Dale Stine 12.31.24BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Dale Stine -----------------
BO ARD/COMMITTEE: Human Rights Committee
DATE OF APPOINTMENT. 2/1/23 -------
Appointed by: City Commission
FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
2/7/22
TERM END. 12/31/24
.
TERM LIMIr. 12/31/24
to Committee Liaison on
Scan o
Scan o
Scan o
o Board and Committee Application (Completed on _1_12_8_1_2_1 _
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _2_17_1_2_3 _
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
amended through December 2010)
FEB 72023 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
OFFICE OF THE CITY CLERK Y 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 REPORT! G Keep, 2OR}Y in file and ORIGINAL for Annual Report.
Received o. 2/7/23 Signed by _Lf1fl I
ittee Member
Processed on:. 1h By Employee:
City Clerk's Office Staff Initials
2/7023 » Employee: KN\ _
City Clerk's Office Staff Initials
Date
Date
Scanned on:
Date
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 MASTERIB&C Checklist 2015 MASTER.docx
We re committed to providing excellent public service and safety to ol who live, work, and ploy in our vibrant, topical, historic community.
l
City of Miami Beach, I/OO Convonlion Canter Drive, Miami Beach, Florida 33139 ywy_IiaIibaachllgov
OFFICE OF THE CITY CLERK, Rafaal E. Granado, Cly Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: Ci#yClerk@miamiboochfl.gov
February 03, 2023
Mr. Dale Stine
1573 Pennsylvania Ave. #1 N
Miami Beach, Florida 33139
SUBJECT: Human Rights Committee
Dear Mr. Dale Stine:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2024.
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.
cc: Monica Beltran, Parking Director
Lidyce Grana, 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
City of Miami Beach, LOO Con vention Conler Drive, Miami Bach, Florida 33 139 yyywy._miaribcachll_go
OFFICE OF THE CITY CLERK, Rofol E. Granado, Ciiy Clerk
Tel: 305.673.7411, Fx. 305.673.7254
Emai l: Cit/Cl erk@mi amibeach ll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Dale Stine
RE: Human Rights Committee
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
ab ove-m e ntio n e d b o a rd or com m itt e e o f the C ity o f M ia m i B e ach to which I have been appointed for a
term ending : 12/31/2024.
T o m y co lle a gu e s a nd to all o f tho se I rep rese nt a n d serve , I ple dg e fairn e ss, integ rity and civility, in a ll
a ctions taken a nd a ll com m unicatio ns m a de by m e a s a p ublic se rvan t.
I h a ve b e e n issu e d a co p y of se ctio n 2 -1 1.1 o f the M ia m i-D a de C o u nty C o d e (C o nfl ict o f In te rest and
C o de o f E thics O rdina nce), a s w ell a s F lo rida C o m m issio n o n E thics G u id e to the S unshine A m e nd m e nt
and C o de o f E thics for P u b lic O ff icers and u nd e rstand tha t as a m e m b e r o f a C ity o f M ia m i B e ach B o ard
a nd/or C o m m itt ee , I m ust co m ply w ith the fina ncia l d iscl o sure* requirem e nts of M ia m i-D ade C o unty or the
S tate o f F lo rida (de pending on the b oa rd or co m m itt ee on w hich I se rve) on July 1st, fo llow in g the cl o sing
o f the cale nda r ye a r o n w hich I h ave se rv ed.
• a le S tin e
Sworn to and subscribed before me this~· . 2023
K eil a M en a C ace re s
D e p uty C lerk
*P le a se visit the C ity o f M ia m i B e a ch w eb site a t w w w .m ia m ib e a chfl.g o v un d e r C ity C le rk/B o a rd an d
C o m m itt ees fo r additio nal info rm atio n rega rding the F ina ncia l D iscl osure R equirem e n ts.
MIAMI BE
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 72023
CIT 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.
b {()[ JS]f,
I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a m;n;mum d-Om~nths)
»rs«a. He», 'iE, jg.
»-L/o» Lil /'d $.so/ R, 2381
7
□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).
[[Qr]9 [ [[JS/[eSS
Hy[mess ]]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.
, I tleclare that I have read the foregoing document and that the facts stated in it
2/7/23
Date
Dale Stine
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
_________ (City of Miami Beach Board/Committee Member).
Dnvet mo ✓Produced ID
of ntification
Personal! -
Signature of Not
Name of Notary, Typed, Printed, or Stamped
MI A MI BE H
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
DIVERSITY STATISTICS REPORT
Stine Dale
Last Name First Name •
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:
IZf Male
[ remale
0 Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
[Asian or Pacific Islander
LA Caucasian/white
D Native American/American Indian D Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Lyes
LJ No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
L.2es
A 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
M IA M IB E H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 .7 41 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)
Stine Dale
Last Name First Name M~le 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 00, days in jail, or both.
t 7
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:ICLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE-
EMI SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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
2022
First Name
Dale
Middle Name/Initial
Mailin """gno
City, S
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: Miami Beach
(Municipality)
Board where serving
Human Rights Committee
Alternate address (if home address is exempt) I Work telephone I 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
(9' 'sf
I hereby swear (or affirm) that the information above is a true and correct statement. .-es
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
aracoRECEIVED
D Electronic Copy
FEB 72023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
MIAMI BE CITYW IDE (CW ) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 M eridian Aven ue, Suite 200/Miami 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: 217123
Applicant Name: Dale Stine
Board/Committee Name: Human Rights Committee
Address: ')
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1u3
Vehicle lnfor ·
Ta g :
State:
Make:
Home Phone
Pre ferre d Contact M eth o d; J3,
Color:
Year:
Model:
Applicant St+nature: e
Please provide signed form to the irking 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 mna epar men ec Ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
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