Ilija Mosscrop - 3193 Royal Palm Avenue LLC • A Merl E ?E'1 - 1 QkIEST
i\r! i i/\/\ BEACH b ' «i c�T Fo IL E)(T" S 16/.4
of: •t')(l 5T I,-.ri G vA M/t 3 t i1
City of Miami Beach Office of the City Clerk
Pm.1%,e_,
1700 Convention Center Drive, .Miami Beach, FL 33139
1-4-15]-10c i:5)9�
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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
rAo5se-Crop ILIJA
NAME OF LOBBYIST: (Last) (First) (M.I)
MnSS o AS t_I�S °
co 14.0 Lt IcoLra PO M tdmi BC-11 FL. '5. 13°1
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State). (Zip Code)
30S‘S$4-•9119 '70S 1 S2ikt,°lc11-7 TLX 3-Ae gEU-So vil'1 • rl E
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify.this office if your_contact information changes:.address,phone, or e-mail address.
LOBBYIST RETAINED BY:
(.o-e t. PALM -AvCc-1VE LL(. nop-ruA CCUILWiIT2 )
NAME OF PRINCIPAL/CLIENT:
Cr) per- _PALM /rtevr= UL- 3193 (WOK- PACM AvE M. 6, 331`f •
BUSINESS NAME AND A (RDESSS� (Number and Street)• (City) (State) . (Zip Code)
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:
• • IDENTIFY ALL PERSONS HOLDING, DIRECTLY"OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LO.BBY'ISSU:E_
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Issue to be lobbied(Describe in detail):
iii.C:IT1(,ACEN;CI.ES/INDIVIDU:ALS`D BE:LOBBIED
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the •eneral 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
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Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,farmlial oG professional
relationship, or other relationship giving rise to an appearance '
p. p g g ppearance of an impropriety,with any current city commissioner or c personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g) Any Financial, Familial or Professional Relationship --o
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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: I L1 A MOSS(.fLO j)
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.
Signature: Date:
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 F \ rl o�
•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"Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
Mo5Scp-oP 1L1 JA
•NAME OF LOBBYIST: (Last) (First) (M.I)
MOSSC ILO P ASSOCIATE'S °4-0 (I ••I CO t.,-.1 1LD 1‘1 1 AP11, FEAcN FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3°5 • 534 •011141 30S • S4 • OigZ1 SLiTA e- SELLsovTN .,J-ET
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
•
I. LOBBYIST RETAINED BY:
31q- Ro'rn PAtM A V6t4VE c.LC CJoshvA G UIZ�I T 2-�
NAME OF PRINCIPAL/CLIENT:
2/191) IZ$Cre • PA/"' E• E LL c '�I q3 Itri'i 4& NKr, AE MD 3314. 0
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
91l •3/0 ''7CeZ-
Fill out thls.section If principal Is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION,PARTNERSHIP OR TRUST:
II gika• lATOIRP§Mrttlit4
31ct3 so(k PM-ti Ave : L4D 1=LIL ArDP/not-1 if f.1,oiLic CFsIG +flo•.J
• Issue to be lobbied(Describe in detail):
III.CIT�tY AGENCIES%INDI%I®}UAL*SAOPBE_ LO_B_B1ED.: 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 City personnel sought to be lobbied --further, pursuant t ty Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 most ding said City
personnels' commencement of service with the City to the present date, stating the genera.:. > re subject
contractual relation.
A)Full Name of Individual/Title B)Any Financial,Familial or Professional Relationsh `41
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IV. DISCLOSURE OF'1 AS AND AMOUNTS OF LOBBYIST COMPENSATIC ,SCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): .
•
A) LOBBYIST DISCLOSURE:(Required) {d 'r O O 0
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). –11 i L 400 —
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 /(-No: Are you lobbying on a present or pending bid forgoods, 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 X 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 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, shall register with the clerk as required by this .
section but,shall not be required to pay any registration fees.
•
El Yes )(No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT 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 EXPENDITU S OR COMPENSATION DURING THE REPORTING
PERIOD. _
. , . . c..... rs---.... ......---1)
• Signal a of Lobbyist
I do solemnly swear that all of the foregoing facts are true and co ect and that I have read or am familiar with the
provisions contained in S:ction 2-482 of the wiami Beach City Code and all reporting requirements.
Signature of Lobbyist: ,
Signature of Principal/Client: /I • i •
VI. LOBBYIST IDENTIFICAT •N: , /RINCIPAL IDNTIFICATION:
prore-Pi e D M�.�-i— OD-6, a--� �6 (D ( 3z — `1f- 7'
tJ Produced ID !9 Q R
Form of Identification Form of Identification J gi i •
o R= ❑ Personally known (Lobbyist) personally known(Principal) ,8
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°°^6 VII. SIGNATURE AND STAMP OF NOTARY:
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`� i State of Florida, County of Miami Dade a
' �.I at y State of F.rids, Co.. my a :'ami-e •de III
Sworn to and subscribed . fore a Zn/c) Sworn ••nd subscri.ed . • m
•
o This %b day of �` 2009 This • • 4. of I r ` la.. 1:
c.
d.��aRni''c• { Qom• �� ,' • A�I r
I;.= r Slgna u e of Public No a -State of Florida ham! !� - -. _1 es
ary Signatu : .f P ..� 41.,..1.es ,.SI Notarization of Lobbyist's si nature Notarization
Notarization of Principal's sig d re I %;"0 ,�`,:•
t!
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
:-Annuals"Registration:fee:;[ Yes'[ :]No .Amount Paid_$].59 • -MCR# 3.05 64_3' .(Date'P.aid• - /C
LobbyistRegistration Eorm received.and verified,by:.
-E:\CLER\BALL\aFORMS\LOBBYIST.FORMS\Lobbyist Registration-Form 21109.doc JW' <'. •> -tRevised.02/11/,2009
IV. DISCLOSURE OF TI 3 AND AMOUNTS OF LOBBYIST COMPENSATIOA ;CLOSE WHETHER HOURLY,FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) id ,1 O O.
•
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). 1 r 600 — •
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 'No: Are you lobbying on a present or pending bid forgoods,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":
•
El Yes 91 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 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, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees.
❑ Yes
liC
No: Are you representing_a not-for-profit corporation or entity without special compensation or
reimbursement. . .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT 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 EXPENDITU S OR COMPENSATION DURING THE REPORTING
PERIOD. .
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Si gnat e of Lobby ist
9 Y
I do solemnly swear that all of the foregoing facts are true and co ect and that I have read or am familiar with the
provisions contained in S ction 2-482 of the iami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID 04,251-4/00--0?-.O? `° 0 Produced ID
' Form of Identification Form of Identification
co N ❑ Personally known(Lobbyist) ❑ Personally known (Principal)
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y VII. SIGNATURE AND STAMP OF NOTARY: .
gm Cc I
z :State of Florida, County of Miami Dade State of Florida, County of Miami-Dade
Sworn to and subscribed'.,-fore e
—�,,E-"-f.5 734--- Zpj(� Sworn and subscribed before me
m This b day of , 2009 This day of ,2009
,t:<, -,_; ;.':n Signa u e of Public No ary—State of Florida • Signature of Public Notary—State of Florida
" .. Notarization of Lobbyist's si nature 'Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY /
,'Annual Registration fee:?[ Yes'[ ;]:No .`Amount=Paid`$.$O • _MCR:# 30,7 64-4 ::Date,P.aid• .__777Z.
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Lobbyist'RegistrationForm received,and-verifiediby:, '
°E:\CLER\BALL\aFORMS\LOBBYIST.FORMS\Lobbyist.Registration Form 21109.doc .' •Revised:02/1'1/2009
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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: • (L I JA 1'1 O S S (L-0 P
I understand that no later than October 1st of each year, I must file the following
forms,,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 Form
2) Disclosure 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.
•
Signature: Date:
F:ICLER\LOBBYIST1Lobbyist Registration Form 32708.doc