Antonio Purrinos 12/31/2012 IA MIAMI LE
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
12/16/2010
Antonio Purrinos
2899 Collins Ave #1720
Miami Beach, Florida 33140
,,k:° , ` } Hispanic Affairs Committee
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
to the above referenced agency, board or committee for a term ending: 12/31/2012.
If you are unable to accept this appointment, please notify City the Cit Clerk's Office at
(305) 673 -7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
9 9
Sincerely,
lek
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Nannette Rodriguez
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 safely to all who live, work and la in our vibrant, tropical, historic co
p Y p community.
f BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411 Fax: (305) 673 -7254
TO Antonio Purrinos
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: 12/31/2012.
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 theFlorida 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 on the board or committee on which
I serve) on July 1st, following the closing of the calendar - ' n which I have served.
- - 1 —
Antonio Purrinos
Sworn to and subscribed before me this J day of ilk " 010.
1 a /
; Q
. 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 la in our '
p y v vibrant, tropical, historic community.
r--- MIAMI BEA H CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: s`'r'' "A/' •===///7
Last Name First Name Middle Initial
.
HOME w ADDRESS: 0 !�� G /,, r c v
Apt o. House No. /Street City State Zip Code
PHONE: 71 '� '�/� ` i-f.woz.c2.,c/i3cAdcrd.o.
Work F Email address
Business Name: .- - = Position:
Address: \ _
No Street 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: Yes ❑ or No ❑
• (Please circle one): I am now a resident of North Beach South Beach Middle Beach
• I am applying for an appointment because I 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 [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)
0 Affordable Housing Advisory Committee ❑ Marine Authority
❑ Art in Public Places Committee ❑ Miami Beach Commission for Women
0 Beautification Committee ❑ Miami Beach Cultural Arts Council
❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee
❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program
❑ Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
❑ Committee on the Homeless ❑ Parks and Recreation Facilities Board
❑ Committee for Quality Education in MB ❑ Personnel Board
❑ Community Development Advisory ❑ Planning Board*
❑ Community Relations Board ❑ Police Citizens Relations Committee
❑ Convention Center Advisory Board. ❑ Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
❑ Design Review Board* ❑ Safety Committee
❑ Disability Access Committee ❑ Single Family. Residential Review Panel
❑ Fine Arts Board ❑ Sustainability Committee
❑ Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee
❑ Golf Advisory Committee ❑ Visitor and Convention Authority
❑ Health Advisory Committee 0 Waterfront Protection Committee
❑ alth Facilities Authority Board ❑ Youth Center Advisory Board
JOispanic Affairs Committee
0 Historic Preservation Board
❑ Housing Authority
0 Loan Review Committee *Board Required to File State Disclosure Form
Note: If appl , • r Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Boar•: _ r _ . o ❑ Years of Service:
2. Present participation in Youth Center activities by your children ■ o ❑. If yes, please list the names of ,
your children their
ages, and which programs. List below:
Y
Child's name
Age: Program:
Child's name: Age: g � Program:
F: \C:L . R \$ALL \aFORMS \BOARD AND CC)MMITTEES \QC: Applicafion.doc
o Have you ever been convicted of a felony: Yes ❑ or No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ❑ or 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:
z .
• I am now employed by the City of Miami Beach: Yes ❑ or No . hich department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child ❑, brother 0, or sister ❑ who is employed by the
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 appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: Male ❑ 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- American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial rou s of Africa.
9 P
❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Cl 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 includes, 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 Challenged: Yes r
Y Y g o Non.
Employment Status: Employed ❑ Retired ❑ Homemaker 0 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 ourself
Y
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 h - = attest to the accuracy and truthfulness of the application and have received, read and will icle II '
A ` -- of the City -bode "standards of C nduct for City Officer Employees abide by Chapter 2,
y s, m ployees and Agency Members."
:: , / \r / C) e-- / { ....9, / / 12. 6 , tr
Ap • ic is Signature Dat Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to thi j: lication
NOTE:, pp, r .,G
,.. , AP • cations „remain on y for a eriod of :one: 1 calendar ear:'
' j t )�
Received in the City Clerk's Office by : ,.,.,,,' it ► 18,0)_ it Date: / 5 /2010
Control o Date:. / /2010
Name of i eputy Clerk
1
I
MIAMI. r c .
. • SOURCE OF INCOME STATEMEVI
Phease - Print or Type_ ` First Name . Middle Name /Initial Last Name
Disclosure •
For Tax Year
Name: =='2 c> /J—r-' , /' •
1 ?/ Endin
-Mailing Address: ._ . fdP ..., . nr•` /7..... CD .
•
City/State/Zips i , / . .
Soda! Security Number:
Filing as a : County Employee:
Municipal Employee of:
Position held or sought:
2;4 f
Board where serving: Term or Employment
- • rz:). • •
Began on
•Department - employed:
Work Address:
. It your home address is exempt from is .records pursuant to
Florida Statutes s§ 119.07 please check here instructions): D Work Telephone:
Home Address:
i
Street Ad
. i
City -State . Zip • Zi Code
r
- Please Gist .below in descending order with the largest source first, the name, address and
principal :business activity of every source of • your 9 P salary our income including ub�lic sala 'you
received or -any -- person received for •your benefit or use during the' disclosure period. The
income of your - spouse - or any business partner need not be disclosed. If continued on .a
separate sheet, check here: El - • - . . .i • .
:Description of the Principal
Name of Source-of Income Address Business Acfiivi r '
,. . 1
1 hereb ear (or affirm) that the aforesaid information
n is a true and correct statement.
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4g , , , ,, ' C 'r=-C // . 1
..Signat . f - person disclosing - • -
- to si ned
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