Laurence Herrup 12/31/07
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CIty of MIaIIII "'h, 1700 Convention Center Drive. Miami Beach, Florida 33139, www.miomibeochA.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEL: 1305) 673-7411, FAX: (305)673-7254
01-18-2007
Laurence Herrup
1580 Stillwater Drive
Miami Beach, Florida 33141
SUBJECT: Board of Adjustment
Congratulations! You have been appointed by the City Commission
to the agency, board or committee named above for a term ending 12/31/2007.
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,
2~~~.b
City Clerk
cc: Saul Frances, Parking Director
Antonieta Stohl
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
We ore commined 10 providing excellent public service and safety 10 all who live, work, and ploy in our vibrant, tropical, historic community
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city of Miami leach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochR.gov
OFFICE OF THE CITY CLERK, Rabert Parcher, City Clerk
TEl: (305) 673-7411, FAX: (305) 673-7254
TO Laurence Herrup
RE: Board of Adjustment
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 serve) on July 1st, following the closing of the calendar year on c I have served.
Laure ru
Sworn to and subscribed before me thi"'-:a.\ day~, 200~
~Ot.'1 ..
Deputy Clerk
'Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Cierk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We ore committed to providing excellent public service and safety fa 01/ who Jive, work. and ploy in OUf vibrant, tropical, historic community
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MIAMI BEACH
NAME:
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Last Name
HOME ADDRESS:
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CITY OF MIAMI BEACH
AND COMMITTEE APPLICATION FORM
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Email address C-I>I'"
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Professional License (describe) a....p ~
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l-v(og- Stat:tt2Ch a G"P~:~::iCi'nSi'
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 'or No 0
. Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ior No 0
. Are you a registered voter in Miami Beach: Yes 'or No 0
. (Please check one): I am now a resident of: North Beach ~outh Beach 0 Middle Beach 0
. I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Cl.P~
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that on Iv three 13\
choices will be observed bv the City Clerk's Office. (Regular Boards of City)
o Art in Public Places Committee
o Beach Preservation Board
o j3eautification Committee
!'I'Board of Adjustment'
o Budget Advisory Committee
o Committee on Homeless
o Committee for Quality Education in MB
o Community Deveiopment Advisory'
o Community Relations Board
o Convention Center Advisory Board
o Debarment Committee
o Design Review Board'
o Disability Access Committee
o Fine Arts Board
o Goif Advisory Committee
o Health AdvisoryCommittee
o Health Facilities Authority Board
o Hispanic Affairs Committee
o Historic Preservation Board'
. Board Required ta File State Dlsclasure fann
o Housing Authority'
o Loan Review Committee'
o Marine Authority'
o Miami Beach Cultural Arts Council
o Miami Beach Commission on Status of Women
o Miami Beach Florida Sister Cities
o Normandy Shores Local Gov't Neigh. Improvement
o Oversight Committee for General Obligation Bond
o Parks and Recreation Facilities Board
o Personnel Board"
o Plannin9 Board'
o Police Citizens Relations Committee
o Production Industry Council
o Public Safety Advisory Committee
o Safety Committee
o Transportation and Parking Committee
o Visitor and Convention Authority"
o Youth Center Advisory Board
F:\CLER\SALL\B&C Application\B&C Application Revised 091106 jakes.doc
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 II Years of Service:
2. Present participation in Youth Center activities by your chlldren'Yes! I No [I. If yes, please list the names of your children, their
ages, and which programs. List below:
Chiid's name: Age: _ Program:
Child's name: Age: Program:
. .Have you ever been convicted ~f a felony: Yes 0 or No Ilf yes, please explain in detail:
. Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No ~f yes, please explain in detail:
. Do you currently owe the City of Miami Beach any money: Yes 0 or No 'If yes, explain in detail
. Are you currently serving on any City Boards or Committees: Yes.6 or No D. If 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:
. I am now employed by the City of Miami Beach: Yes 0 or NO' Which department?
. Pursuant to City Code Section 2-25 (b): Do you have a parent 0, s~'1se 0, child 0, brother 0, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): tv I> .
This section is "not required" but desired: Age: years old Gender: Male 0 Female 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
e accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
t C de "Standards of Conduct for City Officers, Employees and Agency Members."
1/01 ~v~~ A.- ~~
Date Name of Applicant (PLEA E PRINT)
Pie attach a copy resume to Is application
NOTE: Applications will remain on I e for a period of one (1) calendar year.
Received in City Clerk's Office by
ame 0 Deputy 11e~ ,
Document Control Number (Assigned by the City Clerk's Office) +---t--\:--- Entered By
Date
Oate
2
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F:\CLER\SALL\B&C Appllcation\B&C Application Revised OH11 06 ,jakes.doc