Ann Thomas 12/31/2008
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
03-09-2007
Ann Thomas
465 Ocean Dr #516
Miami Beach, Florida 33139
tlilJec"'[':;; Disability Access Committee
Congratulations! You have been appointed by Commissioner Saul Gross
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 1 st, 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.
~:dtJLJJJJ
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Heidi Johnson-Wright
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, 2-458 and 2-459
Ordinance No. 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 Employee
We are committed to providing excel/ent public seNice and safety to 01/ who live, work. and play ;n our vibrant, tropicol. historic community
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: 1305) 673-7411, FAX: (305) 673-7254
TO Ann Thomas
RE: Disability Access 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 0 the board or committee on which
I serve) on July 1 st, following the closing of the calendar yearmr rved.
,c;Z{~ ~ ~
, ~- tnn Tho
Sworn to and subscribed before me thi~day of
/
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 cammi/ted 10 providing excellent public seNice and safety to 01/ who live, work, and play in our vibrant, tropical. historic community
CITY OF MIAMI BEACH BOARDS AND COMMITTEE
APPLICATION FORM
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 [ ]
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes [ ] or No M
I am ap~lying. ~~r a Board appointment ~ecau~e I have special abilities, _kno~ledge, experien<:e:_.Yes [ ]
My special ablhtlesr knowledge, or expenence IS: (-1 f .::: Co l' \ ,,-<I /7 I t::.(. \ - /, - / ,/ (/ t-h 'i )
Are you a regis~ter.ed vo~er in ~ia~i Bea~h: Yes [ ] or No [ ] /. __..
NAME: -1/ ~"t' / / /./ t' ;t.'7 ,%;7 '-.,
/.. r , ,. , /
La Name" /_\"'"'/" I :..; First Name Middle Initial
Home L:j:'.. ~).-S C\~ E. Ou" Lh - / f) '.I /J1/({ {." T / f]:. 'fC..J, -L..{_.?-.:;' / :;." (j
Address: No. Street City State Zip Code I
PhonE(, ::?C <IS ?;',,:<
Home
..~( I
ork
Fax
Email address
I am now a resident of: North Beach [ ] South Beach~ Middle Beach [ ]
Business Name: Applicant's Position:
Address:
[ ] Owner
] Stockholder/Shareholder
] Corporate Officer
City
] Other Explain:
State Zip Code
No.
Street
f-:- /. (;) k. ) h
Professional License (describe): ' ,:? 1./
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes [
;1
,,""-).4J /-J
'1.:."-;' ./"1 l"'-
Expires:
or No IX::j If yesr please explain in detail:
,/
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [ ] or N9/N. If yesr please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [ ] or No P<J
If yesr explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes [ ] or No [X]
If yes; which board? I
What organizations in the City of Miami Beach do you currently hold membership in?
~ ~ 0 ,~
t,....:., L:~ /1 ( /) ( c' ) r) ! F--
// -. ,~
Name:
Title:
Name:
Title:
~i~t ~II prop~rtiesown~have an interest in~hic, hare }ocated ~ith~l'l}h,e ,C~ty of,~iami Beach:
I . /.. I~' \ (, .., -;, ~ ,! " I .._- / J ,f1 I . ,,' ) J \ i' / r
-- '- ",_, '-- ~,- -..... '__ "'-.'-__I,~_"",_,""',-fV ../ ...... \._> t---.
,
I am now employed by the City of Miami Beach: Yes [ ] or No,))''l" If yes, which department.
Pursuant to City Code Section 2-25 (b): Do you have a parent [ ]r spouse [ ]r child [ ]r brother [ ]r or sister [ ] who
F :\CLER \$ALL \ELlZABET\B&C\BCAPPLIC04.doc
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is employed by the City of Miami Beach? Check all that apply. Identify the department(s):
//' I vi; (( c:/ 0 e f i fit <-.d h;", ( C. r, > , j! / 'I I' I
( Please Iist"your preferences in order of ~nking [1] first choice [2] second choice, and [3] third choice, Ple.se note ,:., L .)
V only 3 choices will be observed by the City Clerk's Office.
(Regular Boards of City) (*Board Required to File State Disclosure form)
[ ] Art in Public Places
,[ ] Audit Committee---',
/" [~.Barrlirf~_EnVirOnment Committee.'
r J-1;leach Preservation Board
[ ] Beautification Committee
[ ] Board of Adjustment (Flood Mgmt.)*
[ ] Budget Advisory Committee
[ ] Codc EAforccmcAt T;Jslc Forcc
..J, [;;...1 Committee on Homeless
-) [ ] Committee for Quality Education in MB
[ ] Community Development Advisory*
[ ] Community Relations Board
[ ] Convention Center Advisory Board
[ ] Convention Center Capital Projects Oversight
[ ] Debarment Committee
[ ] Design Review Board*
[~} Fine Arts Board
, [ ] Golf Advisory Committee
[ ] Health Advisory Committee
[ ] Health Facilities Authority
[ ] Hispanic Affairs Committee
[ ] Historic Preservation Board*
[ ] Housing Authority*
[ ] Loan Review Committee*
] Marine Authority*
] Miami Beach Cultural Arts Council
] Miami Beach Commission on Status of Women
] Miami Beach Florida Sister Cities
] Normandy Shores Local Gov't Neighborhood Improvement
] North Beach Youth Center Oversight Committee
] Nuisance Abatement Board*
] Oversight Committee for General Obligation Bond
] Parks and Recreation Facilities Board
] Personnel Board*
] Planning Board*
] Police Citizens Relations Committee
] Production Industry Council
] Public Safety Advisory Committee
] Safety Committee
] South Point Advisory Board* to Redevelopment Agency
] Tourist ;Jnd Con'.'cntion Ccntcr Exp<lnsioA Authority
] Transportation and Parking Board
] Visitor and Convention Authority*
] Youth Center Advisory Board
Note: If applying for Youth Advisory Boardr please indicate your affiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes [ ] No [ ] (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 agesr and which programs. List below.
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
Gender: M [ ] or ~
This section is "not required" but desired: Age: [ ]
Ethnic Origin (Check one)
White ~ African-American/Black [ ] Hispanic: [ ]
Asian or Pacific Islander [ ] American Indian or Alaskan Native [
]
Employment Status: Employed [ ] Retired [ ] Home-maker [ ] Other [
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
::i~::":r/4f?N'~f~f~ I. D ~am;! AP~cant ~~~~;R~~~ S
Attachment: Please atta~ a copy of your resume to your application.
NOTE: 18~Ii~iORy11i11 r. ai n file for a period of one (1) calendar year.
Received in City Clerk's Office alp{ /0. by Clerk
Document Control Number (Assigned by the City C rk's Office) /q1 f Rev #7- 01/08/04
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