Russell Hartstein B&C Application NNA�Ml BEACH
NAME: Hartstein Russell
Last Name First Name Middle Initial
HOME ADDRESS: p.o. box 191121 Miami Beach FL 33139
Apt No. Home No./Street City State Zip Code
PHONE: 786 372 0299 786 372 0299 info@funpawcare.com
Home Work Fax Email Address
Business Name: Fun Paw Care,LLC Position: CEO
Address: p.o..box 191121 Miami Beach FL 33119
No. Street City State Zip Code
Professsional License(describe): Expires:
Ac:ach
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: Yes
•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:
Have worked extensively with green and sustainability initiative in professional and personal I
•Are you presently a registered lobbyist with the City of Miami Beach? 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 Housing Authority
Art in Public Places Committee Loan Review Committee
)�h/ Beautification Committee #✓D 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 Ouality Education in MB Miami Beach Sister Cities Program
7a) Committee on the Homeless Normandy Shores Local Gov't Neigh. Improvement
Community Development Advisory Parks and Recreation Facilities Board NO
Community Relations Board Personnel Board
Convention Center Advisory Board Planning Board*
Debarment Committee Police Citizens Relations Committee
Design Review Board* Production Industry Council
14 3 Disability Access Committee Safety Committee
Fine Arts Board Single Family Residential Review Panel
Gay,Lesbian,Bisexual and Transgender(GLBT) '[1] 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
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 Money Beach any money: No If yes, please 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:
• I am now employed by the city of Miami Beach: No Which department?
o 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 department(s):
The following information is voluntary and is neither part of your application nor hds 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:
• 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 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 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 Russell Hartstein agreed to the following terms on 4/18/2012 10:41:02 AM
Received in the City Clerk's Office by: Date: / /2012 Control No Date: l� v
-'�Name of Deputy Clerk
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
HartsteinRussell
NAME:
First Name
Last NameMiddle Initial
FL33139
HOME ADDRESS
:
p.o. box 191121Miami Beach
Home No./StreetState
Apt No.City
Zip Code
info@funpawcare.com
786 372 0299786 372 0299
PHONE
:
WorkEmail Address
HomeFax
CEO
Business Name:
Fun Paw Care, LLC
Position:
p.o. box 191121Miami BeachFL33119
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
Yes
Yes
South Beach
circle one): I am now a resident of:
Have worked extensively with green and sustainability initiative
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
[3]Beautification CommitteeMarine Authority
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 Advisory[2]Parks and Recreation Facilities Board
Community Relations BoardPersonnel Board
Convention Center Advisory BoardPlanning Board*
Debarment CommitteePolice Citizens Relations Committee
Design Review Board*Production Industry Council
Disability Access CommitteeSafety Committee
Fine Arts BoardSingle Family Residential Review Panel
Gay, Lesbian, Bisexual and Transgender (GLBT)[1]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:
No
Are you currently serving on any City Boards or Committees:If yes, which board?
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
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)
White
No
Physically Challenged:
Employed
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 Russell Hartstein agreed to the following terms on 4/18/2012 1
Received in the City Clerk's Office by:Date: / /2012Control No.Date: / /2012
Name of Deputy Clerk