Carl Zablotny 12/31/2009~` ~ ~ t
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachtl.qov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
12/21 /2007
Carl Zablotny
1800 Sunset Harbour #2103
Miami Beach, Florida 33140
SUBJECT: Police Citizens Relations Committee
Congratulations! You have been reappointed by Mavor Matti H. Bower
to the above referenced agency, board or committee for a term ending: 12/3112009.
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Carlos Noriega
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 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 Carl Zablotny
RE: Police Citizens Relations 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: 12/31/2009.
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 Florida (depending on the board or committee on which
I serve) on July 1st, following the closing of the calendar year on which I have served.
Carl Zablotny
y n~>~ ~~a,L% r
Sworn to and subscribed before me this'~~ d y of , 200
,~ S,Z`~~' -,~j
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 all who live, work and play in our vibrant, tropical, historic community.
m MIA/v11BEACH
BOARDS AND COMMITTEE APPLICATION FORM
Pursuant to City Code section 2-2?_(4) o and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement sf
be fulfilled in the following ways: a) an individual sholl have been a resident of the city for a minimum of six months; or b) on individual sh
demonstrote ownership/interest for a minimum of six months in a business established in the city.
Resident of Miami Beach for a minimum of six (b) months: Yes or No ( )
Phone: ~~J ~~~ ~G4fa
Home Work
(Please check one): I am now a resident of:
Business Name:
Address:
Demonstrate an ownership/interest in a business in Miami Beac for a minimum of six (b) months: Yes ( ] or No [ ]
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes°~
My special abilities, knowledge, or experience is:
Are you a registered voter in Miami Beach: Yes -br No ^ n
NAME: Q Ld 1 ~I ;
', V L
Lost Name first Nome Middle Initial
Home ~Q Q SU ~.i ~ i -Zf3UJ'v2 ,~0~, (b J V -' ! Q ~LI~ 3 ~ j ~~
Address: No. Street City State Zip Code
No.
Street
City
^ Owner ^ Stockholder/Shareholder ^ Corporate Officer ^ Other Explain:
Professional License (describe):
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes ^ or No ^ If yes, please explain in detail:
State Zip Code
Expires:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No~ If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes ^ or No
If yes, explain in detail:
_.
4. Are you currently sery~~ng on any City Boards or Committees: Yes or No_ ^.
If yes; which board? (~j (~'~ l'! (~`C'r~ ~ ~ ~ `~']~TI~n~J ~ ~Yyj/h ! %~~
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
Title:
Title:
List all properties owned or hove an interest in, which are located within the ity of Miami Beach:
Fax Email address
North Beach ~1 South Beach~Middle Beach ^
Applicant's Position:
C:\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK14\BC APPLICATION NOV 20051 .DOC
I om now employed by the Ci'y of Miami Beach: Yes ^ or No~ If yes', which deportment?
Pursuant to City Code Section 2-25 (b): Do you have a parent ^], spouse ^J, child ^], brother ^l, or sister ^] who is
employed by the City of Miami Beach? Check all that apply. Identify the department(s):
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.
Re ular Boards of Cit
^ Art in Public Places Committee ^Housin Authorit
^ Barrier Free Environment Committee ^Loan Review Committee`
^ Beach Preservation Board ^Marine Authority
^ Beautification Committee ^Miami Beach Cultural Arts Council
^ Board of Adjustment (Flood Mana ement ^Miami Beach Commission on Status of Women
^ Bud et Adviso Committee ^Miami Beach Florida Sister Cities
^ Committee on the Homeless
^ Committee for Qualit of Education in Miami B
h ^Normand Shores Local Gov. Nei hborhood Im rovement
eac
^ Community Development Advisory Committee* ^North Beach Youth Center Oversi ht Committee
^Oversight Committee for General Obligation Bond
^ Communit Relations Board ^Porks & Recreational Facilities Board
^ Convention Center Advisory Board ^ Per onnel Board *
^ Debarment Committee ^ P nning Board `
^ Design Review Board ` olice Citizens Relations Committee
^ Fine Arts Board ^ Production Indust Council
^ Golf Adviso Committee ^ Public Safet Adviso Committee
^ Health Adviso Committee ^ Safe Committee
^ Health Facilities Authorit ^ Trans ortation & Parkin Committee
^Hispanic Affairs Committee ^ Visitor & Convention Authority *
^Historic Preservation Board ` _ rJ Youth Center Advisory Board
*Board Required to File State Disclosure form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth
Center:
Past service on the Youth Center Advisory Board: Yes ^ No ^ Years of Service ^
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:
This section is "not required" but desired: Age: ^ Gende : .ale o Female ^
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
M tubers."
icant's Si nature
P 9 Dote Name of Applicant (PLEASE PRINT)
A achment: Please attach a py of your resume to your application.
NOTE: Appli ations will remain file for a period of one (1) calendar year.
Received in City Clerk's Office I by Deputy Clerk
Document Control Number (As gn d b the City Clerk' Offic Revised 11/15/OS
C:\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK14\BC APPLICATION NOV 20051.DOC