Max Gelber 06/08/21MW/A/BEA CH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: 2ug ·elbot /4/o
BOARDICOM MITTE E: _hA r eis5i
FOR SCANNER
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DATE OF APPOINTMENT:
Appointed by: er is ¡or _tl
es . 6//24• 6/8/2/ FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
0 ~ 1Jeycf AppointmenUReappointmentú-ma~~ to Committee
- o@GGsmttee Alavo come„, //{] àO
o Résumé/Curriculum Vitae ~ v jd-
o Diversity Statistics Reporting (Completed on ó_/ )
o Oath
Liaison on
RECEIVED
AUG 18 2020
Ty OF MIAMI BEACH
04o or a ;T CLERK
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, 2458 and 2-459
✓County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
✓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
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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 DIARSITY STATISTICS REPORTING K
]y/9o ses a,a..
fj$lg0_„co- Ad=
1j fi// !e d-Ù By Employee: ~':""'~.'.-;:, ~,& ~- _, ... _e:::
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
FCLER\BOARD AND COMMITTIES DATABASE CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to ponding excellent public service and safety to all who live, wok, and play n or vibrant nocal hstac zonun.
O ath of O ffi ce
O ath of C ivility
and
A cknow ledgem ents
TO: Mr. Max Gelber
RE: Youth Commission
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: 06/08/2021.
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.
0l le
Mr. Max Gelber
swom to and susensed etore me m __f'_„aq_Ape1a02o
*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.
MIAMI-. Erm SOURCE OF INCOME STATEMENT
Section 2-11.1() ot th e County Ethics Cod e require s th at certain employees and public officials file a financial disclosur e Stateme nt on a year ly basis by July 1st
of every year.
Disclosure for Tax Year Ending I last Name First Name Middle Name/Initial
20 19 Gelb Nos A
Mailing Address - Street Number, Street Name, or P.0. Box
S+4 5 laqrc DO
City, State, Zip
71.d,, 33\\ \ra }ah ,
If your home address is your mailing address , and your home address is exempt from public reco rds pur suant to Fla. Stat $119.07, read
instructi ons on the following pa ge and check here.DJ
Fling as an Empl oyee (check one)
[] county [] Pub ic Health Trust [ Munici p al:
(Municipality)
Departm ent
Pos ition or Title Empl oy ee ID Number
W ork address IWOl1( telephone Employment bega n on/ended on
Fling as a Board Member (check one )
[] county [J Municipal: \ri &ach
(Municipality)
Board where serving
e ossi0
Alternate address (if home address is exempt) [or teletone !Term began on/ended oo
Li st below every sour c e of incom e you recei v ed, al on g with th e address an d th e principal acti vi ty of ea ch sour ce . In clu de your pub lic salary. Place th e sources cf
inco m e in desc ending or der, w ith th e la rgest sou rce first Exa mp les of sou rce s of incom e inclu de: com p en sation for services , income from business, gains from
property deal in gs, interest , rents, di vi den ds, pen si on s, IRA distributions, an d soc ial security pa yments . Also, in clu de any sour ce of income received by anoth er
perso n for yo ur ben efit. However, th e in come of your spou se or any business partn er need not be discl osed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
k %. ¾
$
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I hereb y sw ear (or affirm} that the info rmation abo ve is a tru e and correct state ment
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Signature of Person Disclosing
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RECEIVED BY ELECTI ONS DEPARTMENT:
2ere» RECEIVED
El ectronic Cop y
AU G 18 777
CITY O ·AIA MI BEACH
I.- 7-TT (P E-
OFFICE USE ONLY Accep ted: Y I N Defi ci ency. Proc essed Date/in itials:. Scanned Date/initials:
138_S-14 COE 2016
J\I\IAMI BEACH
City of Miami Beach Board & Committee
Citywide Parking Application
LAST NAME:
ATE OF APPLICATION:.gus9_ l62020
Celle; FIRST NAME: ?lay --'------
NAME OF BOARD/COMMITTEE: [th_ v s60
ADDRESS: 15 Lag@ 0
WORK PHONE: H OME PHONE: $0$- $5-5\06
CELL PHONE: )6 1($-53
VEHICLE MAKE VEHICLE MODEL VEHICLE YEAR TAG NUMBER
Horb« CR-V 20\ LLN A3q
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 ATTENDED LOTS OR GARAGES
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 (year/make/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: h«Gae
MIA MN,BEACH
City of Miami Beach
l7O Coventon Cent er Drive
Miami Beach, Florac 33139
ww _miamibeachigo.
OF FICE OF THE CITY CLERK
Em ail BC@ am_beach_f go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI AC
STATE OF FLORIDA
couN7Y o Ai ut Dll
l, the undersigned, do hereby state under oath, and under penaty of perjury, that the flawing
facts are true:
l am in compliance with the affiliation requirement of Miami Beach City Cde Sectens 2-22¡4)
as (check (/) all that apply):
7 Resident of the City of Miami Beach for six months or longer
[] Demonstrates an ownership interest (for a minimum o six months) in a business estaiisnec
in the City (for a minimum of six months).
Ownership Interest" means the ownership oi ten percent (10%) or more {inaudng tne
ownership of 10% or more of the outstanding capital stock) in a business
"Business" means any sole proprietorship. sponsorship, corporation. limited iiaiiity comsny.
7277 - ·ts
Signature Date
MA Geller
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ] physical presence or ? onlne
ootazaon. ms l'_day a Auq st _ab y k Gelb&
(City of Miami Beach Board/Committee Member)
g Produce i ÉggibA Lxx 'S Leo
Form of Identification
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Name of Notary, Typed, Printed, or Stamped
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¡_'f~'\ MY COMM!S-~'00 tOO ~~m t, • y y &M? vs3"__1
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