Barbara Patchen 12/31/07
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City of Miami Beach, 1700 Cc>rwention Center Drive, Miomi Beoeh, Florida 33139, wwwllIiamibcochflgov
OFFiCE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305.673-74] 1, Fox 305.673.7254
01-09-2007
Barbara Patchen
2068 N Bay Road
Miami Beach, Florida 33140
SUBJECT: Community Relations Board
Congratulations! You have been appointed by Commissioner Simon Cruz
to the agency, board or committee named above for a term ending 12/31/2007.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or
after Januc;lry 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,
~~~lb~)J
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: 305-673-7505
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, Miomi Beach, Florida 33139, wwwmiamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305.673.7411, Fax 305.673.7254
TO Bunny (Barbara) Patchen
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: 12/31/2007.
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 se<ve) on July 1st, following the closing of ~e calen;E.:'J:C::lfd~ Jz~_
Bunny (Barbar;~n
Sworn to and subsc,'bed before me Z ~~< _ da~ ~,,"A J _, 2oofJ1
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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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MIAMI BEACH
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 ownershlplinterest 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 l/~r No . /
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: YesJ or No 11
Address:
e-
Middle Initial
Phone:
36
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L~-(' ~~: C 11 0
33Jq(;
Zip Code
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Y /? !loCi /::..6(1\
Business Name:
J\J If)
I
Applicant's Position:
Address:
No.
Street
City
State
Zip Code
DOwner C Stockholder/Shareholder 0 Corporate Officer D Other Explain:
R-<-fl f
6s1 ff"R:~:S
Expires: ::z (j 03'
Professional License (describe)
t\lt'1Ch "
1. Have you ever been convicted of a felony: Yes 0 or N~f yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [] or No 9<'lf yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [] or No'ilf yes, explain in detail
4. Are you currently serving on any City Boards or Committees: Yes 0 or N~lf yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Title:
Name:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
HnrY\~
I am now employed by the City of Miami Beach: Yes 0 or NY If yes, which department?
FICLEmS,ALL \B&C ,4ppl!cal(ii1.+V~C P.ppl'callon Pe\llS8li UU11 OfS.uoc
Pursuant to City Code Section 2-25 (b): Do yau have a parent ,spause ,child ,brother or sister who is employed by the City of Mia.mi
Beach? Check all that apply. Identify the department(s)
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)
Housing Authority*
Loan Review Committee'
Marine Authority'
Miami Beach Cultural Arts Council
Miami Beach Commission on Status of Women
, Miami Beach Florida Sister Cities
L Normandy Shores Local GOy't Neigh. Improyement
. Oversight Committee for General Obligation Bond
,. Parks and Recreation Facilities Board
APersonnel Board*
i, planning Board*
XPolice Citizens Relations Committee
- Production Industry Council
" Public Safety Advisory Committee
,1 Safety Committee
::::. Transportation and Parking Committee
Visitor and Convention Authority*
cJ Youth Center Advisory Board
i Art in Public Places Committee
Barrier Free Environment Committee
[J Beach Preservation Board
[J Beautification Committee
Board of Adjustment*
[1 Budget Advisory Committee
J Committee on Homeless
J Committee for Quality Education in MB
o Community Development Advisory*
[j Community Relations Board
)(~onvention Center Advisory Board
o Convention Center Capital Projects Oversight
o Debarment Committee
o Design Review Board'
o Fine Arts Board
o Golf Advisory Committee
o Health Advisory Committee
o Health Facilities Authority Board
o Historic Preservation Board*
*Board Required to File State Disclosure form
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: Ye~'No.' Years of Service: -r;;: If' /11 l;, ~)? (.t
2. Present participation in Youth Center actiYities by yc?u'"r~hildren Yeso No .J. If yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
Child's name:
This section is "not required" but desired: Age: _ years old
Ethnic Qrigin (Check one)
White 4l African-American/Black [J Hispanic: [J
Asian or Pacific Islander [J American Indian or Alaskan Native [J
Employment Status: Employed [ Retired :..:J Home-maker CJ Other
Age: _ Program:
Gender: Male iJ
Female 0./
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"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
ArtI~ VII ~ of th~ Ci ) "Stand~rds of\ Conduct for City o:cers, Empl~!ees aJn~ A9~~~,y Me!)bers:; . J
NL .cllo./' Q1 JI'it:;2jI<U 7 L~)f)~ 1')1) 1/1 C-; {'~ tI tp l
AppliCant's Signature d'atE;" . Name 06~1~~n~~~11~E PRI NT) /
Attachment: Please attach a copy of your resume to your application. (, .~) )
NOTE: Applications will remain on file for a period of one (1) calendar year.
Received in City Clerk's Office
Document Control Number (As igne' by the City Clerk's Office)
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Entered By _ ';)-L-.7
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Date
Date
Revised 9/11/06 Ih
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