Sharone Lankry - South Beach Synagogue, Inc. 6Zet 1.016K
MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 20 �, � : Q 5
LOBBYIST REGISTRATION FORM
i-(!r� FILL
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.
Lankru Sharone
NAME OF LOBBYIST: (Last) (First) (M.l)
Shuva Israel South Beach, Inc., 629 Lenox Avenue, Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)281-0284
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Sharone Lankru
NAME OF PRINCIPAL/CLIENT:
South Beach Synagogue, Inc.
D/B/A Shuva Israel South Beach, 629 Lenox Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)281-0284
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:Sharone Lankry I OD aia
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: NON-PROFIT
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review
Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops
or Committees. if necessaru. relatina to the pronertu located at 629 Lenox Avenue. Miami Beach. Florida.
Issue to be lobbied(Describe in detail):
lll. 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 NO
title of person to be lobbied
Planning Department and Building Department Staff None. X
PB, HPB, BOA, City Commission, as necessary None. 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
None
None.
None.
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Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)Non Profit, no compensation.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Non-Profit, no compensation.
(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.XNo: Are you Iobbvina on a present or pending bid for aoods.eauioment or services.or on a present or pending
award for aoods.eauinment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes Xlo: Are you lobbvina on a nendina application for a Development Aareement with the City or application for,
chanae of zonina man desianation •r chanae 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.
X Yes No: Are you representina 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
• ► •== ► - ► . _ ► . •11 - ►, _ .0► • IN THE CITY OF MIAMI BEACH
Fes$ ._ ': . . .! c _► _ _ = m ; I AN HAVE BEEN NO
EXPENDITURES OR._ •11' ► = '` ' ► -• : ► •'
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and t : I have read or am f iliar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting requireme,
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
•
Produced ID PC- '- Produced ID Dc2 L .c-4-2,s i
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTA ;_v HAYDEN A.SUSAN.
NOTARY PUBLIC .
State of Florida, County of Miami-Dade t STATE OF FLpgiDA State of Florida, County of Miami-Dade
Sworn to and subscribed before me Corm#FF20994.8 Sworn and subscribed before me
This i •ay of , 2015 �; A ;_ Expires 311:5!2019 This a t •- of (`'` ,2015
D-(ar ( C r`: a _ 3— / s` jar fr S"
Signatur- of lic Notary-State o Florida " Signature of-!t• try-State of Florida a
Notariz.. ion of Lobbyist's signature Notarization of 'rincioal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ o Amount Paid$ MCR# Date Paid
Lobbyist Registration Form receive nd verified by:
A/F:p
. AMI.BE CH
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: Sharone Lankry
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, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed t' the iami-Dad ounty Commission on Ethics and Public Trust.
SI• - •re: / Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
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