Merle Shama 12.31.231B
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BOARD AND COMMITTEE CHECKLIST
APPOINTEE: MERLE SHAMA DATE OF APPOINTMENT: J/J-- 7 /;) 3
BOARD/COMMITTEE. A(o4,ssr8 Appointea • 0 . 1hod/3 nu
FOR SCAN NER FOR CLE RK sTAFF J)/g)/22 Jz f
scan o o Letter of Appointment TERM END:/fl.'< TERMLuMrr: 1l31 13
Scan o o Letter of Reappointment
o CoP.¥.P[ Letter of Appointment/Reappointment e-mailed to Committee Liaison on
2]29]2 ] ]
o Board and Committee Application (Completed on 2 2%/23
o R~sum~/Curriculum Vitae ] J
o Diversity Statistics Reporting (Completed on _ Lg,23
o Oath Scan o
RECEIVED
6 2023 MAR
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 MIAMI BEACH
crYO!Gui~riv@ii OFFICE I
o Citywide Permit Application (Parking Department Form)
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o Bo0klet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
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Processed on:
Scanned on:
. Jo DIV5r,:ITY,STATISTICS REPORT! 2, 0L /K n » ?/=_2lee hZi...- t::.,,"~---:~~---------------
D, t e Clerk's Office Staff Initials
_o_l_--=r- __ 7,,.3 By Employee: ,_<All _
Date Ci cir o#lee sear 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 are committed to providing excellent pubic service and safety to all who live, work, and in our vibrant, topical, historic community.
City of Miami Beach, I/OO Convention Coner Drio, Miami Boch, Florida 33 139 yyw_miaIibcachhl_go
OFFICE OF THE CITY CLERK, Rofaol E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: City Clerk@miamibeachfl.gov
February 27, 2023
Ms. Merle Shama
11 Island Avenue, #911
Miami Beach, Florida 33139
RE: Miami Beach Commission For Women
Dear Ms. Merle Shama:
Congratulations! You have been appointed by Commissioner Laura Dominguez to the above-
referenced Board or Committee, for a term ending: 12/31/2023.
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,
cc: Monica Beltran, Parking Director
Monica Matteo-Salinas, City Liaison
E N C LO SURES:
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 of Miami Beach, 17O0 Convention Canter Diva, Miami Beach, Florida 33 139 www.miamibeachll.go
OFHICE OF IHE CITY CLERK, Ralool E. Granado, Cy Cloik
Tel 305.673.7411. F0»: 305.673.7254 ....... ·, : .. ,.·•.: .. •.· ..
Email: Cilerk@mlamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Merle Shama
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: 12/31/2023.
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.
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.
Sworn to and subscribed before me this 6 ~y ofJ/~&3
r-:cr-' >~ 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.
City of Miami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
O FF ICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 6 2023
CITY OF MI AMI BEA CH
OFFI CE OF THE CITY CLER
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.
o.ova. 1alaod ven ue, # 7L ,/i a i beach,Fl st3?
□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.
· re that I have read the foregoing docume
0
Signature
le/le _@la@ q -[ s] Pina ia '' {er [oh @a
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~ysical presence or o online notarization,
a'M a a a. ]le Sh4/4
________ (City of Miami Beach Board/Committee Member).
Y es »o Ft [D a tf a t oy (CD)
Form of Identification
Name of Notary, Typed, Printed, or Stamped
CHARLES J. DAGOSTIN(NO] (ARY SE AL )
M Y COM M I S SI ON # HH 165705
EXP IRE S: December 14, 2025
Bonded Thru Notary Pub lic Underwriters
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
ww w.miamibeachl l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Shama le le,
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:
Lale
LI remale
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander LI Caucasian/white
0 Native American/American Indian Loher-- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Les
~so
D I prefer not to answer.
Do you consider yourself Physically Disabled?
wes
4+
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
MIAMI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephon e: 305.673.7411
BOARD & COMMITTE E FINAN CIAL ACKNOWLEDGEMENT STAT EMENT
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)
Last Name First Name Middle Initial
I understand that no later than July1of 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.
5io.,
Date I 1
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\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M l·DADE - EEI 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
Last Name
3lo
Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.0. Box
I1Is.an q
City, St
3313
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 [I] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board em b er (chock ono)
Droy EJone»t. (C.7op pt/'4 Be«ct-,
(Municipality)
Board where serving Mani 'eah, Cos9or bloc-U
Alternate address (if home address is exempt) I Work telephone I Term beg7on/ended on
2 003
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
~pose, 1sl4 /ye.#ft @l "lpicier
mp.-L 330237 ,
I hereby swear (or affirm) that the information above is a true and correct statement.
.2.2re
T Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy RECEIVED
D Electronic Copy
M4AR 6 2023
CITY OF MIAMI BEACH
OFFICE OF THE C ITY CLERK
OFFICE USE ONLY Accepted; Y / N Deficiency: Processed Date/initials:Scanned Date/initials:
138_SP-14 COE 2016