Henry Lares 12/31/2011m !ViI~MIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (3051 673-7411, Fax: (305) 673-7254
01 /26/2010
Henry Lares
1200 West Ave. # 817
Miami Beach, Florida 33139
Historic Preservation Board
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12/3112011.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely;
.~/ ~
ob~rcher
City Clerk
cc: Saul Frances, Parking Director
Thomas Mooney
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
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 and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to providing excellent public service and safety to all who live, work and play in ovr vibrant, tropical, historic community.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (305i 673-741 1, Fax: (305) 673-7254
January 26, 2010
TO: Henry Lares
RE: Historic Preservation Board
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the
Government of the United States, the State of Florida, and the City of Miami Beach,
and to perform all the duties of a member of the above-mentioned board or committee
of the City of Miami Beach to which I have been appointed for a term ending
12/31 /2011.
I have been issued. a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict
of Interest and Code of Ethics Ordinance), as well as Florida Commission on Ethics
Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees, and understand that as a member of a Cit of Miami Beach Board and/or
Committee, I must comply with the financial disc) re* quirements of Miami-Dade
County or the State of Florida (depending on he boar or committee on which I
serve) on July 1st, following the closing of the c lendar year on~grhich I have served.
Henry Lares
Sworn to and subscribed before me this ~ S~ day of U ~ , 2010.
~g.~r,
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
~~~ { ~y,~`! ~ ~ ~ ~~~ ~ CETY OF MIAM{ BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: ~' ~"~'~ C~'..1, tZ
Last Nam% II I, ~ First Name ~ ~ fiddle Initi~~
HOME ADDRESS: ~ t ~ ~ ~~ '~-~`'~~ --
Apt No. _ _ House No./Street City S to Zip Code
PHONE: ~~~~ ~7 ~Z ~ ~ Z- ~
Home _„ Work
Business Name:
Address:
No.
Fax Email address
Position: ~f y
~~ ~
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.
• 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: Ye or No 0
• (Please circle one): I am now a resident of: orth Beach S uth Bea Middle Beach
• I am applying for an appointment because 1 have special abilities, kno a experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No
Please list your preferences in order of ranking [1j first choice [2] second choice, and [3j third choice. Please note that only three l3)
choices will be observed by the Cltv Clerk's OfFce. (Regular Boards of City)
^ Affordable Housin Adviso Committee D Housin Autho '
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Authori
D Board of Ad'ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro'ects Oversi ht Committee D Miami Beach Sister Cities Pro ram
^ Committee on the Homeless ^ Normand Shores Local Government Nei h. im rovement
^ Committee for Qual' Education in MB 0 Parks and Recreation Facilities Board
D Communi Develo ment Adviso ^ Personnel Board
D Commun' Relations Board D Plannin Board*
^ Convention Center Adviso Board ^ Polite Citizens Relations Committee
^ Debarment Committee ^ Production Indust Council
D Desi n Review Board* ^ Public Safe Adviso Committee
^ Disabilit Access Committee D Safe Committee
^ Fine Arts Board D Sin le Famil Residential Review Panel
D Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabili Committee
^ Golf Adviso Committee D Trans aren Reliabil' & Accountabil• Committee "TRAC"
^ Health Adviso Committee D Trans ortation and Parkin Committee
^ Health Facilities Autho ' Board ^ Visitor and Convention Authori
^ His anic Affairs Committee D Waterfront Protection Committee
Historic Preservation Board ^ Youth Center Adviso Board
*Board Required to Flle State Disclosure Form
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 ^ No ^ Years of 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:
Child's name: Age: Program:
Child's name: Age: Program:
F:\CLEP.\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
.Have you ever been convicted of a felony: Yes =! or No~ yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~ or No ~f yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No~i,. ff yes, explain in detail
. Are you currently serving on any City Boards or Committees: Ye~ or No ~. If yes; which board?
• What organiz tons inttu< City of Miami Beach do you currently hold membership in?
Name: ,~~ L~ Title:
Name:
Title:
S
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
/`. ~~ f•-f~ ~ i I lti-i 1. V ~
• I am now employed by the City of Miami Beach: Yes ^ or 1 o Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): f~i]
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender:
d Female
Ethnic Origin: Check one only (1)
^ White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ African-AmericanBlack (Not of Hispanic Origin): All persons having origins in any of the Bladc radal groups of Africa.
f~-kiispanic: Alt persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
0 Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pacific Islands. This area indudes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
^ American Indian or Alaskan Native: All persons having origins In any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challentaed: Yes ^ or Nm(~:
Employment Status:
Retired 0 Homemaker p Other ^
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 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 Code 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 have business or immediate family ties (CFR 570.611).
Upon request, copies of these laws may be obtained from the City Clerk.
ythe accurac and truthfulness of the application and have received, read and will abide by Chapter 2,
City Code " ndards of Conduct for Cjty Officers, Empi es and Agency Me~bers."
s Signature
Name
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
-~-.~_ _ r
Received in the City Clerk's Office by : -~~) ~~`~~ Date:o~~ Control No. Date: _/ !~9
Name of Deputy Clerk
I®~
Please Print or Type
Name:
Mailing Address;
City/State/ZiR;
Discfasure
For Tax llgar
Ending;
Social Security Number; ---~-G>,-~' l ~--~~~ ~ ~ ~-'
Filing as a; ~ Courtty Empiayee;
® Municipal Empiv(y~ee afi:
pQSition~ held or sought; ~~`--~ ~(~ ~ -~- ~~ ~ ~-
Sward where serving; ~'~""'~~ Term or Employment
Began on : 2 ~ G,
Daparl~ment where emplvyedt
Work Acitiress;
if your boene address es exempt tram public records pursuant to
Florida 51atul:es § 1iB.Q7 please Check here (read ireslruCtions~:
Home Address; ~~c~
~~
Work Telephone;
~~ ~~ I `~
treat Atitlress
City State Zip Cade
Please list below im cies~nding order with the Largest source first, the name, address and
principal business acEivity of e?very source crf your income including public salary you
received or any parson received far pour benefit or use eluting the disclQSUre period. The
income of your spouse or arty business partner Head Hat be disc~arsed. If continued on a
separate sheet, check here; ~
Description oaf the
-sarne of Source of Income
Kar by ewe r (or ffirm) that the aforesaid infvrrnation 'ts z true arad correct statement.
'~ z.~z s ; ~~ i v
5igna ure of person c3isciosi g Date sigfisd
SOURCE OF INCOME STATEMEhIT