Jacobo Epelbaum 12/31/08
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City of Miami Beach, 1/00 Convention Center Drive, Miami Beach, Florido :n 139, www miornibcochfl gov
OFFICE OF THE CITY CLERK. Robert Parcher, Cdy Clerk
Tel 305-673-741 I, Fox 305-673-7254
12-22-2006
Jacobo Epelbaum
8035 Cecil Street
Miami Beach, Florida 33141
I."'EQT: Community Relations Board
Congratulations! You have been appointed by Jorge M. Gonzalez, City Manager
to the agency, board or committee named above for a term ending: 12/31/2008.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
~~J?b
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Barbara Hawayek
ATTACHMENTS:
1. City Code Ordinance section, applicable to agency, board or committee
2. General Provisions of Ordinance NO.97-3086 Amended by Ordinance No. 2006-3543
3. Ordinance No. 97-3105
4. Citywide parking permit application - Return completed application to the Parking
Department located at Palm Court Building, 309 23rd Street, Suite 200 - Tel: 305-673-
5. Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
6. Miami Beach Code Section 2-459
7. Miami-Dade County Code Section 2-11.1
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwwmiamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305-673-7411, Fax 305-673-7254
TO Jacobo Epelbaum
RE: Community Relations Board
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of
a member of the above-mentioned board or committee of the City of Miami Beach to which I have
been appointed for a term ending: 12/31/2008.
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theFlorida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure* require-
ments of Miami-Dade County or the State of Florida (depending on the board or committee on which
I serve) on July 1 st, following the closing of the calendar year on which I have served.
,200_.C
......
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
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MIAMIBEACH
BOARDS AND COMMITTEE APPLICATION FORM
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: oj 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.
Resident of Miami Beach for a minimum of six (6) months: Yes [\"] or No [ ]
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes r] or No [ ]
Yes [ ]
I arn applying for a Board appointment because I have special abilities, knowledge, experience:
My special abilities, knowledge, or experience is:
Are you a registered voter in Miami Beach: Yes E4Yor No 0
.T/1 (' C' 80 L::- /'">L- '-~? --"9 t.......-/t~F"l
Last Name First Name
Home ~., 35 cc:-'- C / ~
Address: No. ' Street
NAME:
5'/--
/2/1, /5 '
City
Middle Initial
/-/4- J}.IC//
State Zip Code
Phone:
Email address
Home
Work
Fax
(Please check one): I am now a resident of:
Business Name: )~11 c ;tf I,) ){ e-'?~ ; A
';1'2. L//lf Z-r-/' /l/ ~ j),
No. ~ffi~
North Beoch 0 South Beach 0 Middle Beach ~-
Address:
Applicant's Position:
$c-:'-yJ;;j/ ff
, State
/VI ~
City
j 3/37
Zip Code
q::.Owner 0 Stockholder/Shareholder 0 Corporate Officer 0 Other Explain:
Professional License (describe):
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes 0 or No ~ If yes, please explain in detail:
Expires:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No n If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes 0 or No a1'
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes or or No D.
If yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
;t/i/J ;:Y ~ C~
/1-1 C-' ,Ptf"Z' /'1' YJ'
Title:
Narne:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach: "
C:\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK14\BC APPLICATION NOV 200S1.DOC
I am now employed by the City of MI . Beach: Yes 0 or No l8:f If yes, which deportment?
Pursuant to City Code Section 2-25 (b): Do you have a parent OJ, spouse 0], child OJ, brother OJ, or sister OJ who is
employed by the Oy of Miami Beach? Check 011 thO'/l!!lJhCtify the deportment{,}
(
Please list your preferences in order of ranking [1] first choice [2J second choice, and [3J third choice_ Please note that only
three (3) choices will be observed by the City Clerk's Office.
Reqular Boards of City)
J;!_Art in Public Places Committee DHousinq Authority
o t rrier Free Environment Committee DLoan Review Committee"
o Beach Preservation Board DMarine Authority "
o Bea'Jtification Committee DMiami Beach Cultural Arts Council
o Board of Adjustment (Flood Manaqementf" DMiami Beach Commission on Status of Women
o Budget Advisory Committee DMiami Beach Florida Sister Cities
o CO'!lmittee on the Homeless DNormandy Shores Local Gov_ Neighborhood Improvement
o Committee for Quality of Education in Miami Beach DNorth Beach Youth Center Oversight Committee
o Community Development Advisory_Committee" OOversight Committee for General Obligation Bond
-l5r Community Relations Board N. 7TJ'~~ ,h.:11 /" , DParks & Recreational Facilities Board
o Convention Center Advisory Board o Personnel Board"
o Debarment Committee o Planning Board"
,--p Design Review Board .. o Police Citizens Relations Committee
o Fine Arts Board o Production Industry Council
o Golf Advisory Committee o Public Safety Advisory Committee
o Health Advisory Committee o Safety Committee
o Health FaCIlities Authority o Transportation & ParkinQ Committee
OHispanic Affoirs Committee o Visitor & Convention Authority ..
OHistoric Preservation Board .. o Youth Center Advisory Board
*Board Required to File State Disclosure form
Note: If applying for Youth Advisory Boord, please indicate your affiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes 0 No 0 Years of Service 0
2. Present participation in Youth Center activities by your children Yes 0 No D. If yes, please list the names of your children,
their ages, and which programs_ list below:
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
This section is "not required" but desired: Age: 0
Ethnic Origin (Check one)
White 0 African-American/Black 0 Hispanic: 0
Asian or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed 0 Retired 0 Home-maker 0 Other 0
"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."
Gender: Male or Female 0
Attachment:
NOTE: Appli
Received in City Clerk's Office _j ~
Document Control Number (Assigned
/1. I ill L? ~ IJ [Dd':'c?-) L- ~C'A d-'?7J /__~ 7'-~
Dote Name of Applicant (PLEASE PRINT)
Please attach a co at.your resume to your application.
atian will remain file for 0 period of one (1) calendar year.
I
Deputy Clerk
Revised 11/15/05
C:\DOCUMENTS AND SETTlNGS\ClERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK 14\BC APPLICATION NOV 20051 DOC