Maria Paulsen 12.31.25MIA M I BEACH
B O A R D A N D C O M M IT T E E C H E C K L IST
APPOINTEE: Maria A Paulsen DATE OF APPOINTMENT: Mar 13, 2024
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BOARD/COMMITTEE: Affordable Housing Advisory Co Appointed by: Kristen Rosen Gonzalez
reRow o. 12-/31/ +nun._l31 )1 FOR SCANNER
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RECE IVED
MAR 1 8 2024
FOR CLERK STAFF
o Le tt er of A pp oin tm ent
o Le tt er of R eapp ointm ent
o C opy of Le tter of Ap poi ntm en t/R eap p oi ntm en t e-m aile d to C om m ittee Liaison on _
o B oard and C om m itte e Ap pl ic ation (C om pl eted on I
o R ~su m ~/C ur ricul um Vi ta e
o D iversity S tatistics R ep or ti n g (C om pl et e d on
o O ath
CIT Y OF MIAMI BEACH
OFF!CE OF THE IT Op
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓C ity C ode O rd in ance S ection applicable to the agency, board or com m ittee
✓C ity C od e S ection s 2-2 1, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
✓C o un ty C o de S ection 2-11.1 -- C on fli ct of Interest and C ode of Ethics O rdinance (as
am en ded th rou gh D ecem ber 2010)
✓A m en dm ents to th e C ode of Ethics O rdinance (S eptem ber 2009 thro ugh July 2012)
✓H igh lights of th e M iam i-D ade C ounty Ethics C ode
✓S u n sh in e La w a nd P ublic R ecor d s - Fre quently A sked Q uestions
✓M em or an d um - S ol ic itation by C ity Board and C om m itt ee M em bers
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o C ityw ide P erm it A p plica tion (P arking D epart m ent Form )
o B ook l e t - G ui d e to S u nshine A m endm ent & C ode of Ethics for Public O fficers and Em ployees
o S ou rce of Incom e S ta tem ent
o A ckno w led gm ent S tatem ent
o B oa rd a nd C om m itt e es Li aison R esponsibilities
o D iversity S tatistics R ep ort ing
[Z] I acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) If any mem ber of an agency, board or committee fails to attend 33 percent of the regularly scheduled
m eetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less ro unds down to the next whole number and .5 or more ro unds up to the
next w hole num ber.
NOTE: M em bers of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year; or upon abstaining fro m voting due to a conflict of interest on four different
applications within a calendar year. A mem ber who is removed shall not be reappointed to membership on the
board for at least one year fro m the date of removal.
R e ce ive d o n : Ne182 sos»X_6 /4
D a te
so2l1al or e s f
C ity C lerk's O ffi ce Staff Initials
Board or C om m itt ee M em ber
D a te
WVe ar e committed to providing excellent public service and saley to all who live, w ork , and pl a y in our vibrant, tropical, historic community.
M IA M I BEACH
C ity o f M ia m i B e a ch , /OO Conven tion Contor Drive, Miam i Beach, Florida 33 139 yyew_miamibea chfl_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox 305.673.7254
Email: CiNyClerk @mi am ibeach ll.go v
March 13, 2024
Ms. Maria Paulsen
400 NE 101 Street
Miami Shores, FL 33138
RE: Affor da ble H o usi ng A dvi sor y Com m i ttee
Dear Ms. Maria Paulsen:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2025.
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. Reg¼
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Marcela Rubio, 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
MIAMI BEACH
City of Miami Beach, 1ZOO Convention Con to Drive, Miami Boach, Florida 33 139 yyyw_miamibachllgov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk @miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Maria Paulsen
RE: Affordable Housing Advisory 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: 12/31/2025.
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 Ordinan ce), 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. Maria Paulsen
Sworn to and subscribed before me this ft day~
Keil&
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 B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
O FFIC E O F TH E CI TY C LERK
Email: BC@miamibeachf]_gov
Telephone: 305 .673 .7 411
RECEIVED
MAR 1 8 2024
CIT Y OF MIAMI BEA CH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: _
D 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: _
[/[1am a full-time employee of a business (for a minimum of six months) and l 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: First Horizon Bank
Business Address: 400 Arthur Godfrey Rd Suite 102 Miami Beach, FL33140
"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 are true.
Mar 18, 2024
Signature
Maria Paulsen
Date
Printed Name
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 331 39
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REP ORI
Paulsen Maria 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:
L]Male
[ Female
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
Ll Amnican American/Black
D Asian or Pacific Islander
El Caucasian/white
LJ Native American/American Indian D Other - Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yes
No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
v es go
D I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFTSIBOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEA C H
City of M iam i Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .mia mibeachfl .gov
OFFICE OF THE CITY CLERK
Email: BC@ miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Paulsen Maria A
Last Name First Name Middle Initial
Acknowledgment 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)
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 Copy of your latest Federal Income Tax Return.
Members of the Planning Board and the Board of Adjustment must electronically file a "Statement of Financial
Interests (Form 1)" directly with the Florida Commission on Ethics.
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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
Mar 18, 2024
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 electronically file a Statement of Financial Interests (Form 1) with the Florida
Commission on Ethics by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics 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.
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F:ICLER \$ALL\BO ARD AND CO M M ITT EES DATABASE\Board and Com m ittee Application\BO ARD AND CO M MITT EE APPLICATIO N FEB 2024.docx
Updated: February 22, 2024
MIAMl·DADE♦EI 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
2023 Paulsen Maria A
Mailing Address - Street Number, Street Name, or P.O. Box
400 NE 101 St
City, State, Zip
Miami Shores, FL 33138
If your hom e address is your m ailing addre ss, and your hom e addre ss is exem pt fro m public records pursuant to Fla. Stat. §119.07, read
instructions on the follow ing page and check here .Dl
Fili ng as an Employee (check one)
[] county D Public Health Trust [ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Fili ng as a Boa rd M ember (check one)
[] county LY'unicipal: Ni(up [t h
(Municipality)
Board where serving
\lcs in luso- -or1HA N{»lb
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
First Horizon Bank 400 NE 101 St M ia Beach, FL VP Private Banker
33140
I hereby sw ear (or affi rm ) that the inform ation above is a true and corre ct statem ent.
Signature of Person Disclosing
-1-34
Date signed
RcEe sY 4-FT9NS PEPARTENE:
D Hardcopy
J Electronic " 1 8 2024
CITY OF MIAMI EACH
OFFICE o 7 4F CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Pro cessed Date/Initials: Scann ed Date/initials:
138 SP-14 COE 2016
M IA M I B E A CH
City of Miami Beach, PARKING DEPARTMENT
BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue, Suite 200 Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
a
PARKING
A s a Bo ar d /C o m m itt e e m e m b e r yo u ar e e n title d to a C ityw id e Par king Perm it, w hich inc lu des C ity H a ll
g ar a g e (G 7) p ar kin g ac c ess (A c c e ss C ar d ), or a co m p lim e ntary Citi Bike /De co Bike M em bership, or a
d isc o u n te d M D C M o n th ly Tra n sit Pas s th ro u g h o u t you r term .
Board Member Information
D a te o f A p p lic a tio n : M arch 24 , 20 2 4
A p p lic a n t N a m e : M aria A P a u lse n
Bo ar d /C o m m itt e e N a m e : A fforda b le H o using A dvisory C om m ittee
A d d re ss: 4 0 0 A rt hu r G o dfr ey R d S u ite 102 M ia m iBe ach, FL 33 14 0
E-M a il A d d re ss: m a ria .p a u lse n@ firstho rizo n .co m
W o rk Ph o n e : 305 468 4147 H o m e Ph o ne :
C e ll Ph o n e : 30 5 588 87 05 Preferred C o ntact M etho d : cell
Please Choose One 1 0 tion:
• Cityw ide Par king Perm it/G 7 Access Car d O Citi Bike/Deco Bike M em bership O M DC_ Monthly Tra nsit Pas s
Vehicle Information (For Citywide Parking Permit/Access Card On ly )
Ta g : EZA T36 C o lor : dark grey
Sta te : Florida Ye ar : 2021
M a ke : Audi M o d e l: Q5
A cityw id e (C W ) p ar kin g p e rm it is ho n o re d a t m e tered p ar king sp a ces an d restricted residentia l zones
p ar kin g sp a c e s. A C W p a rkin g p e rm it IS NOT ho n o red in p roh ib ited ar e a s. A n A ccess C ar d w ill be
p ro v id e d to yo u fo r C ity H a ll G ar a g e (G 7) a c c e ss.
IMPORTANT NOTE: Y o u r ve h icl e lic e nse p la te serv es as yo ur "p ar king p erm it". To avoid any
u n n e c e ssa ry e n for c e m e n t a c tio n s, it is im p o rta n t th a t o u r rec or ds reflect the m ost current and
a c c u ra te in for m a tio n re g ar d in g yo u r ve h icl e lic e n se p la te. In a c cu rate an d /or o u tdated vehicle
in fo rm a tio n m a y le a d to th e issu a n c e o f p ar kin g ci ta tion (s) and /or th e to w ing of your vehicl e.
Ple as e no te th a t th is ne w ac c e ss car d CANNOT b e ho le -p un ch e d o r pe rforated in a n y m anner. To use
th e ne w car d p le as e ho ld th e car d a t clo se p roxim ity to the rea d e r until the g a te o pens. You m ay
n e e d to try th e o th e r sid e o f th e car d . Ple as e e n su re you hold the e ntire surfac e of the car d ag ainst
th e re a d e r un til th e ga te op e n s.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or damage, I will be
responsible to pay a $10.00 replacement fee.
A pp l ic a n t Si g n a tur e: es
Ple a se p ro vi d e si gn e d for m to th e Par kin g D ep ar tm en t lo cated a t 1755 M er idia n A venu e, 2nd floor .
W o rkin g ho u rs ar e 8:30 to 5:0 0 p.m . o r e m a il to : ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
f:\ping\$man\rar\forms\cw boords&commit1ees porkingform.doc form updated 1/18/2024