Carol Motley Ex-Officio 12.31.24l Al
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BOARD AND COMMITTEE CHECKLIST
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Scan o o Letter o f Appointment TERM ENp , l ' TERM Liwrr:
Scan o oLetter of Reapp ointm en t " "P{$] {$° AnointmenuReanointment e-mated to committee Ltaon or
o Board and C om rnittee A pplication (C om pleted on \ .1 I i J 1:,3_)
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o Diversity Statistic s Reporting (C om p let ed on .3[Lo [3 )
o Oath
RE CE I VE D
4AR 16 2023
IMPORTANT INFORMATION FOR BOARD AND C O MM I T TEE MEMBERS BOOK
V Ci ty C ode O rdinan ce Section applicable to the agen cy, board or committee
C ity C ode Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-4 59
t C ounty C ode Section 2-11.1 -- C on flict of Inter e st and C ode of Ethic s Or di nan c e (as
am en ded thro ugh D ecem b er 2010)
Am end m en t s to the C ode of Ethic s Or di n an ce (Septem ber 2009 th rough Jul y 2012)
Highlights of th e Miami-Dade County Ethics Code
t Sunshin e L.aw and Public R ecord s - Frequen tl y Asked Q uestions
M em oran dum - Solici tation by Ci ty Board an d C om m i ttee M emb ers CIT OF MIAMI BEACH
ICE OF THE CITY CLERK
OFF E. O Citywide Permit Application (Parking D ep artmen t Form )
O Book le t - G ui d e to Sunsh in e Amen dm en t & C ode of Ethics for Public Officers and Emp loyees
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0 Source of Incom e Statement
O Ackn owl edgm en t of Finan ci al Di s cl osur e Requi remen t
O Board and C om m ittees Liai son R espon si bilitie s
0
R eceived on :
Scann e d on :
D ate Board or C om m i ttee M em b er
Proce ssed on:~ lv f )4;, By Em ployee: l<M _ 3bi,p or c o one stows
____ '-t,f By Em ployee: _!,.1<.,All-=-_2:. _
City Cl erk's Office Staff Initials D at e
CONCLUDED & RESIGNATION LETTERS
Term Expire d Letter D ate Pro cessed Initials Scan O
R e si gn at ion Letter D ate Processed Initial s scan O
R em o val Letter due to ab s en c es D ate pr o cessed Initial s Scan O
F:CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&.C Checklist 2015 MA,STER.dox
Wa ae coremitted to pc&ding excellent ptlic servce and solely o al who lie, work, ond ploy in oar vibrant, Mopkcoh, histic community
MIAMI
City of Miami Beach, 1/O0 Convention Cantor Duivo, Miami Boch, Florida 33139 yy .Iiamibcachllgoy
OFFICE OF THE CITY CLERK, Rofaol E, Granado, Cy Cdork
Tol: 305.673.7411, fox 305.673.7254
Email: Ci/Clerk@mamtbeochtl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Carol Motley
RE: Convention Center Advisory 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-men tioned board or committee of the City of Miami Beach to which I have been appoi nted 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 Commi ssion on Ethics Guide to the Sunshine Am endment
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 requiremen ts 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 th e calendar year on wh ich I have serv ed.
Sw orn to and subs cribed befor e m e this
K
-92023
P le ase vi si t the Ci ty of Mi ami B each w eb si te at w w w .miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
MIA#IBEA
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl qoy
Telephone: 305.673.7411
RECEIVED
MAR 16 2023
CITY OF MIAM I BEA CH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
t lam a resident of the City of Miami Beach for six months or longer.
p)mm9 f\]ff9 jno«or
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).
[Jan7]9 ()f [11,1PS....r
[1]PS,S, J\([feSi
ta lam 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 Greater Miami Convention and Visitors Bureau
Business Address 1901 Convention Center Drive 33139
"Ownership Interest" means tho 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 solo proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
Under , mnalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are t 03/14/2023
Sign Date
Carol Motley
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of1physical presence or online notarization,
this /i""day ot LIA cu .2043 y_- "1e1'@u
V
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
L Personally Known
Deco. ho co Jeer.
Signature of Notary Public
[A/UA LR eooh
Name of Notary, Typed, Printed, or Stamped
@ii. 0AMA IRENA LEON
pp}$< oary Pue - state ct on» 33%.3$/ commission + H8 00087
@<$ wy comm. £res Jan 3, 2025 NO rt8@ h3/ Notary An.
MI A\MI BEA CH
City of Ml a m i Beach
1/00 Conv ention Center Drivo
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CIERK
Email: BC@mlamiboachfl.gov
Teleph on e: 305.6 73.7 4 11
BOARD & COMMITTEE FINANCIAL A CK N OWLE DGE MENT STATEMENT.
Acknowledgement of fines/suspension for Board/Committee Members for fallure to comply with Miami-
Dade County Financlal Disclosure Code Provision Godo Section 2-11.1(1) (2)
Last Name Fi st NG Middle Initial
I understand that no later than Jul.1, of.each.year all members of Boards and Committees of the City of Miami
Beach, including those of a purely advisor y nature, are required to comply with Mi am i -D ade County Financial
Disclosure Requirem ents.
One of the following forms m us t he.fllad 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)';" or
3. A Copy of your latest Federal Income Tax Return.
Sigrature re
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the per son to a fine
of no_more than $500, 60 days in jail, or both.
fee [Mt4 bate
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Fl or ida,
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 memb er s wh o file thei r
Form 1 with the County Supervisor of Elections autom atically 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.
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F:CLERISALLREGOARD ANDO COMMITTEE APPLICATIONS FINAL DRAF TSBOARD AND COMMIT TEE APPLICATION REG FINAL.dox
Updated: June 2020
M IA\MI BEACH
City of Miami Beach
1700 Convention Center Drive
Mi am i Beach , Florido 3313 9
www.mniamibeach~l.gov
OFFICE OF THE CITY CLERK
Email: BC @ mi am ibe achfl.gov
Tel ep h one: 305.673./411
First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
aske d to compl y with Ci ty diversity reporting requirements.
Gender:
L Jee
Femal e
Other
Eli prefer not to an s w er .
Race/Ethnic Categories:
What is your race?
African American/Black
A sian or Pacific Isl ander
I.J Caucasian/white
Lk Native American/American Indian
El oner --Print Race:
Llprefer not to ans
t1 . Yes
No
l prefer not to answer.
Do you consider yourself Pftygically Disable?
Jee
t34
ll prefer not to answer this question.
Page 6 of 6
F:\CLERISALLREGOARD AND COMMITTEE APPLICATIONS FINAL DRAF TSBOARD AND COMMIT TEE APOPLCATON REG FIAL. docx Updated: June 2020
t(4AM4
&II SOURCE OF INCOME STATEMENT
Section 2-11.1( of he County Ethics Cod requiras ttat certain employees and public ofci3ls fie a facial disi0sure 3!atemner!902 ye2rybasis y±!y 'st
0~ every year. ' '
isclosure for Yax Year Ending [Last Name
2021 [oL+z ,.,,,,, , {:,
Malling Address - Street further, Street tame, or PO.. Io
(56 No/ Uo, kce> D
First Marte Mlddto tame/fitlat
L.
7
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.[]
..... , ..... ~~
I] couny [] Pubic Health Trust [] Municiat:
(4talclaallty}
Department
Position or Tille Etnployee ID Auther
Work address I Work tafciphomt Enptoymant began on/ended a
E] county
Board «hero serving_ f,]
ti each%
Alternate address (if homo address is exempt)
Cul #di.so poor d
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 tho 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, divlderids, pensions, IRA distributions, and soclal security payments. Also, includeo any source of income receiyod by a0}{
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.
tame of Source of income Address Descrlptton of tho Principal Business ctlvity
ttU fol preke( /co e V>, de 2100 523\
V
.,, .. <•hOo
f hereby swear {or affirm) that the information above is a true and correct statement.
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Sigature of flernon D!sf:losinu ~
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rove or iFl ii€.EeiMd tale.
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t) tectonte a# 16 2023
CITY OF MIAMI BEA CH
OFFICE OF THE CITY CLERK
F;ES tdSE QfdLY Aepted Y i N Detiieny-- Processed Date/initials:Scanned Date/initials:..-
138.SP-14 COE 2016
M IA /\/\1 B E H CITYW ID E (CW ) BO AR D & COM MI TTEES
ciy cot Mint sc ad», PAR«NG DEPA«rM Nr PARKING PP][CAT[ON
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph. (305) 673-7505 or (305) 673-7000 0x4, 6200
A citywi de (CW) parking perm it is honored at metered parking spaces an d restricted residential zon es
par king spa ces. A CW parking permit IS NOT hon ored in prohibited areas. An Access Card will be
pro vided to you for City Hal l G ara ge (G Z) access.
IMPORTANT NOTE; Your vehicle licen se plate serves as your "parking permit". In order to avoid
any unnecessary enfo rcement actions, it is important that our records reflect the most current and
accurate informatio n regard ing your vehicl e licen se plate. Inaccura te and/or outdated veh icle
info rm ation m ay lead to the issuance of parking citation(s) and/or the tow ing of your vehicle.
Please note that this new access car d CANNOT be hole--punched or perforated in any manner. To use
th e new card pl ease hol d the card at close pro ximity to the reader until the gate open s. o u 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 lnformation
Date of Application: 3 fl '203
Applicant Name: ?rot /or2
Bo ord /c om mi e s Name Cu. 40@ /llu heel_how(Cul,
Addoss /0o Nw/ of ye 2to /uu 93/2
E-M oil Addre ss @or2, @ ?cv6.co
on
W ork Phon e: Hom e Phone
Cell Phone:3, c 97. ~2O Preferred Contact Method: ~· _· __ ·_.:J_O_b_,,,_v __ ·_-·_/_I _· _· ------'----------~- .. :L.1-- ___,
Vehicle Information
Tag: Dz 0170 Color: Rel-
State: /144 Ao) Year: 9o7
Make: [ten eeleg Model: 6c 300
Applicant Sianature: co (\444,,
Please provide signed lori to th o Parking Departmet located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m . or em ail to: Parki ng~R eception@miam ibegch fl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
p, ·kd D rt tS · ar' Ing 'epa men ection
PERMIT SYSTEM GARAGE ACCESS ~-··
Expiration Date: ID Card Serial #t:
Issued By Print Name: Print Name:
Signature: 6 Signature: 6
Date Issued: Date Completed: