Eliane Soffer Board Application~;
- BO>L,P~~ ,4tJu CCfVI[ti/!iT T ~E ~;PPLIC~;TIOh =CR1~
NAME : ~,~- ~ .~-~-~J` ~
Las? Name -ire+. Name IVuodie InrtEal
' ~~ c.3
Ap No. House Nc./Street City Q Stale Zip ~odE
PHON! :~ ® . O~ l O ~- ~~~~ ~ ~ +~ ~ ~ ~ ~ !`. ~.. (fit ~C B i ~~ ~W4_~- - C~
Home
Business Name' _
Address:
No.
Professional License (describe) _
City
State Zip Code
Expires ~ Attach b copy of .fhe 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 fioliowing ways: a) an individual shall have been a resioent 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: YesNo ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No 0
® Are you a registered voter in Miami Beach: Yes ^ or No D
. (Please circle one): I am now a resident of: North Beach South Beac Middle Bsach
. I am applying for an appointment because I have special abilities, knowledge and experience. Please list below,
® Are you presentl}~ a registered lobbyist with the City of Miami Beach? Yes ^ or No
Please fist your preferences in order of ranking [1j first choice [2j second choice, and (3j third choice. Please note that only three C3)
choices ~-HI tie observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Housin Adviso Committee D Housin Autho '
D Art in Public Places Committee D Loan Review Committee
0 Beauttficatian Committee D Marne Autho
D g~~ of p-d~ustrne~ D Miami Bsach Commission for 1Nomen
D Budget Adviso Committee D Miami Beach Culture( Arts Councll
0 C ftel lm rovements Pro~ects Oversight Committee 0 Nfiami Beach Sister Cifies Pry ram
Committee on the Nameless D Normandy Shores Local Government Nei h. imerovemertt
0 Committee for Quai' Education in MB D Parks and Recreation i=aciifties Board
0 Commun' Develocment Adviso D Personnel Beard
Commun' Retafions Board D Ptannin Board"'
^ Convention Center Advtso Board 0 Police Citizens Retations Committee
D Debarment Committee D Production industry Council
D Design Review Baardr` D Public Safe Advi o Committee
D Disability Access Committee D Safe Committee
D Fine Arts Berard D Sin ie Famit Residential Review Panel
D Ga ,Lesbian, Bisexual and TransQender GLBT ^ Sustainabil' Committee
^ Goff Adviso Committee D Trans area Reiiabil' 8~ Accauntabiitty Committee "TRAC"
0 Health Adviso Committee D Trans ortation and Parkin Committee
D Health i=aciltties Autho ' Board D Visitor and Convention Autho
His anic Affairs Committee ^ Waterfront Protection Committee
D Historic Preservation Board D Youth Center Advisory Berard
"Board Required to File State Disclosure Form
2
Mote: If applying for Youth Advisor~~ Board, please indicate your affiliation with the Scott P~akow Youth Center:
'~ Past service on the Youth Center Advtsory Beard: Yes = No~ Years or Service:
Z Present participation in Youth Center activities by your children Yes_ No L, if yes, please
ages. and which programs List beto~~.
~hi1d`s name: Age: Program:
j Chitd'~ name Aa= Program:
,: L.P .~AL'_ ~a=~Rr1~,5~6~.ARG tiN~- ~~MMiri'~=~\B~ H,~nii~ai~onU62609 N~N .oo,
V
Email address
Work
Street
Fax
Position:
li l the names o` your children, their
~'-ia'Je yp~~ av~' J~a,- ~~' ~%I~i°~ .., c T°i:~'1' ~' oc ~. ~V.i I V°;, al@?5~. °X~iali ~'
it ~ gal:
~ :J. you ~Urr?'ltl~- ~BV~ c Vlo~atlorl;5 C~ ~I?\% O- C~iami ~~aC` ;OdeC YgS .. C NO ~' Vc~c o Q- i
~I,aSc Y,piair I. :2.,~a1,.
• JG VOU currently CWe t'lo ~;liv O' I1~liam; 3°aCi''~ any' rnaney Yes 0"`..=.~" ~` v°S eXOiatr Ir~ aetall
~ .y r° VoU currentiv s]r~~Ir1C C~ ~n\' ~ Its' 3C8r~E C"~lr"litt~°S Yes C NO ~' ;r6S VN'"1lSi 708rG~'
• Wriat or~,anization5 ir'. ,nom '..I?1 ~~ iJiiami ~°a^i"' ~C ;JJL CUrr°"iiiV r>CI~ ^"I~'rt'iC)°rSnl~; Ir:
Name: ~ ftiG
Name: ~ itie
• List all properties owned or have an interest in, which are located within the City of ,Viami Beach:
• i am notir erTZpfoyec by the amity o' f~iiam~ Beach: Yes ~~ or Nou. Which deoartment~
: Furstlant.to C[ty Code Section 2-Z5 (bj: Do you have 2 parent D, spouse _, child ~; brother ~, or sister D who is employsc a~~ t~~.
:. it}~ of Niiami 3~act-~ % Check al that apply. Identify the department(s):
The folkowing intorrr~atton is voiuntan~ and es neither part of your application nor has any bearing on your considerattan for appointment
being asked to comply with federal equal opportuntty reporting requirements..
Gender: D hhale ~ Female
Ethnic Origin: Cheri: one only ;1}
D White (Nat of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Mtctdle Gast.
D afri.:an-American/Stack (Not of Hispanic Originj: AIf persons having origins in any a` the Blaci; racial groups of Africa.
Hispanic: all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race
J t~stan or Pacfftc istantier: All persons having origins in any of the original peoples of the =ar mast, South+rast Asie, the Indian Subcontinent. or
~ the Patftc lstartcls. This area includes, far example, ChirtE, India, .iapan, Korea, the Philippine Islands and Samoa.
D American i~clten or ,4taskan Native: All persons having origins in arn~ of the original peoples of North Arneri.:a, and who maintain
~ Guttural irlet*tttfCCafion through tribal affi{fiaflan or commtmlty recognition.
~.
~hysicatby Chaliengect: Yes ^ or o~
Employment Status =mployed D Retired ^ Homemakers ether D
N6TE: ff appoettted, ycu wilt be reQubt+sd to fotiow certain iavrrs which apply to ctt:y baardicommtttise members.
These havers bnciude, beat are not titratted tn, the following:
c Prohibition from directly or indire:;fly lobbying cit}~ personnel (ftliiami Beach City Code section 2-49)
Prohibition from contracting with the city (Niiam+-Dade County Oode section 2-'I '~ .1).
Prohibition from lobbying before beard/commtttee you have served on fob period or one year after leaving office lNlcam
Beach City Code section 2-z6}.
Requirement to disclose certain financial interests aria gifts ({vi~am+-Dade County Lobe section 2-~ i .1 ).
(re: CMB Community Devetoprnent Advisory Committee): prohibition, during tenure and for one year after leaving offl~~
from having any interest in or receiving any benefit from Community Development BIoc4< Grant funds for either voursef
or thQSe with whom you have business or immediate family ties (CcP 570.61'') "
Upon request, copies of these laws may be obtained from the City Cierl;.
"'. her 1' a f to c % and truthfulness of the application and have received, read and wi{( abide b}~ Crartte~
to V{{ City C d 'Sf;.ant4ards of Gonciuct for Git}~ Officers, =mptoyees and Agency Memb rs."
~`
Apolic nt`s SYgr~e mate Name of HoDl~can~ (~'~~G,S~ ~~ i
pr se attar; 2 cop, o" vottr resume tr, this appltcat~on
~ NO7E: Applccatiortr will remain file for a Deriod ~' DnP ! i ; ~at,endar vea-
Recewec it the ~ t~, ~ieri~<. ~ffto< o~,; ~ - : ~ ~~ mate ~ ~ ;'20 tJ :,ontro~ No ~` 3~j .irate X200;
Name o` ~enuty ~-ert: _ -