Alex Tonarellir
MI AM BEACH
DIVERSITY STATISTICS REPORTING
k Name: > GA r I I
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Board / Committee: Ju( Uce a bir iV& G 9/4 c Ce_
Appointment Date: , /
Pursuant to City of Miami Beach Ordinance 20'09-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category: •
Gender: Mal, Female Li
Race/Ethnic Categories
What is your race?
African-American/Black
l Caucasian/White
Asian or Pacific Islander
` i ,native-American/American Indian }
���t�ther— Print Race: / c4
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
Yes. c ,.t .- ; ( 2
Do-you'coriside. ..ourself Ph"-sically Disabled?
No
1:=J1 Yes 1
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C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015
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