Harvey Burstein Minority Report MIAMI BE A CH
DIVERSITY STATISTICS REPORTING
Name: •//q r V 7 ✓ 0 r S '(''J
Board / Committee: /`7 i avii f / ' a shy" 0 i° 71, �.497
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Appointment Date: /2- 2 /5
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:
Gender: Male all Female ZJi
Race/Ethnic Categories
What is your race?
La African-American/Black
'E1 Caucasian/White
IZ3 Asian or Pacific Islander
La 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, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
--‘1<lo
Z !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