Affidavit (Temple Beth Sholom)
m
-
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerkllDci. miami-beach. fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRlNCIPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, AmON OR
DECISION OF ANY COMMISSIONER; ANY ACTION, DECI~'I)N, RECOMMENDATION OF ANY CITY BOARD OR
COMMmEE; OR ANY ACTION, DECISION OR RECOMMENG 'ON OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURlNG THE TIME PERlOD OF THE EN' :E DECISION-MAKING PROCESS ON SUCH ACTION,
DECISION OR RECOMMENDATION THAT FORESEEABLY WILL E HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMmEE. THE TERM SPECIACALL'l INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRlNOPAL, REGARDLESS OF WHETHER SUCH LOBBYING AmVITIES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFACER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAl."
1) Lobbyist Name: Bercow Jeffrey
Last Name First Name Middle Initial
Business Phone (3Jl..5) l7 7 _ Ii ? 2 0
Message Phone L)
Business Address:
200 S. Biscayne Boulevard
No. Street
Florida
Miami
City
Email Address:
State
33131
Zip Code
850
Suite
JBERCOW@BRZONINGLAW.COM
2) Principal Retained by:
TEMPLE BETH SHOLOM
If different from above
Miami Beach, Florida
City
4144 Chase Avenue
Street
Suite
State
33140
Zip Code
(a) If a corporation, partnership, or trust, i~ ~ntify and provide the address for the chief
officer, partner, beneficiary or interests,
3)
Subject Matter (Describe in Detail):
Synaqoque Renovation
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: Desian Review Rni'lrn
~ \
'1J
S. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
a The City Commission on .2000
Q City Commission Subcommittee on ,2000
a City Staff on ,2000
a City Board or Committee on ,2000
a Personnel on ,2000
~ Identify Others DRB on SF.P'1' ._2001
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above:
NONR
ON JULY 1sT OF EACH YEAR, EACH LOBBYST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USTING A LOBBYING EXPENDITURES IN THE
CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
, /-1
'(.'
~,~ ~
Identify
'; .
~,;' >
,...::
'y.
,::>
.....
..:>
'/
"
/(\
',,/"/
,~
a Did take an oath, or
X Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribe~;;ore me ;;2 00 I
This )3-1k day of ~j-. . ..
. j .'-?
", '("
I ,"',:;iR,it" LISA C, BROOKS
{.rJi."~;\ M'! COMMISSION t CC 856829
'g'~'.l EXPIRES: July 20, 2003
"'~P.f;~'t-.. 8anded Thru Notary Public Underwriters
~u6~
Notary or Deputy Clerk
If Notary, print, stamp or type as commissioned
Registration: ~EPTED
FOR CLERK'S USE ONLY
~!df/Ol
[ ] REJECTED DATE:
If rejected, state reason: /'
Registration fee paid: ll..J'fes [ ] No [] Not-for-Pro~9r9l\l'liiilt~
[ ] Cash []Check MeR# ~O ~
DATA ENTRY DATE: .2000 ENTERED BY: