Richard Baron 12/31/21M IA M I BEACH
O A R D A N D C O M M IT T EE C H E C K LIST
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re»eo. D2/3/// rerun. L2/3/// FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment f7]9/j$$/8overo»sones, ·-o se o cor on e-»
o o ár @ and Committee Application (Completed on, 19o/20/
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on g ),y ]
o Oath
Liaison on
RECEIVED ✓
✓
JAN 29 2021 ✓
✓
CI TY O F MIAM I BEACH ✓
OFFICE DO THE OTY CL E RK ✓
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
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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
' /VERSITY STATISTICS REPORTIN G Keep çQy in file and ORIGINAL for Annual Report.
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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 MASTER\B&C Checklist 2015 MASTER.docx
We are com mitted to oroviding excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, 1700 Convention Cen ter Dri ve, Miami Beach, Florida 33139 yyw_miamhiba chfl_go
OF FICE OF THE CITY CL ER K, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax€ 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
January 14, 2021
M r. Richard Baro n
2526 Lake Ave.
M iam i Beach, Florida 33140
SUBJECT: Board of Adjustment
Dear M r. Richard Baro n:
C ongratulations! You have been reappointed by the City Commission to the above referenced board or
com m ittee, for a term ending: 12/31/2021.
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 encl osed m aterials carefully. Congratulations and good luck.
R espectfully,
R afael Granado
City Clerk
cc: Monica Beltran, Parking Director
Steven Wi lliams, City Liaison
ATT ACHMENTS:
Letter of Appointment
O ath
City C ode/O rdinance section applicable to agency, board or committee
City C ode Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
Ordinance No. 2006-3543 - Am endm ent to City Code Section 2-22
M iam i-Dade County Code Section 2-11.1 - Confli ct of Interest and Code of Ethics Ordinance
City Wi de Permit Application - (P arking Department Form )
Booklet - Gui de to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M IA M I BEACH
City of Miami Beach, 1700 Convent ion Cen ter Dri ve, Miami Beach, Florida 33139 yyy._mi amibgg chf]go
OF FICE OF THE CITY CL ER K, Rafael E. Gran ado, City Clerk
Tel: 305.6 73.74 11, Fax. 305.673.72 54
Ema il: CityClerk @mi ami beach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M r. R ichard Baron
R E: Board of Adjustment
I do solem nly sw ear or affirm to bear true faith, loyalty and allegiance to the Govern ment of the United
States, the State of Florida, and the City of M iami Beach, and to perform all the duties of a member of the
above-m entioned board or comm ittee of the City of M iami 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 fairn ess, integrity and civility, in all
actions taken and all com munications m ade by m e 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
C ode of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment
and Code of Ethics for Public O fficers and understand that as a m ember of a City of Miami Beach Board
and/or Comm ittee, I m ust comply w ith the finan cial disclosure requirements of Miami-Dade County or the
State of Florida (depending on the board or comm ittee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
7-wi. erra aro
Sw orn to and subscribed before m e this ,4t day of ~021
i..
pl ease vi si t the City of Miam i Beach website at www .m iamibeachfl.gov under City Clerk/Board and
C om m ittees fo r additional info rmation regarding the Financial Di sclosure Requirements.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
sur0.197%%.- j)4/
COUNTY OF LAt- LT •
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
£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 established in the
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 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 l have read the foregoing document and that the facts ""3.__ he..
Sigature ole 7
K@ lad [.
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or□online
notanzaion, u2tly « )/(421_ _,2o?ß_y
Cl4re ) k/ff 9s/ (ciy of Mami Beach Board/committee Member).
rosea [rce s _Lose
Form of Identification
Sign
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
~
:)•t-.Rì. -'n.£ Charles J. OAgostin „ 3{ NOTARY PUBLIC
è! STATE OF FLORIDA
23, Rscomm# GG168171
5: <o . "F is Expires 12/14/2021
MIAMl·DAD E- ELI 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 L~am e .AJ Middle Nam e/Initial
2020 //42o)
M aili ng Address - Street Num ber, Street Nam e, or P.O. Box
?o a, /ve
City, State, Zip /lat pe , £ 33//0
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. D
[] Municipal:
Depart m ent
Positi on or Title
W ork address
Filing as a Board Member (check one)
[] county [] Municipal:
(Municipality)
Board w here serving
Altern ate address (if hom e address is exem pt) I W ork telephone I Term began on/ended on
List below every source of incom e you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
pro perty dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person fo r your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Nam e of Source of Incom e Address Description of th e Principal Busines s Activity
t +po lay f ln 2, sr ht4 223 la»Y.
V t
I hereby swear (or affirm) that the information above is a true and correct statement.
L.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
□Hardcopy □Electronic Copy RE e E iVE D
JAN 29 2021
CITY OF MIAMI BEACH
A
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
13 8_S P -14 C OE 2 0 16
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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)
±A s
Last Name
PL,LrAa
st .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 moré?than $500, 69days in jail, or both. / . /
1'27 2/ __ .,_ _ _._ _
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.
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Updated: June 2020
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeach[l._gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
/ /Ao
Last Name 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:
Áíwae
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
L)Asian or Pacific Islander
CD caucasian/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?
J es
No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ív.
J N o
O I prefer not to answer this question.
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Updated: June 2020