Murray H. Dubbin - World of Kids / t
m Ami BEAc H
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.
Mvrr' h •
NAME OF LOBBYIST: (Last) (Fir t) (M.I)
N'\urr 't'{, DolA/31 +7 Pl. 1 2.00 p,4A1.51,A5cpt � • cov-aicaides, J 33131
BUSINESS NAME AND ADDRESS / (Number and Street) (City) (State) (Zi Code)
05)37 ) 4306 30S) ��� �,o/ t w r ra I� v b b I ri F' �1�%J•*
ELEPHONE NUMBER: FAX NUMBER:
EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
1 A)nY c- A- 1 QS (�b Or_ezon 171 OA 1 Fezch c1 3 3139
B SINE S 10'IE AND ADDRESS (Number and Street) (City) State (Zip Code)
c)
LEPH NE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) --
_.-, cal =y n
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 LOBBY ISSUE: - -- = '
Rew)aI c *2-)c( c-,VI � Ca kale Pe r'r1,t e t 5 vi htoa `ca' 72Gcess
Issue to be lobbied(Describe in detail): 1 a ` cA
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: b h 0a31 R� . ,� a 1Drt a v �7" q
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 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,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
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSUR :(Required)
AA ' O. •v 0�— ,. • ' :QS' •
B) PRINCIPAL'S DISQ.OSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). S ai%' P AS bo v'e
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 jo: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes etNo: 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 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 INO: 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 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.
A AAJ■ --4iddiAdigatad
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia ' Beach City Code a all reporting requirements.
Signature of Lobbyist: f
Signature of Principal/Client i 4 :
VI. LOBBYIST IDENTIFICATION: 6ie— PRINCIPAL IDENTIFICATION:
produced ID Produced ID 6 6 v e d Ydk -111 0
Form of Identification Form of Identification
Personal) known (Lobbyist) ersonall known PJ al
y y O ��► e
11110
VII. SIGNATURE AND STAMP OF NOTARY: e•
m 400
State of Florida, Count of Miami-Dade ROBERT MARC SAMUEL State of Flori.-, County of Miami-Dade x. --+ w
Sworn to and subsc '•ed before me '` ` �< NOTARY PUBLIC Sworn and fjscribed before me 3 a m
This 11 day " F. 2 0 1 S �� STATE OF FLORIDA This °) -y of Fe-bio , 201 c� o, m
=e� Comm#EE063016 Ni -fljgg
o8c0
Expires 6/4/2015 ,,tr n 0
Signature t bli Notary—State of Florida Signature of Pui tj otary—State of Florida v
Notarization of Lobbyist's signature Notarization of Principal's signature >� 1
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes[ j No Amount P•it $ .T1 ix� CR# P ` Date Paid -
Lobbyist Registration Form received and verified by: + .7. IU .
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Ann r I egistration Fo .doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
DURABLE POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS.That.I.VERA MENDER.
have made.constituted and appointed.and by these presents do make,constitute and
appoint C'HRISTA GREEN and ILONA-ANNE WISS my true and lawful attorney
(herein called"Agent")for me and in my name,place and stead: •
I. General Grant of Powers. To exercise,do.or perform any act,right.power,
duty.or obligation whatsoever that I now have or may acquire the legal right.power.or
capacity to exercise,do,or perform in connection with,arising out of.or relating to any
person.item,thing,transaction,business,or property,real or personal_tangible or
tntangible.or matter whatsoever.
2. rowers of Collection and Payment. To forgive.request.demand,sue for,
recover,collect,receive,hold all such sums of money,debts,dues,commercial paper.
checks.drafts,accounts,deposits,legacies,bequests,devises,notes,interests,stock
certificates.bonds,dividends,certificates of deposit,annuities,pension,profit sharing,
retirement,social security,insurance and other contractual benefits and proceeds.all
documents of title,all property,real or personal,intangible and tangible property and
property rights.and demands whatsoever,liquidated or unliquidated,now or hereafter
owned b}.or due,owing,payable or belonging to.me or in which I have or may hereafter
acquire an interest:to have.use,and take all lawful means and equitable and legal
remedies and proceedings in my name for the collection and recovery thereof.and to
adjust.sell,compromise.and agree for the same.and to execute and deliver for me.on
my behalf.and in my name.all endorsements,releases,receipts,or other sufficient
discharges for the same.
•
3. Power to Acquire and Sell. To acquire,purchase,exchange,grant options to
purchase or to sell,contract to sell,and sell and convey real or personal property,tangible
or intangible,or interests therein,on such terms,credits and conditions as my agent shall
deem proper. •
4. Rankine Powers. To make,receive and endorse checks and drafts,deposit and
‘eithdraw funds.acquire and redeem certificates of deposit,in banks,savings and loan
associations and other institutions,execute or release such deeds of trust or other security
agreements as may be necessary or proper in the exercise of the rights and powers herein •
granted.
5. Motor Vehicles. '1'o apply for a Certificate of Title upon,and endorse and
transfer title thereto,for any automobile,truck,pickup,van,motorcycle or other motor
chicle.and to represent in such transfer assignment that the title to said motor vehicle is
tree and clear of all liens and encumbrances except those specifically set forth in such
transfer assignment.
6. Tax Powers. To prepare.sign and file joint or separate income tax returns or
declarations of estimated tax for any year or years:to prepare,sign and file gift tax returns
with respect to gifts made by me for any year or years;to consent to any gift and to utilize
any gift-splitting provision or other tax election;to prepare,sign and tile any claims for •
rcliutd of any tax;to sign and tile any application for homestead tax exemption:and to
prepare.sign and tile such other tax forms.consents and agreements as my agent deems
proper:to defend or prosecute,and settle,any disputes concerning my tax obligations.
7. Safe Deposit Boxes. To have access at any time or times to any sate deposit
box rented by me.wheresoever located,and to remove all or any part of the contents
thereof.and to surrender or relinquish said safe deposit box,and any institution in which
an■ suet)sale deposit hox may be located shall not incur any liability to me or my estate
:,s:r result of perminine my agent to exercise this power.
8. Professional Advisors. To receive from my accountants and attorneys.in
confidence,all information,whether or not otherwise privileged,which may in any way
he relevant to my affairs,and to instruct any of such professional advisors to transmit
such information to any other professional advisors.
9. Legal Proceedings. To prosecute,defend and settle all actions or other legal or
administrative proceedings touching my property or affairs or any matter in which I may
be concerned in any way.
10. Qstiaemsnt Plana. To deal with retirement plans and interests therein.
including without limitation individual retirement accounts.rollovers and voluntary
contributions,and to make contributions,withdrawals.choices and elections with respect
thereto and to disclaim benefits thereunder.
I I. Social Security benefits. To take any action deemed necessary with respect
to eligibility for or collection of Social Security benefits due to me.
In particular,but without limiting any of the foregoing.my said agent may deal
freely and completely with interests in any of the following:
Real or personal property wherever located
Securities of every type.
Accounts of every type with depositories
and securities brokers.
I grant to my said agent full power and authority to do and perform all and every
act and thing whatsoever requisite,necessary and proper to be done in the exercise of any
of the rights and powers herein granted.as fully to all intents and purposes as 1 might or
could do if personally present,hereby ratifying and confirming all that my said agent shall .
lawfully do or cause to be done by virtue of this Power of Attorney and the rights and
powers herein granted. This instrument is to be construed and interpreted as a general
Power of Attorney. The enumeration of specific items,acts.rights.or powers herein does
nor limit or restrict,and is not to be construed or interpreted as limiting or restricting,the
general powers herein granted to said agent.
This Durable Power of Attorney shall not be affected by incapacity of the
principal except as provided by Statute. This Power of Attorney does not include the
power of substitution and this Power of Attorney shall be non-delegable except to
delegate to a transfer agent or similar person the authority to register securities into or out
of niy name or the name of a nominee. This Power of Attorney shall be construed so as
to comply with the laws of Florida made and provided with respect to Durable Powers of
,attorney and this Power of Attorney shall therefore be valid until such time as the
undersigned principal shall die,revoke the power or be adjudged totally or partially
incapacitated(except as the court determines the authority granted herein to remain in
force). •
Any agent of mine acting hereunder shall riot be liable for any acts or decisions
made in good faith and under the terms hereof.
Any transfer agent,depository,transferee or other third party whatsoever may rely
fully upon a certificate or affidavit of my said agent that this Durable Power of Attorney
is still in full force and authorizes the particular transaction my said agent is effecting.
and all third parties shall be fully protected in relying upon photocopies of this Durable
• Power of Attorney.
{ This flower of Attorney shall be effective immediately from the date hereof and
shall not he affected by the passage of time.
Signed.sealed and delivered
in the presence of:
•t �
(SEAL)
D 01-1 &,t2.1)/3 enTS:..-Y-_ VERA MENDER
d1iii..
S?'.AT(:Or'FLORIDA
: ss.
COUNTY OF MIAMI-DADE)
The foregoing instrument was acknowledged before the this / day of
_ i. OO8'by VERA MENDER,who is personally known to me.
-v 10
Commission Expires:
NOTARY PUBLIC-STATE OF FLORIDA
:sss._ ,.r t Judith E. Robertson
lssi0n#
:Camm DD66S89tS
•
Expires: JUNE 08,2011 BONDED 7'HRU ATL,ANCIC BONDING CO.,tNC -N TAR Y PUBLIC,State of Florida at Large
. .
MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: 'MOM, ift. 0v b6 (.r)
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyt(or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April Se of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and POlic Trust.
V614—
Signature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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