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Samuelian Qualifying Documents CANDIDATE OATH — E i J ° ``.' `r NONPARTISAN OFFICE: 2015 SEP 10 PM Lid -I (Not for:use by Judicial or CITY i,L.L. ('.. „ firr. ICE School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021,:Florida Statutes) Mark Samuelian (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT*-NAME'MAY NOT BECHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan Office of Miami Beach Commission NIA. (office) (district#) N/A 6 ; I am a qualified elector of Miami-Dade County, Florida; (circuit#) -(group or seat#) I am a qualified elector of the City of Miami Beach.Florida,residing witl lie City at least one year before qualifying for City of Miami Beach elected office,with my legal residence being: 10 Venetian Way�f15U ,Miami Beach,Florida. I am qualified under'the ordinances and.Charter of said City and under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected;: I have qualified for no other public-office in the state, the term of which office or any part thereof runs concurrent with the office I seek;and I have resigned from any office from which I am required to resign pursuant to Section 99.012,Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. / -/ / . 305-915-4316 mark @marksamuelian.com X Signature of Candidate Telephone Number Email Address 10 Venetian Way#1502 Miami Beach FL 33139 Address City State_ ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): 120851660 *Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities(see instructions on page 2 of this form): Mark Samyalin STATE OF FLORIDA COUNTY OF Miami-Dade Sworn to(or affirmed)and subscribed before me this If day of cli I t_44,4. , 20 / . Personally Known: or A ' _;���`�"gip � • g ature of Notary Public Produced Identification: ��py�s R.RATn• an i.t,Type,or Stamp Commissioned Name of Notary Public • 4 : MY COMMISSION#EE 844885 EXPIRES:Februa 18,2017 Type Of Identifii�tion Produced:.. ` ��.��ti.4o� ,• :•n,R r ota u'lic nderwriters f S r P 1 ® 2015 p u DS-DE 25(Rev.;5111) Rule 1 S-2.0001,RAC. I. -■Nomma 19.15.2015 _. ° # r: Ii MIAMI BEACH 7, �. LC 15 SEP 13 PM 14. 13 CITY OF MIAMI BEACH OATHIAPFIRIVIATION STATE OF FLORIDA COUNTY OF MIAMI-DADE Before me, an officer authorized to administer oaths, personally appeared Mark Samuelian to me well known who, being sworn, says that he/she is a candidate for the office of Mayor or City Commissioner, Group No. 6 , for the City of Miami Beach, Florida; that he/she is a qualified elector of said City residing within the City at least one year before qualifying for City of Miami Beach elected office; that his/her legal residence is: 10 Venetian Way#1502, Miami Beach, FL 33139 Miami Beach, Miami-Dade County, Florida; that he/she is qualified under the ordinances (including Miami Beach City Code Chapter 38 governing "Elections")and Charter of said City to hold such office; and that he/she has paid the required qualification fee or filed with the City Clerk a petition approving his/her candidacy signed by sufficient qualified and registered voters to constitute not less than two percent (2%) of this number of such voters as the same shall be on the date sixty (60) days prior to the first day of qualifying as a candidate for office. /(7 ' Signature of Candidate Sworn to(or affirmed) and subscribed before me this /0 day of , 2015, by /Flan* Yrl u2�/iat L! 'tea ure of Notary Public-Stat- of Florida (NOTARY SEAL) / i1l&J/► £• &I to it ���sk p��� Name of Notary Typed, Printed or Stamped ='' ` -- � R.�1F�� �∎ ',,,E MY COMMISSION#EE 844865 :�•.� a� EXPIRES:February 18,2017 Ai% F P Bonded Thru Notary Public Underwriters Personally Known OR Produced Identification Type of Identification Produced SEP 10 2fl15 FORM 1 STATEMENT OF 2014 Please print or type your name,mailing FINANCIAL INTERESTS I FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME: • Samuelian, Mark George MAILING ADDRESS: 10 Venetian Way#1502 CITY: ZIP: - COUNTY: C-, r- Miami Beach 33139 Miami-Dade c.r1 mfii , .�. NAME OF AGENCY: C1'� ''ri NAME OF OFFICE OR POSITION HELD OR SOUGHT: Miami Beach Commissioner, Group 6 You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF [4 CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE =_ **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ****,;= op DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR,WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER(must check one): ld DECEMBER 31,2014 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER CALCULATIONS,OR USING COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES(see instructions for further details). CHECK THE ONE YOU ARE USING: COMPARATIVE(PERCENTAGE)THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY Accenture Stock Sale 46A,Avenue JFKennedy, Luxembourg security of public consulting firm 1-855N4 00000 Accenture Dividend same as above Rental Income 200 E 65 St, NY, NY 10065 Condo unit rental PART B-- SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE None PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. 510 Ocean Drive#204 INSTRUCTIONS on who must file Miami Beach, FL 33139 this form and how to fill it out begin on page 3. CE FORM 1-Effective:January 1,2015 (Continued on reverse side) PAGE 1 Adopted by reference in Rule 34-8.202(1),F.A.C. PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions] (If you have nothing to report,write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Accenture Stock Public Consulting Company TMV Security Public Security PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR None C ,v PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,write"none"or"n/a") BUSINESS ENTITY#1 BUSINESS ENT TY#2 NAME OF BUSINESS ENTITY None ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY c '° ,' I OWN MORE THAN A 5%INTEREST IN THE BUSINESS -" • 4� NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473,or Signature: attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief,the disclosure herein is true and correct. Date Signed: CPA/Attorney Signature: //$ Date Signed: FILING INSTRUCTIONS: • WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form,including If you were mailed the form by the Commission Initially,each local officer/employee,state officer, sianina and dating it,send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment that location. or of the beginning of employment. Appointees If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they prior to confirmation, even if that is less than section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment. reside in Florida, file with the Supervisor of the Candidates for publicly-elected local office must NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying MULTIPLE FILING UNNECESSARY: papers. State officers or specified state employees A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer Thereafter, local officers/employees, state of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are of his or her original Form 1 when qualifying.A address:325 John Knox Road, Building E,Suite required to file by July 1st following each calendar candidate who files a Form 1 with a qualifying 200,Tallahassee,FL 32303. year in which they hold their positions. officer is not required to file with the Commission Finally,at the end of office or employment,each or Supervisor of Elections. Candidates file this form together with their local officer/employee,state officer,and specified qualifying papers. state employee is required to file a final disclosure To determine what category your position falls form(Form 1F)within 60 days of leaving office or under, see the "Who Must File" Instructions on employment.However,filing a CE Form 1F(Final page 3. Statement of Financial Interests)does not relieve Facsimiles will not be accepted. the filer of filing a CE Form 1 if he or she was in their position on December 31,2014. CE FORM 1-Effective:January 1,2015. PAGE 2 Adopted by reference in Rule 34-8.202(1).F.A.C. Form 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME—FIRST NAME--MIDDLE NAME: NAME OF AGENCY: Samuelian, Mark George MAILING ADDRESS: OFFICE OR POSITION HELD: 10 Venetian Way#1502 Miami Beach City Commission, Group 6 CITY: ZIP: COUNTY: FOR QUARTEVNDING(CHECK ONE): YEAR ❑MARCH UNE USEPTEMBER ❑DECEMBER 20/S Miami Beach 33139 Miami-Dade PART A—STATEMENT OF GIFTS Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the date(s)the gift was received.If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You are not required to file this statement for any calendar quarter during which you did not receive a reportable gift. DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT NONE ❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET • C PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT -Q If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy of:that receipt to-this form.You may attach an explanation of any differences between the information disclosed on this form and the information`on the receipt._; I os ❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM CO PART C—OATH I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA COUNTY OF"12.1.4.41(.1..... depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subscribed befor me this /p day of ,20 1 herein and on any attachments made by me constitutes a true accurate, by hia 21c 5i/1 ,i and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. (Signature o�fyNota Public-State of Florida) re :941(rezne.:=Zii=4 (Print,Type,or Stamp mmissioned Name of Notary Public) SIGNATURE OF REPORTING OFFICIAL Personally Known OR Produce. !den'fi -ti• SEP 1 0 2015 Type of Identification Pro•; -• ,,, _ _ MY COMMISSION#EE 844865 PART D—FILING INSTRUCTIONS XPIPES;February 18,2017 '':�o , Bin, on R!O{eey Pubic Urns This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi- cal address:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.The form must be filed no later than the last day of the calendar quarter that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.) CE FORM 9-EFF.1/2007(Refer to Rule 34-7.010(1)(g),F.A.C.)(Rev.9/2013) (See reverse side for instructions) EMI BEACH NOTICE OF TESTING OF THE TABULATING EQUIPMENT (LOGIC AND ACCURACY TEST) AND CANVASSING BOARD SCHEDULE FOR THE CITY OF MIAMI BEACH RUN-OFF ELECTION (IF NECESSARY) NOVEMBER 17, 2015 Pursuant to Florida Statute §101.5612, notice is hereby given of the time and location of the public preelection test of the automatic tabulating equipment (Logic and Accuracy Test) for the November 17, 2015 Miami Beach Run-Off Election (if necessary). Pursuant to Florida Statute §102.141, notice is hereby given of the time and place during which the City of Miami Beach Canvassing Board for the November 17, 2015 Miami Beach Run-Off Election (if necessary) will meet to canvass the absentee electors' ballots and provisional ballots. The City of Miami Beach Canvassing Board will convene at the Office of the Supervisor of Elections, 2700 NW 87 Avenue, Miami, Florida. The Canvassing Board is convening on these dates in preparation to conduct the Miami Beach Run-Off Election to be held on November 17, 2015 (if necessary). DATE/TIME ACTIVITY ATTENDANCE Thursday, 11/12/15 1. Logic and Accuracy Test of the touch All Canvassing Board 10:00 a.m. screen and optical scan voting systems to Members or be used for absentee, early voting, and one designated precinct ballots Canvassing Board Member Friday, 11/13/15 1. Pre-count Logic and Accuracy Test of the All Canvassing Board 10:00 a.m. through optical scan system used for absentee and Members or Tuesday, 11/17/15 provisional ballots one designated 2. Absentee ballot opening and processing Canvassing Board Member (as needed) 3. Duplication of ballots (as needed) Tuesday, 11/17/15 1. Absentee ballot opening and processing All Canvassing Board (as needed) Members 2. Duplication of ballots (as needed) Canvassing: 3. Canvassing of presumed invalid absentee 5:00 p.m. to completion ballots and provisional ballots 4. Tabulation of results r� , 5. Unofficial Results provided by the Supervisor of Elections Friday, 11/20/15 1. Canvassing of provisional ballots All Canvassing-Boa 11:30 a.m. to completion (if needed) Members 2. Certification of Official Results, including provisionals, by the Supervisor of Elections 3. Post-count Logic and Accuracy Test of the optical scan system used for absentee and provisional ballots 4. Race and precinct(s) selection for manual post-election audit 5. Audit process starts to completion Majority of the Canvassing Board Members or designees ' (71°4 7 it All proceedings will be open to the public. To request this material in alternate format, sign language interpreter (five-day notice required), information on access for persons with disabilities, and/or any accommodation to review any document or participate in any City-sponsored proceedings, call 305.604.2489 and select 1 for English or 2 for Spanish, then option 6; TTY users may call via 711 (Florida Relay Service). In accordance with Florida Statute §286.0105, a person who appeals any decision by the Canvassing Board with respect to any matter considered at a meeting, he or she will need a record of the proceedings and therefore will need to ensure that a verbatim record of the proceedings is made. Please note that the Canvassing Board Schedule is subject to change, if needed. Please contact the Office of the City Clerk at 305.673.7411 if you have any questions. The County Canvassing Board Members are TBD - County Judge, Chairperson; Rafael E. Granado, City Clerk; and TBD— Miami Beach Resident. MIAMI BEA ...... NOTICE OF TESTING OF THE TABULATING EQUIPMENT (LOGIC AND ACCURACY TEST) AND CANVASSING BOARD SCHEDULE FOR THE CITY OF MIAMI BEACH GENERAL AND SPECIAL ELECTIONS NOVEMBER 3, 2015 Pursuant to Florida Statute §101.5612, notice is hereby given of the time and location of the public preelection test of the automatic tabulating equipment (Logic and Accuracy Test) for the November 3, 2015 Miami Beach General and Special Elections. Pursuant to Florida Statute §102.141, notice is hereby given of the time and place during which the City of Miami Beach Canvassing Board for the November 3, 2015 Miami Beach General and Special Elections will meet to canvass the absentee electors' ballots and provisional ballots. The City of Miami Beach Canvassing Board will convene at the Office of the Supervisor of Elections, 2700 NW 87 Avenue, Miami, Florida. The Canvassing Board is convening on these dates in preparation to conduct the Miami Beach General and Special Elections to be held on November 3, 2015. DATE/TIME ACTIVITY ATTENDANCE Thursday, 10/15/15 1. Logic and Accuracy Test of the touch All Canvassing Board 10:00 a.m. screen and optical scan voting systems to Members or be used for absentee, early voting, and one designated precinct ballots Canvassing Board Member Friday, 10/30/15 1. Pre-count Logic and Accuracy Test of the All Canvassing Board 1:00 p.m. through optical scan system used for absentee and Members or Tuesday, 11/3/15 provisional ballots one designated 2. Absentee ballot opening and processing Canvassing Board Member (as needed) 3. Duplication of ballots (as needed) Tuesday, 11/3/15 1. Absentee ballot opening and processing All Canvassing Board (as needed) Members c 2. Duplication of ballots (as needed) `�' Canvassing: 3. Canvassing of presumed invalid absentee -77 5:00 p.m. to completion ballots and provisional ballots c-D m 4. Tabulation of results r°- - ) 5. Unofficial Results provided by the Supervisor of Elections Friday, 11/6/15 1. Canvassing of provisional ballots All Canvassing Boar _: 1:30 p.m. to completion (if needed) Members -c"- 2 Certification of Official Results. including provisionals, by the Supervisor of Elections o 3. Post-count Logic and Accuracy Test of the optical scan system used for absentee and provisional ballots 4. Race and precinct(s) selection for manual post-election audit 5. Audit process starts to completion Majority of the Canvassing Board Members or designees All proceedings will be open to the public. To request this material in alternate format, sign language interpreter (five-day notice required), information on access for persons with disabilities, and/or any accommodation to review any document or participate in any City-sponsored proceedings, call 305.604.2489 and select 1 for English or 2 for Spanish, then option 6; TTY users may call via 711 (Florida Relay Service). In accordance with Florida Statute §286.0105, a person who appeals any decision by the Canvassing Board with respect to any matter considered at a meeting, he or she will need a record of the proceedings and therefore will need to ensure that a verbatim record of the proceedings is made. Please note that the Canvassing Board Schedule is subject to change, if needed. Please contact the Office of the City Clerk at 305.673.7411 if you have any questions. The County Canvassing Board Members are TBD - County Judge, Chairperson; Rafael E. Granado, City Clerk; and TBD— Miami Beach Resident.