Debra Schwartz 12/31/22BOARD AND COMMITTEE CHECKLIST
oAre or Aronwrwr._? //1/) APPowreEe:. De bra_k. 5ch i4Et
BOARDICOMMITTEE: LL._Í.(Ca4BL55t in_f6_l Appointed by: ./ayer _a_(Geller
1£€. pl1/2 11 p/9 FOR SCANNER
Scan o
Scan o
Scan o
Scan o
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o ·°)!_. f ette'l ~Appointment/Reappointment. e-mailed t/ C~mmittee
o B ard an Co ~itlee 4plication (Completed on If:):, / ;¡;2/
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on /;J., C) />/
o Oath
Liaison on
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
IT OF MIAMI BEACH Memorandum - Solicitation by City Board and Committee Members
OFF ICE OF THE CITY CLERK
RECEIVED
JAN 4 2022
Scan o
Scan o
Received on:
Processed on:
Scanned on:
OCitywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
/
' 1 ¡0 DIV~~ITY STATISTICS REPORTING Keep COPY in file 3nd ORIGINAL for Annual Report. (AL 2'112/ soca»X. L. dele. Al4la»u //]22 •. erre=ese= a
/. L Date/ n '>
__ L-f _ Lr By Employee:--~--,.~--.#---'--"""'-:,__ _ t de
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
MI AMI BEACH
City of Miami Beach, 1/OO Convention Conter Drive, Miami Boach, Horida 33 139 yyw_miamibachl]_go:
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.72 54
Email: CiClerk@miamibeachfl.gov
December 14, 2021
Ms. Debra Schwartz
5680 Pinetree Drive
Miami Beach, Florida 33140
RE: Miami Beach Commission For Women
Dear Ms. Debra Schwartz:
Congratulations! You have been appointed by Mayor Dan Gelberto 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
appointmenUelection 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.
Rega~
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Veronica Paysse, 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
City of M ia m i Be a ch , r:in-nt nt·nt.. !'eamE-a h HEr.ln <+13g3IL¿mg_t.al'[_y.
OF FI C E OF TH E C ITY CIERK Ra fe l ( Gran a d o Citv Clerk - - - - - - - ,-, -
1l 305673 7 4 11, fax 305673.7254
(mail CM.Clerk@miamibrochfl gcs
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Debra Schwartz
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. , . .
[ ¡is oppovtat4 lo svo r rn«er 4g!±es,
Sworn to and subscribed before me thirur day of ¡)_______~021
*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.
City of Miami Besch
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST ATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
e
Home Address
I am a resident of the City of Miami Beach for six months or longer.
56so fkelee re /äui Bea 334 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).
Name of Business ------------------------
Business Address ------------------------
□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).
[arfe f [[y]feS5.
[11S[[eSS (](feSS
"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
""A. ks,
Signature
D eb r a H±. Shoat
Date 1 '
Printed Name
N O T A R Y
Sworn to (or affirmed) and subscribed before me,,by means of physical presence or g online notarization,
o.2a P eco? Is l ela /_ S se1Z2
________ (City of Mi mi Beach Board/Committee Member).
')iekes re4 se
Form of Identification
Produced ID
Name of Notary, Typed, Printed, or Stamped
g3êj#;¿., CHARLEs i. Gosr $? b ",¿ 1r cou»ussIoN # H 1os7os
¿pg.is; EXPIRES: December 14, 2025
á.E£%"" son&ea mu Notary Pote uái
(NOT ARY SEAL)
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:
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)
HA.
Last Name 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:
<SJ 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 more than $500, 60 days in jail, or both. .a. tdk Ako$, 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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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I-DAD E. EELI
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) 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 Name
202o Shutt
First Name
elo
Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.O. Box
5680 lee Drde
City, State, Zip
(l. 4340 Beac
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 Hele.
Filing as an Employee (check one)
O County O Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
O County [Y unicipal: ai ed
(Municipality)
Board wh~re servii tG ( maisson fe owe n ndo: loveless Cata lee Be4ut!
Alternate address (if home address is exempt) ... I Work telephone I Term 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, check here. D
Name of Source of Income Address Description of the Principal Business Activity
tav (3 Hke«
e ve»le st
a O hé :
6eat .Slue
t6 tllqaa /A. aso
ti« [eccl 3313
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
aie sinea 7
tes7e
5Pa use
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy RECEIVED
O Electronic Copy
JAN 4 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:
Telephon: 305.673.7411
DIVERSITY STATISTICS REPORT
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:
LJ Male
Lk em ale
LJ oher
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
LJ Astan or Pacific Islander
[Ycaucasian/white
D Native American/American Indian
L] other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
(l y es
LI#
D I prefer not to answer.
Do you consider yourself Physically Disabled?
le
No
D I prefer not to answer this question.
Page 6 of6
F:\CLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
CITYWI DE (CW) BOARD & COMMITTEES II.]
cr ot vomi ses±, AR«No PARTENT PARKING APPLICATION ltead
PARKING 1755 Meridian Avenue, Suite 20 0/Miami Beach, FL 33139 /P h: (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 C A N N O T 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.
A C K N O W LE D G E M E N T : 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: ta/a4 /0 al
Applicant Name:
.
6lwartz Delra H.
Board/Committee Name: C o u i s só o? ate í
Address: 5 60 p e heeo Dev e» t ú Beal 33«¢0
E-Moil Address: delrh sclaret@al. co
Work Phone: - Home Phone g4 st87
Cell Phone: 305l37-&0u eferred CototMegg;, en €a « o r H ie cr»
Vehicle Information
Tos: 31
State:
Make:
NU
Y ear :
Model:
6e
2.016
l[-doo
Aplican s at ur e:. e
Color:
Please provide signed form to the Parking Deportment
hours are 8:30 to 5:00 p.m. or email to:
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
cated at 1755 Meridian Avenue, 2"d floor. Working
P, ·ki D ts ar mna eparmen ection
PERMIT SYSTM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
orm up'are