Debra H. Schwartz Board and commititee application package Last Name eepeA 44 .
First Name Middle Initial
Home Address -(q*I ami IFL• 931 kb
.3 city State Zip Code
14&9 798 1—ig at t•Copt Home Telephone Work Telephone Cellular Telephone . Email address N
Business Name
Occupation
Business Address city state Zip Code
Professional Ucense(describe):
Expires:
Pursuant to City Code section 2-22(4)a&b: Members of agencies, boards and committees shall be affiliated with the C4;
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 ownershipfinterest for a minimum of six months in a business established in
for a minimum of six months. the City
I
• Resident of Miami Beach for a minimum of six(6)months:Yes 10eor No D
• Demonstrates ownership/interest in a business in Mimi Beach for a minimum of six months:Yes El or No
•Are you a registered voter in Miami Beach:Yes liYor No M
• I am now a resident of-- North Beach M South Beach El Middle Beach E;aro*
am applying for use I have special a e. Please list bet
y because _t bilitiy.kn9WJedge anqexqenenc 0 •
VtA'� e -Wet dLW!S C1
trb•Are you presently a registered lobbyist with the City of Miami Beach?Yes ED or 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 Cfty Clerk's Office.
❑Ad Hoc Charter Review and Revision Board 0 Debarment Committee 0 Miami Beach Human Rights Committee
0 Ad Hoc Committee Centennial Celebration _ 0 Wtqn Review Board* 0 Miami Beach Sister Cities Pro g ram
0 Ad Hoc Committee Flooding Task Force 0 Disability Access Committee 0 Normandy Shores Local Government
— Neighborhood Improvement
❑Affordable Houser g Advisory Committee 0 Fine Arts Board 0 Parks and Recreation Facilities Board
0 Art in Public Places Committee ❑Gay,Lesbian,Bisexual and Transgender 0 Personnel Board
0 Beautification Coffirriffee Enhancement Committee(GLBT)
0 Goff Advisory Committee ❑Planning Board
❑Bicycle-Peckstrian Adm-!§M Committee 0 Health Advisory Committee 0 Police Citizens Relations Committee
❑Board of AcrAistment 0 Health Facilities Authority Board 0 Production Ind!.aft Council
❑Budget Advisory Committee 0 Hispanic Affairr.Committee 0 SaW Committee
0 Capital Improvements Projects Oversight 0 Historic Preservation Board 0 Single Family Residential Review Panel
ommittee
S[2g!mfttee on the Homeless D ousing Authority 0 Sustainability Committee
Committee for Quardy Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee
Committee
0 Community Development Advisory Committee ❑Marine 6uthority
0 Transportation and Parkin q Committee
❑Community Relations Board ❑Miami Beach Commission fbrWomen ❑Visitor and Convention Authority
0 Convention Center Advisor
y Board 0 Viami Beach Cultural Arts Council 0 Youth Center Advisory Board
0 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
FACLERWALLWORNIMBOARD AND COMMITrEES%BC APPLICATION 46 BOARDS 12-16-2013-doc
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 I No Dates of Service:
2. Present participation in Youth Center activities by your children:Yes El No El
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 0 or No IV If yes,please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes 0:or No5KIf yes,please explain in detail:
•Do you currently owe the City of Miami Beach any money?Yes 0 or No 5K If yes,explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No 0 If yes,which board/committee?
®tr�y�lttLl VeL- .'t10 ray 15o^02>
•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 have an interest within the City of Miami Beach:
•Are you now employed by the City of Miami Beach?Yes 0 or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent El, spouse 0., child El brother 0 or sister 0 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 comply with City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories
What is your race?
0 African-American/Black
IZCaucasianNVhde
Asian or Pacific Islander
0 Native-American/American Indian
0 Other—Print Race:
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F:ICLER%$ALLUaFORMMBOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013_doc
Do you consider yourself to be Spanish,Hispanic or Latinola?Mark the"No"box if not Spanish,Hispanic,Lafino/a.
�No
0 Yes
Do you consider yourself Physically Disabled?
lkfNo
0 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:
o Prohibition from directly or indirecctly 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 the 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).
o 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).
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in 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.
o Voting conflict—Form 8B 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.
1 HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION;AND 1 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."
W. 44A WLtt7' J/1,6/-W 114 6BRA
Ap licant's Signatu ate me of plicant(PLEASE PRINT)A. C
%Received in the City Clerk's Office by:
Name of Deputy Clerk C ntrol No. ate
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
FXLERWALLWORMSIBOARD AND COMMITTEES%BC APPLICATION 46 BOARDS 12-16-2013.doc
I
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139:
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 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: �� �.- `
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
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 I. of each year.
1. A"Source of Income Statement"
For your convenience,the form is attached.The form can also be downloaded at:
2. A"Statement of Financial Interests (Form 1)n
For your convenience,the form is attached. The form can also be downloaded at:
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 $500, 60 days in jail or both.
/,-go i
Signature Jbate
Updated:Monday,December 16,2013
Page 4 of 4
F:ICLER%$ALWFORMSIBOARD AND COMMITTEESIBC APPLICATION 46 BOARDS 12-16-2013_doc
RESUME
DEBRA H. SCHWARTZ
RESIDENCE: 5680 Pinetree Drive
Miami Beach,Florida 33140
305-865-7187
MARITAL STATUS: Married Husband—Gerald K. Schwartz
Three children
EDUCATION: Grainger High School,Kinston,N.C., 1957 Graduate
Emory University, Atlanta, Ga., 1961 —BA Degree
PROFESSIONAL: Legislative Assistant, State of Florida
1993-2010
Office Manager,Medical Office
1988-1993
Teacher, Biscayne Elementary School
1961-1965
ACTIVITIES: Volunteer,Miami Beach Senior High School
2011-Present
Volunteer, Mount Sinai Medical Center
2012-Present
Member, Miami Beach Community Relations Board
2008-present
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Ci4'P1TOL CONIP:LEX'
EXP 11/10
DEBRA H. SCHWARTZ
SENATE 34387