Ruth Remington
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: Remington Ruth
Last Name First Name Middle Initial
HOME ADDRESS:1702 1000 South Pointe Drive Miami Beach FL 33139
No. Street City State Zip Code
PHONE: 305-695-1711 305-695-1711 877-683-9103 RemingtonMiami@gmail.com
Home Work Fax Email address
Business Name: - Position: freelance marketing writer
Address: 1702 1000 South Pointe Drive Miami Beach FL 33139
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; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city.
Yes
? Resident of Miami Beach for a minimum of six (6) months:
No
? Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months:
Yes
? Are you a registered voter in Miami Beach:
South Beach
? (Please circle one): I am now a resident of:
No
? Are you a politically or registered lobbyist with the City of Miami Beach:
? I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Activist, Served on various selection committees and GO Bond, Neighborhood Leadership Academy,
Citizens Police Academy, Condo Board.
123Please note that only three (3)
Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice.
choices will be observed by the City Clerk’s Office.
(Regular Boards of City)
Affordable Housing Advisory Committee Historic Preservation Board*
Art in Public Places CommitteeHousing Authority*
Beach Preservation BoardLoan Review Committee*
Beautification Committee Marine Authority*
[2]
Board of Adjustment*Miami Beach Commission for Women
Budget Advisory CommitteeMiami Beach Cultural Arts Council
Capital Improvements OversightMiami Beach Florida Sister Cities
Committee on Homeless Normandy Shores Local Gov’t Neigh. Improvement
Committee for Quality Education in MBParks and Recreation Facilities Board
Community Development Advisory* Personnel Board*
[1]
Community Relations Board Planning Board
Convention Center Advisory BoardPolice Citizens Relations Committee
Cultural Arts Neighborhood District Overlay (CANDO) Production Industry Council
Debarment CommitteePublic Safety Advisory Committee
Design Review Board*Safety Committee
Disability Access Committee Single Family Residential Review Panel
Fine Arts Board Sustainability Committee
Gay Business Development Ad HocTransparency Reliability & Accountability Committee “TRAC”
Golf Advisory Committee Transportation and Parking Committee
Health Advisory CommitteeVisitor and Convention Authority*
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee
*
Board Required to File State Disclosure form
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Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
No
1. Past service on the Youth Center Advisory Board: Years of Service:
No
2. Present participation in Youth Center activities by your children? . 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:
No
?Have you ever been convicted of a felony: If yes, please explain in detail:
No
? Do you currently have a violation(s) of City of Miami Beach codes: If yes, please explain in detail:
No
? Do you currently owe the City of Miami Beach any money:If yes, explain in detail
? Are you currently serving on any City Boards or Committees: If yes; which board?
? What organizations in the City of Miami Beach do you currently hold membership in?
South of Fifth Neighborhood Assoc. (SOFNA) member
Name: Title:
Neighborhood Leadership Academy Alumni member
Name: Title:
? List all properties owned or have an interest in, which are located within the City of Miami Beach:
primary residence: 1000 South Pointe Drive, #1702
No
? I am now employed by the City of Miami Beach: Which department?
?
Pursuant to City Code Section 2-25 (b):
Do you have a who is employed by the City of Miami Beach? Check all that apply.
Identify the department(s):
Gender: Female Race: White
No
Ethnic Origin (Check one) Physically Challenged:
White
"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."
The City Clerk's Office reserves the right to contact you for verification purposes.
I Ruth Remington agreed to the following terms on 3/30/2009 10:24:09 AM
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: Other Other:
Self-employed
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
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