Joy Malakoff 12/31/21MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
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scan o o Letter of Appointment TERM END: I 'DI 'TERM LIMIT: />15/9/
Scan o o Letter of Reappointment
o ~ Appointment/Reappointment_ elmaile<f _to Committee Liaison on
o Board and Committee Application (Completed on _/ ____,., ___._ __ _,
o Résumé/Curriculum Vitae ·
o Diversity Statistics Reporting (Completed on _,
o Oath
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓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
✓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
: A gH CITY OF MIR» ! rrÇF rue-v.OCitywide Permit Application (Parking Department Form)
RECEIVED
JUL 077
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Received on:
Processed on:
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 Keep COPY in file and ORIGINAL for Annual Report.
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Date
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CONCLUDED & RESIGNATION LETTERS
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\BOARD AND COMMITT IES DATABASE\CHECKLIST MA STER\B&C Checklist 2015 MA STER.docx
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
Oath of Offi ce
Oath of Civility
and
Acknowledgements
TO: Ms. Joy Malakoff
RE: 2020 Hall of Fame Selection 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: 12/31/2021.
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.
on±2e T • vower/
Sworn to and subscribed before me this 1 day ~1. 2020
*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.
•d. .t • ho, 2el
a. Au aeon (ft? „a0%
DATE OF APPLICATION: ----
LAST NM E; FIRST NAME:
NAME OF BOARD/COMMITTEE: -----------------
J[[FE,
WORK PHONE: HOME PHONE:
CELLPHONE:
/EH1CLE MAKE
£
VEHICLE MODEL
I understand that Board/Committee Citywide Parking entitles me to park at any
parking meter both on-street and off-street (metered parking lots) I further understand
that Citywide Parking is NOT AUTHORIZED AT_ATTE NDE DLT SQRG ARA GES
EXCEPTION: CITY HALL GARAGE (1755 MERIDIAN AVE).
NOTE: Your license plate now serves as your "parking permit". Parking enforcement
specialists are equipped with handheld and mobile LPR devices to confirm your parking
permit status (valid/invalid).
In order to avoid any unnecessary enforcement actions, it is important that our records
reflect the most current and accurate information regarding your vehicle license plate.
Please provide us with your current vehicle information {yearimake/model/license plate
number}. Inaccurate and/or outdated vehicle information may lead to the issuance of
parking citation(s), and/or the towing of your vehicle.
Applicant's Signature:
VEHICLE YEAR TAG NUMBER
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.mi amibaachfi.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeach.gov
Telephone: 305.673.7417
AFFIDAyII QF AFFILLAQN yIH THE çrF MIAMI BEACH
srare or9RIA_. DL
COUNTY OF /MA)cm- ' {'
I, the undersigned, do hereby state under oath, and under penalty of perjury, that the following
facts are true:
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 {4).
as (check () all that apply;:
[] Resident of the City of Miami Beach for six months or longer.
[] Demonstrates an ownership interest (for a minimum of six months} in a business established
in the City {for a minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
Business" means any sole proprietorship, sponsorship, corporation, limited liability company.
ES7 ne 5}n ate Date 7
NOTARY
Sworn to (or affirmed) and subscribed before me. by 111€ans of~sical presence or□o_nlîne
a..s-.l.a_Te] _ a., Ch4al=1 l)/5
)o4_yet4l4Ky _cay or ami each soar a/committee Memben.
Produced ID X l;.:¡¿''1 K Fom, of kientification
natate Si@rlirf6t fotary Pub!g•. cneres J. Agosti
(NOTARY SEAL)
Name of Notary. Ty_
• Er
Chartes J. DAgostin
$9y e,_ 4gT ARY PUBLIC
STATE OF FLORIDA
ell! comm# GG168171
Expi res 12/14/2021
MIANIBEACH
City of Miami Beach
700 Convention Center Drive
Miami Beac h. Florido 33139
www.miamibeochfl.gos
OFFICE OF THE CITY CLERK
Email:. SC@miamibeach\.gos
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
£„gl« y# Last'Name
L i
Mid dle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
J Male
g remale
loner
L.l 1 prefer not to answer.
Race/Ethnic Categories:
What is your race?
.l Atncan American/Black
Ll Asian or Pacific Islander
à caucasian'white
[lNative American/American Indian
Lther - Print Race.
Llt prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
Ao
Ll 1 prefer not to answer.
Do you consider yourself Physically Disabled?
ll Y es
4
LlI prefer not to answer this question.
Page 6of6
:CLER$ALLREGBOAD MAN COMMITTEE APPLICATIONS FINAL DRAF TSBOARD AND CCOM MIT TEE APPLICATION REG FINAL JD 0
updated. June 2020
MIAIBEACH
City of Miami Beach
1700 Con vention Center Drive
Miami Booch. Florida 33139
w_mgigitegcht_go
OFFICE OF THE CITY CLERK
Email: BC@mniamibeach!_go
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Comm ittee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Dy;p u[a Io(=
astName First N ls± 4.
Middle Initial
I understand that no later than July1,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.
2ne of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach. Forida, no later than 12:00 noon of July 1, of each year.
1/ A "Source of Income Statement:" or
/2. A"Statement of Financial Interests (Fomm 1);' L)>ye
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.
hile9y iv·iatu
r /2,2e2
Date 7 7
' Members of the Planning Board and Board of Adjustment will be notifi ed directly by the State of Florida,
pursuant to F.S. $112.3145/1)a), to file a Statement of Financial Interests (For 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon , July 1. Planning Board an d Boa rd of Adjustm en t members wh o file their
Form 1 with the County Supervisor of Elections automatically satisfy the Co unty's finan cial disclosure
requirement as a Miami Beach City Bo ard/Co mm i ttee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5of6
:CL ER$ALL'REG BAR D AN COMM IT EE APPLICATION S FINL DR AF T SBOARD AN D CCM MIT TEE AP PLICATION REG FINAL d0
Updated. June 2020
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OATH and Letter.pdf
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