Faye Goldin 12/31/2014 11M I M
City/of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
05-15-2014
Faye Goldin
5415 Collins Ave PH-A
Miami Beach, Florida 33140
SUBJECT Miami Beach Sister Cities Program
Congratulations! You have been appointed by Mayor Philip Levine
to the agency, board or committee named above for a term ending: 12/31/2014.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1, 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 official leaves office.
If you are unable to accept this appointment or have any questions, please call the
City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
Rafa 'I E. Granado
City Clerk
cc: Saul Frances Parking Director
Desiree Kane
ATTACHMENTS:
Letter of Appointment
Oath
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 Interest and Code of Ethics Ordinance
City Wide Permit Application -(Parking Department 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 all who live, work and play in our vibrant, tropical,historic community.
MIAMIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO Faye Goldin
RE: Miami Beach Sister cities Program
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: 12/31/2014.
1 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 the Florida Commission on Ethics Guide to the Sunshine Amend-
ment 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*requirements of
Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve) on
July 1, following the closing of the calendar year on wh' h I have served.
Faye Goldin
Sworn to and subscribed before me this day of , 201 tj
d
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
li
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miarnibeachfl.aov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section. 2-11 .1(i) (2)
Board Member name: .
understand that no later than JULY 1 OF EACH YEAR.oll members of Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, are
required to complywith Miami-Dade County Disclosure Requirements. This means thatthe
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation or give advice to the City Commission, must file,even though you may have been
recently appointed.
You must file one of the following with the City Clem of Miami Beach, 1700
Convention Center Drive; Miami Beach, Florida, by July 1, 2010.
1. A `Source of Income Statement (attached) or
2. A `Financial Statement (attached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami-Dade County Code Chapter 1, General
Provision, Section 1-5 may subject the person or firm to a fine not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
Pik
S ��p
Signature- Dote:
MIAMIBEACH BOARD AND COMMITTEE APPLICATION FORM
Last Name First Name Middle Initial
60 L Q—T
Home Address City State Zip Code
S q li 1�:L 33 f 1f o
Home 2Teeleep�phon[ef 1 rr,,I,,r_Work Telephone Cellular Telephone 2-� SS—)49 Email address
MW _0 Business Name Occupation
Business Address City State Zip Code
Professional License(describe): Expires:
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a&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
1 business established in the City for a minimum of six months. �,r{
• Resident of Miami Beach for a minimum of six (6) months: Yes 4�or No Z1
• Demonstrates ownership/interest in a business in mi Beach for a minimum of six months: Yes�:J or No
• Are ou registered voter in Miami Beach: Yes 4Q or No
Y 9
• I am now a resident of: North Beach � South Beach(:a Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miam i Bea ch? Yes�D or No
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 City Clerk's Office.
i Ad Hoc Charter Review and Revision Board _Disability Access Committee I _Miami Beach Human Rights Committee
3 Ad Hoc Committee Centennial Celebration Gay, Lesbian. Bisexual and Transgender VMiami Beach Sister Cities Program
Enhancement Committee GLBT)
D Affordable Housing Advisory Committee _Health Advisory Committee F O Normandy Shores Local Government
Neighborhood Improvement
Art in Public Places Committee =Health Facilities Authority Board Parks and Recreation Facilities Board
Board of Adjustment' Hispanic Affairs Committee 1 Personnel Board
Budget Advisory Committee _ —Historic Preservation Board Planning Board
Committee on the Homeless I Housing Authority =Police Citizens Relations Committee
D Committee for Quality Education in MB i E"Marine&Waterfront Protection Authority Production Industry Council
Convention Center Advisory Board I E:Miami Beach Commission for Women Sustainability Committee
Design Review Board' =Miami Beach Cultural Arts Council ; rE Transportation.Parking.&Bicycle-Pedestrian
Facilities Committee
Visitor and Convention Authority
Board members are required to file Form 1 -"Statement of Financial Interest"with the State.
If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review
Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the
following information:
Type of Professional License License Number
License Issuance Date License Expiration Date
S- CAN
r `
Page 1 of 4
F:,CLERLSALL1aFORMS�BOARD AND COMITI EES13C APP CA ION REvIS ED
f `
. �,oc.r
y
°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes Lj No LVJ Dates of Service:
2. Present participation in Youth Center activities by your children:Yes Z] No
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
Of
• 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 Code?Yes Z3 or Nolz If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes[:a or No 121 If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes ID or No 5z(If yes,which board/committee?
• In what organi ation ) in the City of 4iamij3ea ch d you currently hold embership?
NJ
Name Position
Name Position
I
• List all properties own or which yo ave an inte est thin t Ci�,y of Miami Beach:
• Are you now employed by the City of Miami Beach?Yes IDZI or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent 41. spouse child brother or sister who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s)and 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 omply with City diversity reporting requirements.
Gender: Male Lj Female
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other—Print Race:
Page 2 of 4
F'\CLER\SALL,,aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED aocx
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic. Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
WNo
Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
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 from lobbying before the 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).
o 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).
c Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities.
o Voting conflict—Form 88 is for use by any person serving at the county,city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
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 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 COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
ij liq Fpy� G0L'Q-:rVJ
Applicant's Sig ure Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by zllt
Name of Deputy C D6te
PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A i
COPY OF ANY APPLICABLE PROFESSIONAL. LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
Page 3 of 4
F'kCLERI,SALL aFORMS`kBOARD AND COMM!TTEES,BC APPUCATiON REVISED,2z_x
r
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www,miamibeachfi.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
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)
Board Member's Name: r ff Y v G 0 L_ P.-r- N
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. This means that the members of City Advisory Boards, whose sole or
primary responsibility is to recommend legislation or give advice to the City Commission, must file, even
though they may have been recently appointed.
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"
For your convenience, the form is attached. The form can also be downloaded at:
http://www miamidade -gov/elections/Library/source of income statement.pdf
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fl.us/ethics/forms.htm1
3. A Copy of your 2013 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.
Ig
Signature Date
Updated:Thursday,March 13.2014
Page 4 of 4
F ICLER,SALL,aF0Rb1SWARD AND CC)N%1ITTEES\8C APPLICATIGN REVISED aoc.
Name: Faye Goldin
&Address: 5415 Collins Avenue,Apt: PHA
Miami Beach, Florida 33140
Date of Birth: April 1, 1941
Place of Birth: Brooklyn, NY
Marital Status: Married
Education: 1954-1958-Yeshiva of Flatbush High School
Brooklyn, NY
1958-1962-Brooklyn College, Brooklyn, NY
Bachelor of Art
Work
Experience: 1962-1968- Teacher, New York Public Schools
Brooklyn, NY
1976-1986- Sales Associate, Neiman Marcus
Bal Harbour, FL
1986-2010-Personal Shopper, Neiman Marcus
Bal Harbour, FL
Organizations: Young Presidents Club
Mount Sinai Medical Center
Founders Club
Mount Sinai Medical Center
Founders Club
Miami Jewish Health Systems
CMB
Committees: 1990-1998- Fine Arts Board
1999-2005- Beautification Committee
2005-2010- Police Citizens Relations Committee
2011-2013- MB Sister Cities Committee