Les Bellinson (3)' m MIAMIt~EACH
City of Mi 'mi Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or etained, whether paid or not, by a principal who seeks to encourage the
passage, defeat or modification of any o dinance, resolution, action or decision of any commissioner; any action,
decision, recommendation of the City anager or any city board or committee; or any action, decision or
recommendation of any city personnel du ing the time period of the entire decision-making process on such action,
decision or recommendation that foresee bly will be heard or reviewed by the city commission, or a city bond or
committee. The term specifically includes the principal as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific exclusio s. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Las (First) (M.I.)
Beilinson Les
BUSINESS NAME AND ADDRESS umber and Street) (City) (State) (Zip Code)
Beilinson Gomez Architects, P.A. 8101 isca ne Boulevard, Suite 309 Miami, FL 33138
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
305-559-1250 305-551-1740 LDB cQBeilinsonArchitectspa.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Bets Ross Owner, LLC
BUSINESS NAME AND ADDRESS ( umber and Street) (City) (State) (Zip Code)
Bets Hotel 1440 O can Drive Miami Beach, FL 33139
TELEPHONE NUMBER: FAX UMBER: (Optional) EMAIL: (Optional)
305.531.6100
Fill out this section if principal is a Corpor tion, Partnership or Trust [Section 2-482 (c)j
• NAME OF CHIEF OFFI ER, PARTNER, OR BENEFICIARY:
Jonathan Plutzik
• IDENTIFY ALL PER ONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTERE TIN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A"
11. SPECIFIC LOBBY ISSUE:
Revocable Permit application
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS OBE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any Cit personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any c tractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personn to be lobbied.)
A Full Name of IndividuaUTitle B An Financial, Familial or Professional Relationshi
Mayor None
Commissioners
City Administration; City Attorney's O ice; None
Cit Committees; Cit Boards
fk;/~ ~~
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•~ IV. DISCLOSURE OF TERMS AN AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required
B) PRINCIPAL'S DISCLOSURE (OIL LOBBYIST COMPENSATION):
(Required). $250.00 per hour II
The following information must be ansv
1) Pursuant to Miami Beach City
On Procurement Issues":
Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
2) Pursuant to Miami Beach Ciry ~c
Real Estate Development Issues
2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
3) Pursuant to Miami Beach City ode 2-084 (h) Any person (except those exempt from the definition of
"IobbyisY' as set forth in Sectio 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without sp ial compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of o opposition to any item, shall register with the clerk as required by this
section but, shall not be required o pay any registration fees..
- ----- -------------- --
ream ursement.
V. SIGNATURE UNDER OATH:
~,.~ .,..T.,e~~ .sr ,.~ ...,,...,_._ __.. . ------- ---- - -
PERIOD.
Signature of Lobbyist J
I do solemnly swear that all of the foregoi g facts are true and corcect and that I have read or am familiar with the
provisions contained in Section 2 o Mia i Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identificati n Form of Identification
^ Personally known (Lobbyist) ^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF N TARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 2008 Sworn to and subscribed before me
This _ day of , 2008
8
$ ~
~ .v Signature of Public Notary -State of Florid
Notarization of Lobbyist's signature Signature of Public Notary -State of Florida
Notarization of Principal's si
nature
$
~ g
P
w TO BE CO PLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount
Lobbyist Registration Forrn received and verlfle Paid $ MCR # $ Date Paid
by:
F:ICLER\LOBBYISTLobbvist Ranisfratinn Gnn.. ~~ nu.~..., _ . __.__.__ _
l~/I I AM I ~A i~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, ti++ww.miamibeachfl.aov
CITY CLERK office CitvClerk(g~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Les
I understand that no later than October 1 of each vear, I must file the following forms, pursuant to Section 2-485 of
the Miami Beach City Code, with the City Jerk's Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely b sis will result in my name being transmitted to the Miami-Dade County
Commission on Ethics and for code violati n evaluation.
In addition, once an issue I have register d to lobby on has been resolved, I am required to immediately notify the
City Cler 's Office for lobbyist withdrawal i writing.
~~ /~
Signature: Date:
MIADOCS 4031147 1
IV. DISCLOSURE OF TERMS AND
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$250.00 per hour
AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
B) PRINCIPAL'S DISCLOSURE (OF ~OBBYIST COMPENSATION):
(Required). $250.00 per hour
The following information must be answere
1) Pursuant to Miami Beach City Co a Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
rvi
2) Pursuant to Miami Beach City C de 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
Yes No: Are ou lobb in on a endin a lication for a Develo ment A reement with the Cit or
a lication for chance of zonin ma de i nation or chance to the Cit 's Future Land Use Ma ?
3) Pursuant to Miami Beach City de 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 speci I compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required t pay any registration fees..
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1St OF EACH YEAR E CH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH. LISTIN LOBBYING FXPFNnITI1RFS ns wt=i i ns cnnnacrviceTtn~i
PERIOD.
I do solemnly swear that all of the fore`g
provisions contained in Section 2-482 of 1
Signature of Lobbyist:
Signature of Principal/Client: /~ ~
~-
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Ide
Signature of Lobbyist
facts are true and correct and that I have read or am familiar with the
liami Beach City Code and all reporting requirements.
x PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist) ^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF N TARY:
State of Florida, County of Miami-Dade State of Florida, Cou ty of Miami-Dade
Sworn to and subscribed before me Sworn to nd subs ed before me
This -day of , 2008 This 2~ay of , 20)~8~
s.F"w`
~--~ ~ v,, votary Public State of Florida
Si nature of Public Nota
9 ry -State of Florid ' t'" rry
Signatur of Pu I
taje ,
~4?rSl~~ion DD697983
Notarization of Lobbyist s signature ~
~
Notariz tion of rinc
~g~iature:~ „r-~s,?n*~
f
TO BE CO PLET Y CITY CLERK'S US N Y
Annual Registration fe ]Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verifie by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32 08.doc M ,~ ao..~~ea nzn~nnnn
BETSY ROSS OWNER, LLC
d/b/a BETSY ROSS HOTEL
1440 OCEAN DRIVE
MIAMI BEACH, FL 33139
(305)531-3934
PAY One Thousand Fifty and 00/100 Dollars
4
3
TO THE CITY OF MIAMI BEACH
ORDER 1100 WASHINGTON AVENUE
OF: MIAMI BEACH, FL 33139
CITIBANK
63-8655/2660
a
CHECK NO. DATE
007480 2/1/2010
IJ SEQURITY FEATURES INCLUDED. DETAILS ON B~
~I'00748011' ~: 266086554: 9 L X60 1 7 1 4 411'
AMOUNT
$1,050.00
7480