David Richardson 12/31/2013 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miomibeochfl.aov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
Tel: (305) 673-7411, Fax: (305)673-7254
04-12-2012
David Richardson
SUWEG,T:,,, Personnel Board
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2013.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1 st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
Aa�l
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ramiro Inguanzo
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, #hoard or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 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 Employee
IWe are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m MIAMI BEACH
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
TO David Richardson
RE: Personnel Board
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 theFlonda 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.
X 44,1-
Da vi Richardson
St
Sworn to and subscribed before me this�day of AO 12.
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.
NAME: (C��4�DSG IU(:� bA 1/1 1)
Last Name First Name Middle Initial
HOME ADDRESS: ' I 100�- g ` 5+ Nl. AA4 1 S6N O H-1 33138
2 pt No. House No./Street City St a Zip Code
PHONE: 30e s 3(. ��� &r`I S f-j^_ - py,�,
Home Work Fax Email addressOO
Business Name: SFit/ �1E1 / -E p Position: QG+/NCl �I✓V
Address: gtrw
No. f�A /�A/� Street L � City State Zip Code
Professional License(describe)QA 1 Ci 001 sry�(7 Expires:�Z 3� � Attach a copy of the Hemse
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 Kor No ❑
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minimum of six(6)months: Yes❑or No ❑
•Are you a registered voter in Miami Beach:Yes X or No ❑
• (Please circle one): I am now a resident of. North Beach h Middle Beach
• I am applying for an appointment because I have special abilities,kn:Q Please list below. C fA
•Are you presently a registered lobbyist with the City of Miami Beach?Yes 13 or No
(^GAS u 4tic4
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 ❑Historic Preservation Board
❑Art in Public Places Committee ❑Housing Authority
❑Beautification Committee ❑Loan Review Committee
❑Board of Adjustment* ❑Marine Authority
Budget Advisory Committee ❑Miami Beach Commission for Women
❑Capital Improvements Projects Oversight Committee ❑Miami Beach Cultural Arts Council
❑Committee on the Homeless ❑Miami Beach Human Rights Committee
❑Committee for Quality Education in MB ❑Miami Beach Sister Cities Program
❑Community Development Advisory O Normand Shores Local Government Neigh. Improvement
❑Community Relations Board ❑Parks and Recreation Facilities Board
❑Convention Center Advisory Board WP'ersonnel Board
❑Debarment Committee ❑Planning Board*
❑Design Review Board* ❑Police Citizens Relations Committee
❑Disability Access Committee ❑Production Industry Council
❑Fine Arts Board ❑Safety Committee
❑Gay, Lesbian Bisexual and Trans ender GLBT ❑Single Family Residential Review Panel
❑Golf Advisory Committee ❑Sustainability Committee
❑Health Advisory Committee ❑Transportation and Parking Committee
❑Health Facilities Authority Board ❑Visitor and Convention Authority
❑Hispanic Affairs Committee O Waterfront Protection Committee
❑Youth Center Advisory Board
*Board Required W 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 ❑. 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:
r_ �. 1'TFES�',,CC?�,pp1jC:,:i1CDn 1:100
I": .,�G:�\F•� �-�C7 �..�.. CJ A.J
AND� �.J�::�
r r�•l NAIN01 BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.mia mibeachfl.aov
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: L• �>A y I
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.
� � l ?,-
Signature: Date:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc
I
THIS DOCUMENT HAS A COLORED BACKGROUND-MICROPRINTING-LINEMARK-PATENTED PAPER
AC# 5 8 3 6 5 3 7 STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
BOARD OF ACCOUNTANCY SEQ#L11102001037
. . - LICENSE NBR
110/20/2011J110147926 JAC0015654
The CERTIFIED PUBLIC ACCOUNTANT
Named below IS LICENSED -
Under the provisions of Chapter 473 FS.
Expiration date: DEC 31, 2013
RICHARDSON, LANCE DAVID
1005 8TH ST UNIT PH-1
MIAMI BEACH FL 33139
RICK SCOTT KEN LAWSON
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY
M 1 A M I•DADE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name
Disclosure
b For Tax Year
Name: L�N�-�= - I�-1Ir[� Pos;o EndinA0l0
Mailing Address: OUSE 0 %' V
l�/
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City/State/Zip: 3
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N 71 Social Security Number: - � 'r,
Filing as a: D County Employee: o Ti
0 Municipal Employee of-
Position held or sought: N
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N
Board where serving:?te,&oNNf7L 60App Term or Employm nt cc)
Began on: // L
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read instructions): 0 Work Telephone:
Home Address: 2j6 0 V
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
a Activity
e
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Si. n ure of person isclosinq Dateiiqneb
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