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Gregory Carney 12/31/12 I : - ,_ : - o CA A ANA\ M a 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 1/31/2011 Gregory Carney 440 W. Dilido Dr. Miami Beach, Florida 33139 g::i,:ig.:4114 Golf Advisory Committee Congratulations! You have been reappointed by Commissioner Michael Gongora to the above referenced agency, board or committee i • m ttee for a term ending 12/31/2012. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673- 7411. Please read the enclosed material carefully. Again, .congratulations and good luck. Sincerely, 0 1 St / e Robert Parcher City Clerk cc: Saul Frances, Parking Director I Kevin Smith ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency, board or committee Code Section 2-22, 2-23, 2-24, 2- City 2-25, 2-26, - 2 2 -459 Ordinance 2006 -3543 - Amendment e t to City Code Section 2 -22 Miami -Dade County Code Section 2 -11.1 Conflict of Interest and Code of Ethics Ordinance Wide Per City Application Parkin ty pp (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 safety to all who live, work and play in our vibrant, tropical, historic community. i 1 M P\A AA 1 r l ' 8 it— H . D ' irA\ ti I o► 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 Gregory Carney RE: Golf Advisory 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 ' e C y o Miami Beach, and to perform all the duties of a member of the above - mentioned board or committee Miami ttee 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 9rdinance), 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 com • with h tY the financial disclosure* require - ments of Miami -Dade 3 . on the board or coy. g •- 'ttee on which I � County or the State of Florida Florida de ( p g I serve) on July 1st, following the closing of the calendar mar on which I have : rved. .f`- , v flOyelArlir Sworn to and subscribed f b r i - A ''' before day /��✓/��,2011. 1 f , - i• , • / 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. I I 1 F C "---L- 4 CITY OF MIAMI BEACH 1 I3 N COMMITTEE APPLICA :eN FORM NAME. st Na e � � - , U , Aa La 4 First Name ,„ A , 'ddle in' ial ‘,..„,„ 7 . '"1"'t?'L r 2 HOME ADDRESS. / �' O � , Apt No. " House No. /Street City 6 4 pt to ' p Co . p 6 3 O /7Jc8 yC.4-? PHONE � Z. � � J c�"" � — o C( � /vt �-! Z : Home i Work Fax Email address Business Name: D o o i c S L L C. Position: C_ 0 0 Address: r oq //Z4/,4m l r � 6 / 6 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 inimum 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 i iami Beach for a minimum of six (6) months: Yes ❑ or No • Are you a registered voter in Miami Beach: Yes ,6 or No ❑ • (Please circle one): I am now a resident of: North Beach South Beach Middle Beac ., --- ,.-. 1 m I in franc 1 hire ... _ - pp y g pp be , use special abiliti , knowledg and x rience. - - -1st be! : = d .i� q le v m an 4 ' t 741c; • re you entl a isterea o o istth t City of � .�, e ' ?Y e s 0 or Ne 4,,, No >J 1 ' k . 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 Citv Clerk's Office. (Regular Boards of City) ❑ Affordable Housin • Adviso Committee ❑ Marine Authori ❑ Art in Public Places Committee 0 Miami Beach Commission for Women ❑ Beautification Committee r 0 Miami Beach Cultural Arts Council ❑ B. rd. of Adjustment* ❑ 40,411i Beach Human Rights Committee 1 = udget Advisory Committee 4. i i t iami Beach Sister Cities Program 7 41,.. 0 , ❑ Ca • ital im • rovements Pro.ect t Oversi.ht Committee ❑ Normand Shores Local Government Nei • h. Im • rovement ❑ Committee on the. Homeless ❑ Parks and Recreation Facilities Board ❑ Committee for Quality Education in MB ❑ Personnel Board ❑ Communi Develo • ment Adviso ❑ Plannin • . Board* ❑ Community Relations Board ❑ Police Citizens Relations Committee ❑ Convention Center Advisory Board ❑ Production Indust Council ❑ Debarment Committee 1 ■ Public Safety - - ❑ Design Review Board* i 4iZi1 0 Safety Committee pisability Access Committee ■ Sin le Famil Residential Review Panel le'Fine Arts Board € 2.-• ■ Sustainabili Committee ❑ G , Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parkin 9 Committee ❑ Visitor and Convention Authority ❑ Health Advisory Committee ❑ Waterfront Protection Committee ❑ Health Facilities Authority Board ❑ Youth. Center Advisory Board ❑ Hispanic Affairs Committee ❑ Historic Preservation Board ❑ Housing Authority ❑ Loan Review Committee *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: Yes 0 No 0 Years of Service: 2. Presentlparticipation in Youth Center activities by'your children Yes❑ No 0. If yes, plea' lease fist the names of your children, their ages, and which programs. List below: Child's name: Age: Program: Child's name: Age: Program + F : ` CLrE? \$ALL \aFORM \BO'ARD AND COMMITTEES \BC., Application.doc 6 17,,,, r s 4 •Have you ever been convicted of a felony: Yes ❑ or No rgif yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No . f yes, please explain in detain: • Do you currently owe the City of Miami_ Beach any money: Yes ❑ or No If yes, explain in detail • Are you currently serve ' on any y Boars o Committees: Yes or-No-0. If yes which boar ? ® ,, / ' 7 el) ivi mac : ,E, • What orgy izations in the City of Miami B ach do you currently hold mem. rship in? Name: VP.1? e Name: I Title: • List I1 properties wned or have an in erest in, hi are located vi hin the City of Miami Beach: ifq ,j, k0 • 1 am now employed by the City of Miami Beach: Yes ❑ or N o h i c h department? • Pursuant to City Code Section 2 -25 (b): Do you have a arent ❑,souse ❑ child ❑ brother ❑ or sister ❑ who is employed P spouse P Y by the City of Miami Beach? Check all that ap . 1 n ' 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: 9 Male ❑ Female Eth is Origin Check one only (1) hite (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 groups of Africa. ❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. ❑ 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 affiiiati • or community recognition. Physically Challenged' Yes ❑ or N • 4. Employment Status. Employed 0 Retired 0 Homemaker ❑ Other I 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: PP Y Y o Prohibition from1 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 afterr leaving office (Miami Beach City Code section 2 -26). O Requirement to tdisclose certain financial interests and gifts (Miami -Dade County Code section 2 -11.1 (re :. CMB Community Development Advisory Committee prohibition, during tenure and for P g 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 e y from the City Clerk. I "1 he b - ttest L t ,. a • curacy and truthfulness of the application and have received, read and will abide b Y Chapter 2 Art' le il li — o , r ity , ode "Standards of ondu for City Officer ployees and Agency Members." s Adit.1.1A _ . __. i 3 ( 1 I 1Z y A- c A- temfi- Ap Pit t' = gnatur- Date Name of Applicant (PLEASE P RINT) Plea 1 h a opy of yd resume to this application NOTE: Applications will remain • file for a period of one (1) calendar year / / Received in the City Clerks Office by . .,.�, . Dater 1 010 Control No. 2 & 9 D ate / /2010p'� � � Name of Deputy Clerk - MIAMI BEACH _ City of Micimi • Beach, - 1700 Convention Center Drive, • Miami Beach, Florida 33139, www.micilmibeachil.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305 673.7411 Fax: 305.673.7254 • Actin J fines/suspension owled ement of for Board Members for failure to comply with Miami -Dade . County Financial Disclosure Code Provision • Code Section 2.11.1(1) (2) • • • . C) • Board Member nam r r . Understand that no later than JulY year 1, of each al! .members of .Boards and .Committees of the •Ci of Miami .Beach, including those of a purely adviso nature, :are • tY including P y ry •re. - uiredto - comply with Miami -Dade County .Disclosure Requirements. - This means the members of City Advisory Boards, whose sole or primary responsibility is to recommend • le g isiation or give advice. to the City Commission must.f le .even though you may have been � g � � � 9 Y may recently appointed. You &iustfiIe one of the ith the City Clerk of Miami Beach, .Convention 9 tY • 1700 .Center Drive, Miami Beach, Florida, b� Jul -1 each year. by July v 1. A "Source' of income Statement" .(attached) or 2. A "Financial Statement" (attached( or) 3. A - Copy of the person's current Federal income Tax Return . Failure to file, according to the Miami -Dade .County Code Chapter 1, General Provision, - Section 1.5 may subject the person or firm to a fine not to .exceed - $500.60 or by imprisonment in the county jail for a period not to exceed sixty days, or bot .�� l 3/ // • Si gnat.--. • 9 Da �. �...•w Fes^ c »� "�-;o-- � V:[ �.:: �T14e.- .�::'yC.s:�.�•kT�. +:� ^FFy+;,.' „`. . :6'.... �. S- Cf..ti.�+5 -�-°' ..v. � iL:�.. �.ja�•.Y.�:. ^. �ti Y... i..�- .a.- ......L /q =; tif<':'.0 >Y:' CSC- 'a.+'.'� wv"vt:... "'...< • • -. ^!. .�. ..._, _�... _. �.._.., x ....- :.'. -;.i ;C'�.: •.m,r �_.u.: ;�r,.;v ... .�-r. ... -c... me= �.- ;�, ,�e. -. -. -. �-. c._. voQ: �S:=; �=:.: �:.. av"-=• �..`+* r: a.'; �eusw- o. sa.. �.+... si.. �, c' a. ���=. �+ f` �': a :.c:x�s��F::= ::.c�_.uc�.r^.:r.. _- r^- -�ans� ?f:+. _ - r.,c`a:. ==.�:. k { MIAMI. OFINCOMESTATEMENT - • . - . , COUNTY SO t . .. , - . Ple Yp ase. Print .or Type First Name Middle Name /Initial Last Name . - . - -('''' . . ' .- . .. . . , Disclosure . For Tax Year Larne • �r 0, e ,. IA_ � Ending: . la iting Address: 0 Ci D 1 _9* • - Ci State /Zi ' I q /3 . . L' . 1 L - 31 ' •• • . ' . • Social 4Security'Number: • Filing as a: II:3 County Employee: - 0 Municipal Employee of: . . , . . -. - Position held or sought: • i • ! er Employment - Board where searing: .. Term " " . • • Began an: • Department where employed: Work Address: If your . home address is exempt from public records pursuant to • § Florida Statutes 119,07 please check .hare (read instructions): -Ei • Work Telephone: Home Address: Street Address • . Ci .State. Zip Code . descending order with the largest source first, the name, address . Please lest below in des 9 p rincipal business activity of every source of your income including public salary you - received 'or any person . received for your benefit or use during the disclosure period, The • I siness partner need not be disclosed. If continued an a rne of your .spouse or any separate sheet, .check here: 0 J Description iof the 'Principal Name of Sou ce 'of Income Address Business Activ" . . Mio( 0 6ort7 it 0 L t . , , , . , . . - . i here - - th • 7th:- aforesaid information isa true .and correct statement. • . - ar t o r a -. j Alle.o.4. 4 . ate ned .'• igriature • -rson disco - - g