Tiffany L. Lapciuc board application package . 8L--ARJ Ar4;., CO�Yfai,!!TEE APPLICATION L.+.A{lea'! i°lJR.ri
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Last Na e First Name Middle Initial
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14con -7r_ i2i9 , _�f_tV_z f-L. I I 3/lyo
Home Address City State Zip Code
05-311
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Home T lephone Work Telephone Cellular Telephone Etnail address
Business Name Occupation
Business Address City State Zip Code
Professional License (describe): Expires:
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a & 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 minimu f six months in a business established in the City
for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes or No
• Demonstrates ownership/interest in a business in Mmivni Beach for a minimum of six months: Yes[_�a or No
• Are you a registered voter in Miami Beach: Yes V or No.�:_3_
C--)
• I am now a resident of: North Beach E.3 South Beach [-::) Middle Beach ---
• I am applyin for an appointment because I have sp V bilities, knowledge and experience. Please lisgelo
on I / D 7-1
o Are you presently a registered lobbyist with the City of Miami Beach? Yes 0'or No
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choices Please nffi that
only three 3 choices will be observed by the City Clerk's Office. _
❑Ad Hoc Charter Review and Revision Board ❑Debarment Committee ❑Miami Beach Human Rights Committee
❑Ad Hoc Committee Centennial Celebration ❑Design Review Board* ❑Miami Beach Sister Cities Program
❑Ad Hoc Committee Flooding Task Force ❑Disability Access Committee ❑Normandy Shores Local Government
Neighborhood Improvement
❑Affordable Housing Advisory Committee ine Arts Board ❑Parks and Recreation Facilities Board
❑Art in Public Places Committee ❑Gay,Lesbian, Bisexual and Transgender ❑Personnel Board
Enhancement Committee(GLBT)
Beautification Committee ❑Golf Advisory Committee ❑Planning Board
❑Bicycle-Pedestrian Advisory Committee 0 Health Advisory Committee ❑Police Citizens Relations Committee
❑Board of Adjustment* ❑Health Facilities Authority Board ❑Production Industry Council
❑Budget Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee
❑Capital Improvements Projects Over ❑Historic Preservation Board ❑Single Family Residential Review Panel
Committee
❑Committee on the Homeless ❑Housing Authority ❑Sustainability Committee
❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee
❑Community Development Advisory Committee ❑M vine Authority ❑Transportation and Parking Committee
❑Community Relations Board 1114liami Beach Commission for Women ❑Visitor and Convention Authority
❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board x
❑Waterfront Protection Committee
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review
Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the
following information:
Type of Professional License
License Number
License Issuance Date License Expiration Date
Page 1 of 4 S
F:ICLER\SALL1aFORMS180ARD AND COMM1TTEESIBC APPLICATION 46 BOARDS 12-10-2013.doc �41
°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board:Yes No Dates of Service:
2. Present participation in Youth Center activities by your children:Yes EZI No
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes EZ�or No If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes E-Zt or N ! If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes or Not If yes, explain in detail:
• Are you currently serving on any City Board or Committee?Yes or No If yes,which board/committee?
• In what organization(s)in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List all properties owned or in which you Piave an interest within the City of Miami Beach:
• Are you now employed by the City of Miami Beach?Yes EZI or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent , spouse , child brother or sister who is
employed by the City of Miami Beach? Check all that apply.
If"Yes,"identify person(s)and department(s):
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 55 y with City diversity reporting requirements.
Gender: Male . Female
Race/Ethnic Categories
What is your race?
ican-American/Black
E CaucasianNVhite
ID Asian or Pacific Islander
Native-American/American Indian
Other—Print Race:
Page 2 of 4
F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a.
Y No
EI Yes
Do you consider yourself Physically Disabled?
No
Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
• 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 the board/committee you'have served on for period of one year after leaving office(Miami Beach
City Code section 2-26).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
• 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).
• Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
• Voting conflict—Form 88 is for use by any person serving at the county, city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
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 I HAVE RECEIVED, READ AND
WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS,EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
Applicant's i nature P Name of Applicant(P EASE PRIG'T)
Received in the City Clerk's Office by
ame of Dep ty Clerk Control No. D to
r
j PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A
COPY OF ANY APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
Page 3 of 4
F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc
NAIAMIBEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachn.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.6 73.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:
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
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk-of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A'"Source of Income Statement"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pd
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://wwvv.ethics.state.fl.us/ethics/forms.html
3. A Copy of your 2013 Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
Signature Da
Updated: Monday,December 16,2013
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F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 50ARDS 12-16-2013.doc
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From: Mom tiffanylapciuc@bellsouth.net
Subject: Tiffany Resume
Date: February 6,2014,2:02 PM
To: Mom tiffanylapciuc @bellsouth.net
Tiffany Lapciuc
Born in Miami Beach,Florida
Reside in Miami Beach,Florida
Graduated from University of Miami with a B.B.A. In Finance
And an M.B.A. In Finance
Currently raising six children ranging in age from 27 to 7.
Also three grandchildren.
Married to Marcos Lapciuc previous Chairman of Jackson Health Systems
Served on the Commission for Women for two years
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