Loading...
HomeMy WebLinkAboutOAB Nomination Application for Elected MembersCity of Miami OVERTOWN ADVISORY BOARD/OVERTOWN COMMUNITY OVERSIGHT BOARD NOMINATION FORM FOR ELECTED MEMBERS (To be completed by the NOMINATOR and to be submitted to the office of the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E, T.) by 4:00 PAL on FRIDAY. AUGUST 19 2012, at 1490 N. W. 3'-' AVENUE. NOTE: A person may vote for himself/herself) ---r) A. I, A Teen , a qualified voter or members of the O ertown Advisory Board/Overtown Community Overight Board (OABI©COB), hereby nominate' �''q �/i� as a candidate for election of membership of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/OCOB). I am 18 years of age or older and as proof of my qualifications as an elector of the OAB/OCOB, I hereby submit my credentials as indicated below: ] , I am a resident of the Overtown Area residing at /it�,�' ��� Aenute 2. 1 am the owner of property in the Overtown Area located at ,7 , or or 3. I am an employee or Board Member of community based organization located at community development corporation or and providing services in the Overtown Area, or 4. I operate or am an employee of a business 4 /1 in the Overtown Area located at B. I nominate to serve an the Overtown Advisory Board/ Overtown Community Oversight Board. He/she meets the eligibility requirements because he/she is 18 years of age and also meets one or more of the following qualifications: 1. Resides in the Overtown Area at or 2. Is the current owner of property in the Overtown Area located at —+ '``' -Crya ;7] or Is an employee or a board member of _ development corporation or community based organization located in and providing services t address coity 6vert5sn Atettlat the �►''�F - -- , or 4. Owns or is an employee ofa business in the Overtown Area located at 5. Nominee's info: Phone number Cell phone x N FAX Number E-mail C. Please provide your contact information for the,purpose) of clarifyingthe above and sign below Phone number (-1$ i! .i f 7 )f 7 Cell phone FAX number E-mail rf...5 rr 1 6 5 'Corn Signature FOR OFFICIAL USE ONLY: +IOMINEE'S ADDRESS INSIDE BOUNDARIES? Y N N/A NOMINEE MEETS AGE REQUIREMENTS Y N N/A NOMINEE'S PROOF OF QUALIFICATION SUBMITTED: Prin d Name Date Signed AFFIDAVIT OF BUSINESS EMPLOYMENT/BOARD MEMBERSHIP WITH CDC OR CBO/BUSINESS STA 1 E OF FLORIDA ) SS: COUNTY OF MIAMI-DADE ) BEFORE ME, the undersigned authority, this day personally appeared Rk/Gc.A ,C hwho being by me first duly sworn, upon oath, deposes and says: I,% 4rle-C'/u)' (Community 5?/- S>10,-; an employee of a business/board member of a CDC Development Corporation) or CBO (Community Bases Organization) of • / &-f (street address in Overtown). FURTHER AFFIANT SAYETH NAUGHT. ifj11/4— (Empl yeeBoard Member of a CDC or CBOBusiness) SWORN TO AND SUBSCRIBED BEFORE ME this /y day of , 2512- , by Re JL g4llc,. �, who is personally known to me or t tL.•,,,,.�c- as identification and who did/did not take an oath. SIGNATURE OF NOTARY PUBLIC STATE OF FLORIDA My Commission Expires: iv( k PRINTED, STAMPED OR €D7NAME OF NOTARY Notary Public State of Fior+:.a Dwight S Danie 1 Id Commission EE026185 1 p Expires 11/26/2014 U City of Miami OVER TOWN ADVISORY BOARD/OVER TOWN COMMUNITY OVERSIGHT BOARD NOnlruvATION FORM FOR ELECTED MEMBERS (To be completed by the NOMINATOR and to be submitted to the office of the OI'ERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (ICE.T;} by 4:00 P.M. on FRIDA Y. AUGUST 10. 2012, at 1490 N.W. 3RD AVENUE. NOTE: A person may vote for himself/herself.) A. I, ± , a qualified voter for members of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/OCOB), hereby nominate Defejl (ti`i}f.-. as a candidate for election of membership of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/OCOB). I am 18 years of age or older and as proof of my qualifications as an elector of the OAB/OCOB, I hereby submit my credentials as indicated below: 1. I am a resident of the Ove o Area esiding at Ir }1n Alk j /VP • 2. I am the owner of property in the Overtown Area located at 10101Id !r-- 1. -*4.05 3. I am an employee or Board Member of LC 1L1 a community development corporation or community based organization located at _} / / ( jJ id J 1F P•yl (OC)3 and providing services inA a CA5town Area, or 4 kTTdwF , or 4. I operate or am an employee of a business in the Overtown Area located at I %rx 73 rn CD' VT1 B. I nominate �� ,2 to serve on the Overtown Advisory Board , owz4Cort nity Oversight Board. He/she meets the eligibility requirements because he/she is 18 years of age and also 00e or,,,,more2 the following qualifications:- I. Resides in the Overtown Area at , or or 2. Is the current owner of property in the Overtown Area located at or Is an employee or a board member of community development corporation or community based organization located in and providing services to the Overtown Area at the address Owns or is an employee of a business in the Overtown Area located at or 5. Nominee's Info: Phone number Cell phone FAX Number E-mail C. Please provide your contact information for the nuroose of ckArifv;.,o the above and sign below Phone number £ -&at Cell phone - 2,-242+c FAX number E-mail yaV-y re ,Ci 1 Printed Name Date Signed FOR OFFICIAL USE ONLY: NOMI:NEE'S ADDRESS INSIDE BOUNDARIES? NOMINEE MEETS AGE REQUIREMENTS NOMINEE'S PROOF OF QUALIFICATION SUBMITTED: Y N N/A N NIA D E A 5 DEREK COLE 1010 NW 11 ST. #605 Miami, F✓_ 33136 Creative Director (305) 667-8188 derek@loftyideasrniamt.cam Derek Cole PHOTOGRAPHER 1010 N.W. l lth Si. # till:, • Miami, FL. :13136 derekcole.com (305) 667-8188 City of Miami OVERTOWN ADVISORY BOARD/OVEIL TO ff-'1V COMMUNITY OVERSIGHT BOARD NOMINATION FORM FOR ELECTED MEMBERS (To be completed by the NOMINATOR and to be submitted to the office of the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T.) by 4:00 P.M. on FRIDAY, AUGUST 10, 2012, at 1490 N. Ff: 3RD AVENUE. NOTE: A person may vote for himself/herself) A. I, a qualified voter for members pi the Overtown Advisory Board/Overtown Community Oversight Board (OA.B/OCOB), hereby nominate ) litrou Harr%s as a candidate for election of membership of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/OCOB). 1 am 18 years of age or older and as proof of my qualifications as an elector of the OAB/OCOB, I hereby submit my credentials as indicated below: 1. I am a resident of the Overtown Area residing at B. C. 16 NW ICI- Ave g s4.P 33i3(.. ,or 2. I am the owner of property in the Overtown Area located at +_ r,1 1Y r(W StA�f14- - ►++tc FL. _33135. ,or 3. I am an employee or Board Member of To u Ch i j ( t.tni to 1111 LC r e community development corporation or community based organization located at i 7)4 IV ' ay. 01 carer! FL 3313(and providing services in the Overtown Area, or 4. I operate or am an employee of a business K% ICS CO It in the Overtown Area located at - — j 7 5 _ NW l y t+ r~'1 a � , Ft- 331R, I nominate to serve on the Overtown Advisory Board/ Overtown Community Oversight Board. He/she meets the eligibility requirements because he/she is 18 years of age and also meets one or more of the following qualifications: 1. Resides in the Ovenown Area at 2. Is the current owner of property in the Overtown Area located at v � 3. Is an employee or a board member of development corporation or community based organization located in and providing services address 4, Owns or is an employee of a business in the Overtown Area located at 5. Nominee's Info: Phone number FAX Number Cell phone E-mail or or o unity A t the C) , or 11f. Please provide your contact information for the purpose of clarifying the above and sign below Phone number 7if 6 5?77 -`I So 3 Cell phone E-mail ri.) ' WA.' :riff*" Nj lovt :.J FAX number D. Please sign he Signature U /7-r1,14 1-larri S Printed Name 7P-0/1�. Date Signed FOR OFFICIAL USE ONLY: NOMINEE'S ADDRESS INSIDE BOUNDARIES? NOMINEE MEETS AGE REQUIREMENTS NOMINEE'S PROOF OF QUALIFICATION SUBM D: N NIA N N/A AFFIDAVIT OF BUSINESS EMPLOYMENT/BOARD MEMBERSHIP WITH CDC OR CBO/BUSINESS STATE OF FLORIDA ) ) SS: COUNTY OF MIAMI-DADE ) BEFORE ME, the undersigned authority, this day personally appeared g(//1 4 garr, S , who being by me first duly sworn, upon oath, deposes and says: I, UHT,Y14 grl, S, am an employee of a business/board member of a CDC (Community Development �C/orporation) or CBO (Community Bases Organization) of —Mucky iAn7. W/}`fi Leve_ (street address in Overtown). FURTHER AFFIANT SAYETH NAUGHT. (Employee/Board Member of a CDC or CBO/Business) SWORN TO AND SUBSCRIBED BEFORE ME this /1/. day of 2v/2 , by f T1+11/11 , who is personally known to me or who has produced�'��..�. L,l�.v as identification and who did/did not take an oath. SIGNATURE OF NOTARY PUBLIC `bwt54,t- PRINTED, STAMPED OR STATE OF FLORIDA TYPED NAME OF NOTARY My Commission Expires: cos' Pot. Notary Public State of Flo;:;,,;, `; Dwight S Danie TMy Commission EE026185 1'orno' Expires /1/26/2014 17 . Trina Harris, ToMorrow's Leaders Children Program Director Touching Miami with Love Mailing: P.O. Box 01-3279 Miami, FL 33101 Physical: 711 NW 6th Avenue Miami. FL 33136 Phone: 305-416-0435. ext 204 Fax: 305-416-0438 trim@touchi ngmiamiwithlove,otg www.touchingmiamWthlove.org TOUCHING MIAMI WITH LOVE City of Miami OPERTOWN ADVISORY BOARD/OVERTOWN COMMUNITY OVERSIGHT BOARD NOMINATION FORM FOR ELECTED MEMBERS (To be completed by the NOMINATOR and to be submitted to the office of the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E. T.) by 4:00 P.M. on FRIDAY, AUGUST 10. 2012, at 1490 N.W. 3 D AVENUE. NOTE: A person may vote for himself/herself..) A. I, J A r1 t, 15 . r S&. (� •�} . , a qualified voter tr_giemperipf the Overtown Advisory Board/Ovcrtown Community Oversight Board (OAB/OCOB), hereby nominate as a candidate for election of membership of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/OCOB). I am 18 years of age or older and as proof of my qualifications as an elector of the OAB/OCOB, I hereby submit my credentials as indicated below: 1. I am a resident of the Overtown Area residing at 2. I am the owner of property in the Overtown Area located at 3. I am an employee or Board Member of 6.4/f /4 / h'/Yr t L11c. community based or ion located at %t G' Al /r %� .1k6 1' 6',Ml i T/ • , 4. I operate or am an employee of a business in the Overtown Area located at B. I nominate fI I t) 4,t Oversight Board. He/she meets the eligibility requirem following qualifications: 1. Resides in the Overtown Area at , or or community development corporation or and providing services in ttl-Ovwn Area, or c -r- c-s P1 3c7]' - Fri to serve on the Overtown Advisory BoaatAINDertovait Counity nts because he/she is 18 years of age and aisrrere goneRr manna the ry or 2. Is the current owner of property in the Overtown Area located at or 3. Is an employee or a board member of ,t 1 t a.cC Li' st . t - C• - community deveiopment.corporat'son or community based organization located in and providing services to the Overtown Area at the address 1 b c.) ►J. Le . 7' 4Ic. Ft 1 4-, 4 , 6 5& i 3 @ , or 4. Owns or is an employee of a business in the Overtown Area located at 5. Nominee's Info: Phone number'' 37V/f'4'31 phone 7:6gl9-0,72,3"g" FAX Number / /4 - `-iv7 c'555: E-mail �C//2• Cff . AV: V C. Please provide your contact information for the purpose of clarifying the above and sign below Phone number 1 5'- ticam — L x 3 f Cell phone - 9 S t ' FAX number - - E-mail Di Ci--'. I D. Please sign here: Signature etut Printed Name •;.IL Date Signed FOR OFFICIAL USE ONLY: NOMINEE'S ADDRESS INSIDE BOUNDARIES'/ Y N N/A NOMINEE MEETS AGE REQUIREMENTS Y N WA NOMINEE'S PROOF OF QUALIFICATION SUBMITTED: Employee Name: FRED MIMS JR 07/24/2012 120719: Earnings - Benefits Deductions Leave Code Rate Hours Amount Code Amount Code Amount Code Accrued Taken Balance 35.30 80.00 2,824.00 HEALTH 597.86 HLTH-E 23.68 SICK 0.00 0.00 DENT-R 7.71 VAC3 6.15 0.00 235.41 CBV-E 3.15 MOAR... 75.00 S/LIFE 5.54 AFLAC 60.05 Taxes LTCARE 11.70 Code Current YTD YTD Tax Earnings -Workers' Comp - 8864 44.05 FIT 361.47 4,882.94 40,460.9E SS 118.61 1,758.24 41,862.8C MC 40.95 607.03 41,862.8C Totals Pay Period: 07/08/2012 - 07/21/2012 Eamings 2,824.00 Benefits 597.86 Taxes 521.0: Deductions 186.83 Workers' Comp 44.05 Net Pay 2,116.1, CAMILLUS HOUSE, INC. 1603 N.W. 7th Avenue MIAMI, FLORIDA 33136 (305) 374-1065 FRED MIMS JR 1900 SANS SOUCI BLVD APT 213 MIAMI, FL 33181 Employee Name: FRED MIMS JR Earnings - Benefits Deductions Code Rate Hours Amount Code Amount Code Amount Code Accrued Taken Balance 1241 35.30 80.00 2,824.00 HEALTH 597.86 HLTH-E 23.68 SICK 0.00 0.00 r DENT-R 7.71 VAC3 6.15 0.00 • 235.46 CBV-E 3.15 MOAR... 75.00 S/LIFE 5.54 AFLAC 60.05 --- Taxes - LTCARE 11.70 Code Current YTD YTD Tax Earnings FIT 361.47 4,882.94 40,460.98 SS 118.61 1,758.24 41,862.80 -Workers' Comp - MC 40.95 607.03 41,862.80 8864 44.05 VSID 07/24/2012 1207195 Leave Totals Pay Period: 07/08/2012 - 07/21/2012 Eamings 2,824.00 Benefits 597.86 Taxes Deductions 186.83- 521.03 Camillus House Hope is Where the Heart is. Camillus House, Inc. A Ministry of the Brothers of the Good Shepherd Norwegian Cruise Line Campus 1603 NW 7th Avenue Miami, FL 33136 www.camillus.org Tel: (305) 374-1065, Ext. 429 Fred Mims, MS, CAPP, CST Cell: (786) 299-2238 Director of Direct Care Ministry Email: fredm@camillus.org City of Miami OVERTOWN ADVISORY BOARD/OVERTOWN C0MMUNVITY OVERSIGHT BOARD NOMINATION FORM FOR ELECTED MEMBERS (To be completed by the NOMINATOR and to be submitted to the office of the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T) by 4:00 F.M. on FRIDAY. AUGUST 10. 2012, at 1490 N.W. 3'D AVENUE. NOTE: A person may vote for himself/herself) __-12 A. I, f Ci /7 a qualified voter for members of the Overtown Advisory Board/Overtown Community Oversight Board (OAB/O Old), hereby nominate � �l�,Y ct i as a candidate for election of membership of the Overtown Advisory Board/Overtown Community Overtight Board (OABIOCOB). I am 18 years of age or older and as proof of my qualifications as an elector of the OABIOCOB, I hereby submit my credentials as indicated below: 1. 1 am a resident of the Overtown Area residing at 2. I am the owner of property in the Overtown Area located at 1600 AV ?i,c1 Aff. ar , ar 3. 1 am an employee or Board Member of community development corporation or community based organization located at `` and providing services in the Overtown Area, or m fI4.J V 4. I operate or aan employee of a business 4J6 311Nt ' tieyh "IS , iii& 4 "id di vi in the Overtown Area located at /boo N .did 4fe. 0 i,„ -<nr=- = cm r- _ illB. I nominateAddrj). 2C4e4 A to serve on the Overtown Advisory Boa31�-at3aertc v C[�9rlfnunity Oversight Board. He/she meets the eligilifility requirements because he/she is 18 years of age and als ota ona`gr tine of the following qualifications: I. Resides in the Overtown Area at 2. Is the current owner of property in the Overtown Area located at -;: — or r— v7 _ or 3. Is an employee or a board member of L3 L J . hi-5 6A) i4auc 1 J s community development orporatio or community b ed organization located in and providing services the Overtown Area at the address 1p OD W. 3fd fre , or 4, Owns or is an.apployee of a business in the Overtown,A�rea located at I t' �'�►`J �L..+V01.S ,, fob 1 1 h t s 5. Nominee's Info: Phone number OS• 0i Cell phone 9t '" T 0 f - 03 'ice FAX Number E-mail s , 511 61 ?Amr /. fed -A, C. Please provide your contact information for the purpose of clarifying the above and sign below Phone number o " 1 G . sie / Cell phone FAX number E-mail Qo5,i45, 444/.. c, Qeoar, , " •Re4 Printed Name FOR OFFICIAL USE ONLY: NOMINEE'S ADDRESS INSIDE BOUNDARIES? Y N N/A NOMINEE MEETS AGE REQUIREMENTS Y N N/A NOMINEE'S PROOF OF QUALIFICATION S[113MI t 1 ED: , Jet,)(L} .5l - l-6 /-7 '( At AFH)AVIT OF BUSINESS OPERATOR/EMPLOYEE OF BUSINESS STA 1'E OF FLORIDA ) ) SS: COUNTY OF MIAMI-DADE ) BEFORE ME, the undersigned authority, this day personally appeared At*Oct. ie J ob S , who being by me first duly sworn, upon oath, deposes and says: I, /-` fu POyA,A , am a business operator or an employee of (street address in Overtown). FURTHER AFFIANT SAYETH NAUGHT. (Business Operator/Employee of Business) SWORN TO AND SUBSCRIBED BEFORE ME this / `f day of 20(2 , by Ajii ect o lei , who is personally known to me or who has produced j-)L Tha w*c-4, oat SIGITATURE OF NOTARY PUBLIC STA 1L OF FLORIDA My Commission Expires: as identification and who did/did not take an 0.01 °us, Notary Public State of Fondal Dwight S Danie v- Pit My Commission EE026185 4 or rto* Expires 11/26/2014 PRINTED, STAMPED OR ED NAME OF NOTARY Ica126crc