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Zyn Carco (2) CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: zarco cyn. Last Name First Name Middle Initial HOME ADDRESS: 2421 Lake Pancoast 3H Drive Miami Beach FL 33140 Apt No. House No./Street City State Zip Code PHONE: 305 - 534 - 4663 305 - 534 - 4663 cyn.zarco@gmail.com Home Work Fax Email Address Business Name: cyn. zarco/3F Studios Position CEO : Address: 3F 2421 Lake Pancoast Drive Miami Beach FL 33140 No. Street City State Zip Code P rofessional 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 ● Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: No ● Are you a registered voter in Miami Beach: Yes ● (Please circle one): I am now a resident of: South Beach ● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: Journalist who championed South Beach since 1986 as columnist for Miami News, Miami Herald, Ocean Drive, channels. Was judge for Natl Endowment of the Arts. ● Are you presently a registered lobbyist with the City of Miami Beach? Yes 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 Marine Authority [2] Art in Public Places Committee Miami Beach Commission for Women Beautification Committee [1] 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 Normandy Shores Local Gov’t 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 [3] 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 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: No Years of Service: 2. Present participation in Youth Center activities by your children No 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: 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: Helen Mar Condominums ● 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 appointment. It is being asked to comply with federal equal opportunity reporting requirements. Gender: Female Race: Ethnic Origin: Check one only (1) Asian or Pacific Islander Physically Challenged: 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 section 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 Bea ch City Code section 2 - 26). R equirement 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 w hom 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 cyn. zarco agreed to the following terms on 11/14/2011 11:23:52 AM Received in the City Clerk’s Office by: __________________ ______ _______ Date: _ _ _/ __/____ Control No. __________ Date: _ __/__/_____ Name of Deputy Clerk ùÃÎâÛÊÙÍ öéÈÇØÓÍÉ èÔ×ô×Ð×ÎïÛÊ ðÛÑ×ìÛÎÙÍÛÉÈøÊÓÆ× ïÓÛÏÓú×ÛÙÔöð ÙÃÎÂÛÊÙÍÙÍÏ ôíï÷ÙÃÎ×ÙÓÈÈÛÙÍÏ ÷øçùûèóíî ùÍÐÇÏÚÓÛçÎÓÆ×ÊÉÓÈÃïÛÉÈ×ÊÓÎöÓÎ×ûÊÈÉåÊÓÈÓÎÕ çÎÓÆ×ÊÉÓÈÃÍÖùÛÐÓÖÍÊÎÓÛú×ÊÑ×Ð×Ã úÛÙÔ×ÐÍÊÍÖÈÔ×ûÊÈÉïÛÉÉùÍÏÏÇÎÓÙÛÈÓÍÎÉ ìêíö÷ééóíîûð÷äì÷êó÷îù÷ öéÈÇØÓÍÉéÍÇÈÔú×ÛÙÔÌÊ×É×ÎÈ òÍÇÊÎÛÐÓÉÈ ÌÔÍÈÍÕÊÛÌÔ×Ê å×Úø×ÉÓÕÎ×Ê ùÍÆ×Ê×ØïÓÛÏÓtÉÛÊÈÉ×ÎÈ×ÊÈÛÓÎÏ×ÎÈÖÛÉÔÓÍÎÉÙ×Î× ìÇÚÐÓÙÛÈÓÍÎÉ ïÓÛÏÓô×ÊÛÐØïÓÛÏÓî×ÅÉíÙ×ÛÎøÊÓÆ×ïÓÛÏÓïÍØ×ÊÎ ðÇÄÇÊÃóÎÈ×ÊÆÓ×ÅóÎéÈÃÐ×çéå××ÑÐÃ÷ÐÐ×ø×ÙÍÊÛÈÓÍÎçñ ÷ÐÐ×ûÇÉÈÊÛÐÓÛçéûèÍØÛÃøÛÓÐÃùÛÎØÃúÍÏÚæÓÊÕÓÎ ûÈÐÛÎÈÓÙçÎÓÆÓÉÓÍÎê×ÛÐõÇÓØ×ÉûÆ×ÎÈÇÊÛùÔÛÎÎ×ÐÉ ðÓÎÙÍÐÎêÍÛØéÍÇÈÔöðÍÊÓØÛù÷íïÓÛÏÓï×ÈÊÍùÍÊÚÓÉ ìÔÍÈÍ íÙ×ÛÎøÊÓÆ× ùÍÎÈÊÓÚÇÈÓÎÕ÷ØÓÈÍÊìÔÍÈÍÕÊÛÌÔ×Ê ùÊ×ÛÈ×ØçÌðÛÈ×éÍÇÈÔú×ÛÙÔtÉÖÓÊÉÈÙÓÈÃÉÙ×Î×ÙÍÐÇÏÎ ö×ÛÈÇÊ×ØÙ×Ð×ÚÊÓÈÓ×ÉÐÍÙÛÐÐÇÏÓÎÛÊÓ×É ÛÊÈÉ×ÎÈ×ÊÈÛÓÎÏ×ÎÈ èÔ×ïÓÛÏÓî×ÅÉ éÍÙÓ×ÈÃùÍÐÇÏÎÓÉÈÖÍÊïÓÛÏÓÉÖÓÊÉÈØÛÓÐÃÎ×ÅÉÌÛÌ×Ê éÍÇÈÔöÐÍÊÓØÛ ûÉÉÍÙÓÛÈ×÷ØÓÈÍÊ åÊÍÈ×ÇÌ÷ÎÈ×ÊÈÛÓÎÏ×ÎÈÉÈÃÐ×ÖÍÊÙÓÈÃÏÍÎÈÔÐÃ úííñé åÓÐØéÈÃÐ×éÓÏÍÎéÙÔÇÉÈ×Ê ùÓÊÙÇÏÎÛÆÓÕÛÈÓÍÎèÍÍÈÔÍÖèÓÏ×úÍÍÑÉ ûåûêøéìÍÉÈÉ ûÏ×ÊÓÙÛÎúÍÍÑûÅÛÊØ ÷ÓÉÎ×ÊìÊÓÂ×ÓÎ÷ÎÕÐÓÉÔðÓÈ×ÊÛÈÇÊ×çùú×ÊÑ×Ð×Ã îÛÈÓÍÎÛÐ÷ÎØÍÅÏ×ÎÈÍÖÈÔ×ûÊÈÉòÇØÕ×