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MIAMI BEACH 01P
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"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Choeff Ralph
NAME OF LOBBYIST: (Last) (First) (M.1)
Choeff+Levy P.A., 8425 Biscayne Boulevard, Suite 201, Miami FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
0051434-8338 x 111 rchoeff&hoefflevu.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
MaM Carpenter
NAME OF PRINCIPAL/CLIENT:
118 W. DiLido Drive Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-452-7195
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: fA AiL't C_A&P CW ft_fi'
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST-IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: fn ArRy CA 2PCrJI Lt oo`/A
II.SPECIFIC LOBBY ISSUE;
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Review Board, Planning
Board, Board of Adjustment, Land Use_Development Committee, and City Commission, if necessary, relating to the property
located at.118 W. Dilido Drive,Miami Beach,FL.
Issue to be lobbied(Describe in detail):
m.'CITY AGENCIES/INDIVIDUALS TO 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 general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO
title of person to be lobbied
Planning,Building,Public Works and Fire Department Staff None.
PB,DRB,HPB,BOA, City Commission, and Land Use None.
Development Committee, as necessary None.
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of 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
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
None-
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIS COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ 1 1 ZI 114
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ � it
(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 JCNo: Are you lobbyina on a present or pending bid for goods.equipment or services,or on a present or pendina
award for goods.eauipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes)No: Are you lobbvina on a pendina application for a Development Agreement with the City or application for
chanae of zonina map desianation or chance to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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.XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES, AS LL AS CO N RECEIVED, IN THE CITY OF MIAMI BEACH
EM THE PRECEDING CALENDAR YEAR, A STATE I E FIL D EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR
Signature of Lobby'
I do solemnly swear that al a regoing facts are Irue and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the ami ch C' Cod nd a reportin nts.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ;��,� ""'•�
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal) o Cl
30 %4
VII. SIGNATURE AND STAMP OF NOTARY: N �►
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade • w
Sworn to and subscribed before me S4hi d subscrib d bef a me ;Z A
This day of ,2014 day of ,2014
a �
Signature of Public Notary—State of Florida Sig ure Notary—Sta te of Florida Notarization of Lobbyist's signature Notarizat signature
TO BE COMPLET D ITY CLERK'S STAFF ONLY /A/ -//V,.-
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Dat Paid
Lobb ist Registration Form received and verified by,.
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