Karin Matos 12.31.26--------------
BO A R D A N D CO MMITTEE CHECKLIST
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BOARD/COMMITTEE:[Luhr ft LSI
FOR SCANNER
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DATE OF APPOINTMENT:L]la[2Qi
7Bslit@{Appointed by.(cam.[4n4a (ka#
TERM EN:[1[2J rRM nan+.03l3
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FOR CLERK STAFF
Letter of Appointment
Letter of Reappointment
Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
Board and Committee Application (Completed on )
Resume/Curriculum Vitae
Diversity Statistics Reporting (Completed on
Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
v 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
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 Statement
Board and Committees Liaison Responsibilities
O Diversity Statistics Reporting✓I acknow ledge that pu,suant to Sec.2-22(9)of the M ;am ;Beach Code of O ,d;nances,I w m be ,e m oved
from my board/committee upon failure to attend 33%of the regularly scheduled meetings.
Sec 2-22(9)ff any member of an agency,board or committee falls to attend 33 percent of the regularly scheduled
meetings per calendar year,such member shall be automatically removed.To calculate the number of absences
under the 33 percent formula 4 or less rounds down to the next whole number and 5 or more rounds up to the
next whole number
NOTE:Members of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year or upon abstaining from voting due to a conflict of interest on four different
applications within a calendar year A member who is removed shall not be reappointed to membership on the
board for at least one year from the date of removal
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Received on ~1;--1 ......,¥~•J+-':.<.Jnl...c:'~j..:...)Signed by X ~:_____
6ate ~or Committee Member
/22h •"o U-By Employee
Date City Clerk's Office Staff Initials
MIAMI BEACH
City of Miami Beach,17OO Convention Center Drive,Miami Beach,Florida 33 139 yyyy_miamibeachllgav
OF FICE OF THE CITY CLERK,Rafae l E.Gran ado ,Ciy Clerk
Tel :305.673.7411,Fax 305 .673.7 254
Email:CiNyClerk@miamibeachfl.gov
January 14,2025
Ms.Karin Matos
1465 Cleveland Rd
Miami Beach,Fl 33141
S U B JE C T :Nei gh bor ho od R esili ency Proj ects Advisor y Com m ittee
Congratulations!You have been reappointed by Com m issioner Tanya Bhatt to the above referenced,
board or committee,for a term ending:12/31/2026.
Pursuant to City of Miami Beach Code Section 2-22 (5)a,"Notwithstanding any other provision of the
City Code or of any resolution,commencing with terms beginning on or after January 1,2007,the term of
every board member who is directly appointed by a member of the City Commission shall automatically
expire upon the latter of:December 31 of the year the appointing City Commissioner leaves office or
upon the appointment/election of the successor City Commission member."
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.
Congratulations and good luck.
"#.%.
City Clerk
cc:Jose Gonzalez,Parking Director
Amy Knowles,City Liaison
A TT A CHM E NT S :
Letter of Appointment
Oath
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 Ordinance
City W ide Permit Applica tion -(Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City of Miami Beach,:orwvonb n Conto Divo,Miami Boo.ch,Hlorda 331.39 wy_mio mnita_hfl_go
OKH O TH CITY CI£RK Rafael I Granado,Cy Clod
Il 305 673 7411 fax 305 673 7254
[mal Cielomamboohi go
Oath of Office
Oath of Civility
and
Acknowledgements
TO Ms Karn Matos
RE Neighborhood Resiliency Projects Advisory Committee
do solemnly swear or affirm to bear true faith,loyalty and allegiance to the Government of the Umuted
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 12/31/2026.
To my colleagues and to all of those l represent and serve,I pledge fairness,integnty 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 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 l serve)on July 1st,following the closing
of the calendar year on which I have served
ii Kann Matos
Swom to aod sobscnbed befo,e me th,s ~day~,
'Please visit the City ot Miami Beach website at www miamubeachtl gov under City Clerk/Board and
omnttees tot additional tormation regarding the Financial Disclosure Requirements
City of Miomi Beach
cve ton enter Duve
OFFI OF THE CIY CLERK
Emal BC@mmuamubeachf gov
lehone 305 673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
Ias(check ()all that apply)
~am a resident of the City of Miami Beach for six months or longer.
Home Aaress.lg (ult,a d /yai fad ___3ill
@ 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)
usmess Address.Le f3K (llhu 4h.3Lj,mu,,fad ,(2_3/D 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).
[3rn%(f Py1mes,S,
HS,1me,,J][fSS
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 mn it are true
S1gnatur~Date r I
[@rot II
Printed Name
fII
City of Miami Beach
vnt [)rive
y Ho,h Md ;,3 3¢
a ah»t 10
OHIE OF 'HE +'YI+RK
mail BC@mambeachf\gov
Telephone.305.673.741
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
'-4i n
First Name
L
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 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 l 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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if I am engaged to provide services,for compensation,to either (1)a candidate for City elected
office or (2)a political committee or electioneering communications organization expending funds for or against
candidates for City elected office,such engagement shall be deemed a tender of resignation from the City
agency.board,or committee
s,gnat~t'.!<1"L.~Date I
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 CityClerk
Page 6 of6
f £RS#LL BARD AIL COMMIT HE ES DA I#BASE Boatd and Committee Applicatom BOARD AND COMM IEE APPLICATION JULY 20'4 doc)d a te d Ju ly Z 20 24
o a t.ea
City of M ia m i Beach
Q onventor enter [rive
Mom Roch Eland ?3120
ww w m iam/b each!/go
OFFE OF THE CITY CLERK
Ema l @muamb eachf go
ielehone.30$673 7411
DIVERSITY STATISTICS REPORI
Last Name
K 4a
First Name
L-
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:
Lee te
Female0Other0Iprefer not to answer.
Race/Ethnic Categories:
What is your race?0 African American/Black
[l Asian or Pacific Islander
[Caucasian whiteDNativeAmencan/Amencan Indian
[]Other Print FaceDIprefernottoanswer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Jves3is0Iprefer not to answer
Do you consider yourself Physically Disabled?
Jee
l No
[J prefer not to answer this question
Page 6 ot 6
I ++RE BORD)KN OIMM!I!EE APPLICATION FINAL DRAAH T·BOARD)ANDO COMMIIEE APPICHON REG FINA doc
at t JL,
MIAMI"EI.I
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11 1//the {County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by .July 'stvv0at
Disclosure tor Tax Year Ending
»/90bu
'h "f
Last Name
Pt0»
Mailing Address -Street Number,Street Name,or P.0.Box
ituf evu@rd Ct.
First Name Middle Mame/Initial
L
City,State,Zip -
mvao fad,f33)\
lt your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.$119.07,read
nstructions on the following page and check here.L]
Filing as an Employee (check one)
D County D Public Health Trust [Municipal:
(Municipality)
Departm ent
Pos ition or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (chec k one)
I D County [Yuniciat:
(Municipality)
Board where serving
(0 dG Rslio
Work telephone
305-33 .S7 3
List below every source of income you received,along wth the address and the principal activity ot 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 trom business,gains from
property dealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of income received by anotper
person for your benefit However,the income of your spouse or any business partner need not be disclosed.It continued on a separate sheet,check here.O
Name of Source of Income Address Description of the Principal Business Activity,-4 34fanLmah,.4 ,3 P8 e tis foe./+4+ymini£atl f 33n\1,--l
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t hereby swear (or affirm)that the information above is a true and correct statement RECEIVED BY ELECTIONS DEPARTMENT:
Hardcopy
Electronic Coy
\BOARD &COMMITTEES
PARKING APPLICATION
',N Mi0mi Boob H 33139/Ph.{30594 73 7505 31 (305)673 700 0¥t 20 aPARKING
iNy o!Miami Beach PARKING DEPARTMENT
As c Board/Committee member you are entitled to a Citywide Parking Permit,which includes City +a
0age (>.y parking access [Access Card)or a complimentary Citi Bike/Deco Bike Membership,or a
discounted MDC Monthly Transit Pass throughout your term.
Boord Member Information
o'e f Application:]j [5ill,X?"
Applicant Name [Ar,«m+5s
ard/Committee Name:..14jhby hod±(yithyfcusBAAs4(cc,+rg
Address:4a CteUlt-a Cl py3 3 ,,L ,
s-ht dr {Ro,{?3t]
E-Moil Address Kna ref us0n
Work Phone:Home Phone:5-8l-92
crease<,5a'ascereasenors+a
Please Choose One 1 Or tion:
~Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership MDC Monthly Transit Pass
Credit
Vehicle Information For Cit
7o :Aq
[$tote:
Make:
ide Parkin Permit/Access Card Onl
Color:
Year:
Model:
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 lo you for City Hall Garage (G7)access.
IMPORTANT NOTE:Your vehicle license plate serves as your "parking permit".To ovoid 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
nformation 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.
cant Signature./[,[ao•'3±i -
'coe provide sign@ iJ,,,+e Parking Department located at 1755 Meridian Avenue.2°floor
«oting hours are 8:.30 to 5.00 p.m.or email to:Parkin@Reception@miamibeachtI.gov
e-mail subject:BOARD &COMMITTEE PARKING APPLICATION APPLICANT NAME