Paul J. Venette? , I, '• T, rh l~' ~ r C'TS' ~= MiAMI BEECH
. ~ i.., ,- ,' 3cAC
a ~ B;.r~ARG AND CCMMiTTcE {~?P1CC,TICN =CRM
~~II~C jCa
NAME• `~~ rJ.tlcle Inma
.ast Name 1 ~ Fiat rJame ~
HOMEA~DRESS:
Hp: No -louse NcJStreet ~„ih ~ Slate Z;p Cooe
3vl S~ 37~y ~~(.,. ,ry,F.-.. Ey ~~.,,,~_
PHONE: home.~/ Vvorr =ax Email acoress
/o~ 4~,, ~~i ^r. }o</ ~osilior, l/if ._ f1 n ///r
~usmess Name:
?rofessional tense ltlesciae: _ Expires' Artact a copy o1 me !!sense
Pursuant to City Code section 2.22(4j a and b: Msmbers of agencies, beards, and committees shall be affiliatec with the dty this
reoutremen•. shall oe fulfilred in the followinc ways a; an individual shat, nave been a resident of the :dtr for a minimum of six
months o- bl an indiwaual s^al demonstrate ownersniptintares?for zminimum of siz months it a ousmess es:abfisned it the dt}•.
• Resident o` fvtiam'. Beat for z minimum o` siz {6j months Yes,P or No U
• Demonstrate ar ownership/interest in a business in Miami Beacr for a minimum of six (o"j months: Yes ~ or No G
• Are you a registered voter ir. Miam. Beach. Yea ,C or No . _ _ ---
• (Please cif one) : am now z resieen: of: North Beach Sottth Beach Middle Beaeb-~
• am applying for an appomtmerr. because 1 have special abilities, knowledge and experience. PfBESZ' b's:`belFgw,H
~4iR"~~u•rt /`
.Are you presently a registered ioobyist with the City d Miami Beach? Yes 7 or No ~ / ~, /~ ~ 4~q ~ r^ ai
Piease list your praferences in Diner o? ranking 11) first choice (T second choice and (3:~ btird choice. Please note that only three f3
_w..o..... ...ru ~ nhsnrvari by the. Citv Clerk'a Otfice. (Repurar Boards of City!
Note. I~ applying ipr Youth Anvison,' 6oarc, olease indicate You- affiliauor wrtr the
~ Pas' sewice on the Youtt Center Advrson~ 6oarc. Yes . Nc . Years of Service
2 °rasen: oar6oioatior to Youth Center acovities br you- children Yes= Nc G tf yes, please list the names of your chiidrer then
apes and wmc^ programs. _ist oelow
Age Progam
Chhd`s name-
Child s name Atle ~ropran-:
=~CS'..3.^-.tt ~a=J"r,.".tS ~.kSCi4=r, ANC '_;uaM.lT?i:(:~~.8: y.PC~r:::eorbctC.pc rc~N.~.dc
.Nave yo,. sve~ risen xrvl^tec o! r ielp-y Yes r~ ,:' y"a wease exptatr rr, detail:
. Jc Vat cu•ranc:y~ have a •,'iotaUorl::5: of Cite; at fvSlami 6eac•~ codes: Yes _ o~---~' yes, p;gase zxptair• Ir~ ~e-ai~.
. JO yot' CUrren:'y OWe'he Ciiv Oi ll/riam' Bgacf anA' mone!r Yes o%NO (/fib if ,/gc, EXDlaln In d8iall
r Ore yov r:u--en~iy car/ino or anp ; ~-y 3oa•ds a- Cemr ICaes Yes _ ;~•JiNo r li ,.,_<, s:hir.~~ : oard^ --
• 1Nhat o+aa-rzatians ;r :he Gih a- Liam 9eacr oc you curren5} Wald •neraersnlp ~n^
Name
T tie
Name
- -ills:
• _ist all prpperties owned or have an :nteres'. in whfcr arz Iacated.wRnir [ e "in+ or Nliami beach
ar haw smaioyed by fie G.h of fJiam beach: Yes " o No Which aepartmert?
• ?ursuant to City Code Sectior 2.25 fb~: D:: you have a pars^t "!. spore ~. child ". brother;-., or siste•. whc rs employee pv Lie
City p! Ni,aml eeach'~ Cneof: al! that apply :oentffy the depermzntis), /,r~ -
The follovgng Information is voluntary anc is rghher part of your applieatlon nor Wes arty bearing on your wnsltleration for eppoimmen:. I: !s
Doing asked w comply wlih fudorai epuai opportunity mporting requiremertrs.
vender: E/ate J Femals
~ Wnhe rfaot o; 41$panic Jfigln; ql perypn5 haVing pr131nS Ir anc o` the cngmal peoples pf Euroce, Norte: Ahice of the Mitldle Gael
.~. Afrinan•American/6Mc1: fNO( or Hicoamc Or[ginl. 411 persons having onpms c~ any o'the atavk rac;ai groups o' Africa.
!Hispanic: Alt pen:ons of tolexicer., Fuertn Ricsn Copan Cenasl tr $ntdr gmarar, or o(her Spanish culturo or nngrn. regamless pf (ace
[I Asian or paeific Islantler~. AID. persons nawng origins in. any of the paginal gaggles o' the =a' 'cast. $outneast Aaie the Indian oubcontmeni. or-
;he ~adR;. Islanas 'his erez rrgludee, fc- ezarrole, Chma, mdW. vaoan Korea (he Phlappine stanns arrJ Samofl
Ameri~n Indian or Akskan Nstive~. q0 parsons havbtg onglns it any 01 the ortgma peoples of Norti: ?.mence. and who malrnaln
Culture' ioenlMicatipn through trtoal afgktnion o• oommunlty recopnitior:
Employment Status: Employed rietirod J ^iomemaKer ~~
NOTE. If appointed: you will be required To follow curtain laws which apply to city board/eommfttae members.
These laws include: but are not limited to, the following:
c prchibitipr from dlre~+y or indirectly lobbyinc cin~ personne~ (Miami Brach ::ity Cooe sectior 2-45yj.
cronibihor from contracting with the city (Miami-Dane County Code sectior i-s 1.1 } ~
i ~rpnibftipn iron lppbying before boardlopmmlliee yot have serveo or for psnod r one ysar after leaving ptfice fMiarnl
Beach Ctty Code sectior .-26:.
c Requfremerr. to dlscioas xrtarr 6narw^iai mteres>r anc gift. fMtami-L`adr. County Code sepbor. Z-11 1j
;w. GME Community Uevelopmem Advisory Commfies j. pronibNOS. donne tenure and for one year after leaving ofi:cs
from havmy app interes'. in or receiving any benefi- iron Community Development Block Grant funds for eifier yourself
pr those with whom you nays business or rmmediate family tees 'CFR 5'C.811'..
Upon request copies of these laws map be obtained from the City Clerk.
I
"t hereby attest to the accuracy and truthfulness of the application and have received, read and will abitle by Chapter "L I
A I{ - of(~~+the Clt}• Code "Stands o' Conduct for Cite Officers. cmpln s and A ncmoers "
~k(~II, Lf t~~,i' 11~3I(,>r
_- ~__ ~f.~f ~-,,. ~
Applicen: s $ignaturr. ~-__ _..~.._-. _. _.._
Uaie Nano n1 NVUlrant i~_cASF PRIN~i I
°lease apace a eppo a ymr resumn tot Is apphcaFOn
NOTE. pecatwns wlu mmern or file for a pnnor. of one '1 i Garnnpm year.
Rewlveo m m~ Chv aem: GhSV n,~ / mar= I I ,~ ~ c. :. rntr~i ka
_no_ Uarc Sao;
'ame n' GtltltnV :Jan: -' - - -