Dana Kaufman 12/31/2008
City of Miami Beach, 1700 Convention Center Drive, Miami beach, Florida 33139, vrww.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
December 26, 2007
Dana Kaufman
SUBJECT: Budget Advisory Committee
Congratulations! You have been appointed by Commissioner Tobin to the 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.
Sincereely,
~~
obert Parcher
City Clerk
cc: Saul Frances, Parking Director
Jose Cruz
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) Palm Court Building 309 23'd Street
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m 11AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Dana Kaufman
RE: Budget 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 theF/orida 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 Flori ending on the board or committee on which
I serve) on July 1st, following the closing of the lendar y r on which I have served.
` D a Kauf an
l
Sworn to and subscribed before me this ~ day of 4^a , 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 excellent public service and safety to al! who live, work and play in our vibrant, tropical, historic community.
m ',I.~`;'iBEACH
NAME: ~ ~ ~~ ~ ~~
---~
'~. I > ~ ~~ litSl4 tl ~ ~.HC~
~ ADD G~~4~~liT?°~ A.~F°( ff;ATit~i'~ ~u~e":
'' Last Name First Name Middle Initial
HOME ADDRESS: ~~ ~_~ ~ `~ ~ ~ ~ T ~2- ~ ~ f `.., ~~~ ~~ ~
No. _ Street City tae Zip Code
PHONE:
Home Work 3p~ -~ icy-ZS'Z°Fax Email address ~ i~'-
( c`'. n.
Business Name:
Address:
Position:
No. Street City State Zip Code
Professional License (describe) ~~~ "-' ~j`~' `~ 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 minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) month : Yes or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) month ~ Ye ~ or No
• Are you a registered voter in Miami Bea is Y ~ or No
~_
• (Please check one): I am now a resident of: North Bea South Bea Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your preferences in orde of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the Ci `Clerk's Office. (Regular Boards of City)
-Art in Public Places Committee
~= Beach Preservation Board
Beautification Committee
Board of Adjustment"
-~~Budget Advisory Committee
Committee on Homeless
Committee for Quality Education in MB
Community Development Advisory"
Community Relations Board
Convention Center Advisory Board
Debarment Committee
Design Review Board*
Disability Access Committee
Fine Arts Board
- Golf Advisory Committee
Health Advisory Committee
Health Facilities Authority Board
Hispanic Affairs Committee
J Historic Preservation Board`
"Board Required to File State Disclosure form
Housing Authority'
Loan Review Committee*
Marine Authority"
`Miami Beach Cultural Arts Council
Miami Beach Commission for Women
-Miami Beach Florida Sister Cities
Normandy Shores Local Gov't Neigh. Improvement
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
=Transportation and Parking Committee
Visitor and Convention Authority'
Youth Center Advisory Board
1
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 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 r No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes o+c Nd'1 . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes r No. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes Ng 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 hav an interest in, which are located within the City of Miami Beach:
n~ c, -Q ~ t ~' n\~~
• I am now employed by the City of Miami Beach: Yes r Na .Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ,spouse ,child ,brother , or sister 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: years old Gender: Male ^ Female
Ethnic Origin (Check one)
White -African-American/Black =Hispanic: `Asian or Pacific Islander =American Indian or Alaskan Native
E oy nt Status: Employed ~ Retired ~ Home-maker _~ Other .-
"I hereby a est to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
rticle VII - e City Code "Standards of Conduct for City Officers, Employees and Agency Members." ~
1 ~j~ ~~~ LJQ~1E ~ ~~ t~~~,
Applican 's Si at a Date Name of Applicant (PLEASE PRINT)
Please attach a copy 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 Date
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) _~~~ Entered By ~ ~ ~ Date , /~ 0
Revised 10/ 9/2007 L. Hatfield
2