Mayra Diaz Buttacavoli 12.31.241BE
OARD A N D C O MMITT E E C H E C KLIS T
A PP O IN T EE. Mayra Diaz ut ta ca voli
B OA RD/C O M M ITTEE . D e sig n revi ew b o ar d
DATE OF APPOINTMENT. June 28, 2023
A p p oi n te d by. "Vayor and Commission
FOR SCANNER
Scan o
Scan o
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RECEIVED
JUL -5 2023
FOR CLERK S T AFF 124
o Letter of Appointment TERM ENp. 12 /31/2 0 TERM LI . ? years
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
7/1/2023 _ 7/1/2023
o Board and Committee Application (Completed on
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed 6, 1/1/2023
o Oath
IM PO RTAN T INFO RM A TI O N FO R B O AR D A ND C O M MI TTE E M EM B ER S BO OK
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 C ITY O F M IA M I B E A C H
O FF IC E O F TH E C ITY C LER K
Scan O
Scan O
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
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
0
Received on:
Scanned on:
99,999.8 99 £.9 4 . g 1d ORIGINAL nnuat Report.
71/30° son a o,X7al a- o [.ztaaeo&-
Board or Committee Member
to o l/03 rwoes ~//]
Date City Clerk's Office Staff Initials
1/l2? moors K/]
Date 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\CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\BC Checklist 2015 MASTER.docx
M IA M I BEACH
City of Miami Beach, I/OO Convention Contor Drivo, Mia mi Boach, Florida 33 139 wyw.miaIibeach[l.gov
OFFICE OF THE CITY CLERK, Rofaol E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@miamibeachll.gov
June 29, 2023
Ms. Mayra Diaz Buttacavoli
RE: Design Review Board
Dear Ms. Mayra Diaz Buttacavoli:
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,
- City Clerk
cc: Monica Beltran, Parking Director
Michael Belush, 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 Employees
City of Miami Beach, 1ZOO Cononlion Conler Drive, Miami Boo.h, Hon da 33 139 ygywy_miamibaachfl_go
OFFKCE OF THE CITY CLERK, Rofool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: City/Cl erk@miamibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Mayra Diaz Buttacavoli
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 ending: 12/31/2024.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actio ns taken a nd a ll communications made by me as a public servant.
I ha v e b e e n issu e d a co p y o f se ction 2 -1 1 .1 o f the M ia m i-D a d e C o u nty C o d e (C o nflict of Interest and
C o de o f E thics O rdina nce), a s w ell a s Flo rida 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
o f the cale nda r year on w hich I have served.
42##a,ea- a. M.Ia on, ea«aEavo»
swor to and subscribe d before me this } day r QUI
Keil
*P le a se visit the C ity o f M ia m i B e a c h w e b site a t w w w .m ia m ib e a chfl.g o v u n d e r C ity C le rk/B o a rd an d
C o m m itt ees fo r a dditio na l info rm atio n rega rding the Fina ncia l Di scl o sure R equirem e nts.
MI BE CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OF FIC E OF TH E CI TY CIERK
Email BC@miamibeachf.gov
Telephone. 305673.7411
RECE IVED
JUL -5 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE cr y OF MIMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
h] tam a resident of the City of Miami Beach for six months or longer.
H om e Addres .,e;_· Y'_,___~_-..L.._+ _
[[1 h a v e an own ersh ip intere st (for a m inim um of six mon th s) in a busi ness est abli sh ed in th e
City of Miami Beach (for a m inim um of six m onths).
Name of Business: --------------------------
Hy8{PPS., (d[S,S,
[ \1am 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).
[[a[T (f [J S][]@€S ,
[JI[PS,, f)](Hf@S ,-
"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, limi ted liability compa ny,
or other entity or business association.
Under ponaltios of perjury, I declare that I have read the foregoing document an d th at the facts
stated in it are true.
aZS$#d"en, ca.act-
Mayra Diaz Buttacavoli
7/1/2023
Date
Printed Name
IBE H
City of Miami Beach
1700 Convention Center Drive
Miami Beac h, Florida 33139
ww.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Emai l: BC@m am ibeachfi.go
Telephone: 305.673.7411
DIVERSITY. STATI STICS REP OR I
Diaz Buttacavoli Mayra
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 Mate
El remale
J oner
El prefer not to answer.
Race/Ethnic Categories:
What is your race?
[]African American/Black
E Asian or Pacific Islander
[l Caucasian/white
El Native American/American Indian
[]Other Print Race.
Ell prefer not to an swer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
J o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
lee
Jo
LJ t refer not to answer this question.
Page 6 0f6
FACLERSALL REG\BOARD AND COMMIT IEE APPLICATIONS FINAL RAF TS BOARD AND COMMITTEE APPLICATION REG FINAL.dox
Updated: June 2020
IA /I
City of Miami Beach
17 0 O Convention Center Drive
Miami Beach, Florida 33139
w9.miaribeachtl.goy
OF FICE O F THE CITY CLERK
£moil: BC@mlamipeachf.gov
Telephone: 30 5.6 7 3.7411
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)
Last Name First Name Middle Initial
I understand that no later than July1 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 th an 12.00 noon of Jul y 1, of each ye ar.
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.
7ya- Mc-;zdcooc- 7/1/2023
Signature Date
' 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 m embers 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 CL E R SAL L RE G B OAR D ND C OM M IT TEE AP PLI CA TIO N S FINAL DRAFTS\BOARD AND COMMITTEE; APPLICATION REG FINAL .docx
Updated Jun e 2020
S O U R C E OF INCOME STATEMENT
First Mars
Mayra
Mlddfa Mame/in/tlal
lt your home address Is your malling address, and your home address Is exempt from public records pursuant to Fla. Stat. $119.07, read
instru ctions on the following pa ge and check here.[]
Fling as an Employee (chock one)
[] county [] Public Health Trust [] Municipal:
(Municipality)
Em ployee ID Number
I Work telephon e Empl oyment began or/ended on
[] county [] Municipal: Miami Beach
(Municipality)
Board where serving
[Design Review Board
A)temote address (tt home address ls exempt) I Work telephon e ITorm began on/ended on
6/23 - 12/31/24
List below eve ry sou rco of income you received, along with the address and the principal activity of each source. Include your publlc salary Place the sources of
tncome in descending order, with the largest source first Examples of sources of income include: compensation for services, Incom e from business, gains from
property dealings, Interest, rents , dividends, pensions, IRA distributions, and soc/al security payments. Also, Incl ude any source of Inco m e received by another
person tor your benefit. However, the income of your spouse or any business partner need not be disclosed. tt continued on a separa te sheet, check here.L ]
Name of Source of Income Address Description t the Principal Business Activity
State of Florida pension Government
City ot Miami Beach pension Government
Dividend and interest income Truist Bank and fiduciary trust
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature ot P ers Dl cl osln g '
RECEIVED BY ELECTIONS DEPARTMENT:
J oratcoECEIVED
[] Elec tronl c Copy
JUL -5 2023
CIT Y O F M IAM I BEA CH
O FFIC E O F TH E C ITY CL E R K
REMEMBE R TO PRINT, AND SUBMIT TO THE O FFICE OF THE CITY CLERK VA EMAIL OR HARD0COPY
I
City et Miami te e«h, PAR KING DEPARTMENT
1235 Men±son Avenue, Suh 200/M4or» bes#, + 33139/P% {305) 673250$ sr (30$4 873.7000 ad 4200
CITYWIDE (CW) BOARD & COMMITTEES
PARKING APPLICATION
A citywide (CW} parking permit is honored at metered porking spaces and restricted residential zones
pa rking spaces A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Ga rag e (G?] access.
IMPO R TA NT NO TE: Your vehicle license plate serves as your "parking permil". In order to avoid
any unneces sary entorcem ent actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated veh icl e
information may lead to the issuance oh parking citation(s] and/or the towing ol 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 m ay need
to try the other side of the card. Please ensure you hold the entire surfa ce of the card against the reader
until the gale open s.
ACKNOWLEDGEMENT: I acknowledge that should m y access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
oard Me
Dote of Application
App lic ant N am e:
ion
v0
Boord/Committee Name:
Address
E-Mail A ddr ess: Fmnb 1208@aol.com
Work Phone: Hom e Ph one
C el l Phon e 305-319-0 304 Preferred Contact Method Email
v h i:h Inf ti e tcle orma to n
Tag: /SA E M N Color. White
State: F/aide, Year: 2o1¥
Make: Mercedes Benz Model: q/s oo 0
Applicant Sianature: )7eepoi-4? /,teccvoo
Plea se provide signed form to th~ Parking Department located at 1755 Meridian Avenue, 2 floor W orking
hours are 8:30 to 500 p.m. or email to: ParkingReception@miamibeachfl.gov
o-mail subject: BOARD & COMMITTEE PARKIN G APP LICATION - A PPLICANT NAME
GARAGE ACCESS
ID Card Seril #.
Print l am e
Signature:
Date Completed.