Michael W. Larkin/Alan Waserstein~~
~p~
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged
in lobbying activities. The teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Larkin Michael W
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zlp Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Alan Waserstein
NAME OF PRINCIPAL/CLIENT:
Charms 63 Nobe, LLC 6001 NW 153 Street, Suite 110 Miami Lakes Florida 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 827-8373 wasrco@aol.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Alan Waserstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Alan Waserstein, Richard Waserstein, Charles Waserstein, and Marta
Waserstein
II. SPECIFIC LOBBY ISSUE:
Board of Adjustment Application for 103 63rd Street
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Dept., BOA, Planning Board, City Commission * None
~~
Y {
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY
FLAT RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) S 375 l10 cer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 375 00 Rgr hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No Are xgu lob inq on a precept or pending bid for i~~,_gquipment or services or on a
resent or pending award for goods eguipment or serviice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
oyes X No• Are you lobbying on a pending ainnlication for a Development Agreement with the City or
gp~lii~tio:. for change of zoning map designation or change to the City's Future Land Use
ap?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without spedal wmpensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the deck as required by this
section but, shall not be required to pay any registration fees..
[~ Yes X No• Are yggl,~presenting a not-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYLST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~~~ ~ n
Signatu of
I do solemnly swear that all of the foregoing facts are true and rrect and that I have read or am
familiar with the provisions contained in Section -48 of the Mi i ch City Code and all reporting
requirements.
~~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: NCIPAL IDE FI TION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
[~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Fkxida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyists signature
~nally known ( i~•~•.•~•~•........
,,~ti:'~'ry~;; TERESA L MARQUES
+; r. MY COMMISSION # DD 653705
~~RI' ~~. Bonded rnroRN ~' Puny Urd~erwriters
State of Florida, Cou
Swom~ subscribed before me
rnis~_( day of~~ 20 U~
Signature of is -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY oa 6 y~ 2 g
Annuai Registration fee: [ ri ]Yes [ ] No Amount Paid ~~ MCR # Date ~ J ~ /
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\;ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
Lek ~ ~
City of Miami Brach, 1744 Conver' on Center Drive, Miami Bench, flori~o 33139, www.miamibeochfl.gov
Ctil' CLERK C)~ice CifyClerk~mic~mibeachfl.gav
Tel: 345.673.741 t ,fax: 345.b73.7254
L08BY15T NAME: Ill ~ ~a~~ Le.-,~ ~C1n
understand that na later than October 1st of each~ecer, I must file the following
forms, pursuant to Section 2-483 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 ~ Lobbyis# Expenditure Farm
2~ Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-0ade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, ! am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
C~,/~-~ -x-12 ~
Signature: Date: