Daniel Nixon - 12/31/2013 ® MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305) 673-7411, Fax: (305)673-7254
1/6/2012
Daniel Nixon
4646 N. Bay Road
Miami Beach, Florida 33140
Beautification Committee
Congratulations! You have been reappointed by Commissioner Deede Weithorn
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.
Sincerely,
14 4d
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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
TO Daniel Nixon
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 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: 12/31/2013.
1 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 theFlodda 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 1 st,following the closing of the calendar year on which I have served.
N 6
./.Daniel Nixo.�
L
Sworn to and subscribed before me this�S( day of vOw 012.
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.
AM- A.AIAMIBEACH
CITY OF MIAMI BEACH
}� BOARD AND COMMITTEE APPLICATION FORM
NAME: N Ikml�[ PAkvl�-, (
Last.Name First.Name Middle Initial
HOME ADDRESS: ` [v �'-� Rcl M f A M
Puci, Fl_ .�3 / 4/B
Aj)t- o. House No./Street City State Zip Code
PHONE: 13 0 S 313 16 3 t` 3 0.31 (.O(o (1 y Z Drryikonf (6D M 3,10, eo ILI
Home Work Fox Email address
Business Name: R 6-n A F D :f0h r4 S l Position:
Address:
No. Street (3.t�q City State Zip Code
s Professional License(describe) P1 rra f)'1 C,-&i L 1 rr ti<c Expires:-1/31 dt 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 ownershipinterest 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 Wor No ❑
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minimum of six(6) months:Yes I$or No ❑
•Are you a registered voter in Miami Beach:Yes O'or No ❑
e (Please circle one): I am now a resident of: North Beach South Beach iddle Beach j
. I am applying for an appointment because I have special abilities,knowledge and experien ce. e�eli�t5elow:
.Are you presently a registered lobbyist with the City of Miami Beach?Yes❑or No 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 Housing Advisory Committee ❑Marine Authority
❑Art in Public Places Committee ❑Miami Beach Commission for Women
Lt'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 ❑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 Trans ender GLB ❑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:Yes❑No❑ Years of Service:
2. Present participation in Youth Center activities by your children Yes❑ 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: \
FACLER\$ALL\oFORMS\BOARD AND COMMITTEES\BC Applicotion.doc J
*Have you ever been convicted of a felony: Yes❑or No k If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach codes: Yes❑or No;k 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 Wor No❑. If yes; which board?
Rch �3 CN rt kl c TIOYt
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: jF—Ir M F I E 13 F_ 1-k S(no 10 M Title: 114 f /hit 6 E /I
Name: 1\(rL,,t. LJ.m (LL. R Sy +►t r1 hvv�.� Title: M V_sW A
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
A IBS t Oe nrc-a_. L(, � q 6-_ " -13 r} K W O R.L l)
• I am now employed by the City of Miami Beach: Yes❑or NoWWhich department?
• Pursuant to City Code Section 2-25(b): Do you have a parent ❑, spouse❑,child❑, brother❑,or sister❑who is employed by the
City of Miami Beach?Check all that apply. Identify the department(s): 1-40
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: Qr 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 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 affiliation or community recognition.
Physically Challenged: Yes❑or No❑.
Employment Status: Employed❑ Retired X^ Homemaker❑ Other❑ l
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:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• 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).
• 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 aft t to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VI of the City Code"Standar s of Conduct for City Officers, Employees and Agency Members."
J j I) ih,+Xd7N
IJ FE 13 i i Lo i x- 1� �Ik,
Applicant's Signature Date Name of Applicant(PLEASE PRINT)
" Please attach a copy of your resume to this application
NOTE:Applic ion will rem on file for a period of one(1)calendar year.
� v
Received in the City Cleric's Office by: D Date: / 201r 0 Control No. Date` /� 2010
Na a of Deputy Clerk
I
CURRICULUM VITAE
DANIEL D.NIXON,M.D.,F.A.C.P.
Born: January 7, 1934
Citizen: - United States
Marital Status: Marred,three children
Medical Expert-Social Security Administration 2002-Present
Private Practice: Hematology-Oncology,The Mt. Sinai Comprehensive Cancer Center,
Miami Beach, Florida 1969-2002
Senior Attending,Mt. Sinai Medical Center,
Miami Beach,Florida 1969-Present
Staff, Miami Heart Institute, Miami Beach,Florida 1969-Present
Clinical Associate Professor of Medicine
University of Miami School of Medicine 1981-Present
Chief, Division of Oncology,Mt. Sinai Medical Center,
Miami Beach, Florida 1975-1998
Co-Medical Director,The Mt. Sinai Comprehensive Cancer Center,
Miami Beach, Florida 1989-1998
Medical Director,Dade County Hospice,Inc. 1989-1993
Clinical Assistant Professor of Medicine,
University of Miami School of Medicine 1974-1981
Clinical Instructor of Medicine,
University of Miami School of Medicine 1969-1974
Instructor in Medicine,Columbia University College of
Physicians and Surgeons,New York,New York 1968-1969
Assistant Hematologist,Queens General Hospital,
New York,New York 1964-1966
Private Practice: Internal Medicine,Hematology
Rockville Centre,New York 1963-1966
Staff Physician,Internal Medicine,Hematology,
Long Island Jewish Hospital,New Hyde Park,New York 1963-1966
Assistant Clinical Hematologist,Mount Sinai Hospital
New York,New York 1963-1965
MILITARY SERVICE:
Captain,Medical Corps, United States Army 1966-1960
Internist&Chief,General Medical Service,Valley Forge
eneral Hospital, Phoenixville,Pennsylvania 1967-1968
Chief, Me ical Service, 12 Evacuation Hospital(SMBL),
Ford Ord,California&'Cu Chi,Vietnam 1966-1967
CURRICULUM VITAE
DANIEL D.NIXON,M.D.,F.A.C.P.
Page Two
EDUCATION:
M.D. (Honors AOA)University of Pittsburgh School of Medicine
Pittsburgh,Pennsylvania 1955-1959
B.A. (Honors in English) Dartmouth College
Hanover,New Hampshire 1951-1955
Assistant Visiting Physician&Visiting Fellow in Oncology
Francis Delafield Hospital College of Physicians& Surgeons
Columbia University,New York,New York 1968-1969
Fellow in Hematology,Mount Sinai Hospital
New York,New York 1963-1964
Resident in Internal Medicine, Mount Sinai Hospital
New York,New York 1961-1962
Resident in Internal Medicine, University of Pittsburgh Medical Center
Pittsburgh,Pennsylvania 1960-1961
Internship,Mount Sinai Hospital
New York,New York 1959-1960
PROFESSIONAL SOCIETIES AND CERTIFICATIONS:
Diplomat—American Board of Internal Medicine(24505) 1967
Diplomat—American Board of Internal Medicine with
Subspecialty in Medical Oncology(24505) 1973
Fellow—American College of Physicians 1973
International Society of Hematology 1970
American Society of Hematology 1968
American Society of Clinical Oncology 1969
Florida Society.of Clinical Oncology 1977
A
CURRICULUM VITAE
DANIEL D.NIXON,M.D., F.A.C.P.
Page Three
MISCELLANEOUS:
Scientific Advisory Board of the Israel Cancer Research Fund 1978-Present
Visiting Professor,Department of Oncology,
The Chaim Sheba Medical Center,
Tel Hashomer,Israel 1976
Alfred B. Stengel Traveling Fellowship of the
American College of Physicians 1972
Board of Directors,Florida Society of Clinical Oncology 1979-1982
Board of Trustees&Medical Advisory Committee
Dade-Monroe Chapter of the Leukemia Society of America 1970-1972
Medical Advisory Committee, Dade County
American Cancer Society 1972-1974
Co-Principal Investigator,GI Tumor Study Group
Mt. Sinai Medical Center, Miami Beach, Florida 1985-1987
Co-Principal Investigator,Gynecology Oncology Group
Mt. Sinai Medical Center,Miami Beach, Florida 1985-1987
Health Advisory Board,City of Miami Beach,Florida 2002-Present
1
m MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl oov
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 2-11.1(i) (2)
Board Member name:
I understand that no later than .lulu 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.
Fi=13 z
Signature: Date:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEESSC Application.doc
MIAM
SOURCE OF INC®ME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
Name: IFt For Tax Year
Ending:
Mailing Address: & � 5 A-`"� rV a
City/State/Zip: 111 cork i 13 C MC H �'/4 3 3 f'y 6
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of: G l t 136cL%A Aj_A,,,bz,
Position held or sought: Mff/1AV h Ez(A Bic k
Board where serving: QF'Ach 131=,4,ErcA Term or Employment
Began on:
Department where employed:
Work Address: RF_SrA P-4c_,
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read instructions): ® Work Telephone:
Home Address: '4(q 4, pet
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, 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:
Description of the Principal
Name of Source of Income Address Business Activity
Qv t
S
I hereby ear(or affirm)that the aforesaid information is a true and correct statement.
�B 1 , z61 -�_
Signature of rson disclosing Date signed