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Debra Schwartz 12/31/2010m f/!AfJ~IBEACH 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: (305) 673-7254 01 /14/2009 Debra Schwartz 5680 Pinetree Dr Miami Beach, Florida 33140 ~~. Community Relations Board Congratulations! You have been reappointed by Commissioner Ed Tobin to the above referenced agency, board or committee for a term ending: 12131/2010. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, Robert Parcher City Clerk cc: Saul Frances, Parking Director Barbara Hawayek 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, 2-2458, 2-459 Ordinance 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 Employees We are committed to providing excellent public service and safety to al( who live, work and play in our vibrant, tropical, historic community. i ~ ~~, ..,. ~,~ 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: (305) 673-7254 TO Debra Schwartz RE: Community Relations 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: 12/31/2010. 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 Officers and Emp/ogees, 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 year on which I have served. ~~` Debra Schwartz Sworn to and subscribed before me this ~ day of , 200 `~~~ _ Silvia Pr' to Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeadtfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are commiried to providing excellent public service and sofety to all who live, work and play in our vibrant, tropical, historic community. ~_ 111 I ~~~ I B E:~ ciTY OF MiAMi i~EA~~ f ^ ~#t)ARD AND CtJMMiTTEE APPLiCAT1dN i=oRM NAME: ~C.-r)V\I(7~V~ ~G~p v`~ "t ) Last Name First Name Middle Initial HOME ADDRESS: ~~~~ ~[ 1~~~~.C ~~+ • ~ (Q W(+( ~~-G~CG~ ~° ~ )~ No. Street City State Zip Code PHONE: ~~~ ~~ 1~~`" `5~3 S - s ~~'~ ~D S'-.,,~ ~- S~ Home Work Fax f mail address ,.~, ~ r ~r~ (~ ~+ Si'~n~av~~.. d ~~ l2~ , s as~t5~_~'.~a Business Name: -~la~ p'C" ~'~~f"t~Ol_ VCG1Q~ Position: h ~ ~S~ dG~-. 1~ f^'~' Address: 1q~0 P''1~ ~a ~~ / P - ~• ~ • "7C ~ ~ +3 / No. Street City State Zip Code Professional License (describe) Expires: Attach a copy 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; orb) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six ~6) months: Ye~r; 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: Ye~or No ^ r • (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 list below: Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3) choices will be observed by the Citv Clerk's Office. (Regular Boards of City) ^ Affordable Housin Adviso Committee ^ Historic Preservation Board* ^ 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 Pro'ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram ^ Committee on the Homeless ^ Normand Shores Local Gov't Nei h. Im rovement ^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board ^ Communi Develo ment Adviso * ^ Personnel Board* Communi Relations 4oard . ^ 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 ^ Disabili Access Committee ^ Sin le Famil Residential Review Panel ^ Fine Arts Board ^ Sustainabili Committee ^ Ga Business Develo ment Ad Hoc ^ Trans arenc Reliabili & Accountabili Committee "TRAC" ^ Golf Adviso Committee ^ Trans ortation and Parkin Committee ^ Health Adviso Committee ^ Visitor and Convention Authori * 0 Health Facilities Authorit Board ^ Youth Center Adviso Board ^ His anic Affairs Committee * Board Required to File State Disclosure form F:ICLERISALL1Board & Committeest#3&C ApplicationlB&C Application Revised 111308 2.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: ', Child's name: Age: Program: Child's name: Age: Program: .Have you ever been convicted of a felony: Yes ^ or Nq~ If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No~. f yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ^ or Nom, If yes, explain in detail • Are you currently servin on any City Boards or Committ es: Yes~or No ^. If es; which board? OLS 4 ~ ~©rv~ MU-1~1 ~ C~, ~YIS ©cr;~ ~d ~ g • What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: Name: Title: • LII properties owned or have an interest in, which are located within the City of Miami Beach: wl~ • I am now employed by the City of Miami Beach: Yes ^ or N~Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): This section is "not re uired" but desired: A e: ~'! ears old Gender: Male ^ Femal Race: Whit African-American/Black ^ White/Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^ Haitian: ^ Origin Ethnic: Hispanic: Yes or No "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." R. A ~ ~ c~Cf{Zc7 PtiC'TZ 13 a o ~~~,~c- . Applicant's Signature Date Name of Applicant (PLEASE PRINT) ,.e Please attach a copy ©f your resume to this application NOTE: Applications,vrill remain on file for a,period of one (1) calendar year. Employment Status: Employed Retired ^ Home-maker ^ Other ^ Received in City Clerk's Office by Date Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered By Date Revised 09/02!08 LH F:~CLER`,SRLL~Board & C:ommitteesli3&C ApplicationlB&C Application ReviS~d 111308 2.doc