Mark Weithorn 12.31.24/B
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Mark Weithorn
BOARD/COMMITTEE: Police/Citizens Relations
DATE OF APPOINTMENT: L_]Q~]23
Appointed by: Commissioner Dominguez
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
" Letter of Appointment/Reappointment e-mailed
ot[0o)23 ]
o Board and Committee Application (Completed on 1] 23
o R~sum~/Curriculum Vitae .J
o Diversity Statistics Reporting (Completed o, 0,/0I 23
o Oath
TERM No: 2/31/24 TERM LuMrr. 12/31/80
to Committee Liaison on
RECEIVED
FEB 12023
CITY OF MIAMI BEACH
OFFICE C F THIE CITY CLERK
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓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
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 DIVERSITY STATISTICS REPORTING Keep COPY in rte and ORIGINAL for Annual Report.
ecevedon: olloah23 sores»X
Date Board or Committee Member
Processed on: _0_1.,,_f _O_l_\ ·_z..3 By Employee: tM __ .....,_ _
City Clerk's Office Staff Initials
Scanned on:
Date
·lah3 » Employee: ---~kN) _
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:\CLE RIBO A R D AND CO M M ITT IES DATA BA SE\C HEC KLI ST M A STER\B&C Checklist 2015 M A STER .docx
We are committed to providing excellent pubic service and safety to oll who live, w o rk, and in our vibrant, iopicol, historic community.
City of Miami Beach, I/OO Convontion Canter Drive, Miami Beach, Florida 33139 yyy_Iiamibagcht]go
OF FICE OF THE CITY CLERK, Rl0al E. Gran ado, Cy Clerk
Tel: 305.673.7A1I, Fax: 305.673.7254
Email: Ci#yClerk@miamiboochfl.gov
January 05, 2023
Mr. Mark Weithorn
1130 Stillwater Drive
Miami Beach, Florida 33141
RE: Police/Citizens Relations Committee
Dear Mr. Mark Weithorn:
Congratulations! You have been appointed by Commissioner Laura Dominguez to the above-
referenced Board or Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
EE
City Clerk
cc: Monica Beltran, Parking Director
Chief Rick Clements, 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
City o f M ia m i B e a ch , 1/OO Convention Conler Drive, Miami Beach, Florida 33 139 4yAyy_miamilggchf_go
OFFICE OF THE CITY CLERK, Raf0ol E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Ci/Clerk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Mark Weithorn
RE: Police/Citizens Relations Committee
I d o so le m n ly sw ea r or affirm to bear true faith, loyalty and allegiance to the Government of the United
S tates, the S tate of Flo rida , and the C ity o f M ia m i B ea ch, a nd to pe rf orm a ll the d utie s of a m e m b er of the
abo ve-m e ntio n e d b o a rd or com m itt ee o f the C ity of M ia m i B e a ch to w hich I ha ve be e n a p p o inted fo r a
term e nding : 12/31/2024.
T o m y colle a gu e s a nd to all o f tho se I rep resent a nd se rve , I ple dge fairn e ss, inte grity a nd civ ility, in all
a ctio ns taken a nd a ll com m unicatio ns m a de by m e a s a p ublic se rv a n t.
I h a ve b e e n issu e d a co p y of se ction 2 -1 1 .1 of the M ia m i-D a d e C o u nty C o d e (C o n flict of In te rest and
C o de of E thics O rdina nce), a s w ell a s Flo rid a C o m m issio n on E thics G uid e to the S u nshine A m e nd m e nt
and C o de of E thics fo r P u b lic O ffi cers and u nde rsta nd that as a m e m b e r of a C ity o f M ia m i B e ach B o a rd
a nd/or C o m m itt ee , I m u st com ply w ith the fina nci al discl osure* requirem e nts o f M ia m i-D a de C o unty o r the
S tate o f Flo rid a (de pe nd ing o n the b oard o r com m itt ee on w hich I se rve) on July 1st, fo llow ing the clo sin g
o f the cale nda r yea r on w h ich I have se rv ed.
M r. M ar k W ei th o rn
S w orn to and subs cr ibe d b efore m e this O l day or +Clo , 2 023
• narcs iv»acct
Deputy Clerk
*P le a se visit the C ity of M ia m i B e a c h w eb site a t w w w .m ia m ib e a chfl.g o v u n d e r C ity C le rk/B o ard an d
C o m m itt ee s fo r add itio na l info rm atio n regard ing the F ina ncia l D iscl o sure R equirem e n ts.
MIAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
RECEIVED
FEB 1 2023
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):
I am a resident of the City of Miami Beach for six months or longer.
Home Address lo 7)A7 D u6
□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).
[are [ yS[PesS
[3JS[fess [Sf@SS
□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).
[[are (f Hy[PSS
[[s[mess J(]resS
"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
" o@lo1)2=
Signature Date
Mark Weithorn
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
this o!_ day or_@,r yo;_, 2023_. Ao2 )@Aho
(City of Miami Beach Board/Committee Member).
Onvr Lu4€ L Produced ID
Signature of Not
Name of Notary, Typed, Printed, or Stamped
MIA
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeachll, gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
,/)7)/0.- /1A
Last Name 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:
6J Male
[lremate
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
Ll Asta or Pacific Islander
El Caucasian/white
0 Native American/American Indian
Lother-- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
LT ves
%- II prefer not to answer.
Do you consider yourself Physically Disabled?
t I Yes
r1 h No
D 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
1/AMI
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach fl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
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)
L/) 7/0-
Last Name
1A,1
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 days in jail, or both.
zh/3 =D-a-te _
Signature
1 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
MIAMl·DAD E-
EIII SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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 I Last Name First Name Middle Name/Initial
2022 l) 7))- /1Ai
Mailing Address - Street Number, Street Name, or P.O. Box
(122 s7)laze- ¥.
City, State, Zip
9 1) Ezy t L 22r-1/
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 [] Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county E] Municipal:
(Municipality)
Board where serving
e al/ng \
Alternate address (if home address is exempt) Work telephone Term began on/ended on
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
123 2Lu-A 7Te D,
H o os Le, 612, (4-l 1 w .- 23 le? Devol. }
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy RECEIVED
[] Electron ic Copy
FEB 1 2023
CITY OF MIAMI BEACH
OFFIOF OE THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/Initials: _
138_SP-14 COE 2016
/\/\//\/\/\/ CI WI DE (CW) BO AR D & COM MI TTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 M eridi a n Avenue, Suite 200/Mi ami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200
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, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: 2 / /23
Applicant Name: Mark Weithorn
Board/Committee Name: Police/Citizens Relations
Address: /13,e ,A 7 p } A H 337/ )Al
E-Mail Address: OP7 /1-t • " - /-) 1A--/ C.r--i
Work Phone: Home Phone
Cell Phone: 5 -5973)3 Preferred Contact Method:
Vehicle Information
Tag: o9D Hrc Color:
State: F Year:
Make: 7coo Model:
Applicant Sianature: e
2 y
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d 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, ·ki D ar mn a epa r'm en ec o n
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
t t Si :ti
: pmng ·man rar torms cw oarasdcommttees par mgtorm.doc orm upaore
t..-- a
..... ,
1 } sos
' -•• •••·••••• ~{)2t~~••••• •••••••as••••ss~•••~••••-•••