Sharon Kersten 12/31/08
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miomibeochflgov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 3056737411, Fax 305-6737254
01-08-2007
Sharon Kersten
1815 Bay Dr
Miami Beach, Florida 33139
'SUBJect: Police Citizens Relations Committee
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,
~~J-~A-Ci, ) ~ i.tD
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Donald DeLucca
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 Conventian Center Drive, Miami Beach, Florida 33139, wwwmiamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305-6737411, Fax 305-673-7254
TO Sharon Kersten
RE: Police Citizens Relations Committee
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.
~~~
Sharon Kersten
I
Sworn to and subscribed before '"t J" da
- 7 - ,-
Deputy eler
,200/
*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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'," '.'"ho /;\'(:. \V()!.l.. unci r~l!()V in vibfoni, :f:..Jpiccf. historic communiiy.
m
-
MIA/\AI 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: 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 h~ye special abiliti s, knowledge, experience: YeWJ
My special abilities, knowledge, or experience is: G -t.. -
Are you a registered voter in Miami Beach: Yes J4..or No
K rtzJ'l tt: IV
/" J.pst Name
_6 / r 0,.,,+ 0 n...-
Address: I J /.r Off:'i /:) I'L
No.
119r
NAME:
S 1+ ~n....c, A..J
First Name
-r-
-
Middle Initial
Home:
Street
h1 (pt."" (
City
B E. "9 CIJ ,::. c.. .).1/ Y I'
State Zip Code
--be
,^c:iI:lI
Fax
Phone:
or- -i'4.? -
Home
~l- ~'')'O
Work
J:J
(Pic'?,s::: ~" . NLn~; :::~':l_~-,i )(;;;,t' [J
Business Name: feO oS' +ev- CCICo1.M."V\: ~i~ant's Position:
r~C2~ct1 0
o WI-. e..,.-
Address:
~'G
No.
J4-t 46 IIJ L
Street
City
State
Zip Code
eer C Stockholder/Shareholder [J Corporate Officer iJ Other Explain:
~~~,~~~~ional License (deSCribe~;::' ~7 L /-,. ~ ~ ~: (" I?.J, J '-
Expires: 2..00 r
1. Have you ever been convicted of a felony: Yes [j or No~ yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes IJ or N~es. please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [1 or No ~es, explain in detail
4. Are you currently serving on any City Boards or Committees: Ye~ No O. If yes; which board? lot,../ t:. L(t!.tn to ~ J
\lllhat 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:
/g I r tJA--Y I)/l,/IJ E.;
.
I am now employed by the City of Miami Beach: Yes 0 or1'loKl!tes, which department?
F\C:L[f~\$I',LL\13&C iI.ppl!cakJil'.F\8.C l,k'fJ1!CaIIOil Pew"eci U<'110Gdoc
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): /if.J l:>
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*
J Art in Public Places Committee Loan Review Committee'
Barrier Free Environment Committee Marine Authority*
[J Beach Preservation Board . Miami Beach Cultural Arts Council
Beautification Committee Miami Beach Commission on Status of Women
Board of Adjustment* Miami Beach Florida Sister Cities
Budget Advisory Committee L Normandy Shores Local Gov't Neigh. Improvement
. J Committee on Homeless . Oversight Committee for General Obligation Bond
J Committee for Quality Education in MB Parks and Recreation Facilities Board
o Community Development Advisory* Personnel Board*
[j Community Relations Board Planning Board*
J Convention Center Advisory Board ~ice Citizens Relations Committee'
o Convention Center Capitai Projects Oversight ,- Production Industry Council
J Debarment Committee ~; Public Safety Advisory Committee
o Design Review Board* ,! Safety Committee
o Fine Arts Board !:: Transportation and Parking Committee
iJ Golf Advisory Committee Visitor and Convention Authority*
o Health Advisory Committee [J Youth Center Advisory Board
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: Yes C' No ~ears of Service:
2. Present participation in Youth Center activities by your children Yes[] N~ yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
.,
Child's name: Age: _
This section is "not required" but desired: Age: s:..cears old
Ethnic Origin (Check one)
Whlte~rican-American/Black U Hispanic: !J
Asian or Pacific Islander [J American Indian or Alaskan Native 0
Employment Status: Employe~etired ~~; Home-maker C Other [J
Program:
Gender:
Male!]
Fema~
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Art! VII- of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
k~ L,vJI" '/ StfA-~~ /C.€.rt.JTW
plicant's Signature Date Name of Applicant (PLEASE PRINT)
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.
by /(;) y y
I . f
Document Control Number (AsSigned by the City Clerk's Office)
/- t> r "I ( 1'1 d 0('2..
,
Deputy Clerk
Date
Date
Revised 9/11/06 Ih
Entered By
2
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