Julie Basner 08/01/23MIAMIBEACH
BOARD AND COMMITTEE CjIECKL?T,
APPOINTEE I� ffoc �i� so/ `i Ovw 1eXf "4e ATE OF APPOINTMENT:
BOARD/COMMITTEE: ) �C (t ��c5/✓�/� Appointed by: ����� S�`'��
2 TERM LIMIT: t
FOR SCANNER FOR CLERK STAFF � - J
Scan o o Letter of Appointment TERM END:
Scan o o Letter of Reappointment
o p Le er,.,of Appointment/Reappointment e- i`lled to Committee Liaison on
Scan o o Board and Committee Application (Completed on O
Scan o o Resume/Curriculum Vitae Sj 2
o Diversity Statistics Reporting (Completed on Q rif
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓ 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
amcndcd through December 2010)
SEF —9 202Z ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
CITY OF MIAMI BEACH ✓ Sunshine Law and Public Records — Frequently Asked Questions
OFFICEC)-' ""IF CITY CLERK ✓ Memorandum - Solicitation by City Board and Committee Members
o Citywide Permit Application (Parking Department Form)
O Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan O O Source of Income Statement
Scan O O Acknowledgment of Financial Disclosure Requirement
O Board and Committees Liaison Responsibilities
o DI ERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: d�)_ Signed by X
Date Bo tXi o d6kimittee Mem
Processed on: / �a BY Employee:
Em to ee:
Date C s Office Staff Initial
Scanned on: G By Employee:
Date City s Office St -a -Initials
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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to providing excellent public service and .sofety to oil who live, work, and ploy in our vibront, tropicol, historic community
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33134 www.miamibeachll.aav
OFFICE OF THE CITY CLERIC, Rafael E. Granado, City Clerk
Tal: 305A73_741 1, Fax: 305.673.7254
Email: CityCierk@rntamibowhfl.gov
September 07, 2022
Ms. Julie Basner
5931 N. Bay Rd.
Miami Beach, FL 33140
RE: Ad Hoc Advisory Charter Review and Revision Board
Dear Ms. Julie Basner:
Congratulations! You have been appointed by Commissioner David Richardson to the above -
referenced Board or Committee, for a term ending: 08/01/2023.
Pursuant to City of Miami Beach Code Section 2.22 (5)o:
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 is directly
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Rafael Granado, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAMIREACH
City of Miami Beach, 1700 Convenlion Cenler Drive, Miami Mach, Florida 33139 vntitiv.miamibeor_hfl.aov
OFFICE Of THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityC1erk@miamibeachfl.9ov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Julie Basner
RE: Ad Hoc Advisory Charter Review and Revision Board
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
ahove-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending: 08/01/2023.
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.
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 1 st, following the closing
of the calendar year on which I have served.
4)__�
Ms. Julie Basner
Sworn to and subscribed before me this 9 day of Sept 2022
LX Ch s 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.
1
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC(ci)miamibeachfl.gov
Telephone: 305.673.741 1
M��
SEP -9 2022
CITY OF MIAMI BEACH
OFFICE Or' 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
(J) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
Home Address 5931 N. Bay Rd.
❑ 1 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).
Name of Business
Business Address
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).
Name of Business
Business Address
"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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. 2^
" j'`� Sept. 9, 2022
Signature Date
Julie Basner
Printed Name
NOTARY
Sworn to (or affirmed) and ubscribed before me, by means o K physical presence or ❑ online notarization,
this ay of by lot &J ,v
(City of Mi mi Beach Board/Committee Member).
Produced ID ��� �5 ` Cle,? -'"e-
Form of Identification
�rso all ow
Sign e f N ary P lic
Name of Notary, Typed, Printed, or Stamped
CHARLES J.DAGOSTIN
MY COMMISSION # HH 165705
EXPIRES: December 14, 2025
Bonded Thni Notary Pubic Underwriters
(NOTARY SEAL)
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: 305.673.741 1
Basner
Last Name
DIVERSITY STATISTICS REPORT
Julie
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.
Gender:
I Male
Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian
Other — Print Race:
�I 1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
�D Yes
�D No
U I prefer not to answer.
Do you consider yourself Physically Disabled?
1:3 Yes
Q No
U 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
I exr
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: 13C(@rniamibeachf1.gov
Telephone: 305.673.741 1
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)
Basner Julie
Last Name First Name 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 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 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 no more than $500, 60 da s in jail, or both.
Sept. 9, 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 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 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 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 card 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, 1 will be responsible to pay a $10.00 replacement fee.
Rnnrri Mamhar InfnrmriNnn
Date of Application: Sept. 9, 2022
Applicant Name: Julie Basner
Board/Committee Name: Ad Hoc Charter Review and Revision Board
Address: 5931 N. Bay Rd. 33140
E -Mail Address: juliebasner@hotmail.com
Work Phone:
Home Phone
Cell Phone: (917)734-7779
Preferred Contact Method: cell or email
Vol�ir•lo Infr�rmnfir�n
Tag: 49AJUJ
Color:
black
State: FL
Year:
2021
Make: Mercedes
Model:
GL 350
Applicant Signature:
Please provide signed form to the Narking Department located at 1755 Meridian Avenue, 2nd floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
P~Wnn rlannrtmanf Sartinn
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature:.)
Signature: -§
Date Issued:
Date Completed:
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