Laurie Kaye Davis Minority Report AAIAtol $ •
DIVERSITY STATISTICS REPORTING
Name: LA e Ccx y -e Diciv, 3
Board / Committee: V.) O O../v-NM " t1
Appointment Date: h e< i cL0 I
Pursuant to City of Miami Beach Ordinance 2009-3632, 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:
Male Female IZ
Gender: a
Race/Ethnic Categories
What is your race?
g)ffican-American/Black
I. Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
EJ Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic,Lgi<o
Yes
Do you consider yourself Physically Disabled?
No
:a Yes
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