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Faye Goldin 12/31/18;� � � � ;� ;� � � � � a - i� 3 i 1 l '� d � a� � ��'' �i, ; �._ �-� , �� ; � ;�i � � � � _ _` � 3 �' � � ^��''�.,�a : a , �� O��ITT�E C�E��LI�� APPOINT�E: �� Cl`�/�l^/" DATE OF APPOINTMcNT: ��///� BOARDICOMMITTEE: ��"rM �TO� WC�/�Ie.✓qppointed by: l,U/�� -1"��rf0/�" FOR SCANNER FOR CLERK STAFF Scan c c Le�ter of Appointmeni Scan o o Letier of Reappointment o C�py Qf ,L��=e� oi Appointment/Reappoin�men� e- � ailed io Commi��e� Liaison � Scan o o Board �nd Commii�ee ArNfica�ion (Comrleted on � �� ) Scar o o Resum:,/Curriculum Vitae �/� �/-7 � o Div�rsiy S��fistics Reporting (Comple�ed on /� Y Scan o 0 02iF1 Scar o S�an o P.eceived on: Processed on Scanned on: Ii41PORTANT l�iFO�MAT[ON FOR BOARD AND CON[MITTEE MEP�IBERS BQOK ✓ City Code Ordinance Section �oplicable to �he aaency, board or commiZee ✓ City Code Seciions 2-21, 2-22, 2-23, 2-2�, 2-25, 2-20, 2—^.58 and 2-459 ✓ County Code S�ciion 2-11.1 — Conr"[ict o` Interesi �rd Code oT E:hics Ordinance amended �nrough �ecember 2010) ✓ Amendmenis to the Cod� oi Etnics Ordin�nce (Sep't�mb�r 2009 'through Ju!y 2012) ✓ Highligh'ts o� the Miami-D2d� County Etnics Cod2 ✓ Suns�'�ine La�v and Public Records — Frequ:,ntly Ask�d Ques�ions ✓ Memor�ndum - Solicita�ion by Ci�y Board and Commi`ee M�mb�rs � Ci't��ride Permi� Applica�ion (Parking De�arment Form; � 3"U�C� ;�— �UI^: l0 �C.,U�lj�ll^: :=i!�1��!�"18"lI �. �.OrJc 01 Cri.'l,�S IOi i�u��'.lii. V�i!�� c�.� F(iID�OV��. � Source oi fncome S�a�e.��en� C Ackno�,r,�ledgmen� of =ir��ncial Disc!osure Requirement O� D14'� I � Y ST�,TISTfCS 2��0?T, �" � ea� , PY in fi� Gn , O�tclG(t�IAt �cr �nnu2[ Re�or. � �� 1 Signed 'oy � � / � '� D�;� �rd br mmr- ��= �b�r U /��` '� B�� Em fo�re�: � � P > Dace `�Ci' C�,jC� O��ic� S��; Ini:i=!s �/�-��/� � � By Emcloye�: . =.� . �. D?i2 �iy C12�' iiiCc S�a��i i't�dis� �7 �`f ao � � � � ,�N" �"�'pj� _ �� erm Expir2d Le ��r Da�:; Proc�ssed i Ini�ial�� catr,� r•,s z� F:cSl��ation Lciici D2i2 P�OCcSScd "�� Ccp Q � �IliU2.�,. R:,moval Le'tier due to ab��nce� i Da�;, proce�sed I Iniiials I -- - -. .----.. ' - - �:�.CLEKiBOARp t^-.ND CO�tI?.,tl I I 1=� DAIR,S�S�`•CH_CKLIST P'''S I�R15cC CheCnljst in55 Ih_ri��x I Vi:-� '/`.i_ .`�.._ � � ��:'!I.'!?��"-N t. �.r.-..... ..� _ _ ,. Sca� � �/11 Al�ii f B EAC H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, Ci1y Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CilyClerk@miamibeachfl.gov August 21, 2017 Ms. Faye Goldin 5415 Collins Ave PH-A Miami Beach, Florida 33140 RE: Miami Beach Commission For Women Dear Ms. Faye Goldin: Congratulationsl You have been appointed by Commissioner Ricky Arriola to the above-referenced Board or Committee, for a term ending: 12/31/2018. Pursuant to City of Miami Beach Code Section 2-22 (5)a: Notwithstanding any other provision of the City Code or of any Resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointmenUelection of the successor City Commission member. If you are unable to accept this appointment, or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulations again and good luck. t Regards, � Rafa Gran d City Clerk � cc: Saul Frances, Parking Director Bonnie Stewart, City Liaison ENCLOSURES: Oath of Office/Oath of Civility/Acknowledgements City Code/Ordinance section applicable to agency, board or committee City Code Sections 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 City Wide Permit Application -(Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. MIANII BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, Ci1y Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CilyClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Ms. Faye Goldin RE: Miami Beach Commission For Women 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: 12/31/2018. To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all actions taken and all communications made by me as a public servant. 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 Florida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Officers 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 the State of Florida (depending on the board or committee on which I serve) on July 1 st, following the closing of the calendar year on which I have served. r? / , q y/ • % � i - V � M�s.� Faye Goldin Sworn to and subscribed before me this�-1 day of (�l � 2017 � �,� �i� �les D'Agostin = 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. MIAMI•DADE .� � 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 for Tax Year Ending Last Name First Name Middle Name/Initial 2016 I ��'. �� IJ � ! V � � � � Mailing Address — Street Number, Street Name, or P.O. Box � ��1`�,� � f �V � , �✓ �! fT� City, State, Zi�' �1�'� .�, %�. � � r t.�� If your home address is your mailing adtlress, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read instructions on the following page and check here. ❑ Filing as an Employee (cneck one) � County � Public Health Trust Department Position or Title Work address Filing as a Board Member �check one� � County Board where serving �� l� 1 � ��'� ��'' Alternate address (if home addreSs is exempt) � Municipal: � Municipal: Work telephone (Municipality) (Municipa�ity) Employee ID Number Employment began on/ended on �d�i�1 r sS��!'Y' �R 1��+-� �i� Y Work teiephone , Term began on/ended on List below every source of income you receivetl, along with the address and the principal activity of each source. Include your public salary. Place the sources of income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from property 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.❑ IName of Source of Income Address Description of the Principal Business Activity � Cl./1�M � �f �� '�%� �irv� T y. ��1�� I C ��L�t�1C� i �� C�'S 7b� �� 7 "o<l� I hereby swe or affirm) that the information above is a true and correct statement. l � Signature �Of Person Di a�sing ,� �� Date signed RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 COE 2016 � r� � / � � % �� j � �� {� 3� � �� ,:� i � i ,�: 1 ti 1 i '�iau-'�' .� i� �� '�'aw� � � Cety of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov CITY CLERK'S OFFICE Telephone:305.b73.7411 Fax:305.673.7254 CiiyClerk@miamibeachfl.aov Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dade Counfy Financial Disclosure Code Provision Code Section 2-�1.1(i) (2j Baard Member's Name: �t'T- "/ '�' �r � ` �l �� __ I understand that no later than Jul� 1, of each Vear all members of Boards and Committzes of the City o� Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial Discfosure Requirements. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislatian 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 Qrive, Miami Beach, Fforida, no later than 12:00 noon of July �, ofi each year. 1. A"Source oT Income Stai�m�n�" 2. A`�Statement of Financial (nterests (Form 1)" 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 inan 5500, 60 days in jail or botn. Signature � Updated: Monday, April 20, 2015 Page 4 oT 4 F:\CLER\SALL\aFORMSIBOARD AND COMMITTEES�6C APPLICAI IJN REVISED 05022014.cccx � �� Date %�!��'i�� DiVERSITY STAT15T1C5 REPORTING ��-�I � Ga��C� i� Name: , � �'�'� i/��.� /� c:�ti i W��/ Baard / Comrnittee: C'��''�`SS J �� A ointment Date: �� Pp , _ . , Pursuant to City of Miami Be�.c'r� Ordinance 2009-3632, the City is rea,uired to ann«aily prepare and present a repor� to the City Comrnission iden�ifying the City's diversity statistics. This form allow� board and committee applicants and members to voluntarily seif-identify their race, ethnicity, disabl2d status ana gender. Ple�ase check the appropriate box for each category: �� Gencier: iviale � ��male �i Rac2(Ethnic Catec�ories V�1hat is yaur rac�? '�A?ric�n-Americ�.� (�lac�: .� Ga�.'Ca�i3?1�1rVilliP � Asian or P�ci�fic Islan��r � Na�i��re-�merican%�m�r;can ;n�';un � Other — Prin� Race: Do you cortsider yourse(f ta �� Span:sh, Hispanic or l.atin�la? �Mar� the "l�`o" box if not Sparrish, Nispanie, L�fino/a. �No � Y�s Do you consid�r yourseii Physical(y Disabied? �No � Yes t�'t .e'r�� ^'.6.�� ' ^ ✓r t �- .��:;f�...�1,.._.�lUd_(\�':vi'a..��1::.. �i 5i1{V .',�5�'. A'...�i`� i f-�� v��, _.=E�atcrt��,C:.�I_��... .,,� _ ,. � _� �c'' il.. ",. , ,i __ _. _. tnformatio� form OS-2t�'.,3 FIivAL.d;�c ll�date�: f�Aonday, January 25. 201:�