Natanya Rogoff 06/08/23MI A MI B E A CH
BOARD AND COMMITTEE CHECKLIST
-, I '1 -=i ¡ r () APPOINTEE: __ >-[' tfh> DATE OF APPOINTMENT: j._)Ju
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on scoweR roReasrrr fl/33 [// 9_3 scan. ·Letter ot Apoioment rERMEN.Q l· TERMLuMrr o/ 0
Scan o o Letter of,Reappointment
0 ~¢-~rr 3~poíntment/Reappointment -~mailed to Committee Liaison on
Scan o o Boar and Committee Application (Completed on ~ l
so- ·iii@i%iciv 2[3[], j
o Diversity Stat istics Reporting (Completed on ,,
Scan o o Oath
RECEIVED
$EP 01 2022
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agency, board or committee
Cty Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
v County Code Section 2-11 1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 201 O)
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
v Memorandum - Solicitation by City Board and Committee Members 3/TY OF MIAMI BEACH
FPICE OF THE CITY CLERK O Citywide Permit Application (Parking Department Form)
Scan O
Scan O
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
O Board and Committees Liaison Responsibilities
/
O Dl~SITY STATISTI CS REPORT
f/3 o/2 .soca} / Dan Ae
/
Date L ....
,3/[Q_ o»enes t A
Date j
8/3/_/Mey enors 4A
Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials 8can O
Resignation Letter Date Processed Initials Scan O
R em o val Letter due to absences Date processed Initials Scan o
F CL E RB O ARD AND COMM I TTI E S DATAB ASE CH EC KL IST MASTER\B &C Checklist 2015 MA STER docx
ut 1a. ' 1
MI A MI BEACH
City of Miami Beach, I/OO Convention Canter Drive, Miami Boach, Florida 33 139 yyw_miamibgachll.go
OFFICE OF THE CITY CIERK, Rafool E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CilyClerk@miamiboachfl.gov
August 23, 2022
Ms. Natanya Rogoff
5223 N Bay Rd
Miami Beach, FL 33140
SUBJECT:; Youth Commission
Congratulations! You have been reappointed by Commissioner Steven Meiner to the above referenced,
board or committee named above, for a term ending: 06/08/2023.
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 ls dlrectly 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 305.673.7411. Please read the enclosed materials carefully.
Congratulations and good luck.
%4
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, 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 Code of Ethics for Public Officers and Employees
/
MIAM/BEACH
City of Mlaml Beach, LOO Convontn Conker Drwo, Mam [ooh, Hlordo 33139 wry .mkarbQ.hll.dz
OHFKL O TH CITY CIFK, Ralaol ( Grando, Cwy lard
el 305 6/3/a11ta». 305 673 7254
fl Co/Clerk@metamtboac hfl gov
Oath of Of7loo
Oath ot Civility
and
Aoknowlodgomonts
TO Ms Nalanya Rogoff
RE Youth Commission
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 Miam i 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 tor a
term ending 08/08/2023.
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 Gulde 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 com ply 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.
i
/
Swor to and sutscnbed etore me mi_ _aa « __,2022
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
MI AM AI BE A CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, florid0 33139
OFFICE OF TH E CITY CIERK
Email BC@mamubeachf gov
Telephone 305 673 7411
RECEIVED
SEP 01 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AEEIDAVIT 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)
Iam a resident of the City of Miami Beach for six months or longer.
orne ores, '523 1, &au fdlA. ('h, EL_ ai4o
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)
[papp tf [y,1[,
[3y[f,, l([(Hf?Sb
a lam 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)
[]Qr9 Pf Py,1mes
Py,1rP,, [(res,j
Ownership Interest" means the ownership of ten percent (10%) or more (including tho ownership of
10% or more of the outstanding capital stock) in a business
Business" means any solo proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association
Under penalties of perjury(l,I declare, that l have read the foregoing document and that the facts stated in lt
are vue.]'.k pp, D7 lf a.4lujii srj glera
Ng4 pg,E
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by mean~ o¥ysical presence or o online notarization,
«82r0A«a s ha 23,1ati pa oj o°
(City of Miam· each Board/Committz· Member)
' ¡Cy ,,yo?< 2,,<<>
Produced ID yvr 7
Form of Identification
gjii;g., cHRLES J. DAGosTw
$ ?? M coMMIssIoN # HH 16s7os
±,9Nd.is; ExPREs: December 14, 2025
@ i%" Bonded Thru Notary Public Underwriters
(NOTARY SEAL)
MIAMI BEACH
City of Miami Beach
I700 Convention Center Drive
Miami Beach, flondo 33139
ww..miamtbeach ll goy
OFFICE OF IHE CITY CIERK
Emol C@muamibe achL. g0y
Telephone 305 673 7411
BOARD & COMMIEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committoo Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Soctlon 2-11.1(1) (2)
Lasr NA7 me ame/ Mi~aie initiai
I understand that no later than Jul1Qoach.gar 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 Requirem ents
Qng of the following forms must po 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 Finan cial Interests (Form 1)'," or
3 A Copy of your latest Federal Income Tax Return.
Failure to filo one of these forms, pursuant to the Miami-Da de County Code, may subject the person to a fine
of no more than $500, 60 days in jail, or both. ita a e@
Signature Date
' Members of the Planning Board and Board of Adjustm ent will be notified directl y by the State of Florida,
pursuant to F.S $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12.00 noon, July 1. Planning Board an d Board of Adjustm ent mem bers wh o file their
Form 1 with the County Supervi sor of Election s automatically satisfy the County's financi al disclosure
requirement as a Miami Beach City Board/Committee member and need not file an addition al form with the Office
of the City Clerk. However, compliance with the County disclosure requirem ent does not satisfy the State
requirement.
Page 5 of 6
F CLER$ALL RE GBOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATON REG FINAL docx
Updated. June 2020
RE ARRI ramammal
..HE9999 i&ijiiii
Clear From Print Form
SOURCE OF INCOM E STATEMENT
Section 2-11 1() of tho County Ethics Code requires that certain employees and public offclals file a financlal disclosure Statoment on a yearly basis by July 1st
of every year.
Dlsctosuro for Tax Year Endlng
2021
Last Name or FIrst Mamo MIddle Name/Inltlal
> L...
Malllng Address - Street Number, Street Noma, or P.0. Box
623M 2 Bl CIi. saio, zi ")
- m feal F
If your home address Is your malling address, and your homo address ls exempt from public records pursuant to Fla. Stat 119.07, read
Instructions on the following pago and check hero.El
Fling as an Employee (check ono)
[] county I] Public Health Trust E] Munlcipat:
(Municipality)
Department
Posltlon or Tllo Employco ID Number
Work address I Worl< tolopl1ono Employment bogon on/ended on
[] County
Board whore serving
Alternato address (I homo address ls oxempt) Work telephone Te
-055-408-27305
List below overy source of incomo you received, along with the address and the principal activity of each source. Include your public salary Place the sources of
Income in doscondlng order, with the largest source first. Examples of sources of income include: compensation tor sorvices, Income from business, gains from
property dealings, Interest, ronts, dividends, ponslons, IRA distributions, and soclal security payments. Also, Include any source of income received by another
person for your benefit However, tho income of your spouse or any business partner need not be disclosed. Ht contlnuod on a separate sheet, check here.L_]
Name ot Source ot Incomo Address Description of the Principal Buslneso Activlty
,
Pee,t> J coo - -
I hereby swear (or affirm) that the information above ls a true and correct statement RECEIVED DY ELE CTIONS DEPARTMENT:
wore RECEIVED
L] Electronic Copy
SEP 01 2022
CITY OF MIAMI BEACH
CLERK
EMEMBER TO PHINT SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAI L OH HARDCOPY
MIA M/BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
v. muamtbeac.hll,goy
OFFICE OF THE CITY CLERK
Email gC@mniamibeachf_go
Telephone 305 673 7411
DIVERSITY STATISTICS REPORT
L a st im e First Name
t
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:
J a e
(O remale
omher
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
El Amnican American/lack
DB,Asian or Pacific Islander
ECO caucasianwmte
El Native American/American Indian
Ll Other - Print Race •
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
C}Yv es
No
Ll tprefor not to answer
Do you consider yourself Physically Disabled?
o no
Ll tprefer not to an swer this question
Page 6 of 6
F ACLERSALL R E GBOARD AND COMMITTE E APPLICATION S FINAL DRAFT SBOARD AND COMMIT EE APPLICATION REG FINAL doc
Updated. June 2020
/\4 A //BEACH CwDE (Cw) O AR D & COM»E Es
cw et Miami es+, PARK.No E PA R t Nr PAR KING PP[[CATON
1755 Merdian Avenue, Suite 200/Mi0mi B8each, Ft 33139/Ph (305) 6737505 or (305) 6737000 + 6200 PARKING
A cilywi de (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spa ces. A CW parking permit IS NOT honor ed in proh ibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access,
IMPORTANT NOTE: Your veh icle licen se plale 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 ol parking citation (s) and/or the towing of your vehicle.
Please nole that this new access card CAN N OT be hole-p unched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gote opens. You may need
to try the other side of the cord. Please ensure you hold the entire surface of the cord against the reader
until the gate op ens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, l will be responsible to pay a $10.00 replacement fee.
Board Member information
Date of Applicator: $
Applicant Name: Ke,
Board/Committee Name. n
Address +,323 1
E-Mail Address.
Work Phone. Home Phone
Preferred Contact Method
Vehicle Information
Tag: 1A Z Color: lt€
State· L- Year: 00a
Make: El cni Model: 6
Applicant 5ianature: a5
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2 floor Working
hours are 8/30 1o 5.00 pm or email to: ParlingReception@miamibeachfl,gov
o-mail subject: BOARD 8& COMMITTEE PARKING APPLICATION -- APPLICANT NAME
Porkinq De partment Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Dalo. ID Cord Seal i
lssued By Print Name Print Name.
Signature ai Signature. 5
Dote Issued Dole Completed