_LcReferred by: Commissioner Liebman
Mayor or. Commissioner
S..,.,.,-h MI_ ... , );"0.-'''.
CITY OF SOUTH MIAMI BOARD/COMMITTEE APPLICATION
6131J Sunset Driv"
South M"lIlI1li, FL 33143
Phone No. 31J5-663-6340
Fax: No. 305-663-6348
1. I am interested in sening on the following board(s)Jcommittee(s):
Budget & Finance .:.Pa.::<i<s:::..:&:.:.R.::6C:::.. ====-____ _
Fun c:boiu Secood choice
Third choice Fourlb choice
Name: _________ ~~M~~=;~mO~M~O:::.'7~rr~6:.:.Y----------------
(please print)
2.
3. Home Address: 7631 SW67 Ave., South Miami, FL33143
4. Business Address: 9100 S. Dadeland BlVd. #1500, Miami, FL
5. Home Phone No. _____________ -;-_ Business Phone No . ..;3.;.05'--8,,0_4-3-"03.;.2 ___ _
Fax No.
6. ~mmlAddr~s: ______ ~m~~~lm~o'-mo~"~~'_~~~~y.m~oo~.=oo:::.m~ __________________________ __
7. Edocation/Degree Earn.ed: Northeastern Univernity-BS in Business Administration
Pertinent Experience: J have been on the Budget & Finance oommittee the lasl 2 years.
HddEx~e: _________________________ __
8. Comml\llity Service:
9.
10.
11.
12.
VoICes For Children
Attached Resume: (Optional)
Are yon a registered voter?
Are yon a resident ofthe City?
Do yon have a bnsiness in the City?
NO~ No
No ,f.
Yes§
Yes
Yes
l'kDse be aware thill all aPPlicants who are appointed to IDly City board, commission or committee, as well as all
employees·and volunteers, who will provilk IDly service 01' who may come into contact wilh vulneraJJle pinons as
difme4 in Section 435.1J2, FIll. SfIIL (including children and the elderly) in the course of their appointment,
employment or volunteerism, must compliance with Level II Bacfq:rolind Scrl!lming fUld jlngerprinting
requirements as pel', FWriJ/a Still"", Ch. 435. Such individMaI must have passed the bIlckgroand screening to rite
satisfaction oftlte City prior to the appointment to the position or the start of any employ"ment or voburteerisnr;
Maximo 'OigHaDy signed by
Maximo Monterrey
Signaturec..._-,M=o:.:.n:.:t.::e.:,;rr:..:e",y:-:",/. _··..!.·;2£'M!!· .. ,:!:~c:'_';.'!2·o!!!.~g!...' ______ _
Applicant
Revised 4115
Date '-7-2016