Cindy Mattson 12.31.24BOARD AND COMMITTEE CHECKLIST
APPOINTEE: CINDY MATTSON
BOARD/COMMITTEE: HUMAN RIGHTS
FOR SCANNER Scan o Scan o
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RECEIVED
APR 14 2023
CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK
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FOR CLERK STAFF o Letter of Appointment
DATE OF APPOINTMENT: ,z./ t / l,-3
Appointed by: Ct¼ loro(Y) I So.fl {IV\
TERM END: 11 I a. 1 h-'-1 TERM uMIT: 1 i / a I J 28oLetter of ReappointmentoCor J°f Letter of Appoi ntment/Reappoi ntment e-mailed i 3 13 I o Board and Committee Appli cati on (Completed on ll I 'I, J ;2..oo Resume/Curriculum Vi tae o Di versity Stati stics Reporti ng (Completed on 411312023oOath
to Committee
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
L i aison on
✓County Code Secti on 2-11.1 -Conflict of Interest and Code of Ethics Ordinance (asamended through December 2010) ✓Amendments to the Code of Ethi cs Ordinance (September 200 9 through July 2012)✓H i ghlights of the M i am i-Dade County Ethi cs Code✓Sunshine Law and Publi c Records -Frequently Asked Questi ons✓Memorandum -Soli ci tati on by Ci ty Board and Commi ttee Members
o Citywide Permit Appli cation (Parking Department Form)o Booklet -Guide to Sunshine Amendment & Code of Ethi cs for Publi c Offi cers and EmployeesoSource of Income StatementoAcknowledgment of Financial Disclosure Requi remento Board and Commi ttees Liai son Responsi bili ti es
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Recei ved on: 411312023 S i gned by X � �;t,,Date --�-B _o _a _r fi-or _C_o _m _m-i t -te _e _M_e _m_b _e _r _______ _
Processed on: 411312023 By Employee: _}:) __ H�----------------Date City Clerk's Offi ce Staff Initials
Scanned on: _4_11 _8_12_0_2 _3 _____ By Employee: _____ R\(l.._,,.__�------------Date City Clerk's Offi ce Staff Initials
CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initi als Scan o
Resignati on Letter Date Processed Ini ti als Scan o
Removal Letter due to absences Date processed Ini tials Scan o
F:\CLERIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
VVe off:: ccmmi!tcx.J k) providing •?.xcelfent seNice ond sc,fety to oti who live, vvor.<. ond in our vibroni, iropicol, hiuoiic con1munity.
City o f M ia mi B e a c h , I/OO Convention Canler Drive, Miami Bach, Florida 33139 yAw._Iiamibaachilao
OFFICE OF THE CITY CIERK, Raf0al E. Granado, Cy Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CilyClerk@miamiboochll.gov
February 03, 2023
Ms. Cindy Mattson
1700 meridian Avenue# 403
Miami Beach, Florida 33139
RE: Human Rights Committee
Dear Ms. Cindy Mattson:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
do
cc: Monica Beltran, Parking Director
Lidyce Grana, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
City Wide Permit Application - (Parking Department Form)
Booklet Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employ0cs
City of Miami Beach, 1ZOO Convention Coner Drive, Miami Poach, Horda 33 139 y_ye.miaIihachfl_gov
OFFICE OF THE CITY CLERK, Rofaol E. Granado, Ciy Clerk
Tel: 305.673.7411, F0x. 305.673.7254
Email: Ci Clerk@miamibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Cindy Mattson
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
above-mentioned board or committee of the City of Miami Beach to which I have been appointed 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
C o de o f E thi cs Or di nan ce), a s w ell 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.
s. Cindy Mattson
swom to an d subscribe d before me this _]th_ day l/.tA2023
Kell/dfZ--
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.
M IA M I E H
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
APR 14 2023
CITY OF MIAMI BEACH
OFFICE OE TEE CIT 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 1700 MERIDIAN AVENUE 403 MIAMI BEACH FL 33139
□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).
[Jam (f Hy[neSS
[[[ne g []res,S
□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 ------------------------
PS[[es,S, J(]feS
"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
a°"cdg matao 11770%°
Si@nature Date
CINDY MATTSON
Printed Name
NOTARY
./
Sworn to (or affirmed) and subscribed before me, by means of rphysical presence or online notarization,
ltaay April .ao23, _nAy aAtgoa
(([[/ of Miami Beach Board/Committee Member).
Produced FLD2 M3 2 S-Io]-L3 -7)- O
Form of Identification
±±2- s.a.aan a
iota, 1yea, Printed, or Stamped
(NOT ARY SEAL)
Notary Publlc State of Florida
L.aura Torres
My Commlsslon HH 346562
Expires 9/19/2025
1I A\I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeachl]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
MATTSON CINDY A
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:
LJ M a e
LZl Female
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
D Asian or Pacific Islander
El Caucasian/wh ite
OJ Native American/American Indian
DI Other- Print Race: _
DI I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
h o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
t1 I Yes
lo t prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REGIBOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
1AMI
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
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)
MATTSON CINDY A
Last Name 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
Di sclosure 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.
~ ~~ 4/13/2023
Signature [n-
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:\C LE R\$A LL\RE G \B O A RD A N D C O M M ITT E E A P P LI CA TIO N S FIN A L D RA FTS \B O A R D A ND C O M M ITT E E A P P LI C A TIO N R E G FIN A L.docx
Updated: June 2020
MIAMl·DADE- EII 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 [Last Name First Name Middle Name/Initial
2022 MATTSON CINDY A
Mailing Address - Street Number, Street Name, or P.O. Box
1700 MERIDIAN AVENUE 403
City, State, Zip
MIAMI BEACH, FL 33139
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.[]
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 □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
SELF EMPLOYEED 1700 MERIDIAN AVE 403 MIAMI CONSULTING
BEACH FL 33139
I hereby swear (or affirm) that the information above is a true and correct statement.
SignatureofPson Disclosing
Date signed
ecv sv 4If /NIT-
D Hardcopy
I Electronic PP 1 4 2023
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
/\A M[BE, ccrw Ee (Cw OAR & COMMIES lg'Egg
ariii-is-si. i i«iii6 so+rimo PARKING APPLICATION IMAI#Jg
1755 Meridian Avenue, Suite 200/Miami Beoch, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200 PARKIIIG
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: 411312023
Applicant Name: CINDY MATTSON
Board/Committee Name: HUMAN RIGHTS
Address: 1700 MERIDIAN AVE 403 MIAMI BEACH FL 33139
E-Mail Address: CMATTSON@EEOCONSUL TANTS.COM
Work Phone: 786-269-2422 Home Phone 786-208-3333
Cell Phone: 786-208-3333 Preferred Contact Method:
Vehicle Information
Tag: DRC4N Color: SILVER/BLUE
State: FLORIDA Year: 2017
Make: MERCEDES Model: C300
Applicant Sianature: e
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours ore 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 Ina epar men ec' Ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature:
Date Issued: Date Completed:
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