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OVERTOWN ADVISORY BOARD APPLICATION FORM
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NAME: VS Sot -' �v ►/� `J
RESIDENCE ADDRESS:9)(9\C) , i. 1 7 6 G J `U
i zip code)
HOME PHON 7S-r-`L T BUSINESS PHONE: 74
e-mail:,(Y�21 t A/c 4 1014 4.60 , ''',
City Code Sec. 2-884(e) states that no employee of Miami -Dade County,
Florida, or any municipality therein other than City of Miami employees,
shall serve on or be appointed to any Board of the City of Miami, unless the
city commission waives this restriction by a four -fifths affirmative vote of its
membership and the employee is a resident of the City of Miami.
Are you an employee of Miami-ade County or any municipality therein
other than the City of Miami?
Are you 18 years of age or older?
Are you a resident of Overtown?
Are you the owner of property or do you have a business in Overtown? If
yes, give address:
Are you an employee or board member of a community development
corporation or community based organization located in and providing
services to the Overtown area? If s, give name and address:
CITY OF MIAMI
OVERTOWN ADVISORY BOARD NOMINATION FORM
(TO BE COMPLETED BY NOMINATOR AND TO BE SUBMITTED TO THE
OFFICE OF THE OVERTOWN ADVISORY BOARD/OVERTOWN N.E.T. BY
4:00 P.M. ON FRIDAY, OCTOBER 7, 2005, AT 1490 N.W. 3RD AVENUE:)
A. I, -06 T ,.. , a qualified elector for members of the Overtown
Advisory Board hereby nominate as a candidate for
election of membership of the Overtown Advisory Board (OAB). I am 18 years of age or
older and as proof of my qualifications as an elector of the OAB, I hereby submit my
credentials as indicated below:
1. I am a resident of Overtown residing at
, or
2. I am the owner of property or have a business in Overtown located at
, or
3. I am an employee or Board Member of
community development corporation or community based
organization located at
and providing services in Overtown, or
4. I operate or am a\n employee rf abusiness in Oertown located at
'f` %)v & (,�.� i L S -C S 13 (v
B. My nominee N• r S' I is eligible to serve on
the Overtown Advisory Board because he/she is 18 years of age and
meets one or more of the following qualifications:
1. Resides in Overtown at , or
2. Is the current owner of property or has a business in Overtown
located at , or
3. Is an employee/Board Member of
community development corporation or community based
organization located at
and provides services to Overtown, or
4. -0pe ates or is. -an employee of >a business. in_Overtown 1 c ted at
k) (4tv\ �t E ' 1>
5. Nominee's phone number: ) (SOS) 4 - 12-) i o
Signatuee o
06.06) /.2\6(
Phone number of Nominator
FOR OFFICIAL USE ONLY:
NOMINATOR ADDRESS INSIDE BOUNDARIES?
NOMINEE ADDRESS INSIDE BOUNDARIES?
NOMINATOR PROOF OF QUALIFICATION SUBM
N
N
(TO BE COMPLETED BY CANDIDATE DURING -THE
CANDIDATE QUALIFYING MEETING SCHEDULED FOR
_
TUESDAY, OCTOBER 11, 2005, 2:00 P.M.t,LQCATED
AT CULMER CENTER LOCATED AT 1600 11�:W.. 3RD
AVENUE
C. I 6CL , being first duly sworn, depose
and state:
1. I am offering myself as a candidate for the election of
members of the Overtown Advisory Board to be held on
Thursday, October 18, 2005.
2. I qualify for said position as stated in section B of this form.
3. City Code Sec. 2-884(e) states: "No employee of Miami -Dade County,
Florida, or any municipality therein other than City of Miami employees,
shall serve on or be appointed to any Board of the City of Miami." This
restriction may be waived by a four -fifths affirmative vote of the City Commission,
provided that said employee is a resident of the City of Miami.
Are you an employee of Miami -Dade County or any municipa)ity therein
other than the City of Miami?
3. I can be reached by telephone at: Cos ) 04, - 1 22' ��
4. My e-mail address is Ce.. a ( - - 1. i
-te
l
Signature df ndidate
Before, one the undersigned authority, personally appeared
2.1►�►L who, after first being duly sworn, deposes
an states that he/she executed the foregoing to the best of his/her knowledge.
4 4 41.
AL '� "' Mara L Crandon
Nota Public "• � Commission COMM
Did take an oath'""''" E"Plr" labigc"C"
✓ Produced identification: Pi--1350o- IN; -- 60 -5,27- v
FOR OFFICIAL USE ONLY:
NOMINATOR ADDRESS INSIDE BOUNDARIES? Y N
NOMINEE ADDRESS INSIDE BOUNDARIES? Y N
NOMINATOR PROOF OF QUALIFICATION SUBMITTED:
CITY OF MIAMI
OVERTOWN ADVISORY BOARD NOMINATION FORM'',,
(TO BE COMPLETED BY NOMINATOR AND TO BE SUBMITTED TO THE
OFFICE OF THE OVERTOWN ADVISORY BOARD/OVERTOWN N.E.T. BY
4:00 P.M. ON F RI DAY, OCTOBER 7, 2005, AT 1490 N.W. 3RD AVENUE:)
A. I, / .: ei4/ -1, y Li . 2 d.) , a qualified elector for members of the Overtown
Ad isory Board h reby nomi ate as a candidate for
election of membe ship of the; Overtown Advisory Board (OAB). I am 18 years of age or
older and as proof of my qualifications as an elector of the OAB, I hereby submit my
credentials as indicated below:
1. I am a resident of Overtown residing at
Vr
, or
2. I am the owner of property or have a business in Overtown located at
� r ,
3. I am an employee or Board Member of % T e' // 41 t-/tick'- )
community developments osporatio / r community based
organization located at / %�/� /1;`� �f Cf «t'•'�!J _.
and providing services in Overtown, or
4. I operate or am an employee of a business in Overtown located at
B. My nominee is eligible to serve on
the Overtown Advisory Board because he/she is 18 years of age and
meets one or more of the following qualifications:
1. Resides in Overtown at , or
2. Is the current owner of property or has a business in Overtown
located at
3. Is an employee/Board Member of
community development corporation or community based
organization located at
and provides services to Overtown, or
4. Operates or is an employee of a business in Overtown located at
5. Nominee's phone number: / 2;7.; 7
"� ) �" � .
or
Date /
Phone number of Nominator
FOR OFFICIAL USE ONLY:
NOMINATOR ADDRESS INSIDE BOUNDARIES? N
NOMINEE ADDRESS INSIDE BOUNDARIES? Y N
NOMINATOR PROOF OF QUALIFICATION SUBMITTED:
C.
(TO BE COMPLETED BY CANDIDATE DURING THE
CANDIDATE QUALIFYING MEETING SCHEDULED FOR
TUESDAY, OCTOBER 11, 2005, 2:00 P.M., LOCATED
AT CULMER CENTER LOCATED AT 1600 N.W.
AVE ► UE
being first duly sworn, depose
d state:
1. I am offering myself as a candidate for the election of
members of the Overtown Advisory Board to be held on
Thursday, October 18, 2005.
2. I qualify for said position as stated in section B of this form.
3. City Code Sec. 2-884(e) states: "No employee of Miami -Dade County,
Florida, or any municipality therein other than City of Miami employees,
shall serve on or be appointed to any Board of the City of Miami." This
restriction may be waived by a four -fifths affirmative vote of the City Commission,
provided that said employee is a resident of the City of Miami.
Are you an employee of Miami -Dade County or any municipality therein
other than the City of Miami? /V
3. I can be reached by telephone at: "J -.) / <
4. My e-mail address is
�1:
Signatu of .r didate
Before me, the undersigned authority, personally appeared
who, after first being duly sworn, deposes
and states that he/she executed the foregoing to the best of s/her knowledge.
io* • , <, SAMUEL 0. MILLttt
.c
* 1�)_
MY CO"kf 1iSf(1P� 4 DD 278669
1 /AV I l/ a.a . EXPIRES. ,;anuary 4, 2008
----'—C--(2 0 / j/ \. L(.. c�-- -- �,4OF fI0%,
o S nded Th u Budget Notary Somas
Notary Public
Did take an oath
Produced identification: 0
1J ✓ ✓ .4"� Lice 5t'
FOR OFFICIAL USE ONLY:
NOMINATOR ADDRESS INSIDE BOUNDARIES? ( N
NOMINEE, ADDRESS INSIDE BOUNDARIES?'
NOMINATOR PROOF OF QUALIFICATION SUBMITTED: