Ann Lampner Rep of Ruth K. Broad Elementary
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City of Miami Beach, 1700 Convention Center Drive, Miomi Bcoch, Florido 33139, www miolnlbeuchfl.gov
OFFICE OF rHE CiTY CLERK, Robed Parcher, City Clerk
Tel 305-67374i 1 Fox 305-673-72.54
12/15/2006
Ann Lampner
9281 Emerson Ave
Surfside, Florida 33154
SUBJECT: Committee for Quality Education in MB
Congratulations! You have been re-appointed by virtue of your being a representative for the Ruth K.
Broad Elementary School to the above referenced agency, board or committee for a term ending
06/30/2007.
If you are unable to accept this appointment, please notify the City Clerk's Office immediately at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good
~i relYl ._' .). )
, (), , / .'
.. . &-~erf1,("ill€1 IsJ6,
Robert Parcher "
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld
ATTACHMENTS:
1. City Code Ordinance section, applicable to agency, board or committee
2. General Provisions of Ordinance NO.97-3086
3. Ordinance No. 97-3105
4. Citywide parking permit application - Return completed application to the Parking
Department located at the Palm Court Building, 309 23rd Street, Suite 200 - Tel: 305- ~------.-=-
5. Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
6. Miami Beach Code Section 2-459 "Certain appearances are prohibited."
7. Miami-Dade County Section 2-11.1
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachflgav
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305-673-7411, Fax 305-673-7254
TO Ann Evelyn Lampner
RE: Committee for Quality Education in MB
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: 06/30/2007.
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 serve) on July 1 st, following the closing of the calendar year on which I have served.
~\ ~~I\.
h'
.. - Ann E~e-- .-';'pn;;
Sworn
to and subscribed before me this::J3 day o~ I::::>...-~OO-=+
~~D\-~~.
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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TO ,-",he iive, VVO,r,t und pfoV
'.I,:fYOni, tl()picc:!, historic communi(y'
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MIA/\!\l 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 ownership/interest for a minimum of six months in a business established in the city.
I
Resident of Miami Beach for a minimum of six (6) months: Yes or No J
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No rI
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes l
My special abilities, knowledge, or experience is: /
Are you a registered voter in Miami Beach: Yes l' or No \V'
fA
~~rst Na~~'VW'( 50'\;\
NAME:
.Av\ VI
First Name
E
Middle Initial
Home:
Address:
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State
'331:f1
Zip Code
Phone:
Home
(PiVf!.~3:;:~
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Business Name:'YOI )-DV\.A K) (u..1ey\\/\ ~plicant's Position.. :~~.. A/
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Address: 14\ q ~ t \ 1J:\ S-r- \ ~ u n \ CA.
No. Street City
qpwner u Stockholder/Shareholder ~ Corporate Officer [J Other Explain:
~
State
~3\ (n \
Zip Code
Professional License (describe)
,.t;~Ua(:h ,:; :I-;~:.i
Expires:
/
1. Have you ever been convicted of a felony: Yes C or No 0 If yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [J or No ~f yes. please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [l or No ~ If yes, explain in detail
4. Are you currently serving on any City Boards or Committees: Yes ~r No O. If yes; which board?
V\lhat organizations in the City of Miami Beach do you currently hold membership in?
Name:~l Gi ~~ ~C~\ Q.;& \ ~'d
Title: f r i\
(~?
Name:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
I am now employed by the City of Miami Beach: Yes 0 or NO~ If yes, which department?
F\CLEJ~I$ALl IE&e /\ppi!catiol :\1-\/",(: ;:'PUk:dllon Reviserj OU11 fJ6.doc
Pursuant to City Code Section 2-25 (b): Do you have a parent ,spouse . child ,brother or sister who is employed by the City of Miami
Beach? Check all that apply, Identify the department(s}
.~ ((X-
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 Gov't Neigh. Improvement
Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
Personnel Board*
I: Planning Board'
: " Police Citizens Relations Committee
'c Production Industry Council
Public Safety Advisory Committee
fl Safety Committee
C: Transportation and Parking Committee
Visitor and Convention Authority*
CJ Youth Center Advisory 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: Yes NO/Years of Service:
2. Present partiCipation in Youth Center activities by your children Yes[J No ri. If yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
-; Art in Public Places Committee
Barrier Free Environment Committee
Beach Preservation Board
Beautification Committee
i Board of Adjustment*
[1 Budget Advisory Committee
] Committee on Homeless
~ Committee for Quality Education in MB
o Community Development Advisory*
[j Community Relations Board
[1 Convention Center Advisory Board
] Convention Center Capital Projects Oversight
o Debarment Committee
[I Design Review Board'
] Fine Arts Board
[] Golf Advisory Committee
o Health Advisory Committee
o Health Facilities Authority Board
o Historic Preservation Board*
Child's name: Age: _ Program:
This section is "not required" but desired: Age: r~) years old Gender: Male iJ
Ethnic Origin (Check one)
White 0 African-American/Black :J Hispanic: iY
Asian or Pacific Islander [] American Indian or Alaskan Native [j
Employment Status: Employed [] Retired LJ Home-maker [] Other [I
Female lV"
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
cle VII- 0 . he City o~e "Standards of Conduct for City Officers, Employees and Agency Members." V
n" ^ f'- ~ - ( I r ~
' 11'0 I - I 123/01 ,\{\ L:~vE' r V"\ Wv ~'l~
icant's g a ure Date Name of ApPli~nt (PLEASE PINT)
A chment: Please a ach 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 by
Document Control Number (Assigned by the City Clerk's Office)
Deputy Clerk
Date
Date
Revised 9/11/06 Ih
Entered By
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