Samuel Sheldon 12.31.24LAMA/BE //Ii\rVl L. •
FOR SCANNER
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Samuel M. Sheldon DATE OF APPOINTMENT: '1,,,- [l/v/ i "3
soARrcowwrreEe..Dy14nK_ta dotlAoo«tea »»y. _Ah omrs
rEeR ENo. 12-l31h/ rnMur. y2/ 8l)/ Scan o
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
0 -{J°P.f, lt i ~3r of Appointment/Reappointment e-mailed to Committee
o oar@ an@committee Apica«ono (competea, / 10_/207@)
o Resume/curriculum Vitae /; J
o Diversity statistics Reporting (competed on 2/2{_'2,7y
o Oath
Liaison on
RECEIVED
EB 2403
CITY OF t\MAM1 BEACH yr (3) rk OFFICE OF THE 5" 4" "
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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
o Source of Income Statement
Received on:
Processed on:
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
ours nsrcs Roni¢ k cor in«» .a oRea. tor anus Report.
2/2)h23 sores»} 'th
Date \ ard or Committee Member
2/24 /23 error Kt
.EGL ";" __ _,_ '1.By Employee: ------~....C:...---''-------------
City Clerk's Office Staff Initials 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:\CLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to providing excellent public service and safety to al! who live, wok, and ploy 'n our vibrant, tropical, historic commuruty.
City o f M ia m i B e a c h , ZOO Convention Canter Drive, Miami Florida 33139 yyy._miamibaaLchll.go
OFFICE OF THE CITY CERK, Rlaal E. Granado, Chy Clerk
Tel 305.673.7A1I, Fax: 305.673.7254
Email: Ci#yClerk@miamiboochfl.gov
February 23, 2023
Mr. Samuel Sheldon
4434 Post Ave
Miami Beach, FL 33140
SUBJECT: Design Review Board
Dear Mr. Samuel Sheldon:
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.
Res~
Rafae,ranado
City Clerk
cc: Monica Beltran, Parking Director
Mich ael Belush , Ci ty 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 - Am endmen t 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
/L A M M/REA CH I A\Vl D..t•
City of Miami Beach, I/ZOO Convention Conler Drive, Miami Boach, Florida 33 139 yw.Iiam ibc achfl.g o:
OFFICE OF THE CIIY CLERK, Rall E. Granado, City Clerk
Tol: 305.673.7411, Fax 305.673.7254
Emai l: Cit/Clerk@iamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Samuel Sheldon
RE: Design Review 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
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term en ding : 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.
l 11
I { Lg "nr-. samuei Sheldon
Sworn to and subscribed before me this ~f, 2023
Keila Mena Caceres
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.
MI A MI BEA CH
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 24 2023
CITY O F MIAM I BEACH
O FF IC E O F TH E C ITY C LER K
A F F ID A V IT O F A F F ILI A T IO N W IT H T H E C IT Y O F M IA M I B EA C H
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 th at apply):
IZI I am a resident of the City of Miami Beach for six months or longer.
Home Address4434 Po st A ve , Miami Be a ch , 33140
□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 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 p lties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. ; 2/24/23
Date
S a m u e l M . S h e ld o n
Printed Name
NOTARY
Sw~~ ,to}.or affi:med) and subscribed-~efore me, ~~means of 'i).,PMysical presen~e or o online notarization,
fa« lau as23. >mg/ M , Sk(dee
7
(l[/ of Miami Beach Board/Committee Member).
Produced ID
, ., For of identification 7
_ Persorgay Known ",
~,2 T st.
(__.,.,.. / / ¥'£_ ·< £¢;.-•~- ( _,)' .6'.~.,i;,..-'\,.i ~
Signatur of1Notary Public #; s
"r s" Name of Notary, Typed, Printed, or Stamped
ERASM INA E,gyE53q SEAL)
Commlsslon # }H 16272 7
Explres Decomber 6, 2025
Bo nd ed Thu Budget Notary Serves
MIA MI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachf,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
D IV E R S IT Y ST A T IS T IC S R E P O R T
S h e ld o n S a m ue l M
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:
[] Mate
[l remae
.l oner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
El Caucasian/white
LIatve American/American Indian D Other - Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
LJves
J o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
.l ee
zho
D I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MlAM/BEA H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l_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)
Sheldon Samuel M
Last Name First Name Middle Initial
I understand that no later than July 1Of each ear 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.
Qne 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.
Failur to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no ih~re than $500, 60 days in jail, or both.
{ l 2/24/23 =---------------- Date
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:ACLERISALL RE G\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFT SIB OARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI·~ ™··· 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 Sheldon Samuel M
Mailing Address - Street Number, Street Name, or P.O. Box
4434 Post Ave
City, State, Zip
Miami Beach, FL 33140
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 fotowing page and check here.L]
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
I
Filing as a Board Member (check one)
E] county E] Municipal: Miami Beach
(Municipality)
Board where serving
Design Review Board
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 trom
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
The Behar Law Firm, P.A. 1801 NE 123rd Street, Suite 314 Law Firm
North Miami, FL 33181
I here' swea, (or affirm) that the inro,mahon aho,e is a tcue and correct statement.
il Lo
sign ture ot Person Disclosing
1 I
2±22
«sos#77%7%' □Hardcopy
J Electronic p}, 9,4 FEB 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency.
138_SP-14 COE 2016
Processed Date/initials: Scanned Date/initials:
/\l/A //\/B E, CH C WI DE (CW) OARD & COMMITTEES
cwy of Miami ea±, ARKING DEPARTMENT PARKING APP[[CAT[ON
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS N O T honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IM P O R TA N T N O T E: 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 C A N N O T 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.
A C K N O W LED G EM EN T : I a ck now led g e that sho uld my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Dote of Application: 2124123
Applicant Name: Samuel M. Sheldon
Boord/Committee Name: Design Review Board
Address: 4434 Post Ave
E-Mail Address: sheldondrb@gmail.com
Work Phone: (786) 735-3300 Home Phone (786) 468-8332
Cell Phone: (305) 283-0581 Preferred Contact Method: cell
Vehicle Information
Tag: JDAU20 Color: Silver
State: Florida Year: 2013
Make: Toyota Model: Prius
I
I I\
Applicant Sianature: e Ml_3
Please provide signed formh to the Parking Department located at 755 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
Parkina Department ection
PERM IT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e6
Date Issued: Dote Completed:
s
or update