Faye Goldin 12/31/2009~_.~ I t 9
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
12/21 /2007
Faye Goldin
5415 Collins Ave PH-A
Miami Beach, Florida 33140
IJ~IECT: Police Citizens Relations Committee
Congratulations! You have been reappointed by Mayor Matti H. Bower
to the above referenced agency, board or committee for a term ending: 12/31/2009.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
d ~~ n
s~
obert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Carlos Noriega
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, 2-2458, 2-459
Ordinance 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
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
r~~~ ~~ ~ ~~ ~ ~t~ ~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parchar, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Faye Goldin
RE: Police Citizens Relations Committee
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: 12/31/2009.
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 it~e 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 yyyar on which I have served.
',~o~ ~ -
Faye oldin
Sworn to and subscribed before me this ~ day of , 200
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.
~~ ~
~~~
CITY OF MIAMI BEACH BOARDS AND COMMITTEE
a
APPLICATION FORM ( ~ ~~
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with th city; is
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 [ ~or No [ ]
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (ti) months: Yes [ ] or No [
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes [ ]
My special abilities, knowledge, or experience is:
Are you a registered voter in Miami Beach: Yes [ ] or No [ ]
NAME: ~i~ L. f ~ -t N ~~ 1
Last Name / First Name //~~'~~'~ ~~ Middle Initial
Home ~Jr C~~ ~ ~l~~~ai-~i, ~'P.l.I,Cf~ ~J 3
Address: No. Street City State Zip Code
Phone:~~~ ~~~ ~ ~~
Home
I am now a resident of:
Business Name:
Address:
Applicant's Position:
No. Street
City
[ ]Owner [ ]Stockholder/Shareholder [ ]Corporate Officer [ ]Other Explain:
State Zip Code
Professional License (describe):
Attach a copy of the /icense listed above
Expires:
1. Have you ever been convicted of a felony:,Yes [ ] or No [~ yes, please explain in detail:
i. Do you currently have a violation(s) of City of Miami Beach codes: Yes [ ] or No [~ If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money:
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes [ ] or No [~
If yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
Title:
Title:
List all prope~tj~$ ~ne¢,or e an in est in, which are~oc~ed wit ip th~ txity,gf~Miami Beach:
I am now employed by the City of Miami Beach: Yes [ ] or No [ V~If yes, 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):
Yes [ ] or fro [
Work
Fax
Email address
North Beach [ ]South Beach [ ]Middle Beach [~
C:\CMBWEBUOBS\BCAPPLIC I.DOC
.-.,,,~
Please list your preferences in order of ranking [1] first choice [2] next choice and so on --
(Regular Boards of City) (*Board Required to File State Disclosure forms)
Art in Public Places
Barrier Free Environment Committee
Beach Preservation Board
Beautification Committee
Board of Adjustment (flood Mgmt.)*
Budget Advisory Committee
Code Enforcement Task Force
Committee on Homeless
Committee for Quality Education in MB
Community Development Advisory*
Community Relations Board
Convention Center Advisory Board
Convention Center Capital Projects Oversight
Debarment Committee
Design Review Board*
Fine Arts Board
Golf Advisory Committee
Health Advisory Committee
Health Facilities Authority
Hispanic Affairs Committee
Historic Preservation Board*
Housing Authority*
Loan Review Committee*
[ ]Marine Authority*
[ ]Miami Beach Cultural Arts Council
[ ]Miami Beach Commission on Status of Women
[ ]North Beach Youth Center Oversight Committee
[ ]Nuisance Abatement Board*
[ ]Oversight Committee for General Obligation Bond
[ ]Parks and Recreation Facilities Board
[ ]Personnel Board*
[ ]Planning Board*
[tom] Police Citizens Relations Committee
[ ]Production Industry Council
[ ]Safety Committee
[ ]South Point Advisory Board*
to Redevelopment Agency
Expaesie~-At.~efity
[ ]Transportation and Parking Board
[ ]Visitor and Convention Authority*
[ ]Youth Center Advisory Board
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:
Child's name:
Age: Program:
Age: Program:
This section is "not required" but desired: Age: [ ] Gender: M [ ] or F [ ]
Ethnic Origin (Check one)
White [ ] African-American/Black [ ] Hispanic: [ ~]
Asian or Pacific Islander [ ]American Indian or Alaskan Native [ ]
Employment Status: Employed [ ] Retired [ ]Home-maker [ ]Other [
I hereby attest to the accuracy and truthfulness of the application and have reeived, read and will abide by
Chapter 2, Article VII - of the City Cade "Standards of Conduct for City Officers, Employees and Agency
tubers." i l ~ a ~ ;~1.r, ~ ~ ~- ~ .~N
~-;-~.~ 7 tr ~
pplica 's Si nature ,~ ~ Date Name of Applicant (PLEASE PRINT)
Attachment: Please attadi a copy of your resume to your application.
NOTE: Applications will re ain on file for a period of one (1) calendar year.
Received in City Clerk's Offices/~' /~ by Clerk
PLEASE NOTE THAT THE REQUIREMENTS FOR BOARD MEMBERSHIP DETAILED ON THIS APPLICATION
FORM MUST BE MAINTAINED BY CITY BOARD MEMBERS THROUGHOUT THEIR TENURE AS BOARD
MEMBERS. ANY CHANGES TO INFORMATION SUPPLIED ON THIS APPLICATION FORM SHOULD BE
PROMPTLY PROVIDED BY BOARD MEMBERS TO THE CITY CLERK.
Document Control Number (Assigned by the City Clerk's Office};-'- `-+ Rev #6 - 6/01
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