Mitchell P. Korus,~
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NAME:
MI BEACH
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Last Name r
HOME ADDRESS: _ S ~ ~~ ~~` `~.tr
Apt No. Ho a Nvo./3t~~et
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Business Na
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Professional license (describe)
tirY~c1~ ~ Cupy oi' riot licerrsr
Pursuant to Clty Code section 2-22(4) a and b: Members of agencies, boards, ar( committees shall be affiliated with the city; this
requirement shall be fulfilled in tt~e following ways: a) an inriivid~ial shall have been a resident of the city for a minimum of six
months; orb) an individual shall demonstrate ownershipfinterestfor aminimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes~or No 0
• Demonsvate an ownersniplinterest fn a business to Miami Beach for a minimum of six (6) months: Yes~f or No U
• Are you a registered voter in Miami Beach: Yes ,~or No C1 ''~
. (Please circle one): I am now a resident of: // North Beach South Beach die Beagji~
0 1 am appryfng for an appointment because I have specral ab(uUes, knowledge and expen tielaw:
. Are you presently a registered lobbyist with the City of Miami Beach? Yes n or No~
Please list your preferences in order of ranking [1) first choice [2] second choice, and [3] third choice. Please note that only three f31
Ch4iG4s will be otnervcd by the City Clerk's Office (Regular Boards of City)
!-! Affordable Housin Adviso Committee 0 Housin Authori
Ll Art in Public Places Committee 0 Loan Review Committee
'~ Beautification Coininitltro u Marine Authori
0 Board of Ad'ustment' 0 Miami Beach Commission for Women
^ Bud et Adviso Committee 0 Miami Beach Cultural Arts Council
Ca ital Im rovements Pro'eds Oversi ht Committee ^ Miami Beach Sister Cities Pr ram -~
Committee on the Homeless
^ ommittee for Quali Education in MB Q (Normand Shores Local Government Nei h. tm rovement
D Parks and Recreation Facilities Rnarri
^ Communi DeVelo ment Adviso D Personnel Board
0 Communi Relations Board ^ Plannin Board'
fl Convention Center Adviso Board t7 Police Citizene Relations Committee
^ Debarment Committee ^ Production Indust Couneit
^ Desi n Review Board' ^ Public Safe Advise Committee
^ piaabilit Access Committee 0 Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
Ga ,Lesbian, Bisexual and Trans ender GLBT 0 Sustainabili Committee
Gorr Aavlso Committee
^ Mealth Advise Committee
^ Health Facilities Authority Board
^ Hls arnc Affairs Committee t7 Trans aren Reltabili & Accourrtabiti Committee "TRAC"
0 Trans ortation and Parkin Committee
^ Vsitor and Convention Autho '
D Waterfront Protection Committee
0 Historic Preservation Board D Youth Center Adviso Board
'Board Re ulred to File State Disclosure Form
N~fr.• ff af,plying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Confer.
1 Pa~f RRrvice on the Youth Center P.dvisory Board: Yse 0 N oars of SCn+iCe:
2. Present participation in Youth Center activities by your ildren Yest7 No n. If yes, please list the names of your children, their
ages, and which programs. tJSt below.
Child's name; Age: Program:
Child's name; Age; Program:
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Street
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Name - Middle Initial l~
~Ytit i - "Iv
~ ity Slate Zip Cede
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• Have you ever been convicted of a felony: Ytaa 0 or No~f yes, please explain rll ilGtdil,
• Do you curl~ntly Itavc a violdtion(5) of City of Miami Beach Codes: 7e8 U Or No~l'f yes, please explain in detail:
• oo you currently owe the Ciry of Miami Beach any money: Yes !7 or Nq~lf yes, explain in detail
o Are you current) serving on any City Boards or Committees: Ye~r No C-1. If yss; which board?
• What organizations in the
Name: 0 t:
Name;
• list all arooerties o n~St
. I am now employed by
an i
i Beach do you currently hold membership in?
are located vy~ithin the City of
City of Miami Beach: Yas u or
• Pursuant to CIty Code Section 2-25 (bj: Oo you have a parent o, spouse U, child U, brother 0, or sister t7 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ~,r,.~
Tho following Informatlon la voluntary end Is nelthor paR of your appllcatlon nor ha-many bearing on your consldoratlon for appointment It IS
boing aukod to comply with federal oqual eppnrtunlty reporttn8 requlromant..
Gunder: ,~S.i)Aale ^ Female
O
one only (1)
L~f-White (Not of Hispanic Origin); All pennons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ Atricon-Ar++oricaNDlack (Nut Of Hispanic Origitr): Atl per90nS haVIR9 OnglnS In any Or thB Black fdGel grOUpS Of Afica.
~ Hispanic: A11 persons of Mexican, Puerto Rican, Cuban, Central Or South American, or Other Spanish culture or origin, regardless of race,
~ Asian or PaCltic Islandor: All oer~ons having origins in any of the orlrJlnat peoples of rho Far Eaet, Southeast /via, the Indian Subcontinent, on
the PaGAc )elands. This aroa includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
American Indian or Alaskan Native: All persons having odgtns in any of the original peoples of North America, and wno maintain
Cultural Identif5cation through tribal affiliation or communriy rec,>pniuon.
ically Challenged: Yes ~ or
Employment Status: Employed -l Rctircd ^ I lomcmaker O OLFrer O
NOTE: If appointed, you will De r®quired to follow certain laws which apply to city board/commlttee members.
7hosA laves includes, but aro not Ilmltccf to, the fpllvvrirrg:
a Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from ConttaCtinQ with the d(y (Miami-Dade County Coda sACtion 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
o Requirement to disclose certain financial interests and gifts (Miami-Dade County Goda section 2 11,1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interesT in or receiving any benefit from Community Development Block Grant funds for either yourself ,
or those with whom you Flave business or immediate family ties (CI=t2 570.611).
Upon request, copies of these laws may be obtained from the City Clerk,
"I h b hest to the accuracy a~tfrfulness of the application and have r®ceived, read and will abide by Chapter 2,
Art) a of a City Cod n8 af~ lards of Conduct for City OfflCers, Employees and Ag .ncy Members."
Appl lgnaturo Date Name of Applicant (PLEASE PRIN7~
Nlearu- asgGh a co~-Y::taf..Ypu~..~-umo to, thls.appllcatlon
NotE~.~RAlls~!±~~ll ro~na ~..QLI.~IIQ tP.r.I~.RBil9rfl o(oneNls~tbrtdar~q~r.
Received in the City Clerk's Olfioe by
l Control No. _~3 °I Date: % /200 ~~
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12!23!2009 12:20 3055313311 VIRTUAL REALTY ~ PH!:E ~3a!~~a
~# 4 3 7 5 7 21 STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFF..GGIONAL REGULATION
DIVISION OF REAL ESTATE SEQ# L09040301443
. ~ - - - LICENSE NHR
4/03/2009 080325626 BR3001316
:ne tiKLJK„r:K
famed below I5 LICENSED
tnder the provisions of Chapter 475 FS.
expiration date: MAR 31, 207.7..
KORUS, MITCHELL P
5757 LA C~ORCE DR
M:~.AMI BEACH FL 33140
CH1I.RLIE CRI5T CIIARLE3 W . DRAGO
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY
~ -
~ • 605 Lincoln Road Suite 450 • Miami Beach Florida 33139 ~ Te130S-531-2888 Faz:3O5-531;331)
~~ Website: www.virtual-real -usa.tom
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FROM:
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SUBJECT:
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fax = ~ 30~" 6 3
MITCHELL P. KORUS BROKER
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PLEASE ADVISE IMMEDIATELY IF ALL
PAGES ARE NOT KECEIVED PROPERLY
VOICE NUMBER: {305) 531-288@
FAX NUMBER: (305) 53 i -33 I 1
VIRTUAL REALTY U.S.A.,inc.
Lincoln Road
M18mi Beech, Florida
33 1 39
USA
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THE fNFORMATION CONTAINED IN THfS FACSIMILE MAYBE PRIVILEGED AND CONFIDENTIAL.
fT IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY IVAI7f0 ABOVE. IF YUU
RECEIVED THIS COMMUNICATION /N ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE.