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Michael Guss 03/15/2009m of Miomi Id~ach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachA.gov OFFICE OF THE CITY CLERK, Robert Parchar, City Clerk TEL: (305) 673-7411, FAX: x;305) 673-7254 TO Robin Schwartz RE: Gay Business Development 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: 03 / 15 / 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 Pub/ic ~cers and Employees, and understand that as a member of a City of Miami Beach Board andlor Committee, I must comply with the financial disclosure"` require- ments of Miami-Dade County or the State of Florida (dep on the board or committee on which I serve) on Juty 1st, following the closing of the calendar year on whic ave rve -~ ~ ' -Tobin Schwartz Sworn to and subscribed before me this 2~ day of kS~-1 , 200$ ~~~~~` 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. G~i/ '~ NAME: ~ ~ rl W ~ 1`-~~~ ~~ I ~ ~('^ Last Name 6 First Name r~ ~~~ ~ Middle Initial HOME ADDRESS: ~ ~ ~ ~ ~.~(- ~ ~,~~ 331 S j SlItreet PHONE: 3ro ~ ~ } ti, ~~) ~1 3 pS~ ~ ~ T ~ >r~~ r CS lcfb e ,,,/State Zip Coc Home Work ~~ v ~ - ~i"~ Fax t Ema~ address Business Name: ~iN A" w }~ ~ ~ ~~~~ S~L• V" ~- Position: Wl ~ / ~ ~t ~ k Address: /((~yo ~'~~ ~S `yi ~~{./(~ibw~G,I' J /- kJl I w . ~ ~ t/ rvo. Professional License (describe) City State Zip Code _ Expires: • -~~~~~ •~ ~~~y ..ooe section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement shalt 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) month es r No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months es or No • Are you a registered voter in Miami Beac Yes or No • (Please check one): I am now a resident of: North Beach South Bea fiddle 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 (3l choices wilt be observed b the Cit 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" "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 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 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, 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 o No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes o No . If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes No If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes op'No ). If yes; which board? • 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(,o L(~GNbX ~, ~~L M83~L3~ • I am now employed by the City of Miami Beach: Yes ory to .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): 1Vb 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 h e y a t e accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII - C Code "Standards of Conduct for City Officers, Employees and Agency Members." 3 - zs . o ~ ~oa~ ~- ~ S~~Z A ~ nature Date Name 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 Date Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered By Date Revised 10/29/2007 L. HaKeld their m Cil~- of Miomi Math, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk TEI: (305) 673-7411, FAX: (305) 673-7254 TO Michael Guss RE: Mayor's Gay Business Development 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: 03/15/2009. 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. Michael Guss Sworn to and subscribed before me this day of ~ 200 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 ro providing excellent public service and soiety to oll who live, work, and play in our vibrant, tropicol, historic community. Gi/ NAME: ~9 ~ S ,5 ~ C~i'~ ~ f Last Name First Name Middle Initial HOME ADDRESS: C tC~'H / ( ~ ~ ~ / " 6 C uh^ / ~LGrC f'1 ~~ p~No. Stre t City State Zip PHONE: ~Y ZyU'' 7 O ~~ 7 c~lrt~ J u q o o. cr/,y, Home Work Fax Email address Business Na/mLe: /~ ~, V [~ ~s ~t na,~. L [ r~ l ~ p Position: _ ~G/'~'/~G/r~ tija.~+ Address: 'l ~ ~ ~ ~/tt,~r G[ I7C ~vyr /~i rt,.~ CG~'rs ~ Cp s~r ~ /il s ~l Ivo. Street City State Zip Code Professional License (describe) /'K 6, ~ ~ ~ ~/~ lpdr~s-C Expires: l 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) months: 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 or No • (Please check one): I am now a resident of: North Beach South 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 [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 ~ Housing Authority* Beautification Committee '/~ Loan Review Committee* Board of Adjustment* ~~ Marine Authority* Budget Advisory Committee ~~ Miami Beach Cultural Arts Council C~ Committee on Homeless .Miami Beach Commission for 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 Facilities 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 File State Disclosure form 1 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 o No If yes, please explain in detail: . Do you currently have a violation(s) of City of Miami Beach codes: Yes or~lo ~ If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes orNo ~ If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes orf No ~ If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: 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 of N% 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): ~ 1~ This section 's "not required" but desired: Age: ~ years old Gender: Male ~/ Female Ethnic Ori n (Check one) White frican-American/Black -~ panic: ~ Asian or Pacific Islander _ American Indian or Alaskan Native Employment Status: Employed ~ etired ~ 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 Members." A plicant's Sign ure Name 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 Date Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered By Date Revised 10/292007 L. Hatfield