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Annsheila Turkel 12/31/2013 IV City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 01-26-2012 Annsheila Turkel 16 Island 3A COPY Miami Beach, Florida 33139 SUBJECT: Committee on the Homeless Congratulations! You have been appointed by Mayor Matti Herrera Bower to the agency, board or committee named above for a term ending: 12/31/2013. Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1 st, 2007, the term of board members who are directly appointed by a member of the City Commission shall automatically expire on December 31 of the year the appointing elected official leaves office. If you are unable to accept this appointment or have any questions, please call the City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully. Congratulations again and good luck. Sincerely, S Robert Parcher City Clerk cc: Saul Frances, Parking Director Katherine Martinez ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency, board or committee City Code Section 2-22, 2-23, 2-24, 2-25, 2-26,2-458 and 2-459 Ordinance No. 2006-3543-Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application -(Parking Department Form) Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. AAIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachH.aov OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk Tel: (305)673-7411,Fax: (305)673-7254 TO Annsheila Turkel RE: Committee on the Homeless I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United States,the State of Florida,and the City of Miami Beach,and to perform all the duties of a member of the above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2013. 1 have been issued a copy of Section 2-11.1 of the Miami-Dade County Code(Conflict of Interest and Code of Ethics Ordinance),as well as theflorida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees,and understand that as a member of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure* require- ments of Miami-Dade County or the State of Florida(depending on the board or committee on which I serve)on July 1 st,following the closing of the calendar year on which I have served. Annsheila Turkel Sworn to and subscribed before me this KIday of , 2012. ,�VlDeputy Sil rieto Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safety to all who live,work and play in our vibrant, tropical, historic community. "MIAM! BEACH NAME: Turkel Annsheila Last Name First Name Middle Initial HOME ADDRESS: 3A 16 Island Miami Beach 16 Island 33139 Apt No. Home No./Street City State Zip Code PHONE: 305-538-8628 305-321-9011 aturkel@turkel.info Home Work Fax Email Address Business Name: Annsheila Turkel LCSW Position: Psychotherapist Address: Miami Beach FL No. Street City State Zip Code Professsional License(describe): Licensed Clinical social Worker Expries: March 2013 Attach a,cop44F,w-ihcewse Pursuant to City Code section 2-22(4)a and b: Members of agencies, boards,and committees shall be affiliated with the city;this ,requirement shall be fulfilled in the following ways:a)an individual shall have been a resident of the city for a minimum of six months;or b)an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six(6)months: Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes •Are you a registered voter in Miami Beach: Yes • (Please circle one): I am now a resident of: South Beach • I am applying for an appointment because I have special abilities,knowledge and experience. Please list below: I have been involved with issues of the Homeless Population since aftneding Barry university •Are you presently a registered lobbyist with the City of Miami Beach? No L-- Please list your preferences in order of ranking[1]first choice[2]second choice,and[3]third choice. Please note that only threeJ31 choices will be observed by the City Clerk's Office.(Regular Boards of City) Affordable Housing Advisory Committee Housing Authority Art in Public Places Committee Loan Review Committee Beautification Committee Marine Authority Board of Adjustment* Miami Beach Commission for Women Budget Advisory Committee Miami Beach Cultural Arts Council [1] Capital Improvements Projects Oversight Committee Miami Beach Human Rights Committee Committee for Quality Education in MB Miami Beach Sister Cities Program Committee on the Homeless Normandy Shores Local Gov't Neigh.Improvement Community Development Advisory Parks and Recreation Facilities Board Community Relations Board Personnel Board Convention Center Advisory Board Planning Board* Debarment Committee Police Citizens Relations Committee Design Review Board* Production Industry Council Disability Access Committee Safety Committee Fine Arts Board Single Family Residential Review Panel Gay,Lesbian,Bisexual and Transgender(GLBT) Sustainability Committee Golf Advisory Committee Transportation and Parking Committee Health Advisory Committee Visitor and Convention Authority Health Facilities Authority Board Waterfront Protection Committee Hispanic Affairs Committee Youth Center Advisory Board Historic Preservation Board Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: 2. Present participation in Youth Center activities by your children No if yes,please list the names of your children,their ages,and which programs. List below: Child's name: Age: Program: Child's name: Age: Program: • Ha e you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of Money Beach any money: No If yes, please explain in detail: •Are you currently serving on any City Boards or Committees: No If yes,which board? •What organizations in the City of Miami Beach do you currently hold membership in? Name: -- Title: Name: -- Title: • List all properties owned or have an interest in,which are located within the City of Miami Beach: Apt.3A Belle Towers 16 Island Avenue Belle Isle • 1 am now employed by the city of Miami Beach: No Which department? • Pursuant to City code Section 2-25(b):do you have a relative who is employed by the City of Miami Beach?Check all that apply. Identify the department(s): The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. Gender' G� Ethnic Orgin:Check one only(1) White Physically Challenged: No Employment Status: Self Employed NOTE: If appointed,you will be required to follow certain laws which apply to city board/committee members. These laws include,but are not limited to,the following: o Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459). o Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office(Miami Beach Code section 2-26). o Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1). (re:CMB Community Development Advisory Committee): prohibition,during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties(CFR 570.611). Upon request,copies of these laws may be obtained from the City Clerk. "1 hereby attest to the accuracy and truthfulness of the application and have received,read and will abide by Chapter 2,Article VII—of the City Code"Standards of Conduct for City Officers,Employees and Agency Members." Annsheila Turkel agreed to the following terms on 12/17/2011 2:17:37 PM Received in the City Clerk's Office by: Date: / /2011 Control Noa� Date: / /2011 Name of Deputy Clerk I _EACH city of Miami Beach, 1700 Convention Center Drive, Miami'Beach, Florida 33139, www.miamibeachfl.Aav CITY CLERK Office CityClerkCmiamibeachfl..gov Tel: 305.673.741 1 Fax: 305.673.7254 Acknowledgement of fines/suspension foe:Board Members for.failure to comply with Miami-Dade County Financial.Disclosure Code Provision Code Section 2-11.1(i) (2) Board Member name: U .I understand that no .later than July 1, of each Year all members of.Boards and Committees of the .City of Miami.Beach, including those of a-purely advisory nature, are required to comply with Miami-Dade County.Disclosure Requirements. This means that-the members of_City Advisory.Boards, whose.sole or primary responsibility is to °recommend legislation or give advice to1he City Commission,must file,:even-though you may havebeen recently appointed. You.must file one of:the following with the.City Clerk of Miami Beach, 17.00 Convention Center-Drive, Miami :Beach, Florida, by July 1 each.year. 1. A"Source of.Income Statement'(attached)or. -2. A-"Financial Statement".(attached(:or� 3. A Copy of the person's current Federal-income Tax Return Failure to-file, according to the Miami-Dade:County Code -Chapter 1, General Provision, Section 1-5 may-subject the person or firm to.a.fw ne not-to exceed $500.00 .or by'imprisonment'in the county.jail for-a period not to.exceed sixty dayys, or:both. / i7• z Signature: Date: MIAMI moo SOURCE OF INCOME STATEMENT Piease.Print:or Type First Name Middle-Name initial Last Name Disclosure • J For Tax year rl/1ShG'1 ��; ✓r/�� Ending: Name. Niailpng ►ddress: FL ,�4nl 1 3r3�39' City]state/.dip: �f. social.Security Number: • Filing as a. ® County-Employee: E3. Municipal Employee of: Position held or sought: 'eS S r/� 'Terns or.Empl®yment Board where serving: �� `-'� �� . 'Began 13n:g Department�whem erppioyed: 'Work Address: /4 If your home address is exe from pubiic records pursuant tc 306' Florida Statutes:§:114.07 please check here(reed instructions); ® Vork Teleph®ne: . Horne Address: Street Address City State Zip Code below:in :descending order with the largest•source first, the name, address, any Please lest Public salary y® principal business -activity of every source .of your income -including .h received or any person received for your .benefit or use during the,disclosure If continued on ha income ®f your spouse or.-any business:partner:need not.be disclosed. separate sheet, check here: "Description of the Principal Nang fr Source of Income Address. Business AcLivitV ��v�s a vak 6 / ! F er s ear affirm..)that the.aforesaid information:is:a true sand z®rrect statement. 7h y :.Date signed .Signature of person.disciosing