Carolina Beltran 12/31/08
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, WWW l1liamibeachfl gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305-6731411, Fax 305-673-7254
01-08-2007
Carolina Beltran
1602 Alton Rd #603
Miami Beach, Florida 33139
SUBJECT:
Fine Arts Board
Congratulations! You have been appointed by Commissioner Simon Cruz
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,
~~~~,)/~)1
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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: 305-673-7505
5. Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employe
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 Carolina Beltran
RE: Fine Arts 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.
~~.kC!;
. ---.-. Carollna Beltran
Sworn
Deputy Clerk
*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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CITY OF I \MI BEACH BOARDS AND COMM :EE
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: 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.
Resident of Miami Beach for a minimum of six (6) months: Yes iKl or No [ ]
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes [ ] or No [ ~
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes ( ]
My special abilities, knowledge, or experience is:
Are you a r~tered voter in Miami Beach: Yes [
NAME: ~,\-+(2.c::~ i'-.S
Last Name
Home \ (C'; 2 \ lu d ~ ~~t-
Address: No. Street City State Zip Code
Phone: ~ '3Cf~) 63C)00?l.~S (CO; JvOfw'l;:j ,&J\;072'i"'J2Z) C'qCZo zi~~acl. (2)1-1
Home Work CeLL Fax Email address
] or NOc) ] .
C([O\ \00\
First Name
:ri '1 Av"-L ('Ds- lie H
\---\ .
Middle Initial
,.,....... ,.:1 '"
~L :3~i<(u
No.
Street
City
State Zip Code
[ ] Owner [ ] Stockholder/Shareholder [ ] Corporate Officer [ ] Other Explain:
Professional License (describe): Expires:
Attach II copy of the license listed llbove.
1. Have you ever been convicted of a felony: Yes [ ] or No 9() If yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [ ] or No N. If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [ ] or NO.i><)
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes [ ] or No ki
If yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Title:
Name:
Title:
List all propertie.s owned or have an in.terest in, which are located within the City of Miami Beach:
....l~\ \.-02-4 '2l t.:J::L~c,,"<'~\ t:'e. 3-3l"'\D~tt--ofVt'l.e:.::::L-
I am no~ emPI~yed ~y the City of Miami Beach: Yes [_}_~r N~ L>( If yes, which de~rtment. _____
Pursuant to City Code Section 2-25 (b): Do you have a parent [ ], spouse [ ], child [ ], brother [ ], or sister [ ] who
F:\CLER\$ALL \ELIZABET\B&C\BCA PPLIC04.doc
is employed by the City of Miami Be.
Check all that apply. Identify the departn .(s):
------------------------------------
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that
only 3 choices will be observed by the City Clerk's Office.
(Regular Boards of City) (*Board Required to File State Disclosure form)
[ ] Art in Public Places [
[ ] Audit Committee [
[ ] Barrier Free Environment Committee [
[ ] Beach Preservation Board [
[ ] Beautification Committee [
[ ] Board of Adjustment (Flood Mgmt.)* [
[ ] Budget Advisory Committee [
[ ] Caee EFlfaR:emeFlt Tasl( rart:e [
[ ] Committee on Homeless [
[ ] Committee for Quality Education in MB [
[ ] Community Development Advisory* [
[ ] Community Relations Board [
[ ] Convention Center Advisory Board [
[ ] Convention Center Capital Projects Oversight [
[ ] Debarment Committee [
[ ] Design Review Board* [
[~] Fine Arts Board [
[ ] Golf Advisory Committee [
[ ] Health Advisory Committee [
[ ] Health Facilities Authority [
[ ] Hispanic Affairs Committee
[ ] Historic Preservation Board*
[ ] Housing Authority*
[ ] Loan Review Committee*
] Marine Authority*
] Miami Beach Cultural Arts Council
] Miami Beach Commission on Status of Women
] Miami Beach Rorida Sister Cities
] Normandy Shores Local Gov't Neighborhood Improvement
] North Beach Youth Center Oversight Committee
] Nuisance Abatement Board*
] Oversight Committee for General Obligation Bond
] Parks and Recreation Facilities Board
] Personnel Board*
] Planning 8oard*
] Police Citizens Relations Committee
] Production Industry Council
] Public Safety Advisory Committee
] Safety Committee
] South Point Advisory Board* to Redevelopment Agency
] Tel::lfist aRe CeR\<eAliien CeAter Exf-lansieA l\I:Rherity
] Transportation and Parking Board
] Visitor and Convention Authority*
] Youth Center Advisory Board
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: Yes [ ] No M (Years of Service [ ]
2. Present participation in Youth Center activities by your children Yes [ ] No ["CJ. If yes, please list the names of your
children, their ages, and which programs. Ust below.
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
This section is "not required" but desired Age: f}~] Gender: M [ ] or F D<l
Ethnic Origin (Check one)
White [ ] African-American/Black [ ] Hispanic: [><J
Asian or Pacific Islander [ ] American Indian or Alaskan Native [ ]
Employment Status: Employed [ ] Retired [ ] Home-maker [ ] Other [ ::f1-'ee bf7{C?'--kJlelt'ot])SO 17
I hereby attest to the aCOJracy and truthfulness of the application and have received, read and will abide by
~~':n. P, :, ~~~ ~Ie V. II - ~f the Oty Oxl. I Ii ~~'r(,"" OJnduct, for Oty Officers, Employees and Agency
e4)~Qft_ :::2-.t2.. c5- ~:AE.cLl~~'Bt3a~
Applicant's Sigriau:lre ~e Name of Applicant (PLEASE PRINT)
Attachment: Please attach a- co of your resume to your application.
NOTE: .i'wl~~tio!lj-Will re ain on Ie for a period of one (1) calendar year.
Received in City Clerk's Office'U) / ~ / JJJ by Clerk
Document Control Number (Assigned by the City ClerKS Office) ~ Rev #7- 01/08/04
F:\CLER \$ALL \ELIZABET\B&C\BCAPPLIC04,doc