Britta Hanson 12/31/21MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: _jz----"�---'-' ..... fu......._A__.�'-'--""-;;.;.(\_.S_o__;_,,.---.--=-------DATE OF APPOINTMENT:__._\ \-4--
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BOARD/COMMITTEE: _ _._(_{t..,,C..--""'---------Appointed by: __________ _
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment TERM END : TERM LIMIT:
o Letter of Reappointment
o Copy of Letter of AppointmenUReappointment e-mailed to Committee
o Board and Committee Application (Completed on _______ _
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on ------�
o 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
Liaison on
✓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
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 DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Rediived on: __________ Signed by X ____________________ _
Date Board or Committee Member
Processed on: __________ By Employee:-----=.,,.---=-:---:-:---::-:::----,-----------Date City Clerk's Office Staff Initials
Scanned on: __________ By Employee: -----=-::---:::-:--,--:---=:-:::----:::-:---:77--:,-:--,---------
Date City Clerk's Office Staff Initials
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 MASTERIB&C Checklist 2015 MASTER.docx
We ore commi"ed to providing excellent public selVfce and safety lo oil who live, =rk, ond play In our vll:xont, troplcol, historic community.
City Commission
12/3121 12/31/21
1/13/2021 1/20/2021
2/3/2021
Digitally Signed/BH2/3/2021
2/3/2021
2/3/2021
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MIAMHllU>E. � SOURCE OF INCOME STATEMENT
Section 2-11.1(1) of the County Ethics Code requires that certain employees and public officials file a financiai disclosure Statement on a yearly basis by July 1st of every year. Disclosure for Tax Year Ending 2020 Malling Addres
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Middle Name/Initial
ODD�
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
Filing as an Employee (check one)
D County D Public Health Trust D Municipal: (Munlclpallly)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (chock one)
D County D Municipal: (Munlclpallty)
Board where serving
Alternate address (II home address Is exempt) I Wort< telephone ITerm 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 securily 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 d!sc!osed. If continued on a separate sheet, check here.O Name of Source of Income Address Description of the Principal Business Activity
bove is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: D Hardcopy D Electronic Copy
Date signed I
�:��:,� Uz! ��6LY Accepted: Y / H Deficiency: __________ Processed Date/lnlt!als:. ______ Scanned Dale/Initial s; _____ _
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REceived on Feb 3,
2021/Office of the city
Clerk