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Neisen O. Kasdin - Morabito Properties, LLC 1 CA M A I BEACH ...... 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 term "Lob has pecific exclusions. Please r r to Ordinance 2004-3435. i N LOBBYIST: 1 r 11 1 (Last),_ ihi 1 W (City) 2f (M I� Il I� r I !I r t- )? / • (NESS NAME AND ADDRESS (Number ant Street) \d/J ( (C City) (State) (Zip Code)/ s s n� s Nei sn . �►,71fitm,. y co,}, — TELEPF I 0 E NUMBER FAX NUMBER EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: Ki i le LLC UMRCIo Fs NAME OF P' CIPAUCLIENT. w 1 ti T T�. 0? I'. I k APlZ B SI ,AQ y umber and Street) (City) (St. e) (Zip ode) TELEPHO E NUMBER: tlfn/ XJ 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 c� • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH - ORPPATION, PARTNERSHIP OR TRUST. -- i _ r () 8— II .SPE 3b si FIC 0 Y ISSUE: r` �c i � oiI ins Div e -- c 1�r.eser Issue to obbied (Describe in detail): ?Weal ( 0 s III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: -} N Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the I•••i.yistbas en red into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months prece•'. g saki person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied c kWL ?NV V 1 Pursuant to City Code Section 2- 482(g) Every registrant shall •e required to state the exte ot'any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sou • ht to be lobbied as identified on the lobbyist registration form filed. Sec 2-482 • An Financial, Familial or Professional Relationship - _„� r r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE (Required) �.O0 "1'lOu ( B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION) il009_ 00 'ii (Required). 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 V Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues" ❑ Yes L7 No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoninq map designation or change to the City's Future Land Use Map? 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 a not - for - profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, hall register with the clerk as required by this section but, shall not be required to pay any registration fees. ❑ Yes `JLJ'0: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST 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 ' IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the forego' • acts are true and correct and that I have read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach ' i , ..e and all reporting requirements. Signature of Lobbyist Signature of Principal /Client VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: m ❑ Produced ID _o o ❑ Produced ID Form of Identification Form of Identification m No Personally known (Lobbyist) co o o ❑Personally known (Principal) U c N 3 o N N VII. SIGNATURE AND STAMP OF NOTARY: - 0 E m m c 0 n State of Florida, County of Miami -Dade z Q w State of Florida, County of Miami -Dade Sworn o nd subs me ><, "°4d Sworn and subscribed before me This day of , 2011 0• 411- o This day of , 2011 Signature of Public Notary — State of Florida Signature of Public Notary — State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLET Y CITY CLERK'S STAFF ONLY 67.-?/ / ` / Annual Registration fee: [ ] Yes [ ] No Amount Paid $ :a MCR # / a Date Paid Lobbyist Registration Form received and verified by: / F: \CLER \SALE \aFORMS \LOBBYIST FORMS\ Lobbyist Annual Registration Form.doc ma y , f /f ) Revised 1/11/2011 r' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE (Required) IAL°0-' 0 ,./j/ n Jt fr v- -- _- B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION) r III I22 (1t} 00 ! V The following information must be answered: 1 Pursuant to Miami Beach City Code Section 2-488 Entitled • Prohibited Campaign Contributions By Lobbyists On Procurement IIssues". D Yes qo: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending t award for goods. equipment or service? 2) Pursuant to Miami Beach City Code 2 -490 Entitled 'Prohibited Campaign Contnbutions By Lobbyists On Real Estate Development Issues" ❑ Yes L7 No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beacn 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 a not -for- profit corporation or entity without special 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 to pay any registration fees L. Yes Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST 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. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are tr e and correct a hat . ave read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach City ode and r porting requi ents Signature of Lobbyist. Signature of PrincipaliCilent ` r A, VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID X Produced ID FL dr'h/ I (I ( • Form of Identification Form of Identification ❑ Personally known (Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: New Job ` rve w e,/,.� State of Florida, County of Miami-Dade State of RieFieia. County of Sworn to and subscribed before me Swom and subscribe before me This day of . 2011 This "1* day of J t/ I'll_. 2011 Signature of Public Notary - State of Florida Si n e of Public ry - State of F-iefw.a- New jtiK� Notarization of Lobbyist's signature Notarization of Prin pal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes ( ] No Amount Paid $ MCR # Date Paid ■ Lobbyist Registration Form received and verified by: _ ` 1 , _ " 57 �t1,C.MSttabbiisc Ann., -. Revised 1/11 /2011 I • � i MICHAEL SENZ `• — Notary Public - State of New York . - No. 01 SE6114952 . , .rte •• .- • . - f Qualified in New York County �. : , P" Commission Expires August 30, 2012 r A I f t, t ki gg City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel 305 673 7411 , Fax 305 673 7254 LOBBYIST NAME: >� , OO \\\ I understand that no later than February 28th of each year, I must file the following form, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure and Compensation Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami -Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. _OAK_ Signature: Date: