Chana Eisner 6.30.24MI MIBE
City of Miami Beach, ZOO Convention Center Drive, Miomi Beach , Florida 33139 www wmniamibeachl gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
August 14, 2023
Chana Eisner
4101 Pine Tree Dr. Apt 804
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Eisner,
Congratulations! You have been appointed to the above-referenced Board or Committee as a
representative for the Yeshiva Elementary School PTA, for a term ending on 06/30/2024.
If you are unable to accept this appointment or have any questions, please call the Office of the
City Clerk at 305.673. 7 411.
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,
R~ado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, City Liaison
ENCLOSURES:
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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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OFFKCE OF THE CITY CIERK, Rafaol E. Granado, Ciy Clerk
Tot: 305.673.711, fax. 305.673.7254
Email: Ci#Clerk@mtamiboochll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Chana Eisner
RE: Committee for Quality Education in Miami Beach
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: 06/30/2024.
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 0f 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.
Ms. Chana Eisner
sworn to and subscribed before me this '_ day or Aug, 2023
.@
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.
MIAMIBE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 331 39
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
As a voting member of the Committee for Quality Education in Miami Beach, I am in
compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4) and
2-190.137 as:
~ I am a City of Miami Beach resident for six months or longer.
Home Address: 4101 Pine Tree Dr. Apt 804 Miami Beach Fl. 33140
B 1 am the parent/guardian of a student attending a Miami Beach school for the 23-24 school
year.
schoot: 'oshiva Eomonary Schoo
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
"PE LUD ozuvzozs
Signature Date
Chana Bluma Eisner
Printed Name
MI AM I BE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeach]_ gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephon e: 305.673.7411
DIVERSITY ST A TISTICS REPORT
Levin Eiser Chana B
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 Male
[l 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/white
0 Native American/American Indian
0 Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
(lves
[Jo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Ives
(lo
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
/\1\IA M IB
City of Miami Beach
1700 C onv ention 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)
Levin Eiser Chana B
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
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.
(/, Arv2s, 2023
---------------- Signature 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:\CLE R \$A LL\RE G \B OA R D A N D C O M M ITT E E A P P LI C A TIO N S FINA L D RA FTS \BO A RD A ND CO M M ITT E E A P P LI C A TIO N RE G FINA L.docx
Updated: June 2020
MIAMl·DAD E.
EIII
Clear From
$
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 I Last Name First Name Middle Name/Initial
2022 Levin Eiser Chana B
Mailing Address - Street Number, Street Name, or P.O. Box
4101 Pine Tree Dr. Apt. 804
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 following page and check here. D
Filing as an Employee (check one)
[] county ] Pubic 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 E] Municipal: Miami Beach
(Municipality)
Board where serving
Committee for Quality Education in Miami Beach
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
786-245-9179
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
TAU Capital 777 Arthur Godfrey Rd. Suite Hotel Development and Rare
200, Miami Beach FL. 33140 Earth Metal Mining
Biscayne Associates Interest Income
I hereby swear (or affirm) that the information above is a true and correct statement.
fir,-
Signature of Person Disclosing
April 23, 2023
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
toracoRECEIVED
D Electronic Copy
APR 24 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CI En
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MIAMI BE CITYWIDE (CW) BOARD & COMMITT EES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200
l PARKING
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:April 23, 2023
Applicant Name: Chana Levin-Eisner
Board/Committee Name: Committee for Quality Education in Miami Beach
Address: 4101 Pine Tree Dr. Apt. 804, Miami Beach FL. 33140
E-Mail Address: cbleisner@gmail.com
Work Phone: Home Phone
Cell Phone: 786-245-9179 Preferred Contact Method: Cell
Vehicle Information
Tag: IVGG32 Color: Black
State: Florida Year: 2023
Make: Honda Model: Odyssey
Applicant Sianature: e
Please provide signed form to the Parking Department located at 1755 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
p, ·kd D rt ar Ina epa men ec ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signat ure:
Date Issued: Date Completed:
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