Wayne M. Pathman - Andre Klein Li 3 5 51-AvcC
vah.
iV\i I -BEACH F , , ,
City of Miami Beach Office of the City Clerk r 2:1700 Convention Center Drive, Miami Beach, FL 33139:x'{Sid-'`-' ' '"
LOBBYIST REGISTRATION FORM k ,, ,_; r
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.
IV \ e-k-' AA l ,
NAME OF LOBBYIST: (Last) (First (M.I)
POIA) l'1'IGL/v� 1-6.01.5 L-L w 'L 5. ( ISC (S 1 u . ,2 MoD IA (aim; 12/- 3 313/
BUSINESS NAME AND ADDRESS (Number and Street (City) (State) (Zip Code)
31�- Z�fZS 05- 3//- 2--L120 l,JiDa. lr v. - tti,4 euk Leo-,/s .ra M
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
lM - Wife (ciD,;�
NAME OF PRINCIPAL/CLIENT: Ab-Q ,t-N Po cf cz �. t<L 3,fir k(I)
BUSINESS NAME AND ADDRESS (Numb r and Street) (City) (State) (Zip Code)
- 3 LiTtp -- 5109 c-M4le(`" Stt(i\c s Near=l n(f\ (C1 . , ( 0 AA
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 HOL-DING,-DIRECTL-Y--OR-INDIRECTLY,A 5°I MQRE-OWNERSHIP-INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUSTS: •:�_
n.SPECIFIC LOBBY ISSUE:
d �r /_( 55b e 5�- `7`I c 104-ALY:t._—:
Issue to be lobbied(Describe in detail): — -in.'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 relationships=
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NQ
title of •erson to be lobbied ,1/
�YkS + �0mmt+}-e i�
iebtAA is' S
tek M►n a 5.-ka-41. \
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
) L
, 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)5DO j /��g f I 14
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): A
(REQUIRED). `"'►► 4"/A r
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 1. o: 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 (o: Are you Iobbyinq 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.
it
Yes 0: 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 -!_,:-ENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL BE FIL • N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the fore... facts are t ° and c• ect and at I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Be.. h City Code = • - re•ortin re•uire -nts.
Signature of Lobbyist:
Signature of Principal/Client: r
VI. LOBBYIST IDENTIFICATI• : PRINCIPAL IDENTIFICATION:
_Produced ID /Produced ID 'cl UQ/tS Lich{ f y/Sb o(07-740 ? 7
Form of Identifi., DORINDATRIPONEY Form of Identification
,• ':. MY COMMISSION#FF 224382
EXPIRES:jutl 10,2019
Personally known(Lobbyist) •' t8f,....' Bonded Thru Nolan t}„h,in Undenvniars _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade Sta - • lorida,County of Miami-Dade
Sworn to and subscribed before me Sworn an• su -cribed befor me
Thi ' day of AIM(..5 ,201 Thi c2 ' d.• •f C� � '201,T
S gnature of Public ota 1—State of lorida Sig at re o °ublic otary—State of Flon " Y ists, Notary Public State of Florida
Notarization of Lobbyist's signa ure Not zati n of Principal's signature er Honey Oilier
c, My Commission EE 210925
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY bt c%."tr Expires 08/27/2016
Annual Registration fee: [ I Yes[ ]No Amount Paid$ MCR# Date Paid4
Lobbyist Registration Form received and verified by:
F:1CLER1$ALL\aFORMS\LO5BYTST FORMS\Lobbyist Annual Registration Form.doc Revised 01/2212014
F:ICLER\$ALLIaFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc
•
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Requirct5"1 _ ___ _
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): As ^.�
(REQUIRED). v L / r
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 i.4 o: Are you Iobbvinq 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_jo: 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
littem,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
Yes VNo: 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 : NSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL BE FIL I N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
yig,.........-
nature of Lobbyist
I do solemnly swear that all of th:• fore...-• facts are t and c• ect and at I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Bea h City Code : • - re•ortin re•uire •-nts.
Signature of Lobbyist: ��
Signature of Principal/Client --_.___,?
VI. LOBBYIST IDENTIFICATI• .: PRINCIPAL IDENTIFICATION:
Produced ID "°' = � Produced ID �\',
Form of Identifi .'"':_rf: ;: DORINDATRIPONEY _f`. Form of Identification
.. c*= MY COMMISSION#FF 224382
-'��: EXPIRES:.Juh 10,2019
'`'°i:'� Personally known(Principal
Personally known(Lobbyist) ^„ Boded rn�,rvo�a�r i•,ih;lc ilnaeters Y )
VII. SIGNATURE AND STAMP OF NOTARY:
111 I
State of Florida,County of Miami-Dade i State of Florida,County of Miami-Dade
Sworn to and subscribed before me , Sworn and subscribed before me i
Thi (� day of AUK �,201_ A\ This day of ,201
S1 nature of Public Nota –Stalorida Si nature of Public Notary–State of Florida -
Notarization of Lobbyist's signa ure Notarization of Principal's signature_
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY /
Annual Registration fee: [ I Yes[ No Amount Paid$ ' `i' MCR# 4 07 13 Date Paid ��7(l�
Lobbyist Registration Form receive and verified by: I _�
F;\CLER\$ALi\aFORMS\LOBBYIST F MS\Lobbyist Annual Be tration Forni.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MIAMI
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: Otuy&s:-. ;YL
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 lobbyin•. til all fines are paid, unless the fine has been
appealed to Miami-Dad ommission on Ethics and Public Trust.
Signa4r" Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Miscellaneous Cash Receipt :, 4,,_,..i- 1 ;_�, f t Q.:--:,: ;;�°2f:Ji , rot 1:1
CITY OF MIAMI BEACH ., . , 7, -:,.r,
No.
j a '� 033 �a
4 __., ❑ Cash ❑Credit Card Check# C �` / $
(,1/4. 4,46-;ti R 2/ 20 /5...„
-,Received of Li(kgr)e rt)A vil
Address Z. 5. eh,5'?'.,,.• ghh-i 2.4ci() A!.ci er- -
F
..3
', . f.i 5 7 .) ri.1 . ,-11-'6g,0 A/c tie\ ,'ifti 15
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By
- Account Number 6I1 r. v"^ ---1°- `"(
r� ,.,... 1 I i'+ t� EST: i f
Preparersr,.. Dept: , .
r
Q7 J = co -11 _- T
`1 ' C'7
C D C7 J. Y ND
C7 Cu
EU T• Z M e9. D p —.. =
,-. 3 .. c)up o Q 0
O O CID O N CD -+'
CD CD`-O O I:C.)---"
COi) CJ� � ONO 9 W O W W J
..�ci III 61111116:
=
Ln
CO CWT O 3 CID -in
O O O
O O O 3 -
O O = _+ C
I Cn CO
CD
r+
CO
CD
CD
•
PATHMAN
LE'\\TIS, LLP �, - M- : .
ATTORNEYS AT LAW 2015 AUG 28 PR 12: 12
WAYNE M.PATHMAN,P.A. ONE BISCAYNE TOWER• SUITE 2400
HAROLD L.LEWIS,P.A. 2 SOUTHiBISCAYNE BOULEVARD
DAVID E.SACKS MIAMI,FLORIDA 33131-21803 ' =`-
LOUIS P.ARCHAMBAULT*
JOHN A.MOORE** TELEPHONE(305)379-2425
RICHARD N.SCHERMER FACSIMILE(305)379-2420
AARON W.TANDY*** www.pathmanlewis.com
ANTHONY VICTOR DE YURRE
PETER L.MELTZER WAYNE M.PATHMAN
SALOME A.BASCUNAN wpathman@pathmanlewis.com
August 27, 2015
•Board Certified Specialist in Real Estate Law
also admitted to practice in Texas
"'also admitted to practice in New York
Via Hand Delivery
City of Miami Beach •
Registration
Lobbyist
1700 Convention Center Drive, 1st Floor
Miami Beach, FL 33139
Re: Lobbyist Registration — Wayne Pathman
Dear Sir or Madam:
Enclosed for processing please find a Lobbyist Registration form on behalf of our
client, Andre Klein, along with this firm's check in the amount of$350.00. Please note that
the page containing Mr. Klein's original notarized signature will be hand delivered to you
tomorrow morning, Friday August 28.
Please do not hesitate to contact us should you have any questions or comments.
Very truly yours,
PATHMAN LEWIS, LLP
G /
Dorinda Triponey
Legal Assistant