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CITY OF MIAMI, FLORIDA
BOARD MEMBERS' EMPLOYMENT RESTRICTION FORM
The City of Miami Code Sec. 2-884(e) states that an employee of Miami -Dade
County, Florida, or any municipality therein other than a City of Miami employee,
shall not 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.
Please fill out the following:
1, 5.?(- � 6LL >rr IT NA4E FIRST N�IE MI
M, m, 'ar4.-/1
(PRINT `T E NAME OF THE BO; RD)
am a member of the
and
/I am employed by Miami -Dade County or any other muncipality therein
other than City of Miami
I am NOT employed by Miami -Dade County or any other municipality
1-1
therein other than City of Miami
SI E ::OARD MEMBER
1y
DAT
Employment Restriction Form; Last Revised July 2011