David Lancz 12/31/08
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CIty of MIami "'h, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochR.gov
OFFICE OF THE CllY CLERK, Robert Porcher, City Clerk
TEL: 13051673-7411, FAX: (3051673-7254
01-18-2007
David Lancz
1500 Bay Rd #242
Miami Beach, Florida 33139
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 12/31/2008.
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;~/bi{j
Robert Parcher
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 are commjtted 10 providing excellent public service and safety fa 01/ who live, work, and play in our vibrant, !ropical, historic community
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov
OFFICE OF THE C1lY CLERK, Robert Porcher, City Clerk
TEL: (3051673-7411, FAX: (3051673-7254
TO David Lancz
RE: Board of Adjustment
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United Slates, 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 andlor Committee, I must comply with the financial disclosure' require-
ments of Miami-Dade County or the Slate of Florida (depending on the board or committee on which
, -l ~'""". ."""".. ,.."'... "'C9~:"'" '~~6
V ,
David Lancz
Sworn to and subscribed before me this L day of R: b , 200]
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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 Finandal Disdosure Requirements.
We ore committed fa providing excellent public service and safety to 011 who live, work, and play in our vibrant, tropical, historic communiry
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Last Name First Name
HOME ADDRESS: ) SOD e,o\j R6. Art.. 2 '-12.
PHONE: 3'J~ ~~ 7L-)~L0 3~t_)l -5/1
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MIAMI BEACH
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Professional License (describe)
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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 ownershiplinterest 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~r No 0
. Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes 0 or No 0
. Are you a registered voter in Miami Beach: Yes~ No 0
. (Please check one): I am now a resident of: North Beach 0 South Beach 0 Middle Beach 0
. I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your preferences in order of ranking [1J first choice [2] second choice, and [3] third choice. Please note that onlv three /3\
choices will be observed bv the Citv Clerk's Office. (Regular Boards of City)
o Art in Public Places Committee
~Bea Preservation Board
o autification Committee
Board of Adjustment'
o Budget Advisory Committee
o Committee on Homeless
o Committee for Quality Education in MB
o Community Development 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 Golf Advisory Committee
o Health AdvisoryCommittee
o Health Facilities Authority Board
o Hispanic Affairs Committee
o Historic Preservation Board'
* Board Required to File State Disclosure form
o Housing Authority'
o Loan Review Committee"
o Marine Authority"
o Miami Beach Cultural Arts Council
o Miami Beach Commission on Slatus 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 Planning 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\$ALL\8&C Application\B&C Application Revised 091106 jakes.doc
Note: If applying for Youth Advisory Board, please in icate y'our affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory ard: es
2. Present participation in Youth Center acti tie by your c
ages, and which programs. List below:
Child's name:
No IJ. If yes, please list the names of your children, their
A e: _ Program:
Child's name:
Age:
Program:
.Have you ever been convicted of a felony: Ves D or No.il'\ifYes, please explain in detail:
. Do you currently have a violation(s) of City of Miami Beach codes: Ves D or No 0qf'yes, please explain in detail:
. Do you currently owe the City of Miami Beach any money: Ves D or No~f yes, explain in detail
. Are you currently serving on any City Boards or Committees: Ve~ No D. If yes; which board?
Lon :-('" goC\(d
. What organizations in the City of Miami Beach do you currentiy hold membership in?
Name:
Tille:
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: Ves D or ~ Which department?
. Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse D, child D, brother 0, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: '3 3 years old
Ethnic Origin (Check one)
White 0 African-American/Blac~ 0 Hispanic: D Asian or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed~etired 0 Home-maker 0 Other 0
Gender: MaleK
Female 0
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
D",'---P ~. L-2-~7 b.?(,,\~ Lfi,Y7C7-
Applicant's S~ Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain 0 Ie for a period of one (1) calendar year.
Date
Entered By
Date
2
F;\CLER\SALL\B&C Application\B&C Application Revised 091106 jak(~s.doc