Dona Zemo 12/31/2009~~~ ~ ~~ ~j ~~j ~
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
01 /03/2008
Dona Zemo
3101 Indian Creek Dr
Miami Beach, Florida 33140
SUBJECT: Miami Beach Commission For Women
Congratulations! You have been reappointed by Commissioner Saul Gross
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, ~
~j~ ~~~,~~~~ ~ ~~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Maria E. Martinez
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 at! who live, work and play in our vibrant, tropical, historic community.
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 Dona Zemo
RE: Miami Beach Commission For Women
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
Amendmentand Code of Ethics for Public O>ficers 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.
~--~ Dona Zemo
Sworn to and subscribed before me this ~ day_of 200
ilvia 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.
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 [ ]
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 re istered voter in Miami Beach: Yes [ ] or No [ ]
NAME: ~~~~ ~~~~
Last Name
Home 3iOl ~-~7i?~~N C~.~~^l~C l7~' . -
Address: No. Street ~tV~{-
Phone• ~~ -S02-32D 7 `3~ ~ - l~7ot~ I a7d
F~orne c p~ Work
First Name
Y~.1°~•
City
Fax
Middle Initial
~l , X31 y-C~
State Zip Code
C~C v~G~~ w~~a vh", ~Q C~.
Email address (~,~~ vh /- ~~~
i am now a resident of: North Beach [ ]South Beach [ ]Middle Beac ~]
Business Name: ~~_~~~SJi1~~~ ~~1~Z, Applicant's Pos~/iti~on: ~1~--~~~
Address: 1~~ vim` Q V~l Q U1 ~~Q_ . Y ' 1 ~ ~J3~
No. Street City State Zip Code
[ ]Owner [ ]Stockholder/Shareholder [ ]Corporate Officer [ ]Other Explain: ~S l A
Professional License (describe): 1J ~ /~ Expires: N
Attach acopy ofthe /icense listed a ve.
1. Have you ever been convicted of a felony: Yes [ ] or No ~If yes, please explain in detail:
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 serving on any City Boards or Committees: Yes [ ] or No [ ]
If yes; which board? (, S`t'A-t-'t1S Fog l..x~+t~~ S i ~ C-E Z.p ~ 2 )
____
What organizations in the City of Miami Beach do you currently hold membership in?
Name: 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 NE~. If yes, which department.
Pursuant to City Code Section 2-25 (b): Do you have a parent [ ], spouse [ ], child [ ], brothe~ ], or sister [ ]who
is employed by the City of Miami Beach? Check all that apply. Identify the department(s): 'tJ
F: \CLERISALLIELIZABE'ilB&C~BCAPPLIC04. doc
.-~
Please list your preferences in orders... anking [1] first choice [2] second choice,,, ;;d [3] third choice. Please note that
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
[ ]Barrier Free Environment Committee
~'] Beach Preservation Board
[ ]Beautification Committee
[ ]Board of Adjustment (Flood Mgmt.)*
[ ]Budget Advisory Committee
[ ]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 Neighbofiood 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
[ J Production Industry Council
[ ]Public Safety Advisory Committee
[ ]Safety Committee
[ ]Transportation and Parking Board
[ ]Visitor and Convention Authority*
[ ]Youth Center Advisory Board
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:
Child's name:
Age: Program:
Age: Program:
This section is "not required" but desired: Age: [~C ] Gender: M [ ] or F ~,
Ethnic Origin (Check one)
White ~~ African-American/Black [ ] Hispanic: [ ]
Asian or'Pacific islander [ ]American Indian or Alaskan Native [ ]
Employment Status: Employed f~,j~ 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
tiers."
~~~~ ~ ~~t r~~ ~ ~~~~
pplicant's Signature Date Name of Applicant (PLEASE PRINT)
Attachment: Please attach a copy of your resume to your application.
NOTE: Applications will re in on file for a period of one (1) calendar year.
Received in City Clerk's Office ~ /~ /~ f( by Clerk
Document Control Number (Assigned by the City Clerk's Office) ~ ~ ~ Rev #7- 01/08/04
~~~~
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