Helen Swartz 12/31/23BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Helen Swartz January 7 2022
DATE OF APPOINTMENT: '
BOARD/COMMITTEE: Disability Access Committee
FOR SCANNER
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ECEIVED
JAN 12 2022
Appointed'Qmmissioner Kristen Rosen Gonzalez
esoso.//I/2 3. /2// /& FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o , py f L ti o;t¡pointmenVReappointmen: ~ailed to/ Committee
o oar a ä ommittee Application (Completed on L ~;}pd--/
o Résumé/Curriculum Vitae ,,
o Diversity Statistics Reporting (Completed on / / ~
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 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 C ITY O F MI AM I B E A COH
FFICE OF THE CITY CLERK
O o Citywide Permit Application (Parking Department Form)
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Received on:
Processed on:
Scanned on:
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
J o JIVERSITY STATISTICS REPORTING epOPY in file and ORIGINAL for Annual Report. hl,_ 09? _s@reay i
}
Date
)))21)02_a Entoryee: /
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Da¡e I /;t { ~ By Employee: __ .____,,.~-+--;,<"-------,,,~~=----------
rr Date
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 COMMITT IES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
'e are commuted to providing excellent sevice and safety to ail w ho hive, work, and play in o ur vibrant, tropical, historic community.
City of Miami Beach, 1/OO Convention Conter Drive, Miami Booch, Horida 33 139 y¿¿y._miaIile_achf]_goy
OFFICE OF THE CITY CLERK, Rofal E. Granado, City Clark
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: Cit/Clerk@miamibeachfl.gov
December 06, 2021
Ms. Helen Swartz
1330 West Ave, Apt 1804
Miami Beach, FL 33139
SUBJECT: Disability Access Committee
Congratulations! You have been reappointed by Commissioner Kristen Rosen Gonzalezto 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
a
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, 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
M iam i-Dade C ounty C ode S ection 2-11.1 - Con flict of Interest and Code of Ethics Ordinance
C ity Wi de P erm it A pplic ation - (P arking Departm ent Form )
Bookl et - G uid e to the S unshine A m endm ent and Code of Ethics for Publié Officers and Em ployees
M l MIB
City of Miami Beach, 1ZOO Convention Conler Drive, Miami Bach, Horida 33 139 y¿y._miaIibgach[]_go
OFFICE OF THE CITY CLERK, Rofool E. Granado, City Clork
Tel: 305.673.7411, Fox. 305.673.7254
Emai l: City Cl erk@miamibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Helen Swartz
RE: Disability Access 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. Helen Swartz
January 7, 2022
Sworn to and subscribed before me this day of , 2021
*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.
MIAMI BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE 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):
/ am a resident of the City of Miami Beach for six months or longer.
Home Addre3 30 West Ave Apt 1804 Miami Beach, FI 33139
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 N/A ------------------------
HS[/es,S, (]]reSS_
o 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).
N/A
[]3me ([ [IS[[eSS
[3g[fes (]]reSS
"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 tru~ ,_. January 7, 2022
Signature Date
Helen Swartz
Printed Name
NOTARY
Swor~); (or affirmed) and subscribed before me, by means of o physical presene~ o~nline notarization,
..., •Jv«ra) a». Heles Ser
1
Sign
Produced ID
(City of liami Beach Board/Com mittee Member ).
puer lCe Se .:. CHARLES J. DAGOSTIN }$ j %ê wcowsso»o tsr os
%¿,9di ExPRts: Decan ter 14, 2025
fjj%" Bonded Tru Notary Public Undenwriters
(NOTARY SEAL)
M IA M IB E H
C ity of Miami Beach
1700 Convention Center Drive
Mi am i Beach, Flor ida 33139
www.miam ibeach fl,gov
OFFICE OF THE CITY CLERK
Em ail: BC @ miam ibeachfl.gov
Telephone: 305.673 .7 411
BOARD & COMMIIIEE 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)
Swartz Helen
Last Name First Name Middle Initial
I understand that no later than duly1, 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 mor han $500, 60 days in jail, or both.
January 7, 2022
Signature Date
' 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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Updated: June 2020
MIAMIBE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeachl, goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673.7411
Swartz DIVERSITY STATISTICS REP ORI
Helen
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:
DIMae
?enate
" oer O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
.Caucasian white
[j Native American/American Indian O Other - Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Ere
%a.aro as
Do you consider yourself Physically Disabled? s..
o
D I prefer not to answer this question.
Page 6 of 6
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Updated: June 2020
M IA M l·DAD E- Em 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"so.e First Name Middle Name/Initial
2020 Helen
Mailing Address - Street Number, Street Name, or P.O. Box
1330 West Ave Apt 1804 Miami Beach 33139
City, State, Zip
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 Heile.
Filing as an Employee (check one)
DJ county ID Public Health Trust [] Municipal :
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
Miami Beach 1/2 022 □County □Municipal:
(Municipality)
Board where serving
Disability Access Committee
Alternate address (if home address is exempt) ~ Work telephone I Term began on/ended on
106396424
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
Social Security
Social Security Contributions
Stocks/Funds
Income distributions
I hereby swear (or affirm) that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
) 1ga Jon GE /VED «e • Signature of Person Disclosing JAN 12 2022
~~
CITY OF MIAMI BEACH Date signed
p Ip "
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
:2l 24.£ #2•• I?
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A citywide (CW ) parking permit is honored at metered parking space s 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 "par king 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: 1/2022
Applicant Name: Helen Swartz
Board/Committee Nap9i5ability Access Committee
Addres9330 West Ave Apt 1804 Miami Beach 33139
E-Mail Address 4q. ·hel 125@ ·il am eten. gma.com
Work Phone: Home Phone
Cell Phone; TU 639 4Z4 Preferred Coniaci Method: 61 0 639 6424
Vehicle Information
Tag: EQPV55 Color: Black
State: FL Year: 2016
Make: Jaguar Model: XJ-R
Applicant Sianature: ef
Please provide signed form to the 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 & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·ki D ar una epar men ec on
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature:
Date Issued: Date Completed:
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