Liza Samuel 12/31/23MIA IBEACH
BOARD AND COMMIT.7 _IST
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o Letter of Appointment
o Letter of Reappointment
--~_,ö...,,L,-e-,tt,_;f,Í AppointmenUReappointment e-~iled to Committee
o a and Co mittee Application (Completed on ,
• Resumrcorcutom vtee ))/ 2)/,)/
o Diversity Statistics Reporting (Completed on.L2[gg , )
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 RECEIVED ✓County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 201 O)
JAN 4- 2022 ✓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
ITO MIAMI BEACH Memorandum - Solicitation by City Board and Committee Members
OFFICE OF THE CITY CLERK
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement //) ,,!. O DIV/RSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
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CON CLUD E D & RES IGNATION LETTE RS
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:\CLERIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
MIAM[RFACH . \/\ DL ·'
City of Miami Beach, 1/OO Convention Center Dive, Nami Eooch, Ilorida 33139 y _miamibca chll_go
OFFICE OF THE CITY CLERK, Rofool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: City/Clerk@miamibeachfl.gov
November 30, 2021
Ms. Liza Samuel
4550 North Michigan Avenue
Miami Beach, FL 33140
SUBJECT: Animal Welfare Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or
committee named above, for a term ending: 12/31/2023.
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.
Congratulations and good luck.
R RafLranado
City Clerk
cc: Monica Beltran, Parking Director
Julio Rodriguez, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI AM[BEACH
City of Miami Beach, 1ZOO Convention Center Driva, Mvami Booch, Horida 33 139 y¿y._miamibgach[l_goy
OFFICE OF THE CITY CLERK, Rofaol E. Granado, Ciy Clerk
Tel:. 305.673.7411, Fax. 305.673.7254
[mai l:. Cit/Clerk@miamibeachfl. gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Liza Samuel
RE: Animal Welfare Committee
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: 12/31/2023.
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.
Ms. Liza Samuel
D ecemb er
Sworn to and subscribed before met · day
*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.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
M ia m i B ea ch, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@m iamibeachfl.gov
Telephone: 305.673.7411
AEFIDA VII OF AEEILIATION yIIH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF _
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch8ç () al l that apply):
yí , 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).
D 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 I have read the foregoing document and that the facts
stated in it are true.
d December 23, 2021
Date
Liza Samuel
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of [Physical presence or online
oso.so .22 a.U te.her_ ?L L4 S/444
X Produced ID 7) (City of Miami B¡ach Board/Committee Member). F- hu y ,ese
Form of Identification
(NOTARY SEAL)
Name of otary, Typed, Printed, or Stamped
y CHARLE S J. DAGOSTIN t:oo:~ MV COMMISSION t HH 165705
i%, çs¿ EPIRES: December 14, 2025
fjiyç" Bonded Tu Notary Publie hndenwrors
M IA M I BEACH
City of Miami Beach
17 0 0 Convention Center Drive
Miami Beach, Florida 331 39
w_miamibegchf]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Sam uel Liza
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:
e
emale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
O Caucasian/White
L] Nate American/American Indian
Lóther -Print Race: Middle [astern
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
zr
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Lo
r O
Llorefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL .docx
Updated: June 2020
MI \MIBE A CH
City of Mia mi Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
wwwmiam ibeachfl.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)
Samuel Liza
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:
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 more than $500, 60 days in jail, or both. ± D ecemb er 23, 2021
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.
Page 5 of 6
F:IC LE R\$A LLIR E G IBO A RD A ND C O M M ITT E E A P P LI C A TIO N S FINA L DRA FTS\BO A R D A N D C O M M ITT E E A P P LI C A TIO N RE G FINAL .docx
Updated: June 2020
M IA M I-DAD E-
EME
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 I Last Name First Name Middle Name/Initial
2020 S am uel Li za
Mailing Address - Street Number, Street Name, or P.O. Box
4550 N M ichigan Ave
City, State, Zip
M ia m i Beach, FL 33140
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 Hel e.
Filing as an Employee (check one)
O County D Public Health Trust [] Munici pal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
F iling a s a B o a rd M e m b e r (check one)
O County kfonicona:
o[
Work telephone
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
R eal Estate - Beachfrol ht 517 Arthur Godfrey
I hereby swear (or affirm) that the information above is a true and correct statement. u
Signature of Person Disclosing
D ecem ber 23, 2021
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
CJ Hardcopy RECEIVED
trees«on«#% 4- 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT. SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
..£.4."7 e ±"%.
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A city w ide (C W ] par king perm it is honored at metered parking spaces and restricted residential zones
par king spaces. A C W par king permit IS NOT honored in prohibited areas. An Access Card will be
pro vided to you fo r C ity H all G ar age (G 7) access.
IMPORTANT NOTE: Y our veh icl e licen s e plate serv es as your "parking permi t". In ord er to avoi d
any unnecessary enforcem ent action s, it is imp or tant that our records reflect the most current and
accurate info rmation 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 car d CANNOT be hole-punched or perforated in any manner. To use
the new car d please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the car d. Please ensure you hold the entire surface of the car d 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: D e cem b e r 23, 2021
Applicant Name: Liza Samuel
Board/Committee Name:
Address: 4 5 5 0 N M ichig an Ave
E-Mail Address: Li za s a m ue lrea lty @ a o l .c o m
Work Phone: Home Phone
Cell Phone: 30 5 -4 9 0 -4 7 1 7 Preferred Contact Method:
Vehicle Information
Tag: 17 8 K Y D Color: W hite
State: F L Year: 2019
Make: Volkswaaon Model: Atlas
Applicant Sianature: e /
Please provide signed form to ffe Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMM ITT EE PARK ING AP PLICATION - AP PLICANT NAME
p ·ki De rt +tS ar Ina epa men ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
..pmg mon rat torms cw oaras commmtees par mgrorm.doc
D'Agostin, Charles
From:
Sent:
To:
Cc:
Subject:
Attachments:
Liza Samuel < lizasamuelrealty@aol.com >
Thursday, December 23, 2021 5:18 PM
D'Agostin, Charles
Granado, Rafael; Chamberlin, Adrian; Wong, Claudia; Rosel, Karen; Barbou, Regis;
Rodriguez, Julio; Falls, Ricky
Re: Animal Welfare Committee (Appointee)
B&C Appointee Package Signed.pdf; Liza Samuel - saved.pdf
Im p ort an ce : High
Florida os»s oase g
.$540
Li za S am uel
305.490.4717
liz a@ th erightre al torm atters_com
www .therightrealtorm atters.com
Top 1% of R ealtors 2016
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