Tiffany Heckler 12/31/23B O A R D A N D C O M M IT T E E C H E C K L IS T
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FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF
Scan o
Scan o
Scan o
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to
1/12/2022 1/12/2022
o Board and Committee Application (Completed on _,
o Résumé/Curriculum Vitae 1/14/2022
o Diversity Statistics Reporting (Completed on I
o Oath
12/31/23 TERM END:
12/31/29
on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS
✓
Received January 14, 2022',
Office of the City Clerk
City Code Ordinance Section applicable to the agency, board or com ittee
City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2- 19
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 throlgh July 2012)
Highlights of the Miami-Dade County Ethics Code
✓Sunshine law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Commiltee Members
Scan o
Scan o
Scanned on:
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Offic rs and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTl~p COP.Y in file and QElGlAl- fbr Annual Report.
'171t1 sones»X . tolo
Date Bo e Member
1/14/2022 Claa D'A , »ut [ro5Sed o[.(y lrp[0/e@., k
Date City Clerk's Office Staff Initials
1/14/2022 Cao, D'A, »ut .[y P [T D [/g },l
Received on:
Date City Clerk's Office Staff Initials
CONCLUDED & RESIGNATION LETT RS
Term Expired Letter Date Processed Initials
Resignation Letter Date Processed Initials
Removal Letter due to absences Date processed Initials
F:ACLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.dccx
M IA M I BEACH
City of Miami Beach, 1/OO Convention Conter Divo, Miami Boach, Horida 33 139 yw._miamibaachll.go
OF F ICE OF THE CITY CL ERK, Rafael E. Granado, City Clark
Tol: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@mi amibeachll.gov
Ja nua ry 12 , 20 22
M s. T iff any H eckler
435 W est 51 st Street
M ia m i Bea ch, F lo rida 33 14 0
R E : C om mi ttee on the Homeless
D ear M s. T iff any H e ckle r:
C o ng ratula tio n s! Y o u ha ve be e n ap p o inte d by C o m m iss io ner D av id R ic ha rdson to the ab ove -
referenced Boa rd or C o m m itt ee , for a term ending: 12/31/2023.
Pursua nt to C ity of M iam i Bea ch C ode Section 2-22 (5)a:
N otw ithstanding any othe r provision of the C ity C ode or of any R esolution, com m encing w ith
term s beginning on or aft er Ja nua ry 1, 2007, the term of every board m em ber w ho is directly
appointed by a m e m b er of the C ity C om m ission shall autom atically expire upon the latter of:
D ecem b er 31 of the yea r the appo inting C ity C om m issioner leaves office or upon the
appointm e nt/electio n of the successor C ity C om m ission m em ber.
If yo u are una b le to acce pt this ap po intm e nt, or have any questions, please call the Of fice of the C ity
C le rk at 305 .6 7 3.7 4 11.
P le a se re a d th e e n clo sed m ateria ls carefully as the y concern your dutie s, respo nsib ilitie s, and
req uirem ents as a boa rd or com m itt ee m em ber.
C o ngratulatio ns aga in and good luck.
R ega rds,
zi.nad o
C ity C le rk
cc: M o nica Be ltran , Pa rking D irector
Ja nay G ue rrero , C ity Li a iso n
EN C L O S U R ES :
O ath of O ffi ce/O ath of C ivility/A cknow le dgem ents
C ity C od e/O rdinance sectio n ap plicable to agency, board or com m ittee
C ity C o de Se ction s 2-22 , 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdina nce N o. 2006-354 3 - Am en dm en t to C ity C ode Section 2-22
M ia m i-D ade C o unty C ode Sectio n 2-11.1 - C on flict of Interest and C ode of Ethics
C ity Wi d e Pe rm it Ap pli catio n - (Par ki ng D epart m ent Form )
Book l et - G ui de to the Sunshine A m endm ent and C ode of Et hics for Public O ffi cers and Em ployees
City of Miami Beach, 1ZOO Comntin Contes Drive, Muami [coach, Ho«da 33139 y¿y _miaIubu_gchll_g]y
OFKCE OF THE CITY CIERK, Rafaal E. Granado., City Cdesk
tel. 305.673.74l1, fox. 305 673.7254
Email. CityClerk @miamiboochfl.gov
Oath of Office
Oath of Civility
and
Acknowl edgements
TO: Ms. Tiffany Heckler
RE: Committee on the Homeless
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government f the United
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a m mber of the
above-mentioned board or committee of the City of Miami Beach to which I have been ap ointed for a
term ending: 12/31/2023.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and ivility, 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 each Board
and/or Committee, I must comply with the financial disclosure requirements of Miami-Dade [ounty or the
State of Florida (depending on the board or committee on which I serve) on July 1st, followin the closing
of the calendar year on which I have served.
14th Jan
Sworn to and subscribed before me this day of1_.2022
an
Charles D'Agostin
Deputy Clerk
*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.
MIAMIBEACH
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
RECE IVED
JAN 18 2022
CITY OF MIAMI BEA]H
OFFICE OF THE CITY CLERK
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 ( ), as (check
) al)hat apply):
✓I am a resident of the City of Miami Beach for six months or longer.
ore Aures H,555 NU Bf4 K0» MAIA OH HA F 3[0
o I have an ownership interest (for a minimum of six months) in a business established i the City of
Miami Beach (for a minimum of six months).
[qr ff P1][f9 >.
H1g[fes, (]]f9SS
o/" I am a full-time employee of a business (for a minimum of six months) and I am based i an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
v an e ore«e lkkl« 'opof, 4 pbl flits
eon-»s Aono. 4586 By Keal flan« eh33/'0
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability comp}ny, or other
entity or business association.
Under pen "
are true.
ave read the foregoing document and that the fac s stated in it
Signatu Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of j/hysical presence or a online/notarization,
«.la0 o123. 7É," Heo l
~ of Mi7JBeach Board/Commz"tt e Member).
7 ))1t S ,o, S
Produced ID UC# 0 C
Form of Identification
on y Known
Sign
Name of Notary, Typed, Printed, or Stamped
M IA M I-DAD E- SO UR CE OF IN CO M E STATEM ENT El
Section 2-11.1(i) of the County Ethics Code requires that certain employ ees 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 l lame/initial
2021 HECKLER TIFFANY ZIEN z
Mailing Address - Street Number, Street Name, or P.O. Box
4555 N. BAY RD
City, State, Zip
MIAMI BEACH, FL 33140
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 an d ch eck her e.[l
Filing as an Em ployee (check one)
[] county [] Pub l ic Heal th Tr ust [] Municipal:
(M un icipal ity )
Department
Position or Title Employee D Number
Work address I Work telephone Employmt nt began on/ended on
Filing as a Board Member (check one)
[] county E] Municipal: CITY OF MIAMI BEACH
(Municipality)
Board where serving
COMMITTEE ON THE HOMELESS
Alternate address (if home address is exempt) I Work telephone Term beg n on/ended on
(786) 367-0144 1/1212022
List below every source of income you received, along with the address and the principal activity of each source. Include your public s 9lary. Place the sources of
incom e in descending order, wi th 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 in come 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 separa te sheet, check here.[]
Name of Source of Income Address Description of the Prin ipal Business Activity
LSN PARTNERS LLC 801 ARTHUR GODFREY RD STE 401 CONSL LTING
MIAMI BEACH, FL 33140
HECKLER CORPORA TE & 4555 N BAY RD CONSL LTING
PUBLIC AFFAIRS INC MIAMI BEACH, FL 33140
LLORENTE & HECKLER PA 801 ARTHUR GODFREY RD STE 401 LAW FIRM
MIAMI BEACH, FL 33140
I hereby swear (or affirm) that the information above is a true and correct statement. RECEIVED BY ELECTIONS L EPARTMENT:
155. [] Hardco py
$] Electronic Copy
Received Janu ary 14, 2022 ..4l Office of the Ci y Clerk
OFFICE USE ONLY Accept ed:. Y / N Deficiency. Processed Date/initials: Scanne d D lte/Initials:
138_SP-14 COE 2016
MI A MI B EA CH
City of Miam i Beach
1700 Convention Center Drive
M iami Beach , Florida 33 13 9
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 30 5 .6 7 3.7 4 11
Acknowledgement of fines/suspension for Board/Committee Members for failure to co ply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Last Name First Name Middle Initial
I understand that no later than July.1, of each year all members of Boards and Committees f the City of Miami
Beach, including those of a purely advisory nature, are required to comply with Miami-Dad County Financial
Disclosure Requirements.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Converltion 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 t e person to a fine
of no more than $500, 60 days in jail, or both.
.. #l- Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by th State of Florida,
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the liami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment me bers who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's fi ancial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional f rm with the Office
of the City Clerk. However, compliance with the County disclosure requirement does no satisfy the State
requirement.
Page 5 of 6
F:CLERISALL RE G\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINALdocx
Updated: June 2020
MI AM I BEACH
City of Mi a mi Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Tel ep h on e: 305.6 73.7411
DIVERSITY STATISTICS REPORT
Last Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
aske d to co m p ly w ith C ity diversity reporting requirements.
Gender:
Late
Li Fem ale
Ll oner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
Ll Asian or Pacific Islan der
Lk Caucasian/wh ite
L 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?
Los Livo □I prefer not to answer.
Do you consider yourself Physically Disabled?
LE_s
fi
Llt prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
A\/\]A//BE AC[ CI TYWIDE (CW BOARD & COM»T EES a a» .roi ...as. rasas #a#en PARKING APPLICATI ON
1755 Meridian Avecue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200 PARKING
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 Ac ess Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". n order to avoid
any unnecessary enforcement action s, it is important that our records reflect the 1 nost 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 v hicle.
Please note that this new access card CANNOT be hole punched or perforated in an y manner. To use
the new card please hold the card at close proximity to the reader until the gate open . You may need
to try the other side of the card. Please ensure you hold the entire surface of the card o gainst 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 $10.,00 replacement fee.
Board Member Information
Date of Application: 00Pe/ 2,2027
Applicant Nam e: [\Fr9t 2.HELۧ
Board/Committee Name: C0nif6 0 6 How@s$
Address: {555 Nt R0 KO 1Ay[ %1 q L334»
EMol Adres ¡L 2:,26@ y+o0. o
wok Pone 9y00.8 7.37.01 Home Phone 305.8& .3
Cell Phone: t Preferred Contact Method: to(
Vehicle information
Tag: P2KN57 Color: WHIT€
State: FL Year: 2021
M ake: TESA Model: X
oleosa»..f ,l l
Please provide signed form'to th e Parking Depa rtm ent located at 1755 Meridian Avenue, í d floor. W orking
hours are 8:30 to 5:00 p.m . or email to: ParkingR eception@mn iamibeac hfl.gov
e-m ail subject: BOARD 8 COMMITTEE PARKING APPLICATION - APPLICA NT NAME
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Nome:
Signature: e Signature: e6
Date Issued: Date Completed:
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