Maria Caijao 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
Maria Caijao 1/13/2021
Senior Affairs Committee City Commission
12/31/22 12/31/26
1/13/2021 12/18/2020
2/8/2021
Digitally Signed/LMC2/8/2021
2/8/2021
2/8/2021
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: C@m iamibeachfl.goy
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY or 7ñcm bad
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
D ! 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).
[ yam a full-tim e employee of a busine ss (for a minim um oí six month s) and l 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, ! declare that I have read the foregoing document and that the facts
stated in it are true. 4g(ç3 ,-zr2,
Sig ture Date
Llar4 Lan ssz Cya,o
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physica l presence or Gonline
notarization, this ??h 3aye January _,20'b y
Maria Larissa Caijao (City of Miami Beach Board/Comm ittee Member).
X Produced ID
FL Drivers License
Form of Identification
Personally Known
Ciai 'pet
Signature of Notary Pub ic
Charles J D'Agostin
Name of Notary, Typ ed, Printed, or Stamped
(NOTARY SEAL)
,)!)"¡¡ ~ Charles J. DAgostin .i Rg NOTARY PUBLIC
gf _ sTrE o FLORIDA
.&/ comm# GG168171
5»5Tre Ms Expires 12/14/2021
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Received February 8, 2021OfficeoftheCityClerk