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Elizabeth Starr - 2142 MB Property LLC MIAMIBEACH City of Miami Beach Office of the City Clerk o� 1700 Convention Center Drive, Miami Beach, FL 33139 �," LOBBYIST REGISTRATION FORM ik, 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. s-r'tS,Pi�i d LIZ A SST}-- NAME OF LOBBYIST: (Last) (First) (M.I) TviaN Col fi 0•-4 i1 1I)195 .3324v MA-PI`? ST 4301 M iA M I ,Fl- 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (3O ) 3 13-4cialO tyA. eli2Abe+h @s-bran a -heC-kvre.con1 TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address,phone, or e-mail address. I. LOBBYIST RETAINED BY: 2142 t•/1 PFil 7 PE R-TN{ 1-1-C NAM OF PRINCIPAL/CLIENT: • (94 O 6+h ASV EN V E 20-r+-1 pl-0019 N Ev∎l (O 1L., N`( I Gt)L i - _; , P r!F BUSINESS NAME AND ADDRESS (Numb anted Street) (City) (State) (Zip Code) - ( 2l2) (P8g -2 / rn 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: NJ/ — • IDENTIFY ALL PERSONS HOLDING,DI ECTTLLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN-SUC ORPORATION, PARTNERSHIP OR TRUST: , krj ILSPECIFIC LOBBY ISSUE veSCoN RSVleW 7aOAfD : VAR IA.NCE i c L' S`T. sIDE '(A1iD ELEV4,1'IOl-1 Issue to be lobbied(Describe in detail): Ill.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 44e-. NO# fl4 ( FO. 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 ITECT. X 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 t4ONE. 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 p 0RF:(Requi d) C)F1 1-'1 ICU. B) PRINCIPAL'S DISCLOSURE(OF LBBYIST COMPENSATION): (REQUIRED). HQVFi L ii*a SCE.00 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 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 XNo: 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. _YesiNo: 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 HERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. iorAiir dliflah I�I-ier/I∎ _ _ Signa ire o •bbyis i App. 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 Miami B-ach City Code .•• all reporting requirements. Signature of Lobbyist: ` __.,......, ,.... , _ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: NaG3 IC J rn O E CC o Produced ID W `D `" o Produced ID 0 > N Form of Identification V z Form of Identification Y W o' est ..// znoC WZvUa 0 10 /f Personally known(Lobbyist) o 0 0 .L Personally known (Principal) d O o` ; Z N W `O Y O VII. SIGNATURE AND STAMP OF NOTARY: Z o Q o } y U ® m CC } a L New Yur' l�,uv `�vt �; z n State of Florida, County of Miami-Dade Ii 2 w 'ate of - -,' of m L o E W Sworn to and subscribed before me sworn : • sub •-d before me 2 2 c.v _O` Thi 10+h day of Fe br-Ura 2015 This , iay • ' 'bi'w� ,2015 a Z m N AtAl 7� Q e � • i °;� .1 ti ..,, Si•riature of P • c Notary—State of Florida ' " = Signature of Public No - i—State of Florida c Notarization ,, obbyist's signat e N•tarization of Principal's signature TO BE COMPLETED BY CITY ERK'S STAFF ONLY f Annual Registration fee: [ Yes[ ]No Amount Pain $.. D"-' �i CR# ./► 0__ Date Paid c�/7,, /;c Lobbyist Registration Form received and verified by:``___ _/ _i _ ._. — . °_1_%.�� l F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist An V i ' egistration For n.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc I MIAM BEACH 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: EL 124 ST4 STAFF 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 lobbyist (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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. o2. 20� . Si ure: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r:101.:;720-1. 001 02126/2015/2015 tiff 131. .. �rjf i' r;�.�"�' ' �i 3,;y r�i��.-.�.��i a:!„i�Oi Miscellaneous Cash Receipt (�,���'F; 4 •r CITY OF MIAMI MI BEACH No Cash Credit D Card' Check# -$ 25 20. _ - Received of .. ( (` , i 3�� 3 .i�► a f Address -3 3 Z.c F,f ( . • ; ` :+,� qy 7•Jfw��`y� ,>(E r ;,1 el-r 3 Lt O ^� � `For v' 4 - i �: E'=:%P140,-)6P--;_, "i._ ' r.Sr �. I� ' t 'f7" ((!? f i.i 1 .�' f , - -t /ice r# t` 7 f 6 G i • (THIS INFORMATION MUST EE COIWPLE ED) Office of Finance Director Account Number: ,;t:� ,� +.1 , , Ai "Preparer.�,.�= .� x.:.� 4E_ .- j � :���, ---''Dopt: �� ...�_ .� � EXT: :.i. .�.,..�, f •.J � k.i..rr�9..sz ,``5..-4., a I»+..,.ts.:. .F•, rY- - CITY HALL CASHIER OFFI N '. • 1700 CONVENTION CNTR DR :":!1 MIAMI BEACH, FL 33139 02/26/2015 11:04:21 CREDIT CARD - AMEX SALE CARD# X)00000000(1026 INVOICE 0008 SEQ#: 0007 City of Miami Beach-Florida Batch#: 001093 Finance Department Approval Code: 523845 1 City Hail Entry Method: Swiped 1505720-1 02/26/2015 BR1 T131 Mode: Online Thu Feb26,2015 11 :01AM Trans#10-11 SALE AMOUNT $1200,00 10MC$350,00 MCRCLERK - MCR-City Clerk 402711 11 $850.00 MCRCLERK - MCR-City Clerk * MCR#: 402710 CUSTOMER COPY 2 ITEM(S): TOTAL: $1200.00 Credit Car PAID $1200.00 Have a nice day!