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Donna L. Ganz Board application package NAME: Last Name First Name Middle Initial HOME ADDRESS: �- a ^,,0 A 0 • /'�'1i�4 Apt No. House No./Street City State Zip Code PHONE: j e J—V 7 7 40�./c v;g t 1. C°0 do-, Home Work Fax Email address Business Name: N 1A Position: Address: No. Street City State Zip Code Professional License(describe) Expires: 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:Ye or No 0 • Demonstrate an ownership/interest in a business in Miami Be for a minimum of six(6)months-Yes❑or No t� •Are you a registered voter in Miami Beach:Yes ❑or No _ •(Please circle one): I am now a resident of: North Beach Cknow�e h Be Middle Beach • I am applying for an appointment because I have special abilities, ge and xpenence. Please t below: w-,4 EA ®A A N GE : 6c,JC �/i v 4 C..�aa.l-P CA�/"ab i e 9 — � 4 9--1 bep � &--" or�p •Are you presently a registered lobbyist with the City of Miami Beach?Yes a or N P •fie­717 XJ l ,h / w �� �? 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) 0 Affordable Housing Advisory Committee ❑Marine Authority ❑Art in Public Places Committee ❑Miami Beach Commission for Women 0 Beautification Committee ❑Miami Beach Cultural Arts Council ❑Board of Adjustment* ❑Miami Beach Human Rights Committee 0 Budget Advisory Committee 0 Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee ❑Normandy Shores Local Government Neigh. Improvement ❑Committee on the Homeless 0 Parks and Recreation Facilities Board 0 Committee for Quality Education in MB 0 Personnel Board ❑Community Development Advisory 0 Planning Board* ❑Community Relations Board 0 Police Citizens Relations Committee 0 Convention Center Advisory Board ❑Production Industry Council D Debarment Committee ❑Safety Committee cam _ 0 Design Review Board* 0 Single Family Residential Review Panel ❑Disability Access Committee 0 Sustainability Committee ❑Fine Arts Board nnis Advisor Committee °r +; 0 Gay,Lesbian, Bisexual and Trans ender GLBT ❑Transportation and Parking Committee :�:-- ° 0 Golf Advisory Committee ❑Visitor and Convention Authority a-P 7 - ❑Health Advisory Committee 0 Youth Center Advisory Board ==1 i ❑Health Facilities Authority Board �; •• ' 0 Hispanic Affairs Committee ❑Historic Preservation Board ❑Housing Authority D Loan Review Committee *Board Required to 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 0 Years of Service- 2. Present participation in Youth Center activities by your children Yes0 No D. 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- FACLER\$ALL\aFORMS\6O.ARD AND COMMITTEES\BC A.ppiica'ion.doc •Have you ever been convicted of a felony: Yes a or No�If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: Yes❑or No,>36f yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes❑or No XIf yes, explain in detail •Are you currently serving on any City Boards or Committees: Yes❑or No>-< If yes;which board? •What organizations in the City of Miami Beach do you currently hold membership in? Name: A 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:Yes❑or NoKWhich department? • Pursuant to City Code Section 2-25(b):Do you have a parent❑,spouse,,0,child 0,brother 0,or sister❑who is employed by the City of Miami Beach?Check all that apply_ Identify the department(s): /Vd 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 21Female Ethnic Origin: Check one only(1) ❑White (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe,North Africa or the Middle East. ❑African-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa. ❑Hispanic: All persons of Mexican,Puerto Rican,Cuban,Central or South American,or other Spanish culture or origin,regardless of race. ❑Asian or Pacific Islander.All persons having origins in any of the original peoples of the Far East,Southeast Asia,the Indian Subcontinent,on the Pacific Islands. This area includes,for example,China,India,Japan,Korea,the Philippine Islands and Somoa. ❑American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America,and who maintain Cultural identification through tribal affiliation or community recognition. Physically Challenged: Yes 0 or No,_-I. Employment Status: Employed ❑ Retired Homemaker❑ Other❑ 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 City 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. "1 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 de"Standards of Conduct for City Officers, Employees and Agency Members." Zx� ��/b la �o.y.,y A �:v z Applicant's Signature Date Name of Applicant(PLEASE PRINT) Received in the City Clerks Office by: Date: / Control No. Date: Name of Deputy CI y I � flu a City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, www.miamibeachfl.qov CITY CLERK Office CityClerk@miamibeachfl.gov Tel:305.673.7411 , Fax:305.673.7254 Acknowledgement of finesisuspension 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: A 4�A.##2- 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. Signature: Date: F:\CLER\$ALL\aF0RlVIS\B0ARD AND COMMITTEES\13C Application.doc Donna L. Ganz 9 Island Ave. #M-300 Miami Beach,Fla. 33139 (305) 53 (A2 c22 = S `f 77 Experience: January 1987 Florida Highway Patrol Miami, Fla State Trooper March' 1995 Promoted to Sergeant Troop E-Miami January 2000 Promoted to Lieutenant Troop F-Ft. Myers June 2000 Lieutenant Transferred to Troop E-Miami A,451,,& / - /2 C41 re Education: . December 1983 Florida International University,Miami,Florida - Bachelor of Science in Criminal Justice December 1976 Miami-Dade Community College,Miami,Florida Associates of Arts in Criminal Justice Personal Information: C`, n, e Date of Birth: 11-09-54 Hobbies: Bodybuilding,Running, Tennis, and Reading Other Information: Ranked 19 th in the world among female professional tennis players in 1975. Competed at Wimbledon,US Open,French Open, Italian Open and many others during my tennis career. j z-Za -�e �, -n ,.1 Cam, 0�"Lf / 0,0t.) 7 z C.,o 4L�,l &-X"- Ck/ 4- 41 Cj C4 -1 / OAL /-7 --1-7 0 /1 Z__+4-71 �j 0 A -4 0 cc b - / r4- /J /n/ n r re A-/- Z,4 a le'/ /q �C 4�