Lynette Long 12.31.24&AIAPABEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Lynette Long DATE OF APPOINTMENT: January 22, 2W3
BOARD/COMMITTEE: Commission for Women Appointed by: Kristen Rosen Gonzalez
FOR SCANNER FOR CLERK STAFF)� [ �,(a
1 ` � 1
Scan o o Letter of Appointment TER END: �2 /31 ' �! TERM LIMIT: `"'fit
Scan o o Letter of Reappointment
01 Z p 1 f iLLeytter of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on ti C )
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on )
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
RECEIVED ✓ 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
JAN 2 5 2023 amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
iF rU%iANil BEACH ✓ Sunshine Law and Public Records — Frequently Asked Questions
n.r_ :,r ar c;{TY CLERK ✓ Memorandum - Solicitation by City Board and Committee Members
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
O Citywide Permit Application (Parking Department Form)
Initials Scan o
O Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
o Source of Income Statement
Removal Letter due to absences
Scan O
O Acknowledgment of Financial Disclosure
Requirement
O Board and Committees Liaison Resp
nsibilities
o DIVERSITY STATISTICS R;71
G Ke p.COPY' nd ORIGINAL fo Annual Report.
Received on:
January 22, 2023 Signed by
Board or Committee Member
(DDaate
0 1J '
Processed on:
By Employee:
City Clerk's Staff Initials
(DDatte
0 I _, T 2_,3
^Office
N �'
Scanned on:
By Employee:
Date
City Clerk's Office Staff 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
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City of Miami Reach/ 1 /€ o (} nvpni :an. C onhu [Mvn, Minmi I3oa6, Florida 331 39vA%-&.migmibGgckfl.9
CIFE E CA THE CUY CLERK, R.afan) E. Granado, CRY Cork
Tel: 305,673.7A 11, Fax 305,673,725A
Fmcail: 0yCIork0miwib hfl.:gov
January 10, 2023
Ms. Lynette Long
650 West Avenue
Miami Beach, FL 33139
SUBJECT: Miami Beach Commission For Women
Congratulations! You have been reappointed by Commissioner Kristen Rosen Gonzalezto the above
referenced, board or committee named above, for a term ending: 12/31/2024.
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 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.
Congratulations and good luck.
Re
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Monica Matteo-Salinas, 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
MANAIBEACH
City of Miami Beach, 1700 Convention Center Clove, Miami Beach, Florida 33139 www.miamdmchli.gav
OFFICE OF TIE CITY CLERK, Rafael E. Granada, Coy Clerk
Tel: 30&673.7d1 t, Fax: 305.673.7254
Email: CityCteekOmiamibeaA.gow
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Lynette Long
RE: Miami Beach Commission For Women
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: 12/31/2024.
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. n /-
' Ms. Lynette Long V
Sworn to and subscribed before me this Z_ day of2023
r Charles 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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.741 1
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):
m 1 am a resident of the City of Miami Beach for six months or longer.
Home Address650 West Avenue, Apt 501, Miami Beach, FL 33139
p 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).
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 Add
"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, ponsorship, corporation, limited liability company, or other
entity or business association.
Under,nalties of perjury-, I ar that I ave read the foregoing document and that the facts stated in it
are January 22, 2023
Signature Date
Lynette Long
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or a online notarization,
this dayof20L3 by ��'�n ek LOA!2),
(City of Miami Beach Board/Committee Member). No•N
iA
_✓ Produced ID fi, b nV "L S LI U n f -e- �.����
�.�pFtY PUB
For f I ntification ,��� •' O y
Personally K own
1MY COMMISSION
(401 Ii SEl"27
Signature of Notary Public
4F FL
Name of Notary, Typed, Printed, or Stamped ''.�,•' 9's `
\l ,' "'���N�NIIIINg111N�N
�''�� M1M6�C��
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www,miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: l3Wmiam1beachfl.gov
Telephone: 305.673.7411
Lang
Last Name
DIVERSITY STATISTICS REPORT
Lynette
First Name
A
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:
❑ Male
✓� Female
Other
1 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 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
C3 Yes
Q No
Ea I prefer not to answer.
Do you consider yourself Physically Disabled?
U Yes
No
EJ I prefer not to answer this question.
Page 6 of 6
F:ICLER%$ALLIREG0OARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M I A/Vi it B EAC H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC a(�miamibeachfl.gov
Telephone: 305.673.741 1
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(1) (2)
Long
Last Name
Lynette A
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.
QM 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.
FailuA to file one of these o s, pursuant to the Miami -Dade Co nt Code, may subject the person to a fine
0 ore than $500, 60 i ail, or both.
Signat re . Qpte
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
MI®D°'DE SOURCE OF INCOME STATEMENT
Section 2-11.1(1) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2022 Long Lynette A
Mailing Address — Street Number, Street Name, or P.O. Box
650 West Avenue, Apt. 501
City, State, Zip
Miami Beach, FL 33139
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. ❑
Filing as an Employee (check one)
County ❑ Public Health Trust Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
County
Municipal: Miami Beach, FL
(Municipality)
Board where serving
Miami Beach Commission for Women
Alternate address (if home address is exempt)71Work telephone Term began on/ended on
01/22 -12/31/23
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 dealings, interest, rents, dividends, pensions, IRA distributions, and social security 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 sheet, check here.❑
Name of Source of Income
Address
Description of the Principal Business Activity
Social Security
c� S
Residential Real Estate
1507 Marion Street
Washington, DC
Rental Income
Residential Real Estate
9033 Abbott Ave
Surfside, FI
Rental Income
I hereby swearXor a)firm) that the informatiynJhbove is a true and correct statement.
Agnaude of Person Disclosing
)atp signed
RECEIVED BY ELECTIONS DEPARTMENT.
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: scanned Date/Initials:
138 SP -14 COE 2016
M1 A10 I B EAC H CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33134/Ph: (305) 673-7505 or (305) 673-7000 ext, 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit I5 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, I will be responsible to pay a $'10.00 replacement fee.
Rnnrri) AAmmka*r 1nfnrmntinn
Date of Application: January 22, 2023
Applicant Name: Lynette Long
Board/Committee Name: Commission for Women
Address: 650 West Avenue, Apartment 501, Miami Beach, FL 33139
E -Mail Address: Drlynettelong@gmail.com
Work Phone:
Home Phone
Cell Phone: 301-325-6976
Preferred Contact Method:
Vehicle Information
Tag: CPVY76 Color: Blue Gray
State: FL Year: 2021
Make: BMW Model: X1
Applicant Si nature: ,K
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2^J floor. Working
hours are 8:30 to 5:00 p.m. or email to:ar_. ing qgq tjgnerjgmibe clhfl..c civ
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
Onrlrinn nm%r%gr r"=r%* rote+inn
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: A�
Signature: ,d
Date Issued:
Date Completed:
Florida DRIVER" LICE"NSIr
di: -?~L520-521-48-643 0 ". _E
NETTE ALBERTA
P ;650 WEST AVE APT 501
4; MIAMI BEACH FL 33139 _
44123/1948 is F
0412312030 5 05
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