HomeMy WebLinkAboutOAB ApplicationsCITY OF MIAMI, FLORIDA
OVERTOWN COMMIUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4; 00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E. T.), at 1490 N.W. 3R11 AVENUE, Suite 1 I2-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK at 3500
PAN AMERICAN DRIVE. Note; A person may recommend himself/herself
A. I nominate Tra Il') l i V Ras — .5 V l> '] or appointment to the 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 j o vV r l Pet K, 1 Gt C=fi t" r i- l Z or
2. Is the current owner of property in the Overtown Area located at:
C{ C 1vVV 5Tp
' 1 i CI PiWI5 fT i[tvrrt F t 33l3cp or
3. Is an employee or board member of community development
corporation or community based organization located in and provides services to the Overtown Area, at the address
, or
4. Owns or is an employee of a business in the Overtown Area located at:
Nominee's Info: Phone number Cell phone 78 (p S 7 5 0
Fax number E:-mail Pk`i eij (0,17Ci7 ni ► C c-acee 9) t/
B. Please provide a short statement of qualifications of the person you are recommending for appointment;
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C. Please provide your contact information for the purpose of clarifying the above and sign b ow
Phone number Cell phone 7 Ce. S"' �
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Fax number E-mail
it 7 a �C. t� � ll'i�t�l"t t ff G �� J �+
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D. Please sign here:
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Signature
Printed Name
7I
Date igied
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES?
RECOMMEND PERSON MEETS AGE REQUIREMENTS
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED:
ACCREDITED INSTITUTION INSIDE BOUNDARIES Y N N/A
CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (NE. T.), at 1490 N.W. 3" AVENUE, Suite 112-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK at 3500
PAN AMERICAN DRIVE. Note: A person may recommend himself/herself
A. I nominate
meets the
igibility requirements because he/she is 1
1. Resides in the Overtown Area al
for appointment to the Overtown Community Oversight Board. He/she
years of age and also meets one or more of the following qualifications:
Is the current owner of property in the Overtown Area located at:
or
y or
3. is an employee or board member of )L. /) i) ^
s community development
corpration or community based organization located in and prov servic s to t Overtown Area, at the address
4. Owns or is an employee of a business in the Overtown Area located at:
5. Nominee's Info:
Phone number r1111, t ell phone
Fax number E-mail
B. Pleas provide a short statement of qualificat` s of the person you are
nding for appointment: 7r
C. Please provide your contact information for the purpose of clarifying the abovephone
sign below r ,
Phone number Cell hone 5�
Fax number E-mail
D. Please sign h
nature
Printe
Date Sign d
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES? N N/A
RECOMMEND PERSON MEETS AGE REQUIREMENTS N N/A
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED: rib (, Lit f f I r,Q,� S LA 0154*
ACCREDITED INSTITUTION INSIDE BOUNDARIES Y N N/A
CITY OF MIAMI, FLORIDA
co
OVERTOWN COMMUNITY OVERSIGHT BOARD �r
rn
NOMINATION FORM FOR APPOINTED MEMBERS
71
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 1 z, 2018 tWathe ofae of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T.), at 1490 N.W. 3RD AVENUE, Suite 112-&,the ode of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CItERK at3500
PANAMERICANDRIVE. Note: A person may recommend himself/herself. �t
A. I nominate 71404, 41 E r?sob for appointment to the Overtown Community Oversight Board. He/she
meets the eligibility requirements be�ause he/she is 18 years of age and also meets one or more of the following qualifications:
1. Resides in the Overtown Area at ''le /I. (,V. f Co(g OP J z �� 13 i6 or
2. Is the
�,current_owner of property in the Overtown Area located at:
9 zrrN. ul q `peOgl' el- /I / : a- 77.1 , I ,-6 or
3. Is an employee or board member of /V /4 community development
corporation or community based organization located in and provides services to the Overtown Area, at the address
, or
4. Owns or is an employee of a business in the Overtown Area located at:
a
5. Nominee's Info:
Phone number
Fax number
AS: CC 1. I7/Cell phon
E-mail ,'1 j M: Bit, .* .4 • fr s,
B. Please provide a short statement of qualifications of the person you re recommending for appointment:
OWil�'e 6 f r� 4J�e `v� �:�e� ! rq1.
�'fG'73 tie t,i C0119 /'i1. to Ad AFAas e5 .
. -SEe 4 i �! (5eR✓; nn��jj� 0t) Al.413u1l) denim •.k.te
C. Please provide your contact information for the. urpose �fyi the above and sign below
Phone number G�Qj' '1 cCell phone
Fax number E-mail i7 4rt 6 71: 43era (" i 102.
/ m ZEF7-6,__0> 7//0
Printed Name DatE Signed
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES? N N/A
RECOMMEND PERSON MEETS AGE REQUIREMENTS N . N/A
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED: Ccf %‘fQ(.S
ACCREDITED INSTITUTION INSIDE BOUNDARIES Y N N/A
Weis
CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T.), at 1490 N.W. 3Rt' AVENUE, Suite 112-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK at 3500
PANAMERICAN DRIVE. Note: A person may recommend himself/herself.
A. I nominate
for appointment to the Overtown Community Oversight Board. He/she
meets the eligibility q e is 18 years of age and also meets one or more of the following qualifications;
I. Resides in the Overtown Area at or
2. Is the current owner of property in the Overtown Area located at:
he/she
11-0740 i requirements beca a
or
3. Is an employee ar board member of community development
corporation ar community based organization located in and provides services to the Overtown Area, at the address
, or
4. Owns or is an employee of a business in the Overtown Area located at;
I1-190 3 Aide infili i Ft 3 y3 s . l°
5. Nominee's Info: Phone number _OL5-7-90S7eV2efacCell phone
Fax number E-mail oKaekt)a .e-ecraD,Ciap
B.Please provide a short statement of qualifications of the person you are recommending for appointment:
C.
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Please provide your contact information for the purpose of �clarify'n the above and sign below
Phone number ?ar C"e`'[Cell phone r
E-mail br!N /C,rr arety r @ rr1eitazoo;
E
Fax number
m 40 f je._
Printed Name
0ne7//s
Date
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES? N N/A
RECOMMEND PERSON MEETS AGE REQUIREMENTS • IA
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED: A-r-aliktriTsou Sf jj)Y
N N/A
ACCREDITED INSTITUTION INSIDE BOUNDARIES
AFFIDAVIT OF BUSINESS EMPLOYMENT/BOARD
MENMBERSHIP WITH CDC OR CBOIBUSINESS
STATE OF FLORIDA )
SS:
COUNTY OF MIAMI-DADE )
BEFORE ME, the undersigned authority, this day personally appeared
4)111AL) Rpte-ei. , who being by me first duly sworn, upon oath. deposes and says:
I
MA Fu icieiZ , am an employee of a business/board member of a CDC
(Community Development Corporation) or CBO (Community Bases Organization) of
q g ` . cgict ,soi T street address in Over town ).
IVtiAfr7, F1• 3.3 /i3 ‘.,
FURTHER AFFIANT SAYETH NAUGHT.
(Employe : oard Member of a CDC or CBOJBusiness)
SWORN TO AND SUBSCRIBED BEFORE ME this 7 day of
Q Cut
40f� . bykoo ( I II -
`
�' ( ,who is personally knt,�% n to me or
GNATURE OF NOTARY PUBLIC
STATE OF FLORIDA
My Commission Expires:
as identification and who did: did not take an oath.
00MCIVek FE; VleS
PRINTED, STAMPED OR
TYPED NAME OF NOTARY
•
King Kamau
Marketing & Sales Representative
Bottled water, Bottfeless Water Gaolers. Water Filtration
Bagged Ice
Ph. 305.985.8685
Fx. 305.513.5936
dr nkmorewaterboy@gm ail.coat
Miami, FL 3315G; t,
www.waterisgolden_com
A
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CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T.), at 1490 N.W. 3" AVENUE, Suite 112-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK al 3500
PANAMERICANDRIVE. Note: A person may recommend himself/herself.
A. I nominate IC) 6. / it!/ / , F • intment to the Overtown Community Oversight Board, He/she
meets the eligibility equ�ments because he/she is 18 year age and also meets one or more of the following qualifications:
1. Resides in the Overtown Area at /€2,0a L4 l', 2-c� �� or
2. Is the current owner of property in the Overtown Area located t " P 1
or
3. Is an employee or board ember of Al community development
corporation or community based organization locatedlin and provides services to the Overtown Area, at the address
or
4. Owns or is an employee of a busi ess in the Overtown Area located at:
04
5. Nominee's Info: Phone number + 1 - ell phon �' 4 t 64 /(j? y // _
Fax number Email 37�v i�titfWc)C 1 tC�
B. Please provide a short statement of qualifications of the person you are re,:c..kmmending for a aointment:
7 Gar ye_ w—
f�•
w7 n
i tLJ ••
3
ry
C. Please provide your contact information for the purpose of clarifying the above and sign below
Phone number Cell phone % c 6 `/ s
Fax number E-mail
ase sign here:
Pri d Name 6 u 'VOA 14.1 S Date gned
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES?
RECOMMEND PERSON MEETS AGE REQUIREMENTS
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED
ACCREDITED INSTITUTION INSIDE BOUNDARIES
N N/A
FLN Ave mas utsv s
Y N N/A
CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E.T.), at 1490 N.W. 3RD AVENUE, Suite 112-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK at 3500
PAN AMERICAN DRIVE. Note: A person may recommend himself/herself.
A. I nominate / . . �_ _ i for appointment to the Overtown Community Oversight Board. He/she
meets the e igibil' requirements cause he/she is 18 years of age and also meets one or more of the following qualifications:
log/ Alr'&) ?�� c(Z 2 m.:740 ' 33/s(a
1. Resides in the Overtown Area at
2. Is the current owner of property in the Overtown Area located at:
s�
or
or
3. Is an employee or board member of r--ilyv 4) , 6 gib pum� nil"y fie e upment
co oration or communitybased organization located in and prov es services to the Overt n Area, at the address
/_' j31 Acu. ,3/3(, ,or 656.c
4. Owns or is an employee of a business in the Overtown Area located at:
5. Nominee's Info: Phone number Cell phone
Fax number E-mail C/Q.GJ
B. Please provide a short statement of qualifications of the person you are recommending for appointment:
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5 ��,5
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f,ve 0_10,14 02. d Pt !2A) NglIA.,1 ovi WS ::4('
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C. Please provide your contact information for the purpose of clarifying the above and sign below
Phone number Cell phone 3OS
Fax number E-mail o f a
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES?
RECOMMEND PERSON MEETS AGE REQUIREMENTS
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED:
N N/A
bn iet's l c e �n�...
ACCREDITED INSTITUTION INSIDE BOUNDARIES Y N N/A
CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N,E.T), at 1490 N.W. 3" AVENUE, Suite Ill-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERIC at 3500
PANAMERICAN DRIVE. Note: A person may recommend himself/herself
A. I nominate for appointment to the Overtown Community Oversight ht oard, He/she
--
meets the eligibility requirements because he/she is 18 years of age and also meets one or more of the folEwing g1ialificatip is:.
7 or
1. Resides in the Overtown Area at
2. Is the current owner of property in the Overtown Area located at:
3. Is an employee or board member of
corporation or
commuAlty base organization located in and provides services to the Overtown Area:at the address
iu1 ' yrg, or z
r
• 0r
j h, e DC
4. Owns or is an employee of a business in the Overtown Area located at:
ci rnmunity development
5. Nominee's Info:
Phone number
Fax number
3/4I 1 ' Cell phone 5 G ' 1
E-mail GSC&fie SC1frJac LC1tJ
B. Please providc a short statement of qualificationsiorat he pefrqon you e recommend`ng for a ointment:
W,t'.5.
1
jolt -eihp61 _ki
taxi k 0 v
s.,•J 1-3 —.1-41 j 1t v
C. Please provide your contact information for the pu
Phone number
Fax number
D. Pie
Signature
larifyin th above and sign bel
6r Cell phone
! mail- etse.* L
Pri ted Name
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES? N N/A
RECOMMEND PERSON MEETS AGE REQUIREMENTS Y . N/ .�
N/A ]
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED: ft dtt l j .
ACCREDITED INSTITUTION INSIDE BOUNDARIES)
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
4/(4,L,_ £e4—
, who being by me first duly sworn, upon oath, deposes and says:
, am an employee of a business/board member of a CDC
(Community Development Corporation) or CBO (Community Bases Organization) of
/At_b4
(street address in Overtown).
FURTHER AFFIANT SAYETH NAUGHT.
(Employee/Board Member of a CDC or CBO/Business)
SWORN TO AND SUBSCRIBED BEFORE ME this day of
,r p, by I , who is personally known to me or
ed fl-Iiisdeis UC QJl as identification and who did/did not take an oath.
NATURE OF NOTARY PUBLIC PRINTED, STAMPED OR
STATE OF FLORIDA
My Commission Expires:
TYPED NAME OF NOTARY
MORA FORGES
Many past - ate el Fonda
Corrnsm t GG O84616
My Gr+rvn bores Mr 19. 2021
sa+aa too4Vialerg 'bay kW.
CITY OF MIAMI, FLORIDA
OVERTOWN COMMUNITY OVERSIGHT BOARD
NOMINATION FORM FOR APPOINTED MEMBERS
To be completed by the RECOMMENDER and to be submitted by 4:00 P.M. on FRIDAY, AUGUST 17, 2018 to the office of
the OVERTOWN NEIGHBORHOOD ENHANCEMENT TEAM (N.E. T.), at 1490 N. W. 3RD AVENUE, Suite 112-B; the office of
the DISTRICT 5 COMMISSIONER at 3500 PAN AMERICAN DRIVE or the OFFICE OF THE CITY CLERK at 3500
PAN AMERICAN DRIVE. Note: A person may recommend himself/herself.
A. I nominate aPiU 1 E. 14)t. (l t A'WiS for appointment to the Overtown Community O ight Bird. ligshe
meets the eligibility requirements because he/she is 18 years of age and also meets one or more of the following q(ificatio�s:
) or
B.
C.
1.
Resides in the Overtown Area at
2. Is the current owner of property in the Overtown Area located at:
3.
4.
5.
-4 t
or
Is an employee or board member of V10.410(..01/) j T1 w 4 4-6 coRmunity "develcipaent
corporation or community ba d organization located in and provides services to the Overtown ilea,t�jthe address
YD / 4/) l2 r, � e#� r1/I i'ti.-.+, / ?Z �yr�or
Owns or is an employee of a business in the Overtown Area located at:
(kbaw? - /Oov AA/1) 2.- 4L/ .t1M,9J 2 33i3,b
Nominee's Info: Phone number Cell phone k /7 2_ 3
Fax number E-mail t w i'r/��^�^-� S e -1-16 e# ✓gy p , O,f
Please.rovide a short statement of qualifications of the person you are - recommending for appointment:
--I- 4 ,- el, / h h—e, /Le S, e47 f a -a -et/ erf % i-o✓ . /
op why' s - ! . _,! a.. _' ''7
•er, 117 pro :.! �/ e �.>/ SPi✓�L�s �v ILL
t4
c tiQ e — .�,.t 1-, �, �0 / /7 .
Please provide your contact information for the purpose of clarifying the above and sign below - Z ' 9 — / 7 Z. 3
Phone number Cell phone P9--410Pecrrese
Fax number E-mail K c-✓/ %/," G S e ib 4/
D. Pleas
SignatuCe
Printed Name
Ziin 7//
Date Si ed
FOR OFFICIAL USE ONLY:
RECOMMENDED PERSON'S ADDRESS INSIDE BOUNDARIES? Y N N/A
RECOMMEND PERSON MEETS AGE REQUIREMENTS �Y N . N/
RECOMMENDED PERSON'S PROOF OF QUALIFICATION SUBMITTED:t� -''i al( Yl t
ACCREDITED INSTITUTION INSIDE BOUNDARIES Y N N/
AFFIDAVIT OF BUSINESS EMPLOYMENT/BOARD
MEMBERSHIP WITH CDC OR CBO/BUSINESS
STATE OF FLORIDA )
) SS:
COUNTY OF MIAMI-DADE )
CO
30"
-o
BEFORE ME, the undersigned authority, this day personally appeared
140., E. in).- 1 l ' w , who being by me first duly sworn, upon oath, deposes and says:
I, Ka evl E U t) / l jem, 9 , am an employee of a business/board member of a CDC
(Community Development Corporation) or CBO (Community Bases Organization) of
Ode, , Oplimoi I u b (street address in Overtown).
yo ( Nw Th .41i0w+1) 3 to
FURTHER AFFIANT SAYETH NAUGHT.
(Employee/Board Member of a CDC or CBO/Business)
SWORN TO AND SUBSCRIBED BEFORE ME this % day of
, 0/8, by /(e&1 Hi alas , who is personally known to me or
has produced F/Or;dUCU1 as identifica
SIGNATURE OF NOTARY PUBLIC
STATE OF FLORIDA
My Commission Expires:
/l9120 20
PRINTE I, S A P
TYPED NAME OF NOTARY