Henry Peitz Application PackagePeitz, Jr Henry QNAME:
Last Name First Name Middle Initial
800 West Avenue, Apt 646 Miami BeachHOME ADDRESS:
Apt No.Home No./Street City
Florida 33139
State Zip Code
303-915-8043 SamePHONE:
Home Work
peikei2@msn.com
Email Address
Same
Street
Same
City
Same
State
Same
Zip Code
Address:
Retired Position:Business Name:Urban and Regional Planner
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.
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Ɣ 3OHDVHcircle one): I am now a resident of:
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No
Yes
South Beach
No
I am the retired City of Colorado Springs, Colorado Planning Director. I also was the Acting Chair and Vice-Chair of the City of B
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:
Historic Preservation Board
Design Review Board
Planning Board
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:No If yes, which board?
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:
Property
800 West Avenue, Apt 646
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 Henry Peitz, Jr agreed to the following terms on 12/7/2018 11:53:25 AM
Received in the City Clerk's Office by:
Name of Deputy Clerk
Control No.
Date
RESUME FORM
For commission/staff members involved in
Florida, South Carolina Local Government Program
Name of Local Government: City of Beaufort, South Carolina
Name of Commission: Historic Review Board
Name: Henry Quinn Peitz, Jr
Mailing Address: 800 West Avenue, Unit 646, Miami Beach, FL, 33139 and 317 Islands
Avenue, Beaufort SC 29902
Telephone (Business): 303-915-8043
Telephone (Residence): 843-379-9909
This section for commission members only
Term of membership: April, 2014
Term expires: June, 2019
Occupation: Director of Planning/Urban Planner , City 9f Colorado Springs, CO, retired.
1986 to 2002.
Professional Discipline: Urban Planner
(if satisfying a membership
requirement) AICP
Education: Bachelor of Arts, Political Science, American University, Washington, DC
Master of Science, Urban/ Regional Planning, Johns Hopkins, Balto., MD
Demonstrated interest in historic preservation (conferences attended, organizati ons, special
training, courses taken, volunteer activities, or job experience) See Attached Resume