Tony Michael 12/31/22\_., -/
MIAMI BEA C H
BOARD AN D COMMITTE E CH ECKLIST )i ·
A P P O IN T E E : k,N-\-\.,c,~\_ÇV\.ae L D A T E O F A P P o n:¡.:\M E N T : S~b / ~J/
oARDco»Murr e:_L-f F4ß), o/_A ot eay.t . ,o/9
ero e./2-//h2 o . b2/3LI ¡
FOR SCANNER
S can o
S can o
S can o
S can o
S can o
RECEIVED
MAY 19 2021
CI TY OF M IAMI 3EACH
OFFICE OF HA CIT CLERK
FOR CLERK STAFF
o Lett e r of A p p o intm e nt
o Lett e r of R e ap po intm e nt
o -~ -k r tt,_...~,p o in tm e nt/R e a p p o intm e nt _
o Böâ' ä Committee Application (Completed oo ~ ;;Jr¡¡;), (
o R é su m é /C urri culu m Vi tae
o Di ve rsity S tatistics R e po rt in g (C o m p le te d on S. ~/
o O ath
Li a iso n on
IM PO RTANT INFO RM ATIO N FO R BOA RD AND CO M M ITT EE M EM BERS BO O K
✓C ity C od e O rdin a n ce S e ctio n ap p lica b le to the ag e n cy, bo a rd or co m m itt ee
✓C ity C o d e S e ction s 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
✓C o u nty C od e S e ction 2-11.1 -- C on flict of In te rest an d C o d e of Ethics O rdina nce (as
am e nd e d thro u g h D e ce m b e r 2010)
✓A m e n d m e nts to th e C o d e of E thics O rdina n ce (S e pte m b e r 2009 throug h Ju ly 2012)
✓H ig h lig hts of the M ia m i-D a d e C o u nty E thics C o d e
✓S u nsh ine Law an d P u b lic R ecor d s - Fr e q uen tl y A sked Q u e stio ns
M em or an d u m - S ol ici tation by City B o ard an d C om m itt e e M em b ers
Scan o
o C ityw id e P e rm it A pp lica tion (P a rki ng D e p a rt m e nt F or m )
o Bo okl e t - G ui d e to S u nshine A m e nd m e nt & C o de of Ethics fo r P u b lic O ffi ce rs and E m ployees
o S o u rce of In co m e State m e nt
Scan O O A ckn o wl e dgm en t of Fi n an cial Di scl o su re Requirement
O DIV ERSITY STATI STICS RE PORTING a
R e ce ived o n: ~ c:?C'dJ S ig n e d by X~~:a......·~,6,,~----:::::.,,;.,.::::..::==----------
/
D a te
P co oess e d oo: S / {Í :;;M:::lrfsy E m p lo ye e : / AP:. /2' ¿;;., _ V-:.
S o a oo e d 0 0: :s: /¡ czl )-d.) ( B y Em p lo,'ee: / LJ _ __ x'l. _ _ _ ~
CONCLUDED & RESIGNATION LETTERS
T e rm E xp ire d Le tt e r D a te P ro cesse d In itia ls Scan o
R e sig na tio n Lett e r D a te P ro cesse d In itia ls Scan o
R e m o va l Lett e r du e to ab se nce s D a te pro ce sse d In itia ls Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
WVe are commi tted to providing excellent public service and safety to all who live, wo rk, and play in our vibrant, top ical, historic community.
..,___, -.._I
MIAMIBEACH
City of Miami Beach, 1700 Corvenhion Center Drive, Miam i Beach, Florida 33139 yyw_miam[beach_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cay Clerk
Tel 305.6737AIL, Fac 305.673.7254
Email: Ciyderk.@miamibeachll.gov
May 11, 2021
Mr. Anthony Michael
1117 Meridian Ave #7
Miamii Beach, FL 33139
RE: LGBTQ Advisory Committee
Dear Mr. Anthony Michael:
Congratulations! You have been appointed by Commissioner Ricky Arriola 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: Monica Beltran, Parking Director
Morgan Goldberg, 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
• "
MIAMI BE A C H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 yyww.miamibeachf go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel 305.67 37411, Fax 305.673.7254
Email: Ci#yClerk @miami beachll.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M r. Anth ony M ich ael
RE: LG BTQ Advisory Com m ittee
I do solem nly swear or affi rm to bear tru e fa ith, loyalty and allegiance to the G overn m ent of the United
States, the State of Florida, and the City of M iam i Beach, and to perform all the duties of a mem ber of the
above-m entioned board or com m ittee of the City of Miam i Beach to which I have been appointed fo r a
term ending: 12/31/2022.
To m y colleagues and to all of those I represent and serv e, I pledge fairn ess, integrity and civility , in all
actions ta ken and all co m m unica tions m ade by m e as a public serv ant.
I have been issued a copy of section 2-11.1 of the M iam i-Dade County Code (Confli ct of Interest and
Code of Ethics O rdinance), as well as Florida Com m ission on Ethics G uide to the Sunshine Am endm ent
and Code of Ethics fo r Public O ffi cers and understand that as a m em ber of a City of M iam i Beach Board
and/or Com m ittee, I m ust co m ply with the finan cial di sclosure requirem ent s of M iam i-Dade County or th e
State of Florida (depending on the board or com m ittee on which I serv e) on July 1st, followi ng the closing
of the ca lendar year on which I have serv ed. ~·. d -' M r. An thony Michael
Sworn to and subscribed before m e th is,, ]l,
/
p lease visit the City of M iam i Beach website at ww w .m iam ibeachfl.gov under City Clerk/Board and
Comm i tt ees for additional info rm ation re garding the Fi nancial Di sclosure Requirements.
'-" J
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
O FFIC E O F THE CI TY CL ER K
E m a il: B C @ m ia m ib e a chfl.g o v
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATI ON WITH THE CITY OF MIAMI BEACH
STATE O F FLO RI DA
CO UNTY O F [ÁD
I am in com pliance with the affi liation requirement of Miami Beach City Code Section s 2-22 (4),
as (check(✓) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
[J I have an ow nership interest (for a minimum of six months) in a business established in the
City of Miam i Beach (fo r a minimum of six months).
;6 I am a fu ll-tim e em ployee of a business (fo r a minimum of six months) and I am based in an
offi ce or other loca tion of the business that is physica lly loca ted in Miami Beach (for a
minim um of six months).
"O wne rship Interest" m eans the ownership of ten percent (10%) or m ore (including the
owne rs hip of 10% or m ore of the outstanding capital stock) in a business.
"B usiness" m eans any sole proprietorship, sponsorship, corporation, lim ited liability com pany,
or othe r entity or business association.
der penal ti es of perjury , I declare that I have read the foregoing documen t and that the facts
·cara.res. S/ya/ay
Sig riature . Date t
Arelo.y lb»et
Printed Nam e 7
NO TARY A
Sworn to (or affirm ed) an d subs cribe d before me, by means gf$/f ysical presen ce or J online es. , [\Aj nu
________________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
(NO TARY SEAL)
Name of Notœ,d~?flh~ßr Stamped
s, N O TAR Y P UB L I C
g] [sTATE OF FLORIDA
75 comm# G G 958445
8; s . oc 19' Expi res 6/7/2024
- /
MIAMI BEACH
City of Miami Beach
17 00 C onvention C enter Drive
M ia m i Bea ch , Fl orid a 3 3 13 9
www _m ia m ib ea ch [_gov
O FF IC E O F TH E C ITY C LERK
Em a il: BC @ m ia m ibeachfl.gov
Te le p hone : 30 5.6 7 3.7 4 11
BOARD &_CQM MI IEE FINAN CIAL_ACKN OWL EDGE MLENI STAIE MENI
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) ±hst Latrai#e= 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 form s must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noo n of July 1, of each year:
1. A "Source of Income Statement;" or
2. A "Statement of Financial Interests (For m 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
of no more mún3} $500, 60 days in jail, or both.
5
ay subject the person to a fine
Date
a -
M emb ers of the Planning Board and Board of Adjustm ent 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 5of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
- -
MIAMI-DADE- EEI
clear From] "Print For]
SOURCE OF INCOME STATEMENT
Sect ion 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 [Last lame
tu rd
M idd le Nam e/Initial
2020
M aili ng A ddress - Street Num ber, S treet Nam e, or P.O . Box
deo XV
eel L
lf 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 tele.
Filing as an Employee {check one)
□County D Public Health Trust I Municipal :
(M u nicipality )
D e p a rt m e n t
Position or Title Employee ID Number
Work address I W ork telephone Employment began on/ended on
Filing as a Board Member (check one)
D County Yíonica- (Chi g A
(Municipality)
n1 /tre e
7a
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. D
Name of Source of Income Address Description of the Principal Business Activity
#el,fa.U- [o 9 Q =o D r Dee-lo ef Oaol-ls
M iA Beh, T1 335 13j
ear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
s [ir/2
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
t araceo E C EIVE D
O Electronic Copy
MAY 19 2021
CITO (r, EACH
-io
REMEMBER TO PRINT, SIGN, AND SUBMIT TO TH E OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
'-" _,I
M IAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www _miamibea cht],gov
OFFICE OF THE CITY CL ERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
M ie.i.
Last Name Middle Initial
The following information is voluntary and has no bearing on your consider ation for appointm ent. It is being
asked to comply with City diversity reporting requirements.
Gender:
kc»
[rem ale
O Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African Am erican/Black
~
sian or Pacific Islander
aucasian/W hite
ative American/American Indian O Other - Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
:e
5Tao.«ceo ose
Do you consider yourself Physically Disabled?
les
No
I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINALdocx
Updated: June 2020
'-' a
MIAMI BEACH CTw DE cw soAo & co»wees lg
e±rii-ii iwwe sirior PARKING APPLICATION Mg#gE
1755 Meridian Avenue, Suife 200/Miami Beach, FL 33139/Ph: (305) 673-7505 r (305) 673-700 0 ex!. 6200 PAR IG
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
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: S//lz
Applicant Name: [bes
Board/Committee Name:
Address:
E-Mail Address: ln faleC>o uh e ach .o
Mt ce,
Work Phone; S73z2-135 2 [Home Phone \ N .
Cell Phone: 'S::--- ,--... Preferred Contact Method: el
Vehicle Information
Tos: !ICS- $33 Color: za==si
State: N Year: 2co
Make: er<=Des R5Nv2 Model: 5OO NV
Applicant Sianature: e
Please provide signed for to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina D ---- e
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
s
rm up