Ray Breslin 02/13/2009'~F
Cih/ of Miami Mach, 1700 Convention Center Drive, Miami Beach, Fkxido 33139, www.miamibeochA.gov
OFFICE OF THE CITY CLERK, Robert Percher, City Clerk
TEL: (305) 673-7411, FAX:1305) 673-7254
March 6, 2008
Mr. Ray Breslin
2395 Lake Pancoast Drive, #4
Miami Beach, Fla 33140
SUBJECT: Cultural Arts Neighborhood District Overlay Committee (CAN DO)
Congratulations! You have been appointed by Mayor Bower to the above referenced
agency, board or committee for a term ending: 12/31/2009.
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,
.%~'.~ ~~~_L
Robert Percher
City Clerk
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 23rd Street
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We ore commuted to providing excellent public service and soiety to all who live, work, and play in our vibrant, Iropicol, historic community.
Cif~- of Miami Moth, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachA.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
TEI: (305) 673-7411, FAX: (305) 673-7254
TO Ray Breslin
RE: Cultural Arts Neighborhood District Overlay
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: 02,/ 13/2009
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.
y Breslin
Sworn to and subscribed before me this ~ day of 00 J~'~~ , 200
U
~rQ_ 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 ore committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic communiy.
Girl
1 ~~~.J
NAME: 1
't Name '
HOME ADDRESS: ~~ ~ ~ /
No.
PHONE: 3~O ~1 ` ~ ,/ o~
Home Work
Initial
Street City Sfate ~ Code
ax Email address ~~SQ~-dC~
Business Name: C-~!~ vV IV ~ ~ ` Position: >~ '~
Address:
No.
Professional License (describe)
Street
City
State Zip Code
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 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 :Yes r No
• Are you a registered voter in Miami Beac :Yes or No
• (Please check one): I am now a resident of: North Beach South Beac 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 three (3)
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Art in Public Places Committee
Beach Preservation Board
Beautification Committee
Board of Adjustment*
Budges Advisory Committee
Committee on Homeless
i=: 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
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 Locat 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
~ ~ d c~~~'~~'
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
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:
of your children, their
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~ No~f yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes or No If yes, explain in detail
• Are you currently serving on any City Boards or Committee :Yes r No If yes; which board?
.. -- -- -
• What organizations in tah~epC~i~ty of Miami Beach do you currently hold mf~bers)htilp in?
Name: ~~ L 1~ (IJ M~-- 1'~th~~ t ~( Title: /" ~d /~''
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 o No .Which department? ~`"-`'~'
• Pursuant to City Code Section Z-25 (b): Do you have a paren ,spouse ,child ,brother , or sister who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): X }~
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
Employment Status: Employed .Retired ^ Home-maker ~ Other
"I hereby a st to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII the City Co a "Standards of Conduct for City Officers, Employees and Agency Members."
. ~ L, ~ C.i ,~,1
Appllca t s nature Date Nam of Applicant (PLEASE PRINT)
Please attach a copy of 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
Name of Deputy
Document Control Number (Assigned by the City Clerk's Office)
Date
Entered By Date
Revised 70/29/2007 L. HaK~eld