Scherazade King 12/31/22BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ____________________________________ DATE OF APPOINTMENT: ______________
BOARD/COMMITTEE: ____________________________ Appointed by: ___________________________
FOR SCANNER FOR CLERK STAFF
Scan ○ ○ Letter of Appointment TERM END: _______________ TERM LIMIT: _____________
Scan ○ ○ Letter of Reappointment
○Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
_____________
Scan ○ ○ Board and Committee Application (Completed on )
Scan ○ ○ Résumé/Curriculum Vitae
○Diversity Statistics Reporting (Completed on )
Scan ○ ○ Oath
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 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
○Citywide Permit Application (Parking Department Form)
○Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan ○ ○ Source of Income Statement
Scan ○ ○ Acknowledgment of Financial Disclosure Requirement
○DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: _______________________ Signed by X________________________________________________
Date Board or Committee Member
Processed on: ______________________ By Employee: ________________________________________________
Date City Clerk’s Office Staff Initials
Scanned on: ______________________ By Employee: ________________________________________________
Date City Clerk’s Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan ○
Resignation Letter Date Processed Initials Scan ○
Removal Letter due to absences Date processed Initials Scan ○
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Scherazade King 11/06/2020
Black Affairs Advisory Committee Commissioner Meiner
12/31/2022 12/31/2028
11/23/2020
11/23/2020
11/23/2020
11/23/2020
11/23/2020
11/23/2020
Digitally Signed/SK
October 28, 2020
Ms. Scherazade King
5808 Alton Rd
Miami Beach, FL 33140-2023
RE: Black Affairs Advisory Committee
Dear Ms. Scherazade King:
Congratulations! You have been appointed by Commissioner Steven Meiner to the above-referenced Board or
Committee, for a term ending: 12/31/2022.
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.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Heather Shaw, 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)
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.
Oath of Office Oath
of Civility and
Acknowledgements
TO: Ms. Scherazade King
RE: Black Affairs Advisory 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: 12/31/2022.
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.
________________________________ Ms.
Scherazade King
Sworn to and subscribed before me this day of , 2020
________________________________
Charles D'Agostin Deputy
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.
23 November
Email: BC@miamibeachfl.gov
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI 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):
□I am a resident of the City of Miami Beach for six months or longer.
□I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
□I am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (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,
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Signature Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of □ physical presence or □ online
notarization, this day of , 20 by
(City of Miami Beach Board/Committee Member).
___ Produced ID
Form of Identification
___ Personally Known
(NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped
Miami Beach
Scherazade King
11/23/20
X
23 November 20
Scherazade King
X FL Drivers License
Charles J. D'Agostin
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
Mailing Address – Street Number, Street Name, or P.O. Box
City, State, Zip
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. £
Filing as an Employee (check one)
*County * Public Health Trust * Municipal: _________________________________________________
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
*County *Municipal: _________________________________________________
(Municipality)
Board where serving
Alternate address (if home address is exempt)Work telephone Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, 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
SOURCE OF INCOME STATEMENT
OFFICE USE ONLY Accepted: Y / N Deficiency:________________________________ Processed Date/Initials:__________________ Scanned Date/Initials: __________________
RECEIVED BY ELECTIONS DEPARTMENT:
*Hardcopy
*Electronic Copy
138_SP-14 COE 2016
I hereby swear (or affirm) that the information above is a true and correct statement.
_______________________________________________________________________
Signature of Person Disclosing
_________11/23/2020________________
Date signed
X
Received November 23, 2020
Office of the City Clerk
Page 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
BC@miamibeachfl.gov
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
Last Name First Name Middle Initial
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.
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;” or
2. A “Statement of Financial Interests (Form 1)1;” or
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.
Signature Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County’s financial disclosure
requirement as a Miami Beach City Board/Committee 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.
King Scherazade
11/23/20