Tiffany Lapciuc 12/31/24FOR SCANNER
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o Letter of Reappointment
o /4 e f L · r of.....,~ointment/Reappointment e-mailed to Committee Liaison on
'Board and Zormnmnkís f56ieation (completed on
o Resume/cauricuam vtae 2/3/ )3
o Diversity Statistics Reporting (Completed on2/ gàUd7 º Oath 7
RECEIVED
3 2022 FEB
IMIPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
Y 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)
Y Highlights of the Miami-D ade County Ethics Code
Sunsh ine Law and Public Records - Frequently Asked Question s
Memor and um - Solicitation by City Board and Committee Members C ITY O F M IA M I B E A C H
OF FI CE OF TH E CI TY C LE R K
Citywide Perm it Application (Par king Dep artm ent Form)
d B ooklet -- Guide to Sunshine Am en dm en t & Code of Ethics for Public Officers and Employees
Scan o bYs ource of Income Statement
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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:\C L E R \B O A R D A N D C O M M ITT IE S D A TA B A S E \C H E C K LI S T MA S T E R\B &C Ch eck list 20 15 M A S TE R .d ocx
We ate com mitted to providing excellent pub'c service and safety to al who live, work, and play in our vibr ant, hopical, historic community.
M IAMI BE
City of Miami Beach, 1/00 Convonlion Conter Drive, Miami Boach, Ilorida 33 139 y._miamibcachl]gay
OFFICE OF THE CITY CLERK, Ralaal E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
January 20, 2022
Ms. Tiffany Lapciuc
4900 Pine Tree Drive
Miami Beach, Florida 33140
SUBJ ECT: Cultural Arts Council
Dear Ms. Tiffany Lapciuc:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2024.
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.
Respectfully,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Brandi Reddick, 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 Cole f Fthics for Public. (Officers and Fmnloveas
IAMIBE
City of Miami Beach, 1/00 Convention Conter Drivo, Miami Bach, Horida 33139 y¿w_miamiboachll,goy
OFFICE OF THE CITY CLERK, Ralaol E. Granado, Chy Clerk
Tel: 305.673.741, Fox. 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Tiffany Lapciuc
RE: Cultural Arts Council
l 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: 12/31/2024.
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.
l 7rans
Sworn to and subscribed before me th· _r;;;:,·"--~day of ~022
Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
(mmittae fr adlitinal infrmatin ronrorrlin tha Finanri] Tialoetir Riirmonte
E CE IVE D
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
19F, MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City'pdé @éátiors 22 (4)!as (check
(/) all that apply):
✓I am a resident of the City of Miami Beach for six months or longer.
Hom e A dre s. ll65 NE M or id tao @ene M,u.3#O
FEB 3 2072
I have an own ersh ip in tere st (for a minimum of six months) in a busin ess estab lished in the City of
Miami Beach (for a mi n im um of six m on th s).
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la m a full-tim e em plo yee of a busin ess (for a m inim um of si x m onth s) and I am based in an offi ce or
oth er location of th e busin ess th at is phy sic ally located in M iam i Beach (for a mi ni m um of six m on th s).
[qr] (of 4-,/f@Sr.
p[Is][es,s, (](Hf@S5....
"Ownership Interest" means the ownership of ten percent (10 %) or m ore (including the ownership of
10 % or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited lia bility company, or other
entity or business association.
U nder penalties of perjury , I declare that I have read the fo regoing docum ent and that the facts stated in it
are true fl¢ ✓.. / l le4;y pu O2AL3 Signature\v 7 Date
.±!ldy 1fa
N O TA RY
S w orn to (or affir m epj ) and subs cribe d before m e, by m eans of physical pre sen ce or,'óni ine not arization ,
.3.Jae102• 1Eq pci(
________ (C~ of M ía · Beach Board/C om m itte7 rÍ~ber).
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of every year.
Discl osure for Tax Year Ending [Last Name ,
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first Nam e
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M Iddl e Nam e/Initlal
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Malling Addre ss -- Str eet Numb er, Str eet Nam e, r P.O. Box
(405 A, M id ta
City , State, Zi p
Yhar Éo F.33/40
If your home address is your mailing address, and your home address is exemp t from public records pursuant to Fla. Stat. $119.07, read
Instructions on the following page an d ch eck her e.Ll
Fi ling as an Emp loyee (chock one)
[] county [] Public Heal th Tr ust [] Municipal:
(Municipality)
Department
Po siti on or Titl e Emp loyee ID Numb er
W ork addre ss Work te lephone Emp loym ent began on/end ed on
Filing as a Boa rd M em b er (chock one)
] county
Board where serving
M aii l. C hura
Al tern ate addres s (if hömne address Is exempt) Work telephone Term be an on/ended •
lott2- 1215//44
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, wi th the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
prop erty dealings, intere st, rents, dividends, pensions, IRA distributions, and social securlty 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 sh eet, ch eck here.[]
N am e of So urc e of Incom e Address Descr ipti on of the Principal Business Acti vity
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I hereby sw ear (or affi rm ) that th e inform ation above is a tru e and correct statem ent.
sianati Gl ie#san oiycisin "
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Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
J artcoRECEIVED
O Electronic Copy
FEB 3 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
REM EMBER TO PR IN T, SI GN , AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EM AI L OR HARDCOPY.
G e nd e r:
LClMae
[kr emale
Oomer
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
LAfican American/Black
O Asian or Pacific Islander ID caucasian/white
[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?
ves no
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Clves ao
D I prefer not to answer this question.
Dade County Financial Disclosure Code Pro vision Code Section 2-11.1(i) (2)
LapiL
Last Name 7.ES sy
First Name
L-
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 fled 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)';" 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. -eco, 0lor22 soras7= 7 1 ate
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 of6
F:CLER\SALLIREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
Cary or m ua m w B e a c n , PA R KI N G D E P AR I E N I T HI+IV HI ILI/ AI/HIV II)III3JE 3.\a ±l
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200 PARKING
A cilywide (CW) parking perm it is hon ored at metered parking spa ces an d restricted residen tial zon es
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 cord 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: )7
Applicant Name: ('
Address: . 33/40
E-Mail Ad
W ork Phor -, 0S).32 -0$3
Preferred C
Vehicle Information
Tag: DKI 024 Color: Go4
State: floc id0 Year: 3030
Make: Pao Model: tADX
Applicant Sianature: e
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@migmibegchfl.gov
e-mail subject: BOARD 8& COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P, ·d D ar mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e6 Signature: eS
Date Issued: Dote Completed:
s .