Rabbi Y. Kliel Rose 12/31/2008January 16, 2008
Rabbi Y. Kliel Rose
2851 Prairie Avenue
Miami Beach, Florida 33140
SUBJECT: COMMITTEE ON THE HOMELESS
Dear Rabbi Kliel Rose:
Congratulations! You have been appointed by Commissioner Weithorn to the above-referenced
agency, board or committee for a term ending 12/31108.
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 Parch
City Clerk
cc: Saul Frances, Parking Director
City Liaison Maria Ruiz
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 St, Ste 200
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
FEt ' ~mmrnit~ ;.
W'a are committed ta{~xidrng: cvseellemh public s~vrce arrd srrfetg~ ra,al(vvnc~ true, u,~ork, uma~' ~{ov in oar vibrant, tropica{, historic comrxrcerrrn,~.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Rabbi Y. Kliel Rose
RE: Committee on the Homeless
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 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.
Rabbi Y. Kliel Rose
Sworn to and subscribed before me this ~ ~ day of rcv~ , 20(~
Silvia Prieto
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.
® I~/t I AM l B E~~ H CITE OF IilllAlVll gE~acH
I~f~ARD a~Nl~ CC711IItViITTEE APPLIC,ATIl~N FC?R~lt
NAME: _ v~ ~ ~ ~~
Last Name I Q .~ 1 ~ First Name M ~,.,, ~ ~ Middle/ Initial ~/.
HOME ADDRESS: ~~~ t \ l~~\.\~~ /~.. Y ~-- r' '~~~ ~~=~"'~'~ 1 V ~ ~' ~l
No.
PHONE: ~~
Home
Business
Address:
Professional License (describe)
Work
Zip Code
address
Fagrires: Attach r~ cs~~~y ~f the 4ice.;rs~~
Pursuant to City Code section 2-22(4) a and b: Members of agenaes, boards, and committees shall be affiliated with the aty; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the aty for a minimum of six
months; or b) an individual shall demonstrate ownershiprnterest for a minim~u of six months in a business established in the aty.
• Resident of Miami Beach for a minimum of six (6) months: Yes;?Sor No ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No ^
• Are you a registered voter in Miami Beach: Yes [for No ^
• (Please check one): I am now a resident of: North Beach ^ South Beach I~Middle Beach ^
. 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 th
of es p rv the C Clerk' ce. (Regular Boards of City)
Art in Public Places Committee ^ Housing Authority;
^ Beach Preservation Board ^ Loan Review Committee*
^ Beautification Committee ^ Mayor's Green Ad-Hoc Committee
^ Board of Adjustment* ^ Marine Authority*
~udget Advisory Committee ^ Miami Beach Cultural Arts Councl
Committee on Homeless ^ Miami Beach Commission on Status of Women
^ Committee for Quality Education in MB ^ Miami Beach Florida Sister Cities
^ community Development Advisory* ^ Normandy Shores Local Gov't Neigh. Improvement
Community Relations Board ^ Oversight Committee for General Obligation Bond
^ Convention Center Advisory Board ^ Parks and Recreation Faalities Board
^ Debarment Committee ^ Personnel Board*
^ Design Review Board* ^ Planning Board*
^ Disability Access Committee ^ Police Citizens Relations Committee
^ Fine Arts Board ^ Production Industry Council
^ Golf Advisory Committee ^ Public Safety Advisory Committee
^ Health Advisory Committee ^ Safety Committee
^ Health Facilities Authority Board ^ Transportation and Parking Committee
^ Hispanic Affairs Committee ^ Visitor and Convention Authority*
~ ^ Historic Preservation Board* ^ Youth Center Advisory Board
* Board Required to Fil• State Disclosure form
City
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(.~:1?,~'~;~; iatr~eri±s 7s;d Setti,lc~s'~rom~zurbr~tiocal Settmys?Te~npor2ry iniernet ~-i!estCiLi{1C5iG~~: i'i?piin~ticn Revised .Sul~'~s 2Q07.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 ^ 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 ^ or No ~ If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No C'1' If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No Ca! If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ^ or No ~ If yes; which board?
• What organizations in the City of Miami Beach d you currently hold membership in?
Name: til ~ GLi'V7 Title:
Name:
Title:
~'"' • List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ^ or Noy1. 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 B~ Female ^
Ethnic Origin (Check one)
White ^ African American/Black ^ ispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
Employment Status: Employed E7 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 Ctty Officers, Employees and Agency Members:'
_ ~
Applicant's ignature D to Name of Applicant (PLEASE PRINT)
Please atta h a copy of your resume to this application
NOTE: Ap ications will remain on file for a period of one (1) calendar year.
Received in City Clerk's Offiice by ~-~ ~'
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) ~i~~~ Entered
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