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Michael C. Reed Board Application , . ,.... fro A i 1 A i . . 7B ,, ..Y . ? Ae OW NAME: /if, Last Name First �[ Ago' ,�zt�' Name Middle Initial HOME ADDRESS: Qg7 4 #a l �l Ae / r l',!I �� ....?....,w No. Street City State Zip Code PHONE: 6/7 ` o 75 /I!IC!/ICIe Cam/ 7?e60,1/ 601/ Home Work Fax Email address Business Name: �- / E L I AA . / ` .. A Posi tion: .. - . -,i A rZ Address: 7OO • / /7` l� .t/� ,G ,°�l�r /--- re_e�' No. `S l Street City State Zip Code Professional License (describe) Expires: 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 shaIrdemonstrate ownership/interest for' a mininiur of six months in a business established in city. • Resident of Miami Beach for a minimum of six (6) months: Ye or No U • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: YeWr No U • Are you a registered voter in Miami Beach: Yes /6 r No U • (Please check one): I am now a resident of: North Beach outh Beach U Middle Beach U • I am applying for an appointment because I have special abilities, knowledge, experience. Please lis below 6e f /149151 in /ilf ,dr r7esf anel covirftfr. /p i v.��Atekrf..7 am 4 ritAreti f in G .k4i■ils�2211'dl�1 d/ Lv ®!✓'� in CC! iliile#W Cite ' 1 / /Jia� /. 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) ❑ Art in Public Places Committee ❑ Housing Authority* ❑ Beach Preservation Board ❑ Loan Review Committee* ❑ Beautification Committee ❑ Mayor's Green Ad -Hoc Committee 0 Board of Adjustment* ❑ Marine Authority* �XBudget Advisory Committee ❑ Miami Beach Cultural Arts Council ❑ Committee on Homeless ❑ Miami Beach Commission on Status of Women - ❑ Committee for Quality. Education in MB ❑_Miami Beach Florida Sister Cities ❑ Community Development Advisory* 0 Normandy Shores Local Gov't Neigh. Improvement Community Relations Board 3 JSI Oversight Committee for General Obligation Bond ❑ Convention Center Advisory Board 0 Parks and Recreation Facilities Board 0 Debarment Committee ❑ Personnel Board* ❑ Design Review Board* ❑ Planning Board* 0 Disability Access Committee ❑ Police Citizens Relations Committee £ w 0 Fine Arts Board ❑ Production Industry Council e;, 0 Golf Advisory Committee ❑ Public Safety Advisory Committee em M ❑ Health Advisory Committee ❑ Safety Committee r`° c-, ❑ Health Facilities Authority Board ❑ Transportation and Parking Committee 0 ❑ Hispanic Affairs Committee ❑ Visitor and Convention Authority* • © try ❑ Historic Preservation Board* ❑ Youth Center Advisory Board .- * Board Required to File State Disclosure form d EJ1 .. .: 1 r -•r7 O 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 u No J Years of Service: 2. Present participation in Youth Center activities by your children YesJ No U. 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: • Have you ever been convicted of a felony: Yes Li or No,` If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes U or No)( If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes Li or No)< If yes, explain in detail - _ .Are you currently on any CityBoards or Committees: Yes Li or IX 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: • I am now employed by the City of Miami Beach: Yes U or NoSL Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent U, spouse J, child U, brother U, or sister u who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): This section is "not required" but desired: Age: 31 years old Gender: Male Female ❑ Ethnic Origin (Check one) White ❑ African - American /Black Hispanic: 0 Asian or Pacific Islander ❑ American Indian or Alaskan Native 0 Employment Status: Employed 0 Retired ❑ Home -maker ❑ Other 0 "1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII /7 of e City Code "Standard of Conduct for City Officers, Employees and Agency embers." C /?/0d "'Lc 64 Applicant's Signature Date Name of Applicant (PLEASE 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. Received in City Clerk's Office by Date Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered By Date Revised 125/07 jo 2