Patrick Henry 12/31/2010m MI?MIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvvnv.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305J 673-741 1, Fax: (305) 673-7254
01-15-2009
Patrick Henry
~~E~ ~~ Golf Advisory Committee
.~
Congratulations! You have been appointed by Commissioner Jonah M. Wolfson
to the agency, board or committee named above for a term ending: 12/31/2010.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
r,~ ~ /S~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Kevin Smith
ATTACHMENTS:
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 Wide Permit Application - (Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We are committed to providing excellent public service and safety to all who live, work and play in ovr vibrant, tropical, historic community.
~. y F
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305J 673-7254
TO Patrick Henry
RE: Golf 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: 12/31/2010.
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 theF/orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public ~cers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure" require-
ments 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 on which I have served.
~~
Patric enry
Sworn to and subscribed before me this fS'~day of , 200
it
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.
We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community.
~/ 1 ~ Al V , ~ ~~~~ t 1 cITY pF MI~.MI gE~,cH
-- BOARD AND COMMITTEE APPLICATION FrJ' RM
NAME:
t~
~~ ~C
Last ame First Name /J~ ~7 nni.y~e irntiai
HOME ADDRESS: y01U~/ ~Q/'~~01/t- ~~ ~~ `'IhM'1~,6-QG~` 7 ~ ~31yd
No. Street City State Zip Code
38~ 67~-~3~J ~ s8~- oB'ry ~gf~~cK_ hers/y _~`~, ~ ~~~iP- w~,
PHONE: Fax Emad address
Home Work
Business Name:
Address:
No.
Professional License (describe) _
Street
Position:
City
State Zip Code
Expires: Attach a cop}~ of the license
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership~nterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes/ or No ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes~or No ^
• Are you a registered voter in Miami Beach: Yes/~or No ^
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, experience. Please fist below:
_ ,...
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] thirtl choice. riease nv~ inai vr~~v uu~c ~~~
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Historic Preservation Board*
0 Art in Public Places Committee ^Housin Authori *
^ Beach Preservation Board ^ Loan Review Committee*
^ Beautification Committee ^ Marine Authori *
^ Board of Ad~ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Oversi ht ^ Miami Beach Florida Sister Cities
^ Committee on Homeless ^ Normand Shores Local Gov't Nei h. Im rovement
^ Committee for Quali Education in M6 ^ Parks and Recreation Facilities Board
^ Communit Develo ment Adviso * ^ Personnel Board*
^ Communi Relations Board ^ Plannin Board
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overla (CANDO ^ Production Indust Council
^ Debarment Committee ^ Public Safet Adviso Committee
^ Desi n Review Board* ^ Safe Committee
^ Disabilit Access Committee ^ Sin le Famil Residential Review Panel
0 Fine Arts Board ^•Sustainabili Committee
"
"
^ Ga Business Develo ment Ad Hoc ~- TRAC
^ Trans arenc Reliabilit & Accountabilit Committee
Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Adviso Committee ^ Visitor and Convention Authorit *
^ Health Facilities Authorit Board ^ Youth Center Adviso Board
^ His anic Affairs Committee
* Board Required to File State Disclosure form
- ,:;! ER\5AL~1Esoaro ~ Cominittees~B«C. Appiirai~onA5&C N,ppii::aiior Revi~=e " ~ 1308.doc-
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes _ No _ Years of Service:
2. Present participation in Youth Center activities by your children Yes_ No ::~. If yes, please list the names of your children, their
ages, and which programs. List below:
Chilri'c Hama.
Child's name:
Age: Program:
Age: Program:
.Have you ever been convicted of a felony: Yes ~~~ or No~f yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~~! or Nom`.' If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^~ or N~ If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ^ or No~ If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: ~ .,
Name:
• List all properties owned or have an interest in; which are located within the City of Miami Beach:
Flo! U ~/ ~~,id ~~,, ~,~ ~S~ ~6~ ~~~l~l'Un ~~
• I am now employed by the City of Miami Beach: Yes ^ or Nq~ Which department?
truthfulness of the application and have received, read and will abide by Chapter 2,
~ds of Clanduct for City Officers, Employees and Agency Members."
• Pursuant to City Code Section 2-25 (b): Do you have a parent C, spouse ~, child .~, brother J, or sister C who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: ,~ years old Gender: Male~• Female ^
Ethnic Origin (Check one)
Whitej.~African-American/Black ^ Hispanic: ^ Asian or Pacific Islander C American Indian or Alaskan Native ^
"I hereby atte the accuracy
Article VII - City Cade "
~~~'~ C~
Applic Ht's Signature
PRINT)
l /S ~d o1 o~fr~~ ~' 17~~r
~ ~~
Name of A(~f(icant (PLEASE
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Employment Status: Employed ^ Retired ^ H
Received in City Clerk's Office by
of
ker ^ Other ^
Date
Document Control Number (Assigned by the City Cferk's Office) Entered By Date
Revised 09!02/08 LH
Title: