test test~_ 1 ~/ 1 I /"'\/ ~1 , I D L/"'~~' t CITY OF MIAMI BEACH
BOARD AND COMMITTEE AFPL.ICATION FORM
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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 aty for a minimum of six
months; orb) an individual shall demonstrate ownershiplinterest for a minimum of six months in a business established in the dty.
• Resident of Miami Beach for a minimum of six (6) months: Yes ~ or No L
• Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes L or No J
• Are you a registered voter in Miami Beach: Yes [1 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 list below:
Please list your preferences in order of ranking (1J first choice [2) second choice, and (3] third choice. Please note that only three 131
choices wlll be observed by the City Clerk's Office. (Regular Boards of City)
I Affordable Housing Advisory Committee _ __ ~ I. Historic Preservation Board .. ____
^ Arf i~_ Places Committee I Housin Authorit
C Beach Preservation Board a Loan Review Committee
G Beautification Committee _ ~ Marine Authority _ _ _
7 Board of Adjustment' D Miami Beach Commission for Women
D Budget Advisory Committee D Miami Beach Cultural Arts Council
_- - - -
^Capital Improvements Projects Oversight Committee D Miami Beach Sister Cities Program _ i
D Committee on the Homeless Y D Normandy Shares Local Gov't Neigh. Improvement
iliti_es_Board
^ Committee for Quality Education in MB ' [Parks and Recreation Fac
L' Community Development Advisory _ _ _
C Community_Relations Board _ _
L Personnel Board _
C Planning Board'_ ____,
C Convention Center Advisory Board 7 Police Citizens Relations Committee _ _
7 Cultural Arcs Neighborhood Dis_trid Overlay (CANDO) ^ Production Indust Council __
' rl Public Safety Advisory Committee
D Debarment Committee
_ _
D Design Review Board` I' Safe Committee _ _
_ C Single Family Residential Review Panel I
L Disability Access Committee
__
f Fine Arts Board
_ _- i Sustainability Committee
- -
__
C GC G B ess Development Ad Hoc
_.. ^ Trans arenc Reliabdi 8 Accountability Committee "TRAC'
_.
Golf Advisory Committee U Transportation and Parking Committee _ ,
_
I LI rleGlu~nuymu~y t.unnnnlcc _ _ u.~anv,r.~~.. ....~~.... ~.~..~~...... ... ~,Y
~C-Health Facilities Authority Board _ ~ Youth Center Advisory Board _ _
L Hispanic Affairs Committee _ _ _ __
'Board Required to Fite State Dlselosure form ~~
F..\CLtR'\$A.L\oFORMS\30AR~~ ANJ COMMIT?EES\9.'. Apolicahcn 21 I J9.da;