Ray Breslin 12/31/2011m MIAMIBEACH
City of Miami Beach, 1700 Convenfion Center Drive,"Miami'Be
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: i305i 673-7411, Fax: (305) 673-7254
1 /12/2010
Ray Breslin
2395 Lake Pancoast Dr. #4
Miami Beach, Florida 33140
Florida.33a`39, bcww.miamibeachfl.aov
Miami Beach Sister Cities Program
Congratulations! You have been reappointed by Mayo Matti Herrera Bower
to the above referenced agency, board or committee for a term ending: 12/31/2011.
If you are unable to accept this appointment, please noti the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again,
Sincerely,
~~ ~~.e.~/s~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Michael Aller
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or cc
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 ;
City Wide Permit Application - (Parking Department Form)
Booklet --Guide to the Sunshine Amendment and Code of.Ethi~
Employees
ratulations and good luck.
nmittee
Code of Ethics Ordinance
for Public Officers and
We are committed to providing excellent public service and safely to all who live work and play in our vibrant, tropical, hisroric community.
m MIAMIBEACH
..
.City`.of Miami_ Beach,.(7oo Cgnvenfion Center Drive,,lVliamiBed Florida.'33'139 wivw:miamibeachfl:aov
i
OFFICE OF THE CITY CLERK, Robert Parches, Ciy Clerk ~ ,: _. - :. ., , - _ - :__ ~. ,_ _ ,
Tel: (305) 673-2411; Fox:;(305~ 673-7254 ~ '::_' ~ ~:' <.
TO Ray Breslin
RE: Miami Beach Sister Cities Program
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the
United States, the State of Florida, and the City of Miami Beach, and to pert
a member of the above-mentioned board or committee of the City of Miami
been appointed for a term ending: 12/31/2011.
emment of the
all the duties of
;h to which I hay
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Cot
and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics
Amendment and Code of Ethics for Public Of>rcers and Emp/ogees, and u nde
of a City of Miami Beach Board and/or Committee, I must comply with the fi
ments of Miami-Dade County or the State of Florida (depending on the boa
I serve) on July 1st, following the closing of the calendar year~hich I ha
" // Ray E
Sworn to and subscribed before me th~ ~ day
Si
*Please visit the City of Miami Beach website at www.miamibeadtfl.gov under
for additional information regarding the Financial Disclosure Requirements.
(Conflict of In
side to the Su
end that as a
ncial disclosure* require-
orcommittee on which
a~ I ~ 200 ~ 0
Prieto
Clerk
erk/Board and Committees
i
We are commiHed to providing excellent public service and safely to all who live, (work and ploy in our vibront, tropical, historic community.
m PJIA,MBEACH
NAME:
IV
Last Name
HOME ADDRESS: ~,~~ L1'f ~~)
No. rr --Street
PHONE: ~~ ~~ ~v ~~! lo~
Home Work
CITY OF MI1v.ME BEACH
tiRD ANQ COMMITTEE APPt_ICATION FORM
!,
N e Middle Initial
'City ~a Zip Code
S~ ~~' ~ I - ~~~~~
Fax Email address
Business Name:~~~-UJ~ cJ V~~1~ ~ 1 UV y"~~~'ositi n: ~''U~
Address: ~/`~
No. treet ity State Zip Code
Professional License (describe) Expires: Attach a cop}~ of the license
Pursuant to City Code section 2-22(4) a and b: Members of agencies, oards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual sha I have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownershipfinterest for a mini um of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes~(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: ~~J ~
~" p m G r C T~ ' C
Please list your preferences in order of ranking [1] first choice [2] second c oice, and [3] third choice. Please note that only three (31
choices will be observed by the City Clerk's Office. (Regular Boards of ity)
^ Affordable Housin Adviso Committee ist ric Preservation Board*
^ Art in Public Places Committee Hou in Authori
^ Beach Preservation Board ^ Loa Review Committee*
eaut~cation Committee ^ Mari a Authori *
oard of Ad'ustment* ^Mia i Beach Commission for Women
^ Bud et Adviso Committee D Mia i Beach Cultural Arts Council
^ Ca ital Im rovements Oversi ht ^Mia i Beach Florida Sister Cities
^ Committee on Homeless ^ No and Shores Local Gov't Nei h. Im rovement
^ Committee for Qualit Education in MB ^ Pa sand Recreation Facilities Board
^ Communi Develo ment Adviso * ~~ Per onnel Board*
D Communi Relations Board ;~ Pla nin Board
^ Convention Center Adviso Board ^ Poli a Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overla (CANDO ^ Pro uction Indust Council
^ Debarment Committee ^ Pub is Safet Adviso Committee
^ Desi n Review Board* ^ Saf Committee
^ Disabili Access Committee ^ Sin le Famil Residential Review Panel
^ Fine Arts Board ^ Sus ainabili Committee
^ Ga Business Develo ment Ad Hoc ^ Tra s arenc Reliabilit ~ Accountabilit Committee "TRAC"
^ Golf Adviso Committee ra s ortation and Parkin Committee
^ Health Adviso Committee Visi or and Convention Authorit *
0 Health Facilities Authorit Board ^ You h Center Adviso Board
^ His anic Affairs Committee ~
* Boar Required to File' State Disclosure form
F :~CL;=k\SAL' 1Quaro £, '/'ommdteeslB&~ Apphrauon\5&C k,pglication P,evislec ' 13 B.QUc
Note: If applying for Youth Advisory Board, please indicate your afriliationlwith the Scott Rakow Youth Center:
1. Past"service on the Youth Center Advisory Board: Yes :_ No ._ Years o 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: I
Child's name: Age: Program: I
,,, -_. i
Child's name: Age: Program: ~,
.Have you ever been convicted of a felony: Yes ^ or Nom, If yes, ple~se explain in d,,etail
• Do you currently have a violation(s) of City of Miami Beach,'codes: Y s ^ or Not, Ifliyes; please explain in detail:
ership in?
AN~~4-
• Do you currently owe the City of Miami Beach any money: Yes ^ or I~o~ If yes, explain in detail
i
City of Miami Beach:
tment? -r
• Are you currently serving on any City Boards or Committees: Yes ~ o N If yes; which boar ?
~~ I ~ ... i
• What organizatjjio~~ns in the City of Miami Beach do you currently hold m mb
Name: ~,,,, ~ Iy A Title: ~
Name: CO~~`i`~ 1J ~DU~ ~ V~~ ~ G ~~ 'title:
• List all properties owned or have an in/`tereys~t~in,(\w`hich are located within the
. I am now employed by the City of Miami Beach: Yes'0 or Nc~Which
~, i
• Pursuant to City Code Section 2-25 (b): Do you have a parent ~, spouse ~, chi d C, brother ~, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ~) I
This section is "not required" but desired: Age: ~_ years old
Ethnic rigin (Check one)
White frican-American/Black ^ Hispanic: ^ Asian or Pacific Islander ^
"I hereby attest to the accuracy and truthfulness of the application and
Article VII the City Code "Standards of Conduct for City Officers, Em
Applica 's i ure ~ to
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.
Gender: Male Female ^
n Indian dr Alaskan Native ^
received, read and will abide by Chapter 2,
~s and Agency~Members."
N
Applicant (PL
Employment Status: Employed ^ Retired Home-maker ^ Other 0 I
Received in City Clerk's Office by u~ I Date ~
Name of Deputy CI k
Document Control Number (Assigned by the City Clerk's Office) ~ ~ Entered By J Date ~ ~ 3 6 ~
1. Revisetl 09/02/08 LH ~
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