Corey Narson Board & Committee Application
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME:
Narson Corey
Last Name First Name Middle Initial
HOME ADDRESS:
7820
Noremac Avenue Miami Beach FL 33141
Apt No. House No./Street City State Zip Code
PHONE: 305 984 5360 305 672 2225 305 674 4449 ladybeachdoc@yahoo.com
Home Work Fax Email Address
Business Name: Miami Beach Family & Sports Chiro Position Chiropractor
:
Address: 400 Arthur Godfrey Road Miami Beach FL 33140
No. Street City State Zip Code
P rofessional License (describe) : Chiropractic Physician Attach a copy of the
Expires: 02/12/2012 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 o f six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business est ablished in the city.
● Resident of Miami Beach for a minimum of six (6) months: Yes
● Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes
● Are you a registered voter in Miami Beach: Yes
● (Please circle one): I am now a resident of: North Beach
● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
I moved here because of all that Miami Beach is and I want to make sure that it stays that way for my children and the
future.
● Are you presently a registered lobbyist with the City of Miami Beach? No
Please list your preferences in order of ranking [ 1 ] first choice [ 2 ] second choice, and [ 3 ] third choice. Please note that only three (3)
choices will be observed by the City Clerk’s Office.
(Regular Boards of City)
Affordable Housing Advisory Committee Housing Authority
Art in Public Places Committee Loan Review Committee
[1] Beautification Committee Marine Authority
Board of Adjustment* Miami Beach Commission for Women
Budget Advisory Committee Miami Beach Cultural Arts Council
Capital Improvements Projects Oversight Committee Miami Beach Sister Cities Program
Committee on the Homeless Normandy Shores Local Gov’t Neigh. Improvement
Committee for Quality Education in MB Parks and Recreation Facilities Board
Community Development Advisory Personnel Board
Community Relations Board Planning Board*
Convention Center Advisory Board Police Citizens Relations Committee
Debarment Committee Production Industry Council
Design Review Board* Public Safety Advisory Committee
Disability Access Committee Safety Committee
Fine Arts Board Single Family Residential Review Panel
Gay, Lesbian, Bisexual and Transgender (GLBT) Sustainability Committee
Golf Advisory Committee Transportation and Parking Committee
Health Advisory Committee Visitor and Convention Authority
Health Facilities Authority Board Waterfront Protection Committee
Hispanic Affairs Committee Youth Center Advisory Board
Historic Preservation Board
*
Board Required to File 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: No Years of Service:
2. Present participation in Youth Center activities by your children Yes If yes, please list the names of your children, their
ages, and which programs. List below:
Child’s name: Samantha Narson Age: 11 Program: Cheerleading &
Gymnastics
Child’s name: Jacob Narson Age: 13 Program: Waterpolo
● Have you ever been convicted of a felony: No If yes, please explain in detail:
● Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail:
● Do you currently owe the City of Miami Beach any money: No If yes, explain in detail
● Are you currently serving on any City Boards or Committees: No 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 interest in, which are located within the City of Miami Beach:
7820 Noremac Avenue (current home)
● I am now employed by the City of Miami Beach: No Which department?
● who is employed by the
Pursuant to City Code Section 2 - 25 (b):
Do you have a
City of Miami Beach? Check all that apply. Identify the department(s):
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appo intment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: Female Race: White
Ethnic Origin: Check one only (1)
White
Physically Challenged: No
Employment Status: Employed 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:
P rohibition from directly or indirectly lobbying city personnel (Miami Beach City Code secti on 2 - 459).
o
P rohibition from contracting with the city (Miami - Dade County Code section 2 - 11.1).
o
P rohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
o
Beach City Code section 2 - 26).
R equirem ent to disclose certain financial interests and gifts (Miami - Dade County Code section 2 - 11.1).
o
(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.
“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 City Code “Standards of Conduct for City Officers, Employees and Agency Members.”
I Corey Narson agreed to the following terms on 12/7/2010 12:26:05 PM
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Received in the City Clerk’s Office by: __________________ ______ _______ Date: _ _ _/ __/____ Control No. __________ Date: _ __/__/_____
Name of Deputy Clerk