Marjorie York Application PackageM IA M I BEACH BOARD AND COMMITTEE APPLICATION
Last Nare ' /et. at, e Home Address
First Name
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state zi C6de
Cellular Telephone W ork Telephone
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3 04- 724 77A
Home Telephone Email address
Business Name Occupation
Business Address City State Zip Code
Please list your preferences in order of ranking: [1] first choice, [2] second choice, and [3] third choice. Please note that
only three (3) choices will be observed by the Office of the City Clerk.
Ad Hoc North Beach CRA Advy. Comm Ad Hoc Charter Review and Ad Hoc Neighborhood Resiliency
Revision Board Projects Advisory Committee
Affordable Housing Advisory Committee Health Advisory Committee Normandy Shores Local Government
Neigh borhood Improvem en t
Animal Welfare Committee Health Facilities Authority Board Parks and Recreational Facilities
Board
Art in Public Places Committee Hispanic Affairs Committee Personnel Board
Audit Committee Historic Preservation Board * Planning Board *
Black Affairs Advisory Committee Housing Authority Police/Citizens Relations Committee
Board of Adjustment * Human Rights Committee Production Industry Council
Budget Advisory Committee LGBTQIA+ Advisory Committee Program for Public Information
Committee
Committee for Quality Education in Marine & W aterfront Protection Senior Affairs Committee
Miami Beach Authority
Committee on the Homeless Mayor's 41 st Street Committee Sustainability Committee
Convention Center Advisory Board General Obligation Bond Oversight Transportation, Parking, and Bicycle-
Committee Pedestrian Facilities Committee
Cultural Arts Council Ad Hoc Iguana Remediation Visitor and Convention Authority
4 A dvisory Com mittee
Design Review Board * ( Miam i Beach Commission for Youth Commission
Women
Disability Access Committee Next Generation Council Ad Hoc Iguana Remediation Committee
1.
2.
3.
Ny u m4 0 6h (om yu (_n fa
[A
Professional License
Type of Professional License License Number
State of Issuance License Issuance Date License Expiration Date
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F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
N o te : If yo u are se eking ap pointm e nt to a professional seat (e.g . attorn ey, architect, etc.), you m ust attach a copy of your
curre nt! eff ective co rres on din ro fessional license .
A F F ILI A TIO N W IT H T H E CITY O F M IA M I B E A C H
Pursuant to City Code section 2-22(4) a, b, and c: M em bers of A gencies, Boards, and C om m ittees shall be affi liated
w ith the C ity. T his requ ire m e nt shall be fulfilled in the fo llow ing w ays:
a. R esid en t of th e Ci ty for a mi nimum of six months: Yes [ILlNo
• I am a re sid e nt of: South Beach ~ Middle Beach D North Beach D
O r
b . D e m o n stra te s an ow nershT:2{rest (fo r a m inim um of six m o nths) in a business established in the City (fo r a m inim um
of six months): Yes llor No
"Ownership Interest" shall mean the ownership often percent (10%) or more (including the ownership of 10% or more
of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or
business association.
O r
c . Full-tim e em plo yee of such a business (fo r a m inim um of six m o nths); and I am based in an offi ce or other location of
the busin e ss that is physically located in M iam i Beach (fo r a m in im um of six m onths): Yes O or lEJNo
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by
a 417th vote of the Mayor and City Commission.
NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation
requirements of sections 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they
have met either (or both) of said affiliation requirements. The original affidavit shall be filed with the Office of the City Clerk
prior to being sworn in as a member.
• I am ap p lying fo r an ap po intm e nt because I have special abilities, know ledge, and experience. Please list below:
qid, 4ow, oocn=
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F:ICLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
• Ar e yo u a regi s tere d active lobbyi st wi th th e Ci ty of Mi am i Beach ? Yes ll or No lud
• H a ve yo u ever be en con vict e d of a fel on y ? Yes Ll or No LI it yes, pl ease expl ain in det ail:
• D o yo u cu rre ntly ha ve a violation(s) of C ity of M iam i Beach C ode ? Yes O or No C2J If yes, please explain in detail:
• D o yo u curren tly ow e th e Ci ty of Mi am i B each m on ey? Yes ll or No Lh ties, pl ease explain in detai l:
• A re yo u currently serv ing on any C ity Board or C o m m ittee? Yes [YJ or No O If yes, w hich Board/C om m ittee?
Casie e , amg0
• In w ha t o rga niza tion(s) in the C ity of M ia m i Beach do you currently ho ld m em bership? gr"i72%,a a Ages"s##s%2
N am e , Posit"9a ll+,,,2l2, ~t5, ,£ • ply, E s r d °7f"o"$ 4lea fie%=pl er an.7"?8.i cl4e 23%%
• List the ad d re ss of all pro pert ies ow ned or in w hich you have an interest w ithin the City of M iam i Beach:
• Ar e yo u no w em pl o yed by th e City of Mi am i Beach ? Yes ll or No bf 1so, which depar tm ent and title?
• Pursuant to City Code Section 2-25 (b): D o you have a parent 0, spouse 0, child O brother Ll or sister 0
wh o is em p l o ye d by the Ci ty of Mi am i Beach ? Y es lorNo [l
If "Y e s," id en tify pe rson(s) and departm e nt(s): _
* Note: If app lyin g fo r the A t-Large position of the H istoric P reservatio n B oard, please answ er the below questions:
• H a ve you ever re sid e d in one of the C ity's H istoric D istricts fo r at least one year? Yes O or No 0
If yo u an sw e red "Y es," pl ease indicate:
From : To
A dd re ss D ates
Fro m : To
A dd re ss D ates
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F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
N O T E : IF A P P O IN T E D , Y O U W IL L B E R E Q U IR E D T O F O L L O W C E R T A IN L A W S T H A T A P P L Y T O C ITY
B O A R D /C O M M IT T E E M E M B E R S . T H E S E L A W S IN C L U D E , B U T A R E N O T LI M IT E D T O :
o P rohib itio n fr om directly or thro ugh an associate appear befo re or lobby on behalf of a third person, the C ity C om m ission, a C ity
A ge ncy, or C ity pe rsonne l. (M iam i Beach C ity C ode Section 2-459)
o P rohib itio n fr om contracting w ith the C ity . (M iam i-D ade C ounty C ode Section 2-11.1)
o P ro hib itio n fro m lo bbying befo re the Board/C om m itt ee you have serv ed on fo r period of one year after leaving offi ce. (M iam i
B each C ity C ode Sectio n 2-26 )
o R equire m e nt to disclose cert ain financia l interests and gift s. (M iam i-D ade C ounty C ode section 2-11.1)
o S unshin e Law - Fl orida's G overn m ent-in-the-S unshine Law w as enacted in 19 67. T oday, the Sunshine Law regarding open
g o vern m e nt can be fo und in C hapter 286 of the Florida Statutes. These statutes establish a basic right of access to m ost
m e etin gs of Boards, C o m m issions, and other govern ing bodies of state and local govern m ental agencies or authorities.
o V oting con fl ict - F o rm 8B is fo r use by any pe rso n serv ing at the county, city , or other local level of govern m ent on an appointed
or elected Board, C ouncil, C om m issio n, A utho rity , or C om m itt ee. It applies equally to m em bers of advisory and non-advisory
bo dies w ho are prese nted w ith a voting conflict of interest under Section 112 .314 3, Florida Statutes.
o C o m m e ncing w ith term s be ginning on or aft er Ja nuary 1, 2024 , and as a condition of applying fo r appointm ent to a City agency,
bo a rd, or co m m itt ee , each ap plicant m ust voluntarily agree that in the event the applicant fil es w ith the C ity C lerk a Statem ent
o f C and idate fo rm a lly announcing candidacy fo r C ity elective offi ce, such filing w ith the C ity C lerk shall be deem ed a tender of
resignatio n fr om the C ity age ncy, board or com m itt ee, and the m em ber's autom atic resignation shall thereby im m ediately create
a vacan cy in the age ncy, boa rd, or com m itt ee .
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND THAT
THE FACTS STATED IN IT ARE TRUE. ADDITIONALLY, I AGREE AND ACKNOWLEDGE THAT ANY FALSE
STATEMENTS OR FALSE INFORMATION SUBMITTED AS PART OF THIS APPLICATION SHALL BE A BASIS FOR
MY REMOVAL FROM A CITY BOARD OR COMMITTEE. I HAVE RECEIVED, READ AND WILL ABIDE BY CHAPTER
2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS,
EMPLOYEES AND AGENCY MEMBERS" AND ALL OTHER APPLICABLE CITY, COUNTY, AND/OR STATE LAWS
AND STATUTES ACCORDINGLY ,-
Board and Committee Application Checklist: P lease ensure you have provided all info rm ation befo re applying or
rea p p ly in g to any B o a rd an d C o m m itt ee
[] 1h a ve an sw e red all qu estion s ful ly.
[] 1h a ve att ach e d addi ti on al sh e e ts, if ne ce ssary, to pro vi d e require d inf orm atio n.
Ei ha ve att ac he d a curre nt re su m e, pho togra ph, and a copy of any applicable pro fessional license .
l2f' I ha ve co m p le te d an d att ache d the Bo ard & C om m ittee Financial A cknow ledge m e nt Statem ent.
cg' I ha ve co m p le ted an d att ache d the D iversity S tatistics R eport .
tr un d e rsta n d that co m m e ncin g w ith te rm s beginning on or after Janua ry 1, 2024 , and as a condition of applying fo r
ap po intm e nt to a C ity ag ency, bo a rd , or com m ittee, I voluntarily agree that in the event I file w ith the C ity C lerk a
S tate m e nt of C a nd id ate fo rm ally an nou n ci n g candidacy fo r C ity elective off ice , such filing w ith the City C le rk shall be
de e m e d a te n d e r of re sign a tion fr o m the C ity agency, board, or com m ittee .
[] S ub m i t co m p le te ap p licatio n pa ckag e.
V ia E m a il: BC @m i a mi be a ch fl .gov
ve us.Mailo@Parco»
C ity of M ia m i B e a ch
O ffi c e of the C ity C le rk / Board an d C o m m itt ee S ection
17 0 0 C o nven tion C e nter D riv e, 1s Fl oor
M ia m i Be a c h, FL 33 13 9
If yo u ha ve any qu e stio ns, ple ase contact the O ffi ce of the C ity C lerk via em a il: B C @ m iam ibeachfl.gov or tele phone:
30 5 .6 73 .7 4 11 .
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F:\CLER\$ALLIBOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
Note: Florida S tatutes §119 .071: The role of the Office of the City Clerk is to receive and maintain forms filed as public
records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish
your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address
for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a
photograph.
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F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
M IAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachtl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
~
4)4 4 R/ M
Last Name First Name Maae mial
Acknowledgment 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)
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)';" 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 both.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
si@nature 7 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\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
M IAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
Last Name
070/12#/
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:
M ale
[Tr emale
o her
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
0 African American/Black
0 Asian or Pacific Islander
LT Caucasian/white
0 Native American/American Indian
0 Other - Print Race:
LlI prefer not to ans
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yes
Ti o
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes as
0 I prefer not to answer.
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F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
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MARJORIE YORK
• COM M U NITY ACTION AND HUMAN SERVICES
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