Michael DeFilippi Application Package!!,/
/NA I.AM I BEACF BOARD AND COMMITTEE APPLICATION FORM
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Last Name
First Name Middle Initial
7fVe H 6 ee-c‹/4 ?/may
Home Address City State Zip Code
75 6 if 4i/ tic%rare.>/1-7/47!s"7(,cd,.1
Home Telephone Work Telephone Cellular Telephone /
irei Mir
p ep one Emall 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 minimum of 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 Mir ni Beach for a minimum of six months: Yes 1=1 or No
• Are you a registered voter in Miami Beach: Yes L or No .
• I am now a resident of: North Beach South Beach Middle Beach
• I am applying fax a5 appointment because I have special abilities, knowledge and experience. Please list below:
p/I(/Gel"le- ct C f eq c
16'diy.x1:7 re")e-- htr, fra h/e rv?
• Are you presently a registered lobbyist with the City of Miami Beach?Yes 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 City Clerk's Office.
❑Ad Hoc Charter Review and Revision Board ❑Disability Access Committee ❑Miami Beach Human Rights Committee
❑Ad Hoc Committee Centennial Celebration ❑Gay, Lesbian, Bisexual and Transgender ❑Miami Beach Sister Cities Program
Enhancement Committee(GLBT)
❑Affordable Housing Advisory Committee ❑Health Advisory Committee ❑Normandy Shores Local Government ..
Neighborhood Improvement
❑Art in Public Places Committee ❑Health Facilities Authority Board ❑Parks and Recreation Facilities Board
❑Board of Adjustment* * ❑Hispanic Affairs Committee ❑Personnel Board
❑Budget Advisory Committee ❑Historic Preservation Board ) ❑Planning Board
❑Committee on the Homeless ❑Housing Authority ❑Police Citizens Relations Committee
❑Committee for Quality Education in MB ❑Marine&Waterfront Protection Authority ❑Prod n Industry Council
❑Convention Center Advisory Board ❑Miami Beach Commission for Women stainability Committee
❑Design Review Board* { ❑Miami Beach Cultural Arts Council ❑Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
❑Visitor and Convention Authority
* 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
IS . Wci . r A r '1IOZ
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°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 Zt No La Dates of Service:
2. Present participation in Youth Center activities by your children:Yes ZJ No Zil
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 U or No laf7es, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes EZ1 or N - If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes Z9 or No If es explain in detail:.
Y Y Y Y p
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•Are you currently serving on any City Board or Committee?Yes or NoI 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 have an interest within the City of Miami Beach:
•Are you now employed by the City of Miami Beach?Yes LI or No IZK-----
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent I:=1, spouse 4I, child I9 brother E--ti 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 ' voluntary and is neither part of your application nor has any bearing on your consideration for
appointment. It is bein sked to comply with City diversity reporting requirements.
Gender: Male Female U
Race/Ethnic Categories
What is your race?
IZI "fr,.n-American/Black
tt Caucasian/White
.1, Asian or Pacific Islander .
Ul Native-American/American Indian
Other—Print Race: .
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
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Do'you consider .ourself to be ish, Hispanic or Latino/a?Mark the "No"bo not Spanish, Hispanic, Latino/a.
° No
DYes
Do you con ' ourself Physically Disabled?
No
Z1 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 indirectly 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 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.
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.
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."
_____ ___(___„ 4'7 .X Mi C � /�
Applicant's Signature sate ame of'7plicant(PLEASE PRINT) /
Received in the City Clerk's Office by: �� J �� V / /
Name of Deputy Clerk Control 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.
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Licensee Details -
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Licensee Information
Name: DEFILIPPI, MICHAEL (Primary Name) -
(DBA Name)
Main Address: 410 EUCLID AVE J
#6
MIAMI BEACH Florida 33139
County: DADE
License Mailing:
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LicenseLocation: • 1111 LINCOLN RD.
SUITE 400
MIAMI BEACH FL 33139
County: DADE •
License Information
License Type: Real Estate Broker or Sales
Rank: . Sales Associate
License Number: SL3228773
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Status: Current,Active
Licensure Date: 12/09/2009
• . Expires: 09/30/2015
Special Qualifications Qualification Effective
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View Related License Information
View License Complaint
1940 North Monroe Street,Tallahassee FL 32399 :: Email: Customer Contact Center Customer Contact Center: 850.487.1395
The State of Florida is an AA/EEO employer.Copvriaht 2007-2010 State of Florida.Privacy Statement
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Under Florida law,email addresses are public records.If you do not want your email address released in response to a public-records
request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any
questions,please contact 850.487.1395.*Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees
licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may be
used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal
address,please provide the Department with an email address which can be made available to the public.Please see our Chapter
455 page to determine if you are affected by this change.
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