Sidney Goldin Application PackageCITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: Goldin Sidney
Last Name First Name Middle Initial
HOME ADDRESS: 5415 Collins Avenue
Miami Beach Florida
Apt No. Home No./Street City
PHONE: (305) 866-2066
Home
Work
Business Name: Galeria Condos Position:
Address: 5415 Collins Avenue Miami Beach
Street
City
elisid@the-beach.net
Florida
33140
State Zip Code
Email Address
State Zip Code
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 business established in the city.
• Resident of Miami Beach for a minimum of six (6) months Yes
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes
• Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: 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 Miami Beach? 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. (Regular Boards of City)
Choice 1: Health Facilities Authority Board
Choice 2:
Choice 3:
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 Issuance Date
License Number
License Expiration Date
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: No Years of Service:
2. Present participation in Youth Center activities by your children No if yes, please list the names of your children, their
ages, and which programs. List below:
Child Name Age Program
• Have you ever been convicted of a felony: N If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: No If yes, please explain in detail:
• Are you currently serving on any City Boards or Committees: Yes If yes, which board?
Health Facilities Authority Board
• What organizations in the City of Miami Beach do you currently hold membership in?
Name Title
MB Chamber of Commerce
• 1 am now employed by the city of Miami Beach: No Which department?
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
Property
5415 Collins Avenue
Gender: Male
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.
Race/Ethnic Categories
What is your race? Mark one or more races to indicate what you consider yourself to be. White
Other Description:
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No
Physically Challenged: No
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 from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach 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 he application and have received, read and will abi y Chapter 2, Article
VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
I Sidney Goldin agreed to the following terms on
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
Name
me,
Date Of Birth
Race of 84.rtb-
Edutabaft:
WCW* Experie"te:
i I CIRRICtjtUM VrTAE
SW- ney. Goldin
t4iDvo_Mber 17, 1929
14-ary"a0vi
Married
"19h r
.*Cht),Ol Dipipmat 19419
8*1tjTWr* C" couege. Itaffirnowe, Maryland
BaCjVejCW CO SejeMe in gusi"" ArIMiniStr.-Ita", 1954
Univer-lity Of ftlfiffl", ft7Itt'M*.rP, MRrylan.'
Rg9i 0 Nptjjczl Record Admini-stratio-0, 19-56
gaspital, Baltimore, Moryland
Law Schoolt OW60
Univemfty of aiattimore, wool of Law
ealctmo,Maryland
Mast,er of mospttal A-drnintstration, 1962
Medical C~ Ot:'V:'f9Uvia
Resident of fjos-pitdi Adnifnistraotioo, 1062
t4oufft Sinai K I
CWtIlm(L flAffloi$ I
A4]Ot DirCj.ot, Mttdjv4jI Rv-,.cord Dept- 1'957-58
s-4SUv, ,
"Opiorls fumpli-tat, sa--I-Vnfor,
Maryland
:E)co"five DircWtUr, NIH Gr;vnt O'M-92, 1959460
ft,jryfarsd SIMe DepartmeM, Of f4"W HYOene,
1ftirtwm, Maryland
AdmiaMraLive ASSWInt,. JUDY 192 t JUIV 1963
A--;.Si-$Wtlt Dirt-IctOtg lull 11963 to Pebirtairy 1965
",()spgot, mialrd Beach, lnr#ra
ASS-06toOitccW'i, S4Nyten"Wr lgfifi-tictl-tlber'1,968
The Brookda[e HOSPital Ccntet', BrOOklYn,
New York
A-S-SistOftt DIMAW, DecieMber 1968 to May 1970
AS- SOCiAte, Dir 0r, WRY 1,970 tO DtOLM16er 1980
Vice President., IlArTuArY 1981 to Novmmbet 1995
F.IoUtIt Sinai Med cat CenteT, 14ha Seache,
F-Iorlda
Current Organiz-ations-. Board of Dim-4,-cWrs
Miami. a- to cbember of Commerce, 1990 to Present
t4igml jewto i4 me, and Hospitol, 2996 teaPr*90"t
II E 1 P9964W
prev us Committees- Beach Presere atiOln BOa(d
Go of miam! Beach Poke Cjttz�ns- Relations CO mmittee
Visitors and Convention Authonly
Heeit.h Facii4tjes Aul�lonly Board