Joyce Galbut 12/31/2008
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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
02/20/2007
Joyce Galbut
10661 NE Quaybridge Ct
Miami, Florida 33138
JECT.: 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,
?J~)ctJ
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 committee ro providing excel/enr public service and safety ro alf who live, work, and play in our vibrant, tropIcal. h,storic 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 Joyce Galbut
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 andlor 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 ear on which I have served.
Sworn to and subscribed befor
Joyce Galbut
e this 5 day of tn~c.-J,-, 200-:]
~o \<~n
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 committee to providing excelfent public service and safety to all who live, work, and play in our vibrant, tropical, historic cammunity
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Address: /30 () tJ F. / f:,JJ-t,.. J h.r...t. f C..orf'O~ C ~.:2-0 ~ ~) m CI~ t::-u4-
No. Street City State Zip Code
Professional License (describe) 77/ 77- d- jI2.. N . Expires:~O SJ Attacfl a copy of the license
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MIAMI BEACH
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Last Name
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HOME ADDRESS:
No.
PHONE:
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Business Name:
CITY OF MIAMI BEACH
BOARDS AND COMMITTEE APPLICATION FORM
Middle Initial
QI. m a "kA.;
City
.3~/3@
Zip Code
50~ - c?9/-~93
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 0 or No ~
. D~:~~w7q~~~e~u~n Miami Beach for a minim~m of six (6) months: Yes}i1or No 0
. Am you a register~d voter in Miami Beach: Yes 0 or No ~
tl\,,,,,;
. (Please check one): I am now a resident of: North Beach~South Beach 0 Middle Beach 0
. I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
;;., I I ""
R. l!:ky~ iJ IA..t'H el,d J()krH. O.{JJ......~ fLA--'U4 ^l Un.f'(AJ9 ~
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 Committee
o Design Review Board*
o Disability Access Committee
o Fine Arts Board
o Golf Advisory Committee
~ealth AdvisoryCommittee
o Health Facilities Authority Board
D'Hispanic Affairs Committee
o Historic Preservation Board*
* Board Required to File State Disclosure tonn
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 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 A'uthority*
o Youth Center Advisory Board
1
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 0 No ~ Years of Service:
2. Present participation in Youth Center activities by your children Yes~ No lJ. 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 D or'No14 If yes, please explain in detail: .
· Do you currently have a violation(s) of City'of Miami Beach codes: Yes D or No~lf yes, please explain in detail:
· Do you currently owe the City of Miami Beach any money: Yes D or No~. If yes, explain in detail
· Are you currently serving on any City Boards or Committees: Yesf or No D. If yes; which board?
H- eA.J;CL 4:I.v IS fJ~ ~ 8 ~
· What organizations in the City of Miami Beach do you currently hold membership in?
Name:
(h(a~ g-tAd- ~aYh~ ,
Title:
~k.J
Name:
Title:
"'--
· List all properties owned or have an in rest in, which are located within the City of Miami Beach:
/h e Pl-A'U\ s., tJk A.... r (j..... eJ "- 1\ V€-.:3 ~
· I am now'employed by the City of Miami Beach: Yes \(or NoD. Which department?
· Pursuant to City Code Section 2-25 (b): Do you have a parent 0, spouse 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):
1)0
This section is "not required" but desired: Age: years old Gender: Male D Femal~
Ethnic Origin (Check one)
White ~frican-American/Black D Hispanic: D Asian or Pacific Islander D American Indian or Alaskan Native 0
Employment Status: Employed 0 Retired 0 Home-maker 0 Other 0
y attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
1- of the Cit de "Standards of Conduct for City Officers, Employees and Agency Members."
~c.L,' 3/ ?Po 7
Date
--:::Jo ~ (J. ~ b J rJ.. --..J
Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Received in City Clerk's Office by
Name of Deputy ~ ~
Document Control Number (Assigned by the City Clerk's Office)
2
Date
Date
F:ICLER\$ALL\B&C ApplicationlB&C Application Revised 091106 jakes.doc
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