Marlo Courtney Board Application2335 magnolia drive keystone point HOME ADDRESS :Apt No.Home No./Street City FL 33181 State Zip Code 305 796 6589 305 531 4411 PHONE :Home Work Fax marlo@goldmanproperties.com Email Address No 2. Present participation in Youth Center activities by your children Note : If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: Child's name:Age:Program:Program:Age:Child's name:1. Past service on the Youth Center Advisory Board: No Years of Service: ages, and which programs. List below:if yes, please list the names of your children, their Goldman Properties Position:Business Name:Managing Director courtney marlo NAME:Last Name First Name Middle Initial CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM 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)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. No Ɣ5HVLGHQWRI0LDPL%HDFKIRUDPLQLPXPRIVL[ PRQWKV Ɣ'HPRQVWUDWHDQRZQHUVKLSLQWHUHVWLQDEXVLQHVVLQ0LDPL%HDFKIRUDPLQLPXPRIVL[ PRQWKV Ɣ$UH\RXDUHJLVWHUHGYRWHULQ0LDPL%HDFK Ɣ 3OHDVHcircle one): I am now a resident of: Ɣ,DPDSSO\LQJIRUDQDSSRLQWPHQWEHFDXVH,KDYHVSHFLDODELOLWLHVNQRZOHGJHDQGH[SHULHQFH3OHDVHOLVWEHORZ Ɣ$UH\RXSUHVHQWO\DUHJLVWHUHGOREE\LVWZLWKWKH&LW\RI0LDPL%HDFK"Yes No South Beach No Real Estate and Hospitality - Business Development - Historic Preservation - Community Invol Miami Beach No.Street 804 Ocean Drive City FL State 33139 Zip Code Address:Professsional License (describe):Expires:Attach a copy the license Affordable Housing Advisory Committee Housing Authority Art in Public Places Committee Loan Review Committee Beautification Committee Marine Authority Board of Adjustment* Miami Beach Commission for Women Budget Advisory Committee Miami Beach Cultural Arts Council Capital Improvements Projects Oversight Committee Miami Beach Human Rights Committee Committee for Quality Education in MB Miami Beach Sister Cities Program Committee on the Homeless Normandy Shores Local Gov’t Neigh. Improvement Community Development Advisory Parks and Recreation Facilities Board Community Relations Board Personnel Board Convention Center Advisory Board [1] Planning Board* Debarment Committee Police Citizens Relations Committee Design Review Board* Production Industry Council Disability Access Committee Safety Committee Fine Arts Board Single Family Residential Review Panel Gay, Lesbian, Bisexual and Transgender (GLBT) Sustainability Committee Golf Advisory Committee Transportation and Parking Committee Health Advisory Committee Visitor and Convention Authority Health Facilities Authority Board Waterfront Protection Committee Hispanic Affairs Committee Youth Center Advisory Board Historic Preservation Board
No ƔHave you ever been convicted of a felony:If yes, please explain in detail:ƔDo you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail:ƔDo you currently owe the City of Money Beach any money:No If yes, please explain in detail:ƔAre you currently serving on any City Boards or Committees:No If yes, which board?ƔWhat organizations in the City of Miami Beach do you currently hold membership in?Name:Name:ocean drive improvement association Title:Title:secretary ƔList all properties owned or have an interest in, which are located within the City of Miami Beach:Park Central Hotel ƔI am now employed by the city of Miami Beach:No Which department?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 Ethnic Orgin: Check one only (1)White Physically Challenged:No Employment Status:Employed 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 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, Article VII – of the City Code “Standards of Conduct for City Officers, Employees and Agency Members.”I marlo courtney agreed to the following terms on 3/13/2012 7:15:14 PM Received in the City Clerk's Office by:Name of Deputy Clerk Date: / /2012 Control No.Date: / /2012 ƔPursuant 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 department(s):