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Richard Murry ApplicationCITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM MurryRichardH NAME: First Name Last Name Middle Initial FL33140 HOME ADDRESS : 5925 Lagorce DriveMiami Beach Home No./StreetState Apt No.City Zip Code richard@tma-pr.com 305-321-0275305-531-5720305-673-8883 PHONE : WorkEmail Address HomeFax Owner Business Name: The Murry Agency Position: 1130 Washington Avenue, First Floor Nort Miami BeachFL33139 Address: State CityZip Code Street 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 Middle Beach circle one): I am now a resident of:  PR, publicity, media relations, marketing 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 Clerk’s Office. (Regular Boards of City) Choice 1:Gay, Lesbian, Bisexual and Transgender (GLBT) Choice 2: Choice 3: 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: No Have you ever been convicted of a felony:If yes, please explain in detail: No Do you currently have a violation(s) of City of Miami Beach codeIf 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 NameTitle Miami-Dade Gay & Lesbian Chamber  World Outgames 2017Board Winter Party FestivalExecutive Committee Miami Beach Gay PrideBoard member St. John's United Methodist ChurchStaff/Parish Relations Co List all properties owned or have an interest in, which are loca Property 5925 Lagorce Drive No I am now employed by the city of Miami Beach:Which department? The following information is voluntary and is neither part of yo being asked to comply with federal equal opportunity reporting r Gender:Male Race/Ethnic Categories White What is your race? Mark one or more races to indicate what you consider yourself t Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani No No Physically Challenged: 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 Richard Murry agreed to the following terms on 8/16/2013 3:45: Received in the City Clerk's Office by: Name of Deputy Clerk Control No.Date