Amén dmberatentó @ode bfeEt/i r ssrfdpByuoliuoffiraetsraicdEirissplcsyeesmunity.
MIAMI-DAD. EIII SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public offi cials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Di sclosure fo r Tax Year Ending I Last Nam e Ale,o First Name 5 Middle Name/Initial A
2019 'O
Mains Addre ss - stre et Numb er, stre et Nam e, or P.0. Bo 592 { Ala R I
City, State, Zi/Vl fee., t , 33/4o ¡o0a«
If your hom e address is your m ailing address, and your hom e address is exem pt from public records pursuant to Fla. Sta t. $119.07, read
instructions on the following page an d check he re. D
[ Municipal:
Departm ent
Position or Title Em ployee ID Num ber
W ork address
Filing as a Board Wember (ch eck one)
[] county ácaa eth <ihy a h omissien LAU @funiciai
Board w here serving a of Ml ,a
Altern ate address (if hom e address is exem pt) W ork telephone
List below every source of incom e you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
pro perty dealings, intere st, 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 Address Description of the Principal Business Activity
f? NH MA
I hereby swear (or affirm) that the information above is a true and correct statement.
dia6.E5>
Signature of Person Disclosing
)/(o/202o
Date signed
sa s#E ß9IP D Hardcopy
econ'1 0 2020
CITY OF MIAMI BEACH
OFFICE OE AE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:. Scanned Date/Initials: _
138_SP-14 COE 2016
MIAM/BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._migmibeachf],gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@rniamibeachfl.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)
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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 form s must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miam i 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 Federai Incom e Tax Return
Failure to file one of these form s, 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.
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Signature Date
Updated: Th ursday, Decem ber 28, 2017
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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Name:
DIVERSITY STATISTICS REPORTING
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Board I Committee: '/// Con1 s ev
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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¿ Female O
Race/Ethnic Categories
What is your race?
LAflcan-American/Black
G caucastanwte
O Asian or Pacific Islander
'_ Nyative-American/Am erican Ian
Œ:::r Óther- Print Race:---=~=--""""=-·-----------------
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
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Do you consider yourself Physically Disabled?
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information form O5-20-13 FINAL.doc
Updated: Monday, January 28, 2015