Yolanda Sanchez 12/31/23M IA M I BEACH
FOR SCANNER
Scan o
B O A R D A N D C O M M IT T E E C H E C K L IS T
arron ree. }a la da _a hl c ore or ron9yar:. 902
oARocowwree. /A-} k Rblic [laces_ reo»cea..//1 2a,/5/ov
e ro /2II/3a . /2///23
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reap intment
o Copy/ Let . of Appointment/Reappointment e-mailed to Committee Liaison on
S c a n o
S c a n o
S c a n o
io
o Blat d iittee Application (Completed on _ )
·renes»rrve. 2/,/ )3,3
o Diversity Statistics Reporting (Completed on ~~' .~ t.?"7/ ~ _.i-
o Oath
3ECE IVE D
FEB 16 2022
IM P O R T A N T IN FO R M A T IO N FO R B O A R D A N D C O M M ITT E E M E M B E R S B O O K
✓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
"YOF MIAMI BEACH
ICE OF THE CITY CLER_. Jlreifywide Permit Application (Parking Department Form)
S c a n o
S c a n o
0-B6oklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
0 Source of Income Statement
0.6knowledgment of Financial Disclosure Requirement
a DIVERSITY S T A TI S TI C S REPOR TI
Received on:>(·/O·_„2_ _signed by /1rd4<'f-
/ Date ¡
Processed on: d~} {oY _)_. By Employee: --t::,,~-; .• 1,~,-;;;.::--,-----------------,---"-- •)Ne o
Scanned on: ~/¿l(z /:),, L By Employee: _ ___.""'--,,C..,,'--.,.,,C:....,.,c._-....c... _ ah o
for Annual Report.
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials S can o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Wo ate committed to proding excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
T O : Dr. Yolanda Sanchez
• RE: Art in Public Places Committee
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
FEB 16 2022
CITY OF M IAM I BEACH
O FFIC E O F T H E C ITY C LER K
A FF IDAVIT O F A FFILI A T IO N W IT H THE CITY O F MIA M I B EA CH
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 ·) al that apply):
l lam a resident of the City of Miam i Beach for six months or longer. , f
one «nos». o E5lad Hveue,hh/oy, M iaAui Bead, FL 33is39
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).
[p ar @ f [3 [JS][gs
[3yg[mess (]]f9 S S
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).
[]q r 9 (f [y/fess-
3 4 S [n 9 S S (](df9SS
"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, 1/mited liability company, or other
entity or business association.
eclare that I have read the foregoing document and that the facts stated in it r
Signa re
la nda Salé2 Date
Pintean
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of 0physical presençe or a online notarization,
s./2«u 9%. 1o lla toe
(C~ Miami B h Board/Committee zber);_ . tlteres o0<.e
Form of Ide · · lion
(NOTARY SEAL) •
Signatur
Name of Notary, Typed, Printed, or Stamped
; CHARLES J. DAGOSTIN --~~:¡•"~•- ? ? MY COMMISSION # HH 165705
?%, ¿s¿ EXPIRES: December 14, 2025
í@;jjj?" Bonded Thu Notary Public Underwriters
M I A M I-DAD E. EM»mI SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of th e Coun ty Ethics Code requires that certain emp loyees an d public officials file a financial disclosure State m en t on a year ly basis by July 1st
of every year.
Di sclosure for Tax Year En ding Last Name
Sáchcz 2021
First Name I
0 Od
Mi ddle Name/initial
City, State, Zip •
/laui Beach, FL 2313
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 here. D
Filing as an Employee (check one)
□County D Public Health Trust [] Municipal:
(M uni cip ality)
Department
Position or Title Em ployee ID Numb er
W ork address I Work telephone Employment began on /ended on
Filing as a Board Nlember (check one)
coi, y4Mt- E] Municipal: a} I5ea cl DADE (Municipality)
w"jr,y ' li haces } 1 ta tC
Alternate address (if hom e address is exem pt) E5L. ce ¡ Term began on /end ed on
,
Li st below every source of incom e you re ceived, along w ith the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source firs t. Exam ples of sources of incom e include: com pensation for services, incom e fro m business, gains fro m
pro perty dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of Incom e received by another
person for your benefit. How ever, the Incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.El
Nam e of Source of Income Address Description of the Principal Business Activity
'lau.la Sadee o Z6au e.toy Rchredl
self colore/shalo ars /
t 4
a
ve is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy RECEIVED
O Electronic Copy
FEB 16 2022
OFFICE USE ONLY Accept ed: Y / N Defici en cy: Processed Dat e/initials: Scann ed Date/initials:
138_SP-14 COE 2016
MIAMI BEACH
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
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowl edgement of fines/suspension for Board/Com mittee Membe rs for failure to comply wi th Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
5án cdez
Last Name First Name Middle Initiai
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
Di sclosure Requirements.
One of the following forms m ust be fil ed 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: a« »
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 n · · · both.
Sign Date
' Mem bers 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 requirem ent does not satisfy the State
requirement. ''
Page 5 of 6
F:\CLER\$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
ww w.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name Fir 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:
Ll Male
Zlremale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asían or Pacific Islander
LZl Caucasian/white
O Native American/American Indian O Other -- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Span ish , Hispanic, or Latinola?
zu.
Llo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
üho
O I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M\l /A\/\/ B E A CH CTTWDE (Cw oAD & coMweEes. -g
or i mori o-sii. ionie osai«va PARKING APPLICATION I.I
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (3051 673-,7000 e4. 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 oreas. 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 piote. 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 cord. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOW LEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replaceme nt fee.
Board Member Information
Date of Application: 2./0. 22
Applicant Name:
Board/Committee Name:
Address:
E-Mail Address:
€ O» •
Work Phone: . 'O'} Home Phone
Cell Phone:
t
Preferred Contact Method: ho€
Vehicle Information
Tag: Color: Gr. ve
State: Florid a Year: 2o lt
Make: Vo.vo Model: Xc9o
Applicant St+nature: e
Please provide signed fc fo the Parking Department locatet { 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·kd D ar una epar#ment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: e6 »,
Date Issued: Date Completed: '
s .
01