Lucero Levy 12/31/2013 el MIAMI E CH
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
12/01/2011
Lucero Levy
1855 Cleveland Rd, .
Miami Beach, Florida 33141
S.' B EC :=.3 Beautification Committee
Congratulations! You have been reappointed by Commissioner Jorge.Exposito
to the above referenced agency, board or committee for a term ending: 12/31/2013.
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.
Sinc rely,
fi so
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director . -
John Oldenburg
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
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We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
f..
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach;Florida 33139,www.miamibeachfhgov
OFFICE OF THECITY CLERK, Robert Pardher,City Clerk
Tel: (305)673=7411,Fax:(305)673-7254
TO Lucero Levy
RE: Beautification Committee
I do solemnly swear or-affirm:to bear true faith,•loyalty.and allegiance to'the-Government of the
United States,the State ofFlorida,and the City of Miami Beach and to perform all the duties of
a member of the abover mentioned board or committee of theiCity of Miami to which I have
been appointed for a term ending: 12/31/2013.
•
I have beenissued a copyof`Section 2-11.1 of•the Miami;DadetCounty'Code(Conflict of Interest
and Code,of Ethics•Ordinance) as well as theF/onda;Commissio,ron Ethics GuideTto the Sunshine
Amendment and Code of Ethic for Public Officers and Employees,and understand that as a member
'..: of'a City-of'MiamiBeach Board and/or Committee I must complypwith the financial disclosure*`require-
ments of Miami Dade)Countyorthe State of Florida(depending'on the board or committee on which
I serve)on July 1st following the closing of the calendar'yearonwhich•I;have.served.
Lucero Levy
•
fyj �` �'
-Sworn,to.and subscribed before me-this S' day>of ;f/911.1-
NU 01
-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•
ELI IV t I/y'v,I t A�.� CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: 1� \/ i CJ C _ /z-(�
LaskNarre- First Name Middle Initial
HOME ADDRESS: /1'1_4.--- L'G5✓EL .04P 1-/ii9rn h it FL. 33/V/
Apt No. House No./Street City State Zip Code
PHONE: ?OJ^^.“47- 1i7 for-k4.i 8o ?c, L u rd.¢,�.E (�4O/ e •
_
Home Work Fax 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/nterestfor a minimum of six months in a.business established in the city.
.e Resident of Miami Beach for of six.(6) months:Yestl or No ❑
• o Demonstrate an ownershipAnterest in a business in Miami Beach.for a minimum of six(6) months: Yes)J or No 0
o Are you a registered voter in Miami Beach:Yes 71‘or No ❑ .
• (Please circle one): I am now a resident of: o each ' South Beach ` Middle.Beach
e I am.applying for an appointment because I.have special abilities, knowledge and experience. Please list below:
o Are you'presently a registered lobbyist with the City of Miami Beach?Yes 0 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)
❑Affordable Housing Advisory Committee 0 Marine Authority V
O Art in Public Places Committee ❑Miami-Beach Commission for Women .
' Beautfcation Committee ' ' ' 0 Miami Beach Cultural Arts Council
❑Board of Adjustment* ' O'Miami Beach Human Rights Committee
0 Budget Advisory Committee . 0 Miami Beach Sister Cities.Program
❑Capital Improvements"Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
0 Committee on the Homeless ' 0 Parks and Recreation Facilities Board
❑'Committee for.Quality.Education in MB ' ❑Personnel Board
❑Community Development Advisory 0 Planning Board* V V
❑Community Relations Board ❑Police Citizens Relations Committee
❑Convention Center Advisory Board ❑Production Industry Council
0 Debarment Committee .O'Safety Committee
❑ Design Review Board* ' ' V• '0 Single Family Residential Review Panel
❑Disability Access Committee . ❑Sustainability Committee
❑.Fine Arts'Board V '❑Transportation-and Parking.Committee
❑Gay, Lesbian, Bisexual and Transgender(GLBT) 0 Visitor and.Convention Authority
❑Golf Advisory Committee ❑Youth Center Advisory Board
❑Health Advisory Committee ' .
0 Health Facilities Authority Board
❑Hispanic Affairs.Committee
0 Historic Preservation Board .
0 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'ScottlRakow Youth Center:
1.Past service on the,Youth Center Advisory Board: Yes 0 N 0 Years of Service:
2. Present participation in Youth"Center activities:.by your children Yes: No 0. If.yes, .please list the names of your children, their
ages, and which programs. List below:
Child's name: vAge: -Program:
Child's name: Age:, ' Program: /
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Applic.otion.do: /
•Have you ever been convicted of a felony: Yes 0 or No llf yes, please explain in detail:
•
•
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑or No l it,If yes, please explain in detail:
•
• Do you currently owe the City of•Miami Beach any money: Yes 0 or No 7( If yes, explain•in detail
s Are you currently serving on any City Boards or Committees: Yes^Iyror No 0. If_yes; which board?
o What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
• .Name: Title:
. s List all properties owned or have an intteresttii which are located,within the City of Miami Beach:
o I am now employed by the City of Miami Beach: Yes ❑ or No9Which department?
e Pursuant to City Code Section 2-25 (b): Do you have a parent 0, spouse 0, child.❑, brother 0, or sister 0 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 y,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 groups of Africa.
'KHispanic: 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 affiliation or community recognition. .
Physically Challenged: Yesbr No❑.
Employment Status: Employed ❑ Retired ❑ . Homemaker 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 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, .
,110le VII—oft City Code "S ards of Conduct-for City Officers, Employees and Agency Members`."
- � '//' Luc (ZE/j�* L E V
Appl cants Signature Date Name of Applicant(PLEASE PRINT)
v
Received in the City Clerk's Office by: Date:_/ /2010 Control No j-,2------7? Date: /2010� /
• Name of.Deputy Clerk .
® MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov •
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel:305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-1 1.1(i) (2)
Board Member name: / L�c f2D
I understand that no later than July 1, of each year all members of Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, are
required to comply with Miami-Dade County Disclosure Requirements. This means that the
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation or give advice to the City Commission,must file,even though you may have been
recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention
Center Drive, Miami Beach, Florida, by July 1 each year.
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
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
Signature: Da e:
MIAMI.
COUNTY SOURCE OF INCOME STATEMENT
Please.Print or Type First Name Middle Name/Initial Last Name Disclosure
v c E,eo /Z LE►/ For Tax Year
Endin •
Name:
e c-,6-'
Mailing;address:
City/state,zip: �1 t 8 -/j ia/.
FL- 33
social Security Number
Filing as a: in County Employee:
r, Municipal Employee.of:
Position held or sought:
Board where serving: 7/'Fi e-097'7 o Term or Employment
Began nn:
Department where employed:
Work Address
If your home address is exempt from public records pursuant to Work ele Telephone:
Florida Statutes§.118.07 please check here:(read-instructions); P :
Home Address: Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name,c address and
principal 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
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet,check here: f
Description of the Principal
Name of Source of income Address. . Business Activity
• -L i 1
JA-0013 A-t / PIP
I hereby swear (or affirm).thatthe.aforesaid information is:atrue and correct statement,
ignature of person discios' g Date signed