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Home My WebLink AboutChiverton -3AFFIDAVIT OF CANDIDATE FOR APPOINTMENT CITY OF MIAMI, FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI (hereinafter "affiant"), being first duly sworn under penalty of perjury,0--1(11 deposes and says: ,� 1. My name is J> . �J' 1 OQ e %i ER Td' 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the City of Miami for a minimum of one year in Commission District Number 5, prior to accepting the appointment and I am a registered voter and a duly qualified elector of the City of Miami, Florida, presently registered to vote in precinct No. 542. ,. I presently reside at the following address (must include zip code): 94 m) iL , m E! f)2i'cuni PG 3310-7 ,whith is my le al address, and I have resided continually at said address from the /I day of , /9 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the below listed addresses for the cited periods of time (List below all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses For the Period 45-02-9,Uw/9 treEirr- /990 - Page 1 Oh/— O )l30— 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: Ay4 6. Affiant's spouse resides at the following address: (must include city, state and zip code) 7. Affiant's minor children reside at the following address: (must include city, state and zip code) 8. At the present time, affiant is (is not) registered to vote in any city, county or state other than as stipulated in subparagraph 3 above. 9. Name and business address of affiant's employer: ?VP Pe CgAiT,+s, 14c. lQ * ,.14.) cs7 eEET l 24a.,►yt; I FL 3313L 10. A 'ant's occupation: i'i F - DI l P 81$2 TZ0/(S 11. Affiant has been employed in the above -cited capacity for the following period of time: /S' ,/;e5 (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). Page 2 12. Affiant represents that he/she (is) (is not) currently holding another elective or appointive office — whether city, county or municipal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, as of this date, he/she (is) (is not) an employee of the City of Miami, Florida. 14. Affiant represents that, if appointed, he/she shall serve in the office so appointed. SIGNED THIS % DAY OF AFFIANT BEFORE ME, the undersigned authority, personally appeared , who, after first being duly sworn, deposes and states that executed the foregoing to the best of knowledge and belief. CITY CLERK, CITY OF MIAMI, FLORIDA (SEAL) Did take an oath Produced identification Type of identification produced: Page 3 X: ECT1ONS Vetei ;L. issued Miami -Dace CCL..7!`C/, FL Ernitida Tarieta de identificaciOn del elector Enprime Condadc FL 09/08/04 idantiiikasynn Kat 'vote Kerte ace. E. 01144370 CHIVERTON, DAVID S 948 NW 46TH ST MIAMI FL 33127 Signature of voter i Firma del elector 1 Siyati Vote Registration No. Nim. de inscription Nim. Enskripsyon 01144370 Registration Date Fecha de inscription Dat Enskripsyon 05/24/82 Identification Data Datos de dentificacion Ent°. idantifikasyon MB 06/17/64 Party Affiliation Afiliacion partidista Pat; Politil< REP Precinct No. Num. del recinto Nim. Biwo V6t 522 Polling Place I Centro de votacian 1 Lipka' Biwa \lot MOORE PARK 785 NW 38 ST Constance A.,. Kaplan Supervisor of Elections Supervisora de Electiones/Sipevize Eleksyon You are eligible to vote for the representatives from the districts listed below./ Ud. es elegible voter por los representantes de los distritos enumerados abajoi VV elipb pou w vote pou reprezantan nan distr ki ekri anba a yo. Congress Congreso Kongre 017 State Senate Senado Estatai Sena Eta 039 State House Camara Estatal Lachanm Eta a 109 County Commission School Board Community Councii ComisiOn dei Condado junta esodiar Consejo comunitario Komisyon Konte Asanble Edikasyon Konsey Kominote 03 02 Municipal Municipal Minisipal MIOS Mtn 41f 41,11/c.49r . — The Sunshine State LIBIONIEtteillet 163.1$0-64.217-0 PL 83137419311 avoe sox bet Rest- ENDORSE 1744 IA POI amine$ ouruovE 8114740 094040 WE towel consent 'to any Sobriety test required by law • CONCEALED WEI*PON 0-4R FIREARM LICENSE „-••••••,•• • „ • • _ Document Name: Session2 STIN STREET ID: 076400 ARPS PROPERTY SYSTEM - STREET INQUIRY IN USE: YES --HOUSE RANGE-- QUAD 0800 - 0998 NW 46 FACE: ZIP CODE: CENSUS TRACT: CENSUS BLOCK: FIRE 901 ZONE: FIRE SFBC ZONE: NBHD CODE: SUB NBHD CODE: SOLID WASTE ROUTE: TRASH ROUTE: STREET CLEAN ROUTE: N 331272300 2300 2004 1034 3A 03 01 106 00 000 NEXT STREET: HOUSE NO: QUAD: ACTION: 1-CONTINUE NAME TYPE ST PRIMARY ZONE: SD1 ZONE: SD2 ZONE: DDRI ZONE: SEOPWDRI ZONE: HIST PRESVN DIST: SCENIC CORRIDOR: PEDESTRIAN PATHWAY: OMNI TAX DISTRICT: DDA DISTRICT: CD TARGET AREA: NAME: N N N N N N N 02 --SIDE-- 0 EVEN (13) EMPOWERMENT ZONE: N LATIN QUATERS: TYPE: N ACTION: 01 XMIT: Date: 10/1/2004 Time: 2:52:38 PM ELECTIONS X: Voter ID Card Miami -Dade County, FL Tarjeta de identification del elector Condado de Miami -Dade, FL Idantifikasyon Kat Vote Konte Miarri-Dade, FL 01144370 CHIVERTON, DAVID S 946 NW 48TH ST MIAMI FL 33127 Signature of voter / Firma del elector / Siyati Vote issued Ernitida Er,pr,me 09/08/04 Registration No. Num. de inscription Nim. Enskripsyon 01144370 Registration Date Fecha de inscription Dat Enskripsyon 05/24/82 Identification Data Datos de identification Enfo. Idantifikasyon MS 08/17/64 Party Affiliation Afiliacion partidista Pati Politik REP Precinct No. Num. del recinto Nim. Biwo Vot 522 Polling Place / Centro de votacion / Lokal Biwa Vat MOORE PARK 785 NW 35 ST Constance A. Kaplan Supervisor of Elections Supervisors de Elecciones/Sipevize Eleksyon 'You are eligible to vote for the representatives from the districts listed below. / Ud. es elegibie para votar por los representantes de los distritos enumerados abajo.! W elijib pou w vote pou reprezantan ki nan distri ki ekri anba la yo. Congress Congreso Kongre 017 State Senate Senado Estatal Sena Eta a 039 County Commission School Board Comision del Condado Junta escolar Komisyon Konte Asanble Edikasyon 03 02 Municipal ! Municipal / Minisipal MIOS State House Camara Estatal Lachanrn Eta a 109 Community Council Consejo comunitario Konsey Kominote 70127 rtgldf TheoSunshine State — y1a�� 217-0 MONO L 33137fi0118 w�taarmE aitx Ear. pEsr. • 81-1744 M $81 1411100 0S4744 1 -17-10 SaFE 01tlIER coeasrdto any sobriety test required by taw Document Name: Session2 STIN STREET ID: 076400 ARPS PROPERTY SYSTEM - STREET INQUIRY IN USE: YES --HOUSE RANGE-- QUAD 0800 - 0998 NW 46 FACE: ZIP CODE: CENSUS TRACT: CENSUS BLOCK: FIRE 901 ZONE: FIRE SFBC ZONE: NBHD CODE: SUB NBHD CODE: SOLID WASTE ROUTE: TRASH ROUTE: STREET CLEAN ROUTE: N 331272300 2300 2004 1034 3A 03 01 106 00 000 NEXT STREET: HOUSE NO: QUAD: ACTION: 1-CONTINUE NAME TYPE ST PRIMARY ZONE: SD1 ZONE: SD2 ZONE: DDRI ZONE: SEOPWDRI ZONE: HIST PRESVN DIST: SCENIC CORRIDOR: PEDESTRIAN PATHWAY: OMNI TAX DISTRICT: DDA DISTRICT: CD TARGET AREA: NAME: N N N N N N N 02 --SIDE-- 0 EVEN (13) EMPOWERMENT ZONE: N LATIN QUATERS: N VOTING DISTRICT: 05 TYPE: ACTION: 01 XMIT: Date: 10/1/2004 Time: 2:52:38 PM