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Peter Martin Application PackageMartin Peter RNAME: Last Name First Name Middle Initial 603 East DiLido Drive Miami BeachHOME ADDRESS: Apt No.Home No./Street City Florida 33139 State Zip Code 305.674.1206PHONE: Home Work Jivetown@gmail.com Email Address Street City State Zip Code Address: Position:Business Name:Retired Pursuant to City Code section 2-22(4) a and 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. YesƔ5HVLGHQWRI0LDPL%HDFKIRUDPLQLPXPRIVL[  PRQWKV Ɣ'HPRQVWUDWHDQRZQHUVKLSLQWHUHVWLQDEXVLQHVVLQ0LDPL%HDFKIRUDPLQLPXPRIVL[  PRQWKV Ɣ$UH\RXDUHJLVWHUHGYRWHULQ0LDPL%HDFK Ɣ 3OHDVHcircle one): I am now a resident of: Ɣ,DPDSSO\LQJIRUDQDSSRLQWPHQWEHFDXVH,KDYHVSHFLDODELOLWLHVNQRZOHGJHDQGH[SHULHQFH3OHDVHOLVWEHORZ Ɣ$UH\RXSUHVHQWO\DUHJLVWHUHGOREE\LVWZLWKWKH&LW\RI0LDPL%HDFK" No Yes South Beach No 29 Years in Professional Theatre. South Florida Member American Theater Critics Association and Current member of the Cultu 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. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Cultural Arts Council No2. Present participation in Youth Center activities by your children Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: ages, and which programs. List below: if yes, please list the names of your children, their CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM * 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 _______________________ NoƔHave you ever been convicted of a felony:If yes, please explain in detail: ƔDo you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ƔDo you currently owe the City of Miami Beach any money:No If yes, please explain in detail: ƔAre you currently serving on any City Boards or Committees:Yes If yes, which board? Cultural Arts Council ƔWhat organizations in the City of Miami Beach do you currently hold membership in? ƔList all properties owned or have an interest in, which are located within the City of Miami Beach: ƔI am now employed by the city of Miami Beach:No Which department? 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 federal equal opportunity reporting requirements. MaleGender: Physically Challenged:No White Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: 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 board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26). o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). (re: 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). 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 have received, read and will abide by Chapter 2, Article VII – of the City Code “Standards of Conduct for City Officers, Employees and Agency Members.” I Peter Martin agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Peter R. (Roger) Martin 603 East Dilido Drive Miami Beach Fl 33139 305-674-1206 jivetown@gmail.com Resumé for re-appointment to the Miami Beach Cultural Arts Council Born and educated in New Zealand. American citizenship granted in 1966. Miami Beach resident 21 years. Miami/Dade resident 56 years. Fighter pilot Royal Canadian Air Force 1951-1957. Airline pilot 1957-1986. Retired as Captain with Eastern Airlines. Member of the Miami/Dade professional theatre community since 1989. Retired member of Actors' Equity Association, Screen Actors' Guild and American Federation of Television and Radio Artists. Retired member of The Dramatists' Guild. Judge for the Carbonell Awards Committee 2000 -2006. Co-producer and MC for Carbonell Awards Presentations. Nominator for The Silver Palm Awards. Former editor of miamiartzine.com. Former member Miami Beach Arts Trust. Current member of the Miami Beach Cultural Arts Council. Current member of the American Theatre Critics' Association.