Francis Trullenque 12/31/2011. ..
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'` Clt)/ Of MIQIIII BEQC~I~ 1700 Convention Center Drive, Miami Beach, Florida 33 T39, www.miamibeachfl,~gov
OFFICE OF THE CITY.CIERK, Robert Parcher, City Cleck
'--.'TeL• (305,673-741 1, Fax:_{305)' 673=7254. ',
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4/20/201'0 ~ ., ;. ~ ... '-
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Francis Trullenque
" : -5620 Alton Rd ~ ~ .. :.
" ~Miarrli Beac"Ii, Florida 33140,
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` ` ; a ~SIDBJECT: Hispanic Affailrs Committee
.Congratulations! You'have been reappointed by Commissioner Ed'Tobin
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' to the above referenced~.agency; board or committee for a term ending:. ~ .12/31%2011.
If .you are unable to accept this appointment, .please nofify the. City Clerk's .Office at • " ~.,
.(305) 673=7411. _ -
~~ ~~ Please read the enclosed material carefully: Again,'congratulations and' good luck.
~Siricerely;.
' ..; .
Robert ~Parcher ~ "
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'City Clerk
:" ~ . cc: Saul`Frances, Parking Director ~ ~ ,. ~ ~ "
"Nannette Rodriguez ,. ~.
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' . .ATTACHMENTS: ., ; .
. - ~ Letter of Appointment ' .-
Oath .. - - ° ~ .
' 'City Code,Ordinance section, applicable to agency, board or committee
`,: ~ `., -City Code.Section 2 22-, 2-23,.224, 2-25,`2-26, 2-2458, 2-459. `
.r
` ` ...,. 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 Ettiics for Public~Officers and ~ {
. -Employees ~ ~ j
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e ~ . ~
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- , `^We are co"mmitted to providing excellent public service and safety to,all who live, work and playin our vibrant, Tropical, historic community.
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m MIAMI~~A.CF~
City of Miami Beach, 1700 Convention Center Drive, Miami'$each, Florida 33T39, w~n~:miamibeachfl.gov
OFFICE OF THE CITY .CLERK, .Robert Parcher, City Clerk
Tel:. (305 673-74.1 l; Fax::(305~ 673-7254
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TO Francis Trullenque
'RE: Hispanic Affairs Committee
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 theF/orida 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 City of Miami Beach Board: and/or Committee, I must comply with the financial disclosure* require-
ments of Miami-Dade County or the State of Florida (depending oh the board or committee on which
I serve) on July 1st, following the closing of the calendar year on which I have rued: __~..-----
'"""" Francis Trullenque
,!
Sworn to and subscribed before me this ~ day of ~' 2010..
e!~-(~J v
.Silvia Prieto
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.
®l~, ~~ ~s ~~E xaE'P~1~~T~~3~ F~E~M
` . NAME: '`~'>/~lir`r~~jP/CtJ~-'~'" ~.ii'?~r.+~~ is `
° • .' ~ Last Name •"' First Name Middle initial
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HOME ADDRESS: ;5 ~ v2G'' . %~ J ` ~~ ~/~ ~% ~~~~{~
`. Apt ~ ".House No:/Street City State Zip, Code
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' ` ~ ' ome ` .~ Work ° _ Fax Email addr ss •
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Business Name:, •~`' y.~~c /~~~~~~. ~«cc~/positioh: _ - ~~L~s'.~c+'c-.,~ ~
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Address:' ~ ~ ~ `'-G :: ~>/~''/ ~~'"' r ~~~" .. ~ /- /' '' ~.~ % ~ U
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- ~ No: ~ ' Street ity State Zip Code .
,.Professional License (describe) ~ ;- Expires` ' 6ltfach a ropy 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:demoristrate 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:'Yes- ^ or No ^ ~ -
• (Please circle one): i am now a resident of: ~ -North Beach South Beach Middle Beach ~-
• 1:am applying for an appointment because l have special abilities, knowledge and 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 j1] first choice [2] second choice, and [3] third choice. Please note-that only three (3}
..choices wilf:be observed by the City Clerk's Office. (Regular Boards of City)
~.Affordable Hoasin Adviso Committee ^ Housin Authorit
rt in (Public"Place`s Committee= ~ ~ / ~ ^-Loan Review Committee
.
^ Beautification Committee.. :. , _ , ` ^ Marine Authorit
^'Board of Ad'ustment" `,.~ ° . ^ Miami Beach Commissiori'for Women ~ ':,
^ Bud "efAdviso Committee ^ Miami Beach Cultural Arts Council.
:Ca ital Im rovementsPro'ects:Oversi ht Committee. ~ ^ Miami.Beach Sister Cities Pro ram .
^.Committee on.the Homeless ^'Normand :Shores Local Government Nei h. Im rovernent
^`Committee#or Quali Education in MB ~ Parks and Recreation Facilities Board
Communit Develo meet Adviso ^ Personnel Board..
Comrnunif Relations Board ~ Plannin 3oard• ~~
'^ Convehtiori Center Adviso -Board - ^ Police Citizens Relations Committee .
^ Debarment Cammittee ^ Production lridustr .Council
O'Desi n Review Board" ^ Fublic Safet Adviso Committee ,
Disabilit Access Committee. •D' Safet Committee .
~. Fine Arts Board 0 Sin le Famil Residential_Review Pane( ,
O Ga ,Lesbian, Bisexual and Trans ehder{GLBT ^ Sustaihabilit Committee-. '.
^.Golf"Adviso Committee .• _„ ~ ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Health Adviso Committee ~ ~ Trans ortatioh and .Parkin' Committee
^ Health Facilities Authorit :Board ' ^ Visitor and Convention Authorit '
>His anc Affairs Committee ~ ~ ~ Waterfront Protection Committee
^ Historic Preservation~Board ." ^ Youth Center Adviso Board- t
' ~ ~ *Board Required to File State Disclosure Form
Note: If applying for Youth Advisory Board, pleaseindicate 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 Mist the names of your children, their
rages, and' which programs. List below:
Child's name: - Age: Program: .
,.. ,
.Child's name:: ~ 'Age: Program:
F:\CIER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application0G2G09 NEW.dor - j`"
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.Have you ever been convicted of a felony: Yes ^ or`No ~1.df yes, please explain in detail:
• Do you currently have a. violation(s) of City of Miami Beach codes: Yes Ci or Noyes, please explain in detail:
. • Do you currently owe the City of Miami Beach any money: Yes ^ or No _ es, explain in detail
• Are you currently serving on a//ny City Boards or Committ e/s'/Y~s ~~ o ^. If yes; which board?
• What organizations. in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all, properties owned or have an
,which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ^ or N~ Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, b other ^, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): a , /~
'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: , ale ^ Female
~Eth~ni - rlgin:.Check one only (1)
EI'White (Not~of Hispanic Origin): All persons having origins in any of the originalpeoplesof Europe, North Africa or the Middle East.
^ African-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa. 1
~lispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
^ Asian or Pacific Islander: AIL persons having origins in any of the original peoples df the Far East, Southeast Asia, the indiah Subcontinent, on
the Pacific Islands. This area includes, for example, .China, India, Japan, Korea, the Philippine Islands and Somoa.
^Ameiican 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 Challenged: Yes ^ or N
Employment'Status: Employed ^ Retired ^ Homemaker ^ Other ^ '~<Sc ~,~ ~~~~r ~
NOTE: If appointed, you will be required to follow certain laws which.apply to city board/committee remembers.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code sectioh 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 Requirementto 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 maybe obtained from the City Clerk.
"I hereby attest~to'the accuracy and truthfulness of the application and' have received, read.and will abide by Chapter 2,
Article VII - of the Ci od ndards of Condu ~fjo~r~Ci Officers, Employees and Agency Members."
~.._......__ ot'~ ~j Der ,~C i' S' ~ - ~ ~,,c/~j cJ
Applicant sue' a`ture D e Name of Applicant (PLEASE PRINT)
Pleas :~ ttach~a~copyaofyourgresurrie to`~this'apphcafion
/ten` NOTE,~ApplcationSw~lisremam on file fora period of~one'(1)calendar..:year.
.._. ,.
.Received in the Cit Clerk's Office b ~ / ~/
y Y • ` Date: e_'. / .2010 Control No. 1 ~3 Date: _/ /2010
Name of Deputy Clerk- F:\CLER1$ALL\aFORMS160ARD AND COMMITTEESIBC Application.doc
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MI~•DADE '. SOURCE O '. ~ '
F INCOME STATEMENT
- ~ ,Please Print or Type first Name NNiddle.Name/Initial Last Name '
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Disclosure-
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„ .Name:.. . ~~-~u~.!~: S . ,,~ ,~-!s / /[',',~/ Ending
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- Filing as a':. ~'- ,County `Employee; -
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Position `held or sought: ' ` -
.: ' ` . . ='8oard where serving:. ~.~~ ~ ~ ~11J< ,C ,. c~. f' .Term or ;Employm nt ,
-~ ;Began one / ~ w
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'D,epartment where. employed:
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'Work Address:- . ~ . : . S~ ~ < '
- If your home address•is exempt from public reoords.pursuant to ?G~ ~; ~ ~~.
Florida Statutes § 119.07:pleasCCe check here (read instruction/s)~: ~~ -WorkfTelephone: .J ,-~ / .
`Home Address:. • J`~~G ~ ~~7~-~~'~-~ ~~t .•
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' Street~Address _ ~•
•.; - ~ City ' State ., ...'Zip Code ' .
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'~ - Please Iist_below. indescending order°with .the largest source :first, the name, :address .and ~,
'principal business activity of every source of your income.-including ,public aalary~ you
- received or any :person °received for your benefit or use during `the disclosure period.. The -
income~-of yourspouse_or,any.business partner•need:not:be.disclosed. If :continued on a •
. .-separate sheet,:check here:. ®%'~
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°. ri tion of the`Pr +
`Desc p mcipal
;Name o urce:.of Income ,'Atldress <Business.Activ~
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I~hereb ~ swear or affirm
- Y ~ -) that-the aforesaid information is a-true;and correctatatement.
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- ' Signatur on disclosing.. - _ Date signed
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