Nikolas Montolio 12/31/21$ $ . ¡ ¡
Oath of Office Oath
of Civility and
Acknowledgements
;;,
TO : M r. N ikolas M ontolio
RE: LGBTQ A dvi sory C ommittee
l do sol em nly 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 mem ber of the above-mentioned
board or comm i ttee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2021.
To m y col leagues and to al l of th ose I repre sent an d serve, I pledge fairness, integrity and civility, in all actions
taken and a ll com m unic ation s m ade by m e as a public servant.
I have been issued a copy of section 2-11.1 of the Miami-Dad
Ethics Ordinance), as well as Florida Commission on Ethics
Ethics for Public Officers and understand that as a member of
must com ply with the financial disclosure requirements of Mi
on the board or committee on which I serve) on July 1st, fol
have served.
Sworn to and sub
es.
Please visit the City of Miami Beach website
for additional information regarding the Financi
We are committed to providing a:cssni public serice a
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MAIA/IBEACH
City of Miami Beach
1700 Convention Center Drive
Miami 8each, Florido 33139
OFFICE OF THE CITY CLERK
Email: Ç@mriamibeacn7fl_gov
Telephone: 305.673.7411
//0/0eo
Charles J. DAgostin g, NO TAR Y PU BLI C
hsTAE O F FLORI DA
Comm# GG168171
Expires 12/14/2021
AFFIDAVIT O F AFFILIATION WITH THE CITY OF MI AM I BEACH
STATE OF FLORIDA
COUNTY OF
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
JlÍ I am a resident of the City of Miami Beach for six months or longer.
O I have an ownership interest (for a minimum of six months) in a business establi
City of Miami Beach (for a minimum of six months).
O I am a full-time employee of a business (for a minimum of six months) and
office or other location of the business that is physically located in Mi
minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limi
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing docu
äiü; h% pol
flt%Cl5 aa
Printed Nam e
~~~--~----~-------
MIAMI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wow,miamibeochfl,gov
OFFICE OF THE CITY CLERK
Em ail: BC@m iamibeach f._go
Telephone: 305.673.7411
Lotuolio
DIVERSITY STATISTICS REPORT
MU ko la$
Last Name First Name
The following information is voluntary and has no bearing on your consideration fi
asked to comply with City diversity reporting requirements.
Gender:
Zhae
lremale
l ower
Ll t refer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
Ll caucasianwite
Lg Native Am erican/Am erican _pija7
l oner-nit Race: LQt ífO »
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispani
Zi ves
o
à1refer not to answer
, Do you cons ider yours elf Physically
Oves
z2 o
'M1refer not to answer this auesti
F CLERSALL RGOARD ANDO COM»Tree updated: June 202 0 4pp1ye.
-
\1ANA !BEACHCTW E (cw oAR & cON__ cr ci ici s-ad, éiRkio oisrNr PARKING APPL[CA
17 55 Meridian Avenue, Suite 200/Mi6mi Beach, Fl 33139/P1: (305] 673-7505 6r (305) 673-7000 4. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Acces
provided lo you for City Hall Garage (G7) access.
IM PORTANT NOTE: Your vehicle license plate serves as your "parking permit".
any unnecessary enforcement actions, it is important that our records reflect
accurate information regarding your vehicle license plate. Inaccurate a
information may lead to the issuance of parking citation(s} and/or the towing
Please note that this new access card CANNOT be hole-punched or perfor,
the new card please hold the card at close proximity to the reader until the
fo try the other side of the card. Please ensure you hold the entire surface
until the gate opens.
ACKNOWLEDGEM ENT: I acknowledge that should my acces
damage, I will be responsible to pay a $10.00 replacement f
B o a rd M e m b e r infor
Date of Application: o
Applicant Name
I/Z T2 c 2 o dia
Board/Committee Name:
Address: 0
E-Mail Address p,Kol3o
W ork Phone:
cen Phone35 - 3
3rmation
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Vehicle Information
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Tag:
State:
Make:
App·can7vigra!ff .-
Pl ea se pride sigred fr to the Parking Depar
hours are €:30c :Q} • cr email to: Parkingkeception@mi
e-mail subjecn 8OARD & COMMI ! "
Department Section
PRM SYSTEM
fxira tion Date:
lss ued By Print Name:
Signature. s
Da te Issued .
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