Francinelee Hand 12/31/22Ml
BOARD AND COMMITTEE CHECKLIST
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neo by '.2 FOR SCANNER FOR CLERK STAFF
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Scan o o Letter of Reappointment
o C,O.Py ¡ oj.__ L~~ of AppointmenUReappointment e-mailed to Committee Liaison on
- 6ttisi@eta.e-se.o /2/2./2o
o Resume/curriculum vtae jif f ,9,)
o Diversity Statistics Reporting (Completed on 2 /_ "[yy >!a
o Oath ·
Scan o
Scan o
Scan o
1
1
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
Scan o
Scan o
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
Received on:
Processed on:
Scanned on:
O Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report)/,/
L/7/2022±X E_'/• cw»spgr
/""" - 1·0/J-Od-e1 I · ¿_ .•
- 'By Employee. 1 I
/
Date/
J„) l/o 20}oveer
City Clerks Office staff Initials Date
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 COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are commit; to providing excellent service and safety io all who ie, work, and play in our vibrant, tropical, historic community
C ity of Miami Beach, 17OO Convention Center Drive, Miami Beach, Florida 33139 yyaw_miaribachfi_ga
OFFICE OF THE CITY CLERK, Rof0al E. Gran ado, Cy Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Francinelee Hand
RE: Miami Beach Commission For Women
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. S5
(
' sworn to and subscribed before me this -<c day of /A_,2o20
7
/ , 2>-
1 CC.
*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.
MI A MI
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
--~
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
srATE 0E E0OR"P„4, 4 DA7
coUNTY OF [/t- '/1) •
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
f am a resident of the City of Miami Beach for six months or longer.
D 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).
D 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.
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online
otarzaon. the _Z_ cay or Dece h er .zoo 6y Hooe Eld
________________ (City of Miami Beach Board/Committee Member).
/ Produced ID FL p
Form of Identification
n
988_"e9ge. . l' o lacro
Name of Notary, Typed, Printed, or Stamped
4±&@. FON5o JE!'Esto9 $pif@, vosry =ut-sue7sr>
3tiéi commission H02124 C?=5$ y comm. Expires Se 22, 2024
Bonded through National Notary Assn.
L)
MIAMl·DAD E- EIEI SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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 I Last Name
2019 D
Mailing Address - Street Number, Street Name, or P.O. Box
53t
First Name Middle Name/Initial
.e"
y{o
If your home address is your mailing address, and your home address is exemptfrom public records pursuantto Fla. Stat. §119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I 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) I Work telephone rerm 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, ch eck here.[]
Name of Source of Income I Address I Description of the Principal Business Activity
S@ as 4$o
I hereby swear (or affirm) that therinformation above is a true and correct statement.
Signature
r7/el2-0
Date sign ed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy ::.
El ectronic Copy
279
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_SP-14 COE 2016
MIA MB H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachhl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
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)
4/HD
Last Name
±@au4le - 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. ~Income Statement;" or-~-~
2. A "Statement of Financial Interests (Form 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 $560, 60 days in jail, or both.
/ol/>o
Sign Dae 7
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.
Page 5 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMIB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibegchf]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 7411
DIVERSITY STATISTICS REPORT
l'kv» ' ne ....--
Last Nar
-fa ul<é
First Name Middle 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:
D Meae
LL6male
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black L I Asian or Pacific Islander
(LéCaucasian/white
O Native American/American Indian
O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Les
uf No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
□~ e
O I prefer not to answer this question.
Page 6 of 6
F:\C LE R \$A LL\R E G \B O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT S\BO A R D A N D C O M M ITT EE A PPLI C A TIO N REG FIN A L.docx
Updated: June 2020
/\l/A M\] „EA(CH CI wI DE (CW) O ARD & COM I TEEs .g
CityofMiamiBeach,PARKINGDEPARTMENT PA RKIN G A PPLICA TIO N -- PARKING 1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". 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. Inaccurate and/or outdated vehicle
information may lead to the issuance of parking citation(s) and/ or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
dam age, I will be responsible to pay a $10.00 replacement fee.
Board M ember Info rmation
Date of Applicato"„
Applicant Nam·qoe lee
Board/Committee Name:;a,,
Cunt _A
Address 3 13
E-Mail Address:
oau Dea 3340
oebee .rs
work Phong
Cell Phone: 20 ¡ 03o
Vehicle Info rmation
Ta o: [ H f 3
stare: I rí
Home thop 99 4 o -7o
Preferred Corítaçt Method:
Color:
Year:
l
144
Make: \346W Model: &wcr l},e
Applicant Signature: es
Please provide signed form tohe Parking Departent located at 155 Meridian Avenue, 2° floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception @miamibe achfl .gov
e-mail subiect: BOARD & COMMITT EE PARKING APPLICATION - APPLICANT NAME
kina Department S
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
f:\ping\$man \rr\forms \cw boards&committees parkingíorm.doc fo rm updated 9/26/201 7