Sidney Goldin 06/19/2010'fjjjk,\\-' ~ `yjS +jGj{ ~i~ fj)jy~\\" ~1jj. - .: .. c ' - -
` ` . ~ ~ Ct~/ ~'~ ~ICIEt11 ~eCeC~i~ 1700. Convention Center Drive, Miami Beach, florida 33139, v~vv,~.miamibeach#I.~ov
. OFFICE OF THE CITY CLERK, Robert Parcher,.City Clerk
Tel: (305) 673-74T 1; Fax: (305) 673=7254
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_ . r ; 05-17-2010 ~ _ .
. Sidneyv Goldin ~ _
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5415 Collins Ave. Apt.PHA
`.: ~, . ~ .Miami Beach, Florida 33140,. _ ~ ~ ~ . L.
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~~[~BJ~G~: I~ealth Faciiities ~lu~hority ~oarci
' X= Congratulations! You, .have ;been appointed by the -City Commiss'iori to the agency,
board or committee„named above.for aterm-ending: 61't9/20'I0:
.. Pursuant to Ordinance No:.2006-35.43, commencing with`terrr~s begirinin.g on or after
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- January 1st; 2007, the term of board members who are~directly.appointed by a member of
,the City Commission shall .automatically expire on :December 31 of the year the appointing
elected offieial'leaves office:
If you are unable to accept this appointment or have anyquestions, please .call the City.
Clerk's Office at .305-673-741:1..~Please read the- enclosed materials .carefully.
Congratulations again and good luck:
Sincerely, ~ ~ .. .
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G
Robert Parches ~ -
~.. City Clerk
cc::~aul Frances,, Parking ~®irector
.: Patricia vlladker '
~41'TACHMENTS: -
Letter of Appointment ,
Oath t .,
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22 2-23, 2-24, 2-25, '2-26, "2-458 and 2-459
Ordinance No; ,2006-3543 -Amendment to City Code Section :2-22
Miami-Dade County Code Section 2-11.1 -Conflict of Lnterest .and Code of EthicsOrdinance
City Wide Permit Application - (Parking ;pepartment Form) -
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We are committed to providing excellent public service and safety to dll who live, work aad.play in our vibrant, tropical, historic community.
m MIAMI~~~~~;C
Clt)/ Of Miami Beach, 1,700 Convention Center Drive,. Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk ~ ".
Tel: (305) 673-741 1, Fax: (305) 673-7254 , .. " .
TO Sidney Goldin
RE: Health Facilities Authority 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: 6/19/2010.
I 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 theF/orida 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 1st, following the closing of the calendar year on which I have served.
idney Goldin
.Sworn to and subscribed before m i day of , 2010.
Sil aret
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.
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NAME:... ~~ ~--.[/ '~
- ~' ' ~ .: L Name ;,rte`-. ~ first Name Middle Lnitial
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;' ', -. HOME ADDRESS: - 1:;~ ~ ~ ~ ~.~:_ ~ ~ ~~
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A t o. - ''House No./Street ~ CitY .- State Zip Code
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.PHONE: - ~. ~ ~6~~ ~,
- Home Work ~: - Fax _ `Email address
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. Business Name::: :. ~~ Position: -
'~ Address':. _ - - .., ;_ - -
- , : ~ - .:: No. _ Street ~ , : .: City ,.State..... Zip Code
' Professional License (describe) ~ : - - ,. Expires: ~~tach.a copy of the license
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- - `Pursuant to City Code ection 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 fora-a minimum of six
,. months; or b) an individual-shall~demonstrate ownership/intefestfor a minimum;of~six~rnonths~~in, a business established~in the city.
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~~~• Resident of Miami Beach for a rminimum of six (6) months:` Yes r ~ Qr No ^ -
~,.• Demonstrate an ownership/interest in a{ business in Miami Beach fora minimum- of six (6)months: Yesr No 0 - --
• Are you:a registered ~~oter in Miami Beach. Yes r No ^
•, '(Please circle one): I am now a resident of: North .Beach South~Beach- - '. Middle Beach
•.tam applying for an appointment because I have.special abilities, knowledge.and experience. ease elow:
- ~ • Are ~ ou resent) "are- istered lobo fist with the Git of Miami Beach? Yes ^ or Nod
Y p ~y 9 y y -
` Please 'list your preferences 'ih order of ranking {1'] first choice [2] second, choice, and {3] third :choice: Please note that only three (:3) - -
. - choices swill be observed by the City Clerk's Office. (Regular,Boards of City) ~ '
Affordable Housin ~ Adviso '. Committee ' ~ - ~ ^ Housin Authorit
" t] Art ri Public Places Committee ~ -~ ~ ^ Loan:'Review Committee ~ ' p
^£Beautfication Committee - ~ ~ - D~Marine Authorit
Board-:of~Ad'ustment'` `- .: - . ~.: ` ~ ~.^.Miami Beach Commission for Women
. ^ `Bud et'Adviso' Committee. ^ Miami Beach Cultural Arts'Council ~ '
^ Ca ital Im rovements Pro'ects Oversi ht Committee - . .0 Miami Beach Sister.Cities Pro ram ~ -
Committee on the Homeless - ~ ~ . ^ Normand Shores Local Government. Nei h. Im rovement
O'Committee- for Quali Education in MB - - - ~ ^ Parks and Recreation Facilities :Board - -
^ Communit ` Deveio ment•Adviso ~ .. .. ^ ~Persor~nel Board
Communit ,`Relations Board. ,. ^ Plannin .Board* -
~^ Convention, Center Adviso -Board '~:y° - - .- ^ PoliceCitizens Relations Committee,
.^ Debarment Committee - : - . ~ ^ Production I~ndustr Council
^ Desi n Review Board* ~ ~ ~' ~ ^ Public Safet Adviso Committee
^ Disabilit Access Committee D'Safe Committee ~ `
0 Fine Arts Board ` -. -. - ~ ^ Sin le Famil Residential Review Panel
0 Ga , sLesbian,' Bisexual and Trans ender GLBT ~ ^ Sustainabili Committee. -
-^ Golf Adviso Committee - - . ` ~ ;~ - ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC"'
0 Health Adviso _ Committee - ~ .. - D ~"frans ortation and Parkin Committee .
ealth Facilities Authorit. .Board . ~ ~ ^ Visitor and Convention Authorit
^ is ariic Affairs Committee - ~ ` . ~ ^ Vllaterfroht Protection Committee ``
-1-iistorc Preservation Board ~ ~ ~ '-- ~ ' ^ Youth Center Adviso Board
- *Board Required ao file State Disclosure-Form.
.,Child's name: = - - - -
- Age:.Program: - ~ -
F:`,CLER\$ALL\aFORMS\BOARD.AND COMMITTEES\BC'~~pplication062604 iJEW.doc -
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'.Note: If applying~forYouth Advisory Board, please indicate your affiliation with the Scott Rakow Youth• Center: '
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1.~,Past service on the Youth-Center Advisory Board: Yes ~ No^ Years of Service `` ~ ~.
2.. "Present participation . in:Youth Center activities by .your children YesCi ° No ~~. Ifa es lease list ahem. Harries of::your-:children, their.
ages,, and which programs..List below.
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Child' name: - Age:., .Program: - .
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.Have you ever been convicted of a felony: Yes ~; or Nolf.yes, please.explain in detail;
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Do you ctrrently have a violation(s) of Clty of Miami`-Beach codes: Yes:L~ or Nolf yes; please 'explain in detail:.
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t • Doyou current{y,owe the City. of Miami Beach any money:.Yes ~!-or:No~=` If yes,-explain in detail' . , ~ V
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• Are. ou current) .servin on any CityBoards or_Committees:..Yes I- or. No= If yes; which board? .
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• What organizations in fhe~ City of Miami Beach do you currently hold membership in .
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- Name: .., ~ . - ,, µ "... Tifle:.: ~ . .
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.. Name:. ~ : .: ~ :. Title: - r .. -
" ~ ~ • List all , ro erties owned or have n terest in which are located within the. Clty' of Mia
p P mi Beach: _ .-
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. ~ ~ ~ ~ • I am now employed bythe City~of.Miami Beach: Yes~C~-or No~~!. Which department? ~ t-
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• Pursuant to .Ci ~ ~ ode .
C Section 2-25 b Do ou have a agent ^ s ouse u child ~ brother ^ 'or. sister. ~ who. is employed by the
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.City of Miami~Beach? Check all that~Aappiy. Identify the department(s): .~ ~,
~. ~The~followin ~nfocmation is volunta and is neither .part of your: application. nor has any .bearing on your consideration f
9 ~,, ry
`bein asked to com I with federal a ual o or appointment. -lt is
9 P Y q. pportunity reporting requirements.
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~nder:Male ^ Female` ~ ,
" .:.Ethnic:. Arigin:' Check one-only (1:) . :
_ kite '(Not of Hispanic~Origin): All persons having origins in ariy.of the o~iginai peoples of Europe, North Africa or the Middle East. ~ ,
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.. ^ African-AmericanlBlacK ~ (Not.:of Hispanic Origin): All persons. having origins in any of the. Black racial groups of .Africa..'
' ~ ~ ^ Hispanic: All -persons of Mexican, Ruerto. Rican, Cuban, Central br South American, or other Spanish culture. or origin, regardless of racer -
Asansor Pacific )slander: Alf 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. - ' ~ -
O.American Indian: or Aiaskan~-Native:. All-.persons-having origins in any of the original-peoples of North America,.and who maintain
;. Cultural identifcaton through tribal affiliation o~,community recognition. -
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:' - .. ,. Physocally Challenged:.Yes D or'Noo. ~ .. :. .
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~~* Employment Status: Employed ^ ~ Retired Homemaker ^ . Other ^
- .NOTE: If appointed,: you will be required to follow certain laws whichapply to city toa'rd/committee members.
These Taws include, but are not limited to, the following: ~ ~ ~ -
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o ~ ~Rrohibition from directly or indirectly lob6y~ng city personnel '(Miami Beach City Code section 2-459).
o Prohibition'from contractin with the,cit ~ Miami=
- - g ~ y ( Dade County Code section 2-11.1).
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. o Prohibition from lobbying .before board/committee you have-served <on for period of one ,year,--after leaving office (Miami
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Beach City': Code section 2-26).. :. .
o ~ Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section'2-11.1).
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(re:.CMB Community De4elopment Advisory Coommittee): ,prohibition; during tenure ..and' for one year after leaving office;.
" ~ from 'having _ any i,nter'esf 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 (CF.R'570:611), '. ,
lJ on re uest;-copies°ofthese laws•may be.obtaned from~the~.City Clerk. ~ :
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"Ihereby attest :to the accuracy and truthfulness of the application and have receided, read and wilt abide by Chapter 2, .
Article. VI of a City Code'"Stan d f~onduct for City O icers Em :lo ees.and A enc Members."
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Ap licant s Signatur' _ ~ Date ~, Name of Applicant (PLEASE ,PRINT)
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' ~ Piease~attach~~a~co aof° .our3resume=to;this a ' licaflon ~ ~ ~ _~
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NOTE }Applications^will:~remam-on~;file~for aperiod•'of~one (1).calendar.year.
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MIAMHDADE ~ -
• 5®191SCE ®F IIVC®ME STATEMENT
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Please Print or l"ypeFirst Name Middle Name/Initial Last Name
Disclosure
" ~ For Tax Year
Name: S ~ ~ ~ ~ Ending:
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Mailing Address: ~ ~~L,L~~ ~V~'
Ci State Zi : •..
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Social Security Number: c-3
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Filin as a: • ' ~ -
g ~ County Employee.
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® Municipal Employee of:
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Posifion .held or sought: ~ ~,~
~1~~ ~ ~ ~~l ~°~~~ sa . ~ ~
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~6oard where servir
ig: O ~ Term or Employment
Segan on: -~ .,
®epartmen~ where employed:
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V!/ork Address: '
If your home address is exempt from public records pursuant to
.Florida Statutes § 1~.9.®7 please check here (read instructions): ® W®rk ~eleph®ne:
. ~m~~ Address:
Street Address
. City State Zip Code
Please list below in descending ordea with the largest source first,.ttie 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 dis~losed• ~f continued on a
separate sheet, checlk here: ~ ~ `
. ~ ®escrip~i®n o~.~he Principal
Narv~e ®f Source of Income business Actiwi .
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Y hereby swear (or affirm) that the of®s•esaid inf®rmation is atrue aa~d correct statement.
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ig, at~re ®f p rs n disc)®sing ®a sig ed
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