Dana Turken 2019 ADE
COUNTY SOURCE OF INCOME STATEMENT
COUNTY
Section 2-11.1(i)of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending Last Name Firs ame Middle Name/Initial
2019 v ,C'Cr'1 � Lc.)/i.&4
Mailing Address—Street Number,Stree Name,or P.O.Box
City,State,Zip S
If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat. §119.07, read
instructions on the following page and check here.❑
FiliuZas an Employee(check one)
In County lic Health Trust ® Municipal:
(Municipalit
Department
Position or Title Employee ID Number
Work address Work telephone Employ an on/ended on
Filing as a Board Member(check one)
0 County Municipal: -i 07 A` n44 1 fSe/
(Municipality) /'DV I
Board where servingA .ykii:A44--( �� ��A- ..c / A�2 t /-
Alternate address(if home address is exempt) Work telephone Term beg on/ended on
List below every source of income you received,along with the address and the principal activity of each source.Include your public salary.Place the sources of
income in descending order,with the largest source first. Examples of sources of income include:compensation for services,income from business,gains from
property dealings, interest, rents,dividends,pensions,IRA distributions,and social security payments.Also, include any source of income received by another
person for your benefit.However,the income of your spouse or any business partner need not be disclosed.If continued on a separate sheet,check here.❑
Name of Source of Income Address Description of the Principal Business Activity
64.4 45 .. "1,44,'v im 441/41
I h reby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIV !
❑ Hardcopy
n �J ❑ Electronic CoP
nature of Person Disclosing CITY UI vii�Ml BEACH
OFFICE OF THE CITY CLERK
�! civ
Da a signed
OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 COE 2016