Lisette S. Goldstein~ CITY OF MIAMI BEACH •
~ ~ MAMI BEACH
t ~oy~• SP BOARD AND COMMITTEE APPLICATIOPI FORM
\~~~ ~ '
GOLDSTEIN LISETTE S
NAME:
Last Name First Name Middle Initial
1405 WEST 24T" STREET MIAMI BEACH FLORIDA 33140
HOME ADDRESS:
Apt No. House No./Street City State Zip Code
PHONE: (305) 458-1168 (305) 534.2352 lisette.goldstein@mac.com
Home
Business Name:
Work
OLEM SHOE CORPORATION
Position:
Fax Email address
DESIGN CONSULTANT
800 NW 21sT STREET MIAMI, FL.
33127
Address:
No. Street City State Zip Code
THE FLORIDA BAR -LICENSE # - 0110371
Professional License (describe) Expires: Artach a copy of the liccnse
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
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 Citv 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 Ad'ustment* Miami Beach Commission for Women
Budget Advisory Committee
Capital Improvements Pro'ects Oversi ht Committee Miami Beach Cultural Arts Council
Miami Beach Sister Cities Program
Committee on the Homeless Normand Shores Local Government Neigh. Improvement
Committee for Quality Education in M8 Parks and Recreation Facilities Board
Communi Development Adviso Personnel Board
Community Relations Board Planning Board*
Convention Center Advisory Board Police Citizens Relations Committee
Debarment Committee Production Industry Council
Desi n Review Board* Public Safety Advisory Committee
Disability Access Committee Safety Committee
Fine Arts Board Sin le Family Residential Review Panel
Gay, Lesbian, Bisexual and Transgender (GLBT) Sustainability Committee
Golf Advisory Committee Transparency Reliabili & Accountabili Committee "TRAC"
Health Advisory Committee Transportation and Parking Committee
Health Facilities Authority Board Visitor and Convention Autho
Hispanic Affairs Committee Waterfront Protection Committee
Historic Preservation Board Youth Center Advisory Board
5~
to Flle State Disclosure Form
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: Yes No Years of Service:
2. Present participation in Youth Center activities by your children Yes 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:
F:,Ci.ER'SAt.I'.aFGRMS`~.6GARD AND CUMMITTEES`•.6C Application062609 NEw.doc
.Have you ever been convicted of a felony: Yes or No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes or No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes or No If yes, explain in detail
.Are you currently serving on any City Boards or Committees: Yes or No If yes; which board?
ART IN PUBLIC PLACES
• What organizations in the City of Miami Beach do you currently hold membership in?
AR7 IN PUBLIC PLACES
MEMBER
Name: Title:
HEBREW ACADEMY PTA
MEMBER
Name:: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
1405 WEST 24T" STREET MIAMI BEACH, FL. 33140
• I am now employed by the City of Miami Beach: Yes or No .Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ,spouse ,child ,brother , or sister 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: Male Female
Ethnic Origin: Check-one only (1)
White' (Not of Hispanic Originj: All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
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.
Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
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 affiliation or community recognition.
Yes or No .
Employment Status: Employed Retired Homemaker Other
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 ftom lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City 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.
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Art le VII - of the City Code "Standards of Conduct for ity Officers, Employees and Agenc members." _
I Iz~23J~9 L~se~--}~ ~I~.I~-~o-Zr ~c~ldS~
Applicant's Signature V~ Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application ~ ~^~
NOTE: Applications wlll~maln on file for a period of one (1) calendar year.
Received in the City Clerk's Office by : ~_~~V"'~~ ~''~~'~"~ D t . /~/200~ Control No Date: ~l/_/~0
Name of Deputy Clerk
~~..
L/SETTE OLEMBERG GOLDSTE/N
CONTACT INFORMATION:
Lisette Olemberg Goldstein
1405 West 24ti+ Street
Sunset Island #3
Miami Beach, FI. 33140
Cell: (305) 458-1168
OBJECTIVE: TO BE RE-APPOINTED TO THE AIPP BOARD
EDUCATION:
CURRENTLY ENROLLED PART TIME AT MIAMI-DADE
COLLEGE SCHOOL OF ARCHITECTURE
NOVA UNIVERSITY LAW SCHOOL, FT. LAUDERDALE,
FL., JURIS DOCTOR - 1996
BOSTON UNIVERSITY, BOSTON, MASSACHUSETTS
BACHELOR OF ARTS, ECONOMICS - 1990
LANGUAGES: FLUENT IN ENGLISH AND SPANISH
WORK EXPERIENCE:
CURRENTLY WORK PART TIME AT OLEM SHOE
CORP. AS A DESIGN CONSULTANT
DIRECTOR OF DESIGN DEVELOPMENT AND
PURCHASING AT OLEM SHOE FROM 1996-2002
COMMUNITY SERVICE:
ACTIVE MEMBER OF THE HEBREW ACADEMY PTA
ACTIVE MEMBER OF THE GREATER MIAMI JEWISH
FEDERATION WOMEN'S DIVISION
ACTIVE MEMBER OF TEMPLE MENORAH
PROFESSIONAL MEMBERSHIPS:
THE FLORIDA BAR -LICENSE NUMBER: #0110371
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Member Since
05/05/1997
Lisette Olemberg Goldstein
0110371