Marjorie York 12/31/22M IA M I BEACH
B O ARD AN D C OM M ITTE E C H E CKLIST
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o Diversity statistics Reporting (Completed on_ '_, //[)Of
o Oath
F O R S C A N N E R
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECF]/ED Y CIy Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
i.... ✓County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
. . . amended through December 2010)
MAY 11 2021 ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
C ITY OF M}M ¡ gE }¡ Y Sunshine Law and Public Records - Frequently Asked Questions orEo-'-,> Memorandum - Solicitation by City Board and Committee Members
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o Citywide Permit Application (Parking Department Form)
o Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement
_ . _ DIVERSITY STATISTICS REPOR~~eep C O PY in fije and O R IG~IN ~ fl?,~:_:?:
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CONCLUDED & RESIGNATION LETTERS
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Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOARD AND COMMITT IES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safety to all who live, work and olay in our vibrant, tropical. historic community
M IA M I BEACH
City of Miami Beach, 700 Convention Center Drive, Miami Beach, Florida 33 139 yyw_miamibachhl_go
OF FICE OF THE CITY CL ER K, Rafael E. Gran ado, City Clerk
Tel : 305.6 73.74 11, Fac 305.673.72 54
Email: CiyClerk@miamibeachfl.gov
M ay 11, 2021
M s. M arjo rie Y o rk
82 9 15th Street, A P T # 1 O
M ia m i Be ach, Florida 3313 9
RE: Miam i Beach Com m ission For W om en
D e ar M s. M a rjo rie Y ork:
C o ngratulations! Y ou have been appointed by Mayor Dan Gelberto the above-referenced Board or
C o m m itt ee , fo r a term ending: 12/31/2022.
Pursua nt to C ity of M iam i Beach C ode Section 2-22 (5)a:
N otw ithstanding any other provision of the C ity C ode or of any R esolution, com m encing with
term s beginning on or aft er January 1, 2007, the term of every board m em ber w ho is directly
appointed by a m em ber of the C ity C om m ission shall autom atically expire upon the latter of:
D e cem b er 31 of the year the appointing C ity C om m issioner leaves offi ce or upon the
appointm e nt/election of the successor C ity C om m ission m em ber.
If yo u are un ab le to accept this appointm e nt, or have any questions, please call the Offi ce of the City
C le rk at 305 .6 7 3 . 7 411.
P lea se read th e encl ose d m ate ria ls carefully as the y concern your duties, responsibilities, and
requirem ents as a board or com m itt ee m em ber.
C ong ratulations again and good luck.
R ega rds,
R afael G ranado
C ity C le rk
cc: M o nica Be ltran, Parking Di rector
V eronica Paysse, C ity Li aison
ENCLO SUR ES:
O ath of O ffi ce/O ath of C ivility/A cknow ledgem ents
C ity C od e/O rdinance section applicable to agency, board or com m ittee
C ity C o de Se ctions 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
O rdina nce N o. 2006-3543 - Am en dm en t to C ity C ode Section 2-22
M ia m i-D ade C o unty C ode Section 2-11.1 - C on fli c t of Interest and C ode of Ethics
C ity Wi de Perm it Ap plication - (P arking D epart m ent Form )
Book l et - G uid e to the S unshine A m endm ent and C ode of Ethics for Public Offi cers and Em ployees
M IA M I BEACH
City of Miami Beach, 1700 Convention Cen ter Dri ve, Miami Beach, Florida 33 139 yyw_miamibachf]go
OF FICE OF THE CITY CL ER K, Rafael E. Gr anado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Emai l: CilyClerk @mi am ibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M s. M a rjo rie Y ork
R E : M ia m i Be ach C om m ission For Wom en
I do so le m n ly sw ear or affi rm to bear true faith, loyalty and allegiance to the G overn m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perf orm all the duties of a m em ber of the
above-m ention e d board or com m ittee of the C ity of M iam i Beach to w hich I have been appointed for a
term ending: 12/31/2022.
T o m y co llea g ue s and to all of those I represent and serv e, I pledge fairn ess, integrity and civility, in all
actions taken and all com m unications m ade by m e as a public serv ant.
I ha ve be e n issued a copy of sectio n 2-11.1 of the M iam i-D ade C ounty Code (C onfli ct of Interest and
C od e of Ethic s Or di na nce), as w ell as Florida C om m ission on Ethics Guide to the Sunshine Am endm ent
and C o de of Ethics fo r Public O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C o m m itt ee, I m ust com ply w ith the finan ci al disclosure requirem en t s of M iam i-Dade C ounty or the
State of Flo rida (depending on the board or com m ittee on w hich I serv e) on July 1st, followi ng the closing
of the cale ndar year on w hich I have serv ed. r
Sw orn to and subs cribe d befor e m e th is -
pl e a se visit the C ity of M iam i B each w ebsite at www.mi a m ibeachfl.gov under City Clerk/Board and
C o m m itt ees for additional info rm ation regarding the Financial D isclosure R equirem ents.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@miamibeachfl.gov
Telephone: 305.673.7411
AEFIDAVII OF AEEILIATION WITH THE CITY OE MIAMLBEACH
sorer.929)A- Na9,
couNTY OF L 1 [ITU
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
O I am a resident of the City of Miami Beach for six months or longer.
O I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
O I am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, I decla
stated in it are true.
, I have read the foregoing document and that the facts ±c
Date/ /
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or□online
oterzavon. he//r1c ay «_//-] _achy
A1@_ /f_ coy or wear seas soar,corr»nee verso.
Y es FloueuaA Uo-Due 1p
Form of Identification
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
CF9" Expires 12/14/2021
MIAMl·DAD E- EIE
Clear From Print Form
SOURCE OF INCOME STATEMENT
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 fo r Tax Year Ending
2020
Mailing Address - Stre
%2
City, State, Zip
lf your hom e addre ss is your maliig address, and your hom e address 'is exempt from public records pursuant to Fla. Stat $119.07, read
instructions on the following page and check Hele.
Filing as an Em ployee (check one)
D M u n icip al:
Department
Position or Title
W ork address Work telephone
O County {íanicoat: A ia.t [eaA
(M unicipality)
o1(sSoo
Alteni ate address (if home address is e"" IA-- Uoc-u
7a Term be
5 202
List below every source of inco me you rece ived, along with the address and the principal activity of each source. Include your public salary. Place the source s of
income in desce nding order, with the largest source first. Examples of source s of income include: compensation for services, income from business, gains from
pro perty 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. O
Name of Source of Income Address Description of the Principal Business Activity
s Z /A A
I hereby swear (or affirm) that the info rmation above is a true. and correct statement.
Signa ture of Person6 pi sclosing
if
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy RECEIVED
O Electronic Copy
MAY 11 2021
CITY OF MAM! 3EACH
reo.--o-/yK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IA M I B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeach[]_gov
OFFICE OF THE CITY CLERK
Email: BC @ m ia m ib e a chfl.g o v
Telephone: 305. 673 741 1
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
/¥ an Last N
IE
First Name - Middle Initial
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 Financial
Disclosure Requirements.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "Source of Income Statement;" or
2. A "Statement of Financial Interests (Form 1 )1;" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail, or Poth). // '
Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
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F:\CLER\$ALL\REG\BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRA FT S\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibegchf]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl._gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
'1K
Last Name
AAR_
First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
ale
0remale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
Ll Asian or Pacific Islander
DJ Caucasian/wh ite
O Native American/America n Indian
O Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Lyes
J No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Oves
Z1o
O I prefer not to answer this question.
Page 6 of 6
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Updated: June 2020
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