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Laura Jamieson 02/13/2009m Cif~- of Miami Mach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachll.gov OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk TEI: (305) 673-7411, FAX: (305 673-7254 TO Laura Jamieson 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 ~cers 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. .-~°;.' ,~ `"~ r~ ~~. 1` aura Jamieson Sworn to and subscribed before me this ~~day of fl~as°~ , 200 L.~`ltli g~J ~P~uC,~~wf~ De ty Clerk // *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Cletic/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safey to all who live, work, and play in our vibrant, tropical, historic community. I• NAME: c ~ A~'1 l ~~'iSV~ ~C3i,C,(,Y7.3~, Last Name /I First Name /Middle Initial r~ HOME ADDRESS: ~~~ /~ /L7°~ , ~t~i "V~ ~~ ~ l-~l-~'jLL~I /~1~- J_ ~~~ `S No. Street City State Zip Code PHONE: _ L~~ Home ~_~ Work Fax ~'.1~t Business Name:. ~ ~~ ~i ~Q ~ (~~~ n Position: ~ ,A ~,p "~ T ~,l~~jy'-' Address: Professional License (describe) Street State ~ Zip 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; orb) 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) mont :Yes or 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 . No • (Please check one): I am now a resident of: North Beach outh Beach 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 j3] 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* 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 Historic Preservation Board* 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 City " fl3oard Required to File State Disclosure form ~~~~