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Steven M. Oppenheimer
.. { ~ - @ ~i . . _i ~; .. NAME: ~/ ! ~/VyG~/ (~/'~ Las~t~N,aLme ~ l HOME ADDRESS: ~~'~' S /~' ~j4 No. PHONE: ~S•~3'Z•~g/~ 3DS Home Work S/ ~~G ~ nnnn~7f14~ ~O ~~'~• First Name t initial r• ~~~. Street City State Zip Code Fax Email address . QOM Business Name:~R~~2 ~ ~~~ `'~"~`"/~) J~Pd~SifionR / ~' `~~~ `~-~ ,add~~: BIAS ~t-Tiyd/L ~j4/,}~,e.~~ /1.P • .'y~3 FL- ~ / ~'>7 No. /~ /~ (~_ S/treJ~~t l~j]~ / \) City ~1 y~J State Zip Code Professianat License (describe) %~~// 7 ~ L ~^~y/Y!~/N~Y!!~/ Expires:« ~f~ ~~~ t ~ ., -. t~rrsuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement shad 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 ownershiptnterest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6} months: Yes Kor No u • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of soc (6) months: Yes E~ or No Lt • Are you a registered voter in Miami~Beach: Yes lYor N~ U o (Please check one): 1 am now a resident of: North Beach u South Beach u Middle Beach t~' o I am~pplying for an~pointment because I have special abilities, knowledge, experience. Please list below: °~'.'~ ~,7: /L~S~y~~' ~,"y /j/fi,~.&SS Qt-v^-E~ ~3~. fem. why la~l Please list your preferences in order of ranlbng [1) first choice [2) second choice, and [3] third choice. Please note that onN three f3) choices will be observed by the City Clerk's OTfice. (Regular. Boards of City) ^ Art in Public Places Committee ^ Beach Preservation Board t3~autnc~afivn Committee ^ Board of Adjustment' Q Budget Advisory Committee ^ Committee on Homeless i?Committee for Quality Education in MB ^ Community Development Advisory" ^ Community Relations Board a Convention Center Advisory Board ^ Debarment Committee r3 f3esign Review Board* ^ Disat~il-ty Access Committee ^ Fine Arms Board ^ Golf Advisory Committee. D Health Advisory Committee G t-Yeafth Facilities Authority Soard D Hispanic Affairs Committee D Historic Preservation Soard* '` Board Required to Fi{e State Disclosure form D Housing. Authority* ^ Loan Review Committee' ~ Marine Authonty" D Miami Beach :/utturai Arts Ca~xrt~ D Miami Beach Commission for Women ^ Miami Beach Florida Sister Cities D Normandy Shores Local Gov't Neigh. Improvement ^ Oversight Committee for General obligation Bond D Parks and Recreation Faa}ities Board D Personnel Board* Q Planning Baard* I~'olice Citizens Relations Committee~j D Production Industry Counrti D Public Safety Advisory Committee D Safety Committee C~fransportation and Parking Committee ~ 2 ~ Visitor and Convention Authority" D Youth Center Advisory turd f':1>.i '-~„.~.i~ 5 i~~')o- .i....tt3;}~iy....~ is.t:.,. .,.T;;.' ~'E .t. ~ .,, 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 u No U Years of Service: 2. Present participation in Youth Center activities by your children Yes~~ No ;, tf yes, please list the names of your children, their ages, and which programs. List below: Ghitd's name: P~qe:. ~ Program: Child's name: Age: Program: sHave you ever been convicted of a felony: Yes u or No I~If yes, please explain in detail: >a Do you currently have a violation(s) of City of Miami Beach codes: Yes a or tdo ~lf yes, please explain in detail: o Do you currently owe the City of Miami Beach any money: Yes ~ or t\to 1~++~1f yes, explain in detail ~ Are you currently serving on any City Boards or Committees: Yes U or No ~ if yes; which board? e What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: I~me:.. Tiffs: ~ fist all properties dwned Or have an interest in, whlGh are located withtri the City Of Miami Beach: ~~i~e! a 1 am now employed by the City of Miami Beach: Yes a or No:r/Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent u, spouse L1, child Li, brother u, or sister ~ who is employed by the City of Miami Beach? Check ail that apply. Identify the depariment(s}: ~~ This section is "not required" but desired: Age: years old Gender: Male ~ Female B Efhnic Origin (Check one) . White GAfrican-Rmericanl8tack Q Hispania Q Asian or Pacific tstander Q American Indian or Alaskan Native Q Employment Status: Employed t7 Retired ~ Home-maker Q Other ^ "I hereby attest to th>z accuracy and truthfulness of the applicatian and have received, read and will abide by Chapter 2, Article Vlt - of the City Code "Standarcls of Conduct for City Officers= Employees and Agency RRembers." ~~ 3d O r~~'v ©P~E,rv~idlF.2 SCI/, . ~ficartt's Signature ate Name of Applicant ~g SE PRINT} Please attach a copy of your resume to this apptication irtio'iE: Applications will remain on file for a period of one (1) calendar year. Received in City Clerk's Office by Date ' Name of Deputy Clerk Document Control Number (Assigned by the City Clark's Office) Entered By pate ' Revised 10292007 L. Halfiekt ~ ,„ American Association of Endodontists ® Specialist Members RICHARD MAUTNER~ D.D.S. STEVEN OPPENHEIMER~ D.M.D. Proclitae Limited to Endodontics 925 Arthur Godfrey Rd., Suite 207 2999 N.E. 191" St., Suite 602 Miami Beach, FL 33140 Aventura, FL 33180 Phone: (305) 531-0841 Phone: (305) 682-1795 Fax: (305) 531-2808 Fax: (305) 682-1706 STA,~ oFF~~::::. - : - A~ _ 3 3~ 11 DEPARTMEtJTAFst{EALTH -