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Samuel J. Rabin Application Packagetv\IAMI BEACH ,c '1 v\ 4e 1 Last Name First Name <4\ \CAM.1Z12SC BOARD AND COMMITTEE APPLICATION FORM Middle Initial 1 Home Address City State Home Telephone Work Telephone Cellular Telephone Sc( \ J ;� l2Q,IC:�;. '?i.N��1c)if\(N_ Business Name Occupation op 1 1 CV) \\ N ,Ske VA') V\ \\ Business Address _ City Professional License (describe): �— �-� Expires: Please attach a copy of currently effective professional license. Zip Code Cn1GM 1 laNrye( (t Em address State Zip Code 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. Ari individual shall demonstrate ownershi./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) month • Yes or No Li • Demonstrates ownership/interest in a business in M. i Beach for a minimum of six months: Yesr No 1 s. • Are you a registered voter in Miami Beach: Yes U or No —.- • I am now a resident of: North Beach IZI South Beach _..1 Middle Beach • I am appl�ri g..fo an appoint ent because I have special a ilties, kno e nd exgerienc PI e list below: CA al CV, • Are you presently a registered lobbyist with the City of Miami Beach? Yes LA 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 Office of the City Clerk. ❑ Affordable Housing Advisory Committee ❑ Health Advisory Committee ❑parks and Recreation Facilities Board °O ❑ Art in Public Places Committee ❑ Health Facilities Authority Board ❑ Personnel Board ❑ Audit Committee ❑ Hispanic Affairs Committee ❑ Planning Board** ❑ Board of Adjustment ** ❑ Historic Preservation Board* ❑ Police Citizens Relations Committee ❑ Budget Advisory Committee ❑ Housing Authority ❑ Production Industry Council ❑ Committee on the Homeless ❑ Human Rights Committee ❑ Sister Cities Program ❑ Committee for Quality Education in MB E LGBT Advisory Committee ❑ Sustainability Committee ❑ Convention Center Advisory Board ❑ Marine & Waterfront Protection Authority C Transportation, Parking, & Bicycle -Pedestrian Facilities Committee Cultural Arts Council ❑ Miami Beach Commission for Women ❑ Visitor and Convention Authority ❑ Design Review Board * ❑ Normandy Shores Local Government Neighborhood Improvement ❑ Youth Commission D Disability Access 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 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx °° Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with the Scott Rakow Youth Center and/or the North Shore Parks Youth Center: • Please describe your past service with the City's Youth Centers (include dates of service): • Present participation in Youth Center activities by your children: Yes LD No 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 or No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes Zi or Noes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes ,_ or No yes, explain in detail: • Are you currently s�aSingo��anC�ty Board r��fr Yes or No yes, which board/committee? ` \r\\ • 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 or No Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have arent , spouse , child brother or sister 11 who is employed by the City of Miami Beach? Yes [-Zior No 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: MaleLJ Female Race/Ethnic Categories What is your race? Li African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx 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? 4�'IQo 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 C e ' - ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFIC , EMPLOYE AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STAT S ACCORDING ' ." Applica ure Received in the Office of the City Clerk by: ` L&&\ - r\ J ✓ Date / Name of Applicant (PLEASE PRINT) 1 c /ili -)/) s/ d 3 ////d' 6 Name of Deputy Clerk Control No. Date 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 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx 800 BRICKELL AVENUE SUITE 1400 MIAMI, FLORIDA 33131 EMPLOYMENT: 1995 to present 1985 - 1995 1978 - 1985 1983 thru 1985 1982 thru 1983 1981 thru 1981 1979 thru 1981 SAMUEL J. RABIN, JR., ESQUIRE TELEPHONE: FACSIMILE: EMAIL: WEBSITE: (305) 358-1064 (305) 372-1644 sjr@miamilawyer.com www.miamilawyer.com LAW FIRM OF SAMUEL J. RABIN, JR., P.A. - Miami, FL Sole Practitioner: Practice devoted exclusively to criminal defense in the federal courts of the United States of America and the state courts of Florida. Within the field of criminal law, the firm specializes in white collar offenses and violations of federal criminal law; health care related litigation; money laundering and banking related offenses; grand jury matters and litigation with the internal revenue service. LAW FIRM OF MOORE AND RABIN, P. A. - Miami, FL Partner: Firm practiced exclusively in field of criminal defense in the federal courts of the United States of America and the state courts of Florida. MIAMI-DADE COUNTY STATE ATTORNEY'S OFFICE - Miami, FL Deputy Chief Assistant State Attorney to State Attorney Janet Reno: Handled major crime prosecutions (capital murder cases) and major narcotics trafficking and conspiracy cases. Cross -designated to prosecute federal drug cases through a government strike force known as CENTAC 26. Division Chief: Supervisor of group of attorneys in a felony trial unit. Narcotics Division: Trial attorney in this unit which concentrated on narcotic related offenses. Felony Trial Division: Worked in the felony trial division handling prosecutions of all classes and degrees of felony crimes. SAMUEL J. RABIN, JR., ESQUIRE Page 1 of 3 BAR ADMISSIONS: Supreme Court of the United States of America Supreme Court of the State of Florida Eleventh Circuit Court of Appeals Fifth Circuit Court of Appeals United States District Court for the Southern District of Florida United States District Court for the Middle District of Florida United States District Court for the Eastern District of Michigan United States District Court for the Western District of Pennsylvania PROFESSIONAL ASSOCIATIONS AND ORGANIZATIONS: National Association of Criminal Defense Lawyers Member - 1985 to present Florida Association of Criminal Defense Lawyers, Miami Chapter Board of Directors & Member -1987 to present Florida Association of Criminal Defense Lawyers Statewide Director -1995 to present National Health Lawyer's Association Member - 1994 to present Dade County Bar Federal Courts Committee Member -1993 & 1997 Florida Association of Criminal Defense Lawyers Charter Member -1992 to present Federal Bar Association Member - 1986 to present Florida Bar Association Member -1979 to present Florida Bar Grievance Committee Member -1991-1994 Florida Bar Grievance Committee Chairman -1993 -1994 American Bar Association Member - 1979 to present Dade County Bar Association Member - 1979 to present Federal Bar Committee Co -Chairman Criminal Courts Committee Vice -Chairman Dade County Bar Association Vice -Chairman SAMUEL J. RABIN, JR., ESQUIRE Page 2 of 3 EDUCATION: Nova University School of Law Juris Doctor Degree conferred 1978 Purdue University BSIM Degree conferred 1976 CHARITABLE & CIVIC ORGANIZATIONS: Sunset Island III & IV Homeowner's Association Board Member Greater Miami Jewish Federation Member Bench & Bar Unit of B'Nai B'Rith Member American Civil Liberties Union Member Anti -Defamation League of B'Nai B'Rith Member Rabbi's Advisory Board of Temple Israel of Greater Miami Member Temple Beth Sholom Member SAMUEL J. RABIN, JR., ESQUIRE Page 3 of 3 11 4.-4140. Member Since „,s Samuel Joseph Rabin Jr. 011 111 11 0273831 MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK CityClerk@miamibeachfl.gov Telephone: 305.673.741 1 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: cc.N.\ Lk—�G 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 1, of each year. 1. A "Source of Income Statement" 2. A "Statement of Financial Interests (Form 1)" 3. A Copy of your latest 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. Signature Date Updated: Tuesday, October 04, 2016 • Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx SOURCE OF INCOME STATEMENT Disclosure or Tax Year Ending !Last Nam First Name Middle Name/Initial IA VIAAXO Halling Ad ress — Street Street Na e, or P.O. B� VL-� 7 jl(L t J V City, fe, Zip -51 tAA-� ) ID Number If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read instructions on the following page and check here. 0 County/Public Health Trust r] Municipal: Q (Municipality) Department Position or Title Work address Work telephone Employment began on/ended on Fiiina as a Board Member (check one) County Board Municipal: (Municipality) Board where serving Alternate address (if home address is exempt) Work telephone L Term began on/ended on List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of income In descending order, with the largest source first. Also, include any source of income received by another person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here. 0 Nance of Source of Income Address f Description of the Principal Business Activity a wc � kA, tv`l , SZ a?� i`✓i OO <6‹ �-1.1 �AdH- L C cTut1/l. I hereby sw r affirm) th, the inion kAAA ; ice, g a-1 n above is a true and correct statement. Signature erson Disclosing Date signed RECEIVED BY ELECTIONS DEPARTMENT: U Hardcopy Electronic Copy OFFICE USE ONLY Accepted: Y / N Deficiency: 138_SP•14 COE 2015 Processed Date/Initials: Scanned Date/Initials: