Alexander C. AnnunziatoCITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
AnnunziatoAlexanderC
NAME:
First Name
Last NameMiddle Initial
FL33139
HOME ADDRESS
:
14311000 West AvenueMiami Beach
Home No./StreetState
Apt No.City
Zip Code
AC.Annunziato@gmail.com
7863654118
PHONE
:
WorkEmail Address
HomeFax
Business Name:
Position:
Miami BeachFL
Address:
State
No.
CityZip Code
Street
Expires:
Attach a copy the license
Professsional License (describe):
Pursuant to City Code section 2-22(4) a and b:
Members of agencies, boards, and committees shall be affiliated
requirement shall be fulfilled in the following ways: a) an indi
months; or b) an individual shall demonstrate ownership/interest
Yes
No
Yes
South Beach
circle one): I am now a resident of:
I have served on the board of adjustment for three terms and hav
No
123Please note that only three (3)
Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice.
choices will be observed by the City Clerks Office.
(Regular Boards of City)
Affordable Housing Advisory CommitteeHousing Authority
Art in Public Places CommitteeLoan Review Committee
Beautification CommitteeMarine Authority
[1]Board of Adjustment*Miami Beach Commission for Women
Budget Advisory CommitteeMiami Beach Cultural Arts Council
Capital Improvements Projects Oversight CommitteeMiami Beach Human Rights Committee
Committee for Quality Education in MBMiami Beach Sister Cities Program
Committee on the HomelessNormandy Shores Local Govt Neigh. Improvement
Community Development AdvisoryParks and Recreation Facilities Board
Community Relations BoardPersonnel Board
Convention Center Advisory Board[2]Planning Board*
Debarment CommitteePolice Citizens Relations Committee
[3]Design Review Board*Production Industry Council
Disability Access CommitteeSafety Committee
Fine Arts BoardSingle Family Residential Review Panel
Gay, Lesbian, Bisexual and Transgender (GLBT)Sustainability Committee
Golf Advisory CommitteeTransportation and Parking Committee
Health Advisory CommitteeVisitor and Convention Authority
Health Facilities Authority BoardWaterfront Protection Committee
Hispanic Affairs CommitteeYouth Center Advisory Board
Historic Preservation Board
Note
: If applying for Youth Advisory Board, please indicate your aff
1. Past service on the Youth Center Advisory Board:
No
Years of Service:
if yes, please list the names of your children, their
No
2. Present participation in Youth Center activities by your chil
ages, and which programs. List below:
Age:Program:
Child's name:
Age:Program:
Child's name:
No
Have you ever been convicted of a felony:If yes, please explain in detail:
Do you currently have a violation(s) of City of Miami Beach code
No
If yes, please explain in detail:
No
Do you currently owe the City of Money Beach any money:If yes, please explain in detail:
Yes
Are you currently serving on any City Boards or Committees:If yes, which board?
Board of Adjustment
What organizations in the City of Miami Beach do you currently h
Name:Title:
Name:Title:
List all properties owned or have an interest in, which are loca
None/Currently rent my apartment
No
I am now employed by the city of Miami Beach:Which department?
Pursuant to City code Section 2-25(b):
do you have a relative who is employed by the
City of Miami Beach? Check all that apply. Identify the departme
The following information is voluntary and is neither part of yo
being asked to comply with federal equal opportunity reporting r
Gender:Male
Ethnic Orgin: Check one only (1)
Hispanic
No
Physically Challenged:
Homemaker
Employment Status:
NOTEIf appointed, you will be required to follow certain laws which
:
These laws include, but are not limited to, the following:
Prohibition from directly or indirectly lobbying city personnel
o
Prohibition from contracting with the city (Miami-Dade County Co
o
Prohibition from lobbying before board/committee you have served
o
Beach Code section 2-26).
Requirement to disclose certain financial interests and gifts (M
o
(re: CMB Community Development Advisory Committee): prohibiti
from having any interest in or receiving any benefit from Co
or those with whom you have business or immediate family ties
Upon request, copies of these laws may be obtained from the
I hereby attest to the accuracy and truthfulness of the applica
VII of the City Code Standards of Conduct for City Officers,
I Alexander Annunziato agreed to the following terms on 2/13/201
Received in the City Clerk's Office by:Date: / /2012Control No.Date: / /2012
Name of Deputy Clerk