Laura Leyva 12/31/2008
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city of Miami leach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.gov
OFFICE OF THE CITY ClERK, Robert Porcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
02/21/2007
Laura Leyva
PO Box 5317
Hialeah, Florida 33014
:'^' Health Advisory Committee
Congratulations! You have been appointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12/31/2008.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
fro/A
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Cliff Leonard
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-2458, 2-459
Ordinance 2006-3543 - Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to providing excel/en' public service ond sofety '0 01/ who live, work, and play in our vibrant, troplcol, historic community
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
TO Laura Leyva
RE: Health Advisory 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 1st, following the closing of the calendar year on I have served.
ura Leyva
Sworn to and subscribed before me this _ day of \.J\o..n::.X\ , 200:;1-
~-
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.
We are committed to providing excel/en' public service ond safety to 01/ who live, work, and play in our vibrant, tropical, histoflc community
&
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Mli\/'v\l BEACH
NAME, Let~tte
HOME ADDRESS: Drlo. ;) Y
No.
PHONE: ~S. 8'lo lD '-d'f L <0
Home Wo~
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Address:
Professional License (describe)
Middle Initial
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PC
State
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Zip Code
Email address
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State Zip Code
Expires:
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 minimu7f six months in a business established in the city.
. Resident of Miami Beach for a minimum of six (6) months: Yes ~ No 0 /
. Demonstrate an ownershiP/~nterest in a business i~iami Beach for a minimum of six (6) months: Ye~~or No 0
. Are you a registered voter in Miami Beach: Yes 4 or No 0
. (Please check one): I am now a resident of: North Beacj>(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 [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)
o Art in Public Places Committee
o Beach Preservation Board
o Beautification Committee
o 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 Cdmmittee
o Design Review Board*
o Disability Access Committee
o Fine Arts Board
~..9olf Advisory Committee
MHealth 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 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 R~creation 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\SALL\B&C Applic8tion\B&C ,^,pplicatioll f~()l!iscd OD11 Db iakes doc
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past sent,ice on the Youth Center Advisory Board: Yes No I Years of Service:
2. Present participation in Youth Center activities by your children Yes No . If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: _ Program:
..
Child's name:
Age:
Program:
.Have you ever been convicted of a felony: Yes [i or No If yes, please explain in detail:
· Do ybu currently have a violation(s) of City of Miami Beach codes: Yes, 0 or No . If yes, please explain in detail:
· Do you currently owe the City of Miami Beach any money: Yes 0 or N . If yes, explain in detail
· Are you currently serving on any City Boards or Committees: Yes 0 or N
· What organizations in the City of Miami Beach do you currently hold membership in?
Name ~& u......t~^"""t ~ nle_~L....
Name:
Title:
· List all properties owned or have an interest in, which are located within the City of Miami Beach:
/1A-
· I am now employed by the City of Miami Beach: Yes 0 or N~iCh department?
· Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse 0, child lJ, brother ='l, or sister Cl who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ~ { 4-
This section is "not required" but desired: Age: "? ~ years old Gender: Male 0 Female n//
Ethnic Origin (Check one) V t
White 0 African-American/Black 0 Hispani~ Asian or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed 0 Retired 0 Home-maker 0 Other 0
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Ame1. VII- of lh Code "Standa'ds of cond; ,;,ty ;;;mPlor:.:A:ney ;~b."'."
Date Name of Applicant (P~
... 0.... \<es.
"-.J Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office)
Entered By
Date
Revised 1/25/07 jo
Received in City Clerk's Office by
Date '-3 Is; 1 cS=}-
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