Dana Turken 12/31/2013 MIAMIBEACH
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
12/01/2011
Dana Turken
108 4th Dilido Terrace
Miami Beach, Florida 33139
Youth Center Advisory Board
Congratulations! You have been reappointed by Commissioner Jorge Exposito
to the above referenced agency, board or committee for a term ending: 12/31/2013.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ellen Vargas
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, 2-2458, 2-459
Ordinance 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
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMIBEACH
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
TO Dana Turken
RE: Youth Center Advisory Board
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 cal ndar year on which I have served.
Dana Turken
Sworn to and subscribed before me this day of 2010P..,
t
Silvia i o
Deputy 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.
MIAiJU
—"
BOARD AND COfV1 0 T TEE APPLICATION FDF 1V,,
NAME' .
mast Name First Name Middie Initial<3
HOME ADDR.. ,
Apt Not. House No./Street �C`ity State Zip Code
PHONE: � r ~V �� ��t� OIL_ ,��J fl�` '� 's/;),t0!? /(J/�l�G
Home Work Fax Email address
Business Name: Position:
Address:
No Street City State Zip Code
Professional License(describe) Expires, Attach b copy of the license
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 0 or No 0
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: Yes ❑or No 0
• Are you a registered voter in Miami Beach: Yes 0 or No 0
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes❑or No 0
Please list your preferences in order of ranking [1] first choice [2) second choice, and (3)third choice. Please note that oniv three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
0 Affiorciable Housin Advisory Committee 0 Housing Authority
0 Art in Public Places Committee ❑Loan Review Committee
El Beautification Committee ❑Marine Authority
❑ Board of Adjustment` D Miami Beach Commission for Women
D Budget Advisory Committee 0 Miami Beach Cultural Arts Council
0 Capital improvements Projects Oversight Committee D Miami Beach Sister Cities Program
❑ Committee on the Homeless C Normandy Shores Local Government Neigh. improvement
D Committee for Quality-Education in MB ❑Parks and Recreation Facilities Board
❑ Community Development Advisory ❑Personnel Board
0 Community Relations Board ❑Planning Board*
0 Convention Center Advisory Board ❑Police Citizens Relations Committee
0 Debarment Committee ❑Production Industry Council
❑Desion Review Board* ❑Public Safety Advisory Committee
❑DisabiW Access Committee ❑Safety Committee
❑Fine Arts Board D Single Family Residential Review Panel
D Gay, Lesbian, Bisexual and Transgender(GL67) ❑Sustainability Committee
❑Golf Advisory Committee 0 Transparency Reliability & Accountability Committee"TRAC"
❑ Health Advisory Committee 0 Transportation and Parkin Committee
❑Health Faciiitws Authority Board 0 visitor and Convention Autho
❑ Hispanic Affairs Committee 0 VVatertrDnt Protection Committee
❑ Historic Preservation Board ouch Center Advisory Board
"Board Required to File State Disclosure Form
Note: If applying for Youth Advisory Board, piease indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Boa . Yes No=
i
gave you ever Deer, corwicte. o .fon\' Yes svTvo ves alease expla►lOietalt.
• Do you currently have a violations) of City of Miami Beach codes Yes : or, No ve:. please expiair Ir. detail
• Do you currently owe the City of Miami Beach any money. Yes or No yes explain in detail
• Are you currently serving or any City Boards or Committees Yes. r No If yes whicr board's
• What organizations in the City of Miami Beach do you currently hole membership in?
Name: Title
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
He/7-7 tL-
• I am now employed by the City of Miami Beach-, Yes NoG. Which department?
• Pursuant to City Code Section 2-25(b): Do you have a parent D, spouse child brother C, or sister D 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: D Male Wee--male
Ethn Origin: Check one only (1)
bite (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe,North Africa or the Middle East.
D African-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American,or other Spanish culture or origin,regardless of race
D Asian or Paefftc isiander:All persons having origins in any of the original peoples of the Far East,Southeast Asia,the Indian Subcontinent.or
the Pacific Islands. This area indudes,tar example,China, India,Japan, Korea,the Philippine Islands and Soma.
J American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America,and who maintain
Cultural identification through tribal afltiiation or community recognition.
Physically Challenged: Yes D or NoD.
Empioyment Status: Employed D Refire Homemaker Dther D
NOTE: If appointed, you will be required to follow certain lawns which apply to ctty boardicommlttee members.
These laws include, but are not limited to,the following:
c Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
C Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
D Prohibition from lobbying before board/commtttee you have served on for period of one year after leaving office (Miam
Beach City Code section 2-26).
C, Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
(re- CMB Community Development Advisory Commtttee): 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.
"! hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2.
A cte VIi– of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
od I
- '`� f//a- �}-d/t� 4-A)4- l ot4l
A is Signature Date //� Na e doff Applicant.(PLcP.SE PRINT;
Pie a ch a our re ume o t ficationG(
Py PP
NOTE.ApplicationA w II remain r file f r a period of one (1) calendar year '
Receivec in the ;itv Cierk's Office by 470 Date _ 12009 :,ontrol No 2 Date
ame o'Deputy 3lerF.
MIA/\Al BEACH
i
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11.1(i) (2)
Board Member name: /4/U P T-U/--/,c/-_F A/
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 to the City Commission, must file,even though you may have been
recently appointed.
YOU must file One of the following with the City Clerk of Miami Beach, 1700 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 fine not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
Z'o
ignature: ate:
M® SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name
Disclosure
For Tax Year
Name: A) A-1 Ending: D f
Mailing Address: 4 c 4-1IP"O
City/State/Zip:
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: Term or Employment
Began on:- ///0
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read instructions): E3 Work Telephone:
Home Address:
-Street Address
City State Zip Code
Please list below in descending order with the largest source first,the name, address and
principal business activity of every source of your income including public .salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet,check here:
Description of the Principal
Na a of-.Source of Income Address Business Activity
1 reby swear(or affirm)that the aforesaid information is a true and correct statement.
Signature of person disclosing Date signed