FIRST NAME LAST NAME(S)

ADDRESS, CITY, STATE, ZIP CODE

OCCUPATION

BUSINESS / EMPLOYER

TELEPHONE (HOME) TELEPHONE (BUSINESS)

BELOW PLEASE LIST ANY OTHER PROPERTY(IES) TO WHICH YOU HOLD TITLE LOCATED WITHIN THE CITY OF MIAMI LIMITS

CITY CODE SECTION 2-884(E) STATES, "NO EMPLOYEE OF MIAMI-DADE COUNTY, FLORIDA, OR ANY MUNICIPALITY THEREIN OTHER THANCITY OF MIAMI EMPLOYEES, SHALL SERVE, OR BE APPOINTED TO, ANY BOARD OF THE CITY OF MIAMI"

ARE YOU AN EMPLOYEE OF MIAMI-DADE COUNTY OR ANY MUNICIPALITY THEREIN OTHER THAN THE CITY OF MIAMI?

THE HISTORIC AND ENVIRONMENTAL PRESERVATION BOARD MUST BE COMPOSED OF THE FOLLOWING POSITIONS BELOW.PLEASE CHECK ALL THAT THE CATEGORIES FOR WHICH YOU ARE ELIGIBLE:- Nominees for the professional positions who meet the demonstrated knowledge and requirement should also check "citizen."- Nominees who meet any of the categories listed should also check "alternate member."

ARCHITECT REGISTERED IN THE STATE OF FLORIDA

LANDSCAPE ARCHITECT REGISTERED IN THE STATE OF FLORIDA

HISTORIAN OR ARCHITECTURAL HISTORIAN QUALIFIED BYMEANS OF EDUCATION OR EXPERIENCE, AND HAVINGDEMONSTRATED KNOWLEDGE AND INTEREST IN DADE COUNTYHISTORY AND ARCHITECTURAL HISTORY.

ARCHITECT OR ARCHITECTURAL HISTORIAN HAVINGDEMONSTRATED KNOWLEDGE AND EXPERIENCE INARCHITECTURAL RESTORATION AND HISTORIC PRESERVATION.

EXPERIENCED REAL ESTATE BROKER LICENSED IN FLORIDA

PERSON EXPERIENCED IN THE FIELD OF BUSINESS ANDFINANCE OR LAW

CITIZEN WITH DEMONSTRATED KNOWLEDGE ANDINTEREST IN THE HISTORIC AND ARCHITECTURAL HERITAGEOF THE CITY AND/OR CONSERVATION OF THE NATURALENVIRONMENT.

SIGNATURE DATE

ALTERNATE MEMBER WHO QUALIFIES UNDER ONE OF THEABOVE CATEGORIES

E-MAIL ADDRESS

APPLICATION FOR HISTORIC AND ENVIRONMENTAL PRESERVATION BOARD

YES NO

INSTRUCTIONS FOR SUBMITTAL

COMPLETE FORM, PRINT, SIGN, AND MAIL WITH REQUIRED ATTACHMENTS TO:

CITY CLERK'S OFFICECITY OF MIAMI

3500 PAN AMERICAN DRIVEMIAMI, FL 33133

ATT: PRISCILLA A. THOMPSON

Planning/HP/HEP Board Application 02/2010

REQUIRED ATTACHMENTS

RESUME WHICH INCLUDES EDUCATION, WORK EXPERIENCE, ORGANIZATIONS AND COMMUNITY ACTIVITIES.

OPTIONAL ATTACHMENTS

LIST OF ANY PUBLISHED WORK OR PROJECTS RELATED TO HISTORIC PRESERVATION AND/OR ARCHITECTURAL HISTORY.(IF NOT INCLUDED IN RESUME/CV)

NO MORE THAN TWO (2) LETTERS OF RECOMMENDATION

CERTIFICATE OF COMPLETION OF ETHICS COURSE