Daniel Nobel 12/31/22M IA M IBE A CH
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BOARD AND COMMITTEE CHECKLIST
APPOINTE. uo? lolo_l/ DATE OF APPOINTMENT: Pel>01 -20z 7
BOARDcOMMIrTTEE. heAI} /4 So _Appointed by. smyyoor 3 _1@4 ev
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RECEIVED
FEB 11 2022
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
t Ci ty C o de O rdi n ance Section ap plic abl e to th e agen cy, board or comm i ttee
Y Ci ty C o de S ection s 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
v C o un ty C od e S ection 2-11.1 -- C onflic t of Interest and C od e of Ethics O rdinance (as
am ende d through Decemb er 2010)
✓A m end m ents to the Code of E thics O rdinance (Septem b er 2009 thro ugh July 2012)
t Hi g hligh t s of the Mi am i -Da de Co un ty Et hic s C ode
t S un s hi ne Law an d Pub l ic R ecord s -- Frequen tl y A ske d Q uestion s
V M e m o ran d um - Solici tation by City Board an d Co m mi tt ee Members CIT Y O F MIA M I BEACH
OFFICE OF THE CITY CLERK O C ityw id e P e rm it A pplication (P arking Depart m ent Form )
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O B o okle t - G ui d e to Sunsh in e Am en dm en t & C ode of Et hics for Public O ffi cers an d Emp l oyees
o So urce of In com e Statem ent
O A ckn o wl e dg m en t of Fi nan ci al Discl osure Requirem en t
O DIVERSITY STATISTICS REPORT
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F:CL E R \B O A R D AND C OM M IT TIES DA TAB A S E\CH E CK L I ST M A STE R\B &C Checklist 2015 M A STER.docx
We are committed to providing excellent public serice and safety to all who live, work, and play in our vibrant, tropical, historic communly.
MIAMIBEACH
City of Miami Beach, 1700 Convonlion Contor Dio, Miaml Boch , Florida 33 139 wwww.miamÍboachfl.gov
OFFI CE OF THE CITY CLER K, Rafool E. Granado, Cwy dork
Tl: 305.673.7411, Fc 305.673.7254
Ema l: Ca»yCderd,@mlatbeachll.gov
TO: Mr. Daniel Nobel
RE: Health Advisory Committee
Oath of Offioo
Oath ot civility
and
Aoknowlodgements
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. '
Dae@ tole _
Mr. Daniel Nobel
Sworn to.and subscribed' ~efore methis \ il
"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. ' "
S O U R C E O F IN C O M E S TAT E M E N T
Section 2-11.1(@) of the County Ethics Code requlres that certain employees and publlc officlals flle a financial disclosure Statement on a yearly basls by July 1st
of every year.
DIsclosure tor Tax Year En dlng
2021
FIrst Nam e Middle Name/Initiai
U
M alling Addres s - Street Num ber, Street Namo, or P.0. Box
So
City , Sta te, Zip
hi; F 2141
lf your hom o address ls your malling address, and your hom e address ls exempt from public records pursuant to Fla. Stat . $119.07, read
Instructions on the following page and check here. D ·
Fling as an Employee (check one)
[ county □Public Health Trust [] Municipal:
(M un icipal ity)
Departm ent
,·
Posit on or Tltl e Em ployee ID Number
.
Work addres s I Work telephone Employm ent began on /en ded on
Fling as a Board Member (check one)
[] county kI Mont at : Mu kea J (Municipality)
Board wh ere serv ing
Alte m ate address (If hom e address ls exempt) Tenn began on/en ded on
-58 AA- l Dec-2\
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 deallngs, Interest, rents, dividends, pensions, IRA distributions, and soclal security payments. Also, Include any source of Incom e received by another
person for your benefit. However, the Income of your spouse or any business partner need not be disclosed. If conti nued on a separate sheet, ch eck here.LI
Nam e of Source of In come Address Description of the Principal Business Actlvtty
lhs N \2 H Ae
y F 213
I hereby swear (or afflrm ) that the Inform atlon ab ove Is a true an d correct statem ent.
Signatu re of Pers on Disclosing
[b --21- Date slgn ed
ncvE Y HP/N5 PARNE.
) aratcoy -'UE:lVEE
aee#%%, 1 a
CITY OF MIAM
OFFICE or +„·Il BEACH
t us
MIAMAIBEACH
5
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.,miamibeachf,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.goy
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)
NO_
Last Name First Name Middle Initial
I understand that no later than July1, of each ear 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
, t
2. A "Statement of Financial Interests (Form 1)';" or
3. A Copy of your latest Federal Income Tax Return.
- ·r ii¡ti ¢
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
o more thp,5500, 89d9y$ i ñ4, or bot. uo-oh? - [el -Il-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.
Page 5of6
F:CLERISALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MI A MI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVE RSITY STATISTICS REPORT
Last Name
Dpt U
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.+É a
9 ?
Gender:
X3wae
LJremale
oner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
Caucasian/white
O Native American/American Indian
Lother - Print Race.-
LJ i prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
av.
o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
v a»
~ ~:refer 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 A MI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@mlamibeachf.got
Telephone: 305.673.7411
RECEIVED
FEB 11 2022
CITY OF MIAMI BEACH
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 (4), as (check
(/) all that apply):"
X am a resident of the City of Miami Beach for six months or longer.
Home Aaaress. IL Sul Sloe De !uu«Beal F 14/
□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).
[[ame f [1[][@Si»
Business Address ----------------'--------------
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).
[[ame tf [[y,[fS5
[[JS[mes,, ((]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.
· 4a „f•
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it [ Se Melo ? pzazz
Si ure Date
Diel olel
P. t d N . . · i\, ,.1 . · · rmntec ,ame _· 'U , f
Sworn to (or affiëed and subscribed~-f }or. e ~ •• "~:; ofo /~_JI P p_,r,e. ~~z_. r ti ~º_1
,_l. :_._•.'u0
:_ '_·_:_<
el/el ? 1o" L i, /Uo_ -
(Pity of MiamyBeach Board/committee Member).
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