Nathaniel Korn 12/31/2010m N;IAIV~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
Nathaniel Korn
7171 Ba y Drive Unit 6
Miami Beach, Florida 33141
~~~ t~ Fine Arts Board
Congratulations! You have been reappointed by Commissioner Jonah. M. Wolfson
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
Gary Farmer
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 aft who live, work and play in our vibrant, tropical, historic community.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
TO Nathaniel Korn
RE: Fine Arts 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 ~cers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with th inancial disclosure* require-
ments of Miami-Dade County or the State of Florida (depen ing the and or committee on which
1 serve) on July 1st, following the closing of the calendar y~r o hi I ave served.
Sworn to and subscribed before me this
lathaniel Korn
_ day of , 20~
Silvia Prieto
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 safety to alt who live, work and play in our vibrant, tropical, historic community.
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NAME: ~ ~l v I V ~~'{ H l~ ~ ~ ~-- `~
Last Name ~y, ^ ~l First Name MidCdle Initial (~
HOME ADDRESS: ~~' ~ ~ ~ ~/~''I 1, 2 II N f~ (lJ IyI ~~M ~ ~Ef~"F~ i C- ~~ ~ I I
No. Street City State Zip Code
PHONE: 2~`'1 ' ~~ ( I CP (~ l0/ATI= fGv/1!~/ ~ /~MA(L-.Cc~
Home Work Fax Email address
Business Name:
Address:
No.
Professional License (describe) _
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 ownershipfinterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (ti) months: Ye~J 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 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 ^ Health Facilities Authori Board
^ Art in Public Places Committee ^ His anic Affairs Committee
each Preservation Board ^ Historic Preservation Board*
^ Beautification Committee ^Housin Authorit
^ Board of Ad'ustment* ^ Loan Review Committee"
^ Bud et Adviso Committee ^ Marine Authori
^ Ca ital Im rovements Oversi ht ^ Miami Beach Commission for Women
^ Committee on Homeless Miami Beach Cultural Arts Council ?i
^ Committee for Quali Education in MB ^ Miami Beach Florida Sister Cities
^ Communit Develo ment Adviso ^ Normand Shores Local Gov't Nei h. Im rovement
^ Communit Relations Board ^ Parks and Recreation Facilities Board
^ Convention Center Adviso Board ^ Personnel Board*
^ Cultural Arts Nei hborhood District Overla CANDO ^ Plannin Board
^ Debarment Committee ^ Police Citizens Relations Committee
^ Desi n Review Board* ^ Production Indust Council
^ Disabili Access Committee ^ Public Safe Adviso Committee
Fine Arts Board ^ Safe Committee
^ Ga Business Develo ment Ad Hoc ^ Sin le Famil Residential Review Panel
^ Golf Adviso Committee ^ Trans arenc Reliabili & Accountabili Committee °TRAC"
^ Green Ad Hoc Committee ^ Trans ortation and Parkin Committee
^ Health Adviso Committee ^ Visitor and Convention Authori
^ Youth Center Adviso Board
* Board Required to File State Disclosure form
,..1 F~~
Street
City State Zip Lode
_ Expires:
Position:
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Nate: 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 No~ If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or Nq~l. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No~ 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: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
( ~i4 ~ Q . V N ~'C' Co
• 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 required" but desired: Age: 2~ years old Gender: Male Female ^
Ethnic Origin (Check one)
Whit~African-American/Black ^ Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Articl VII - e Ci ode "Standards of Conduct for City Officers, Employees and Agency Members."
Applicant's Signature Date Name of Applicant (PLEASE
PRINT)
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 ^ Home-maker ^ Other ^
Received in City Clerk's Office by /'GG~e
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) ~ Entered B ate ~ ~ ~
Rev sed 09/02/08 LH
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