Robert Moehring - 2924 Prairie Partners, LLC . .
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City of Miami Beach Office of the City Clerk n
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.
Moehring Robert
NAME OF LOBBYIST: (Last) (First) (M.l)
DOMO Studio LLC, 420 Lincoln Road, Suite 506 Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-674-8031 robert@domodesignstudio.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact:information changes:address,phone,ar e-rtrair address.
I. LOBBYIST RETAINED BY:
2924 Prairie Partners, LLC
NA� o 2 i Box40249 Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-542-1131 tmgeng64@aol.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
I
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY see attached
1
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY R INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, 3
PARTNERSHIP OR TRUST: see attache _J
Development Approvals and Permitting Issues, including, but not limited to Historic
ll. 'rese attion ew rd, Planning Board, Design Review Board, Board of Adjustment, Land Use Development
Committee,and City Commission, if necessary,relating to the property located at 2924 Prairie Avenue, Miami Beach FL.
Issue to be lobbied(Describe in detail):
Ill,CITY;AGENCIES NDIVIQUAL TO se-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 a eneral 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 , Building, Publlic Works and Fire Dept Staff None X
, I, , °":, =•', I ommtsston,an• an. Ise
None X
III- •,..-• •u.1r -- .- .•. .__, . ....
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
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1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
PRINCIPAL'S DISCLOSURE(OF OBBYISJ♦COMPENSATION):
(REQUIRED)... ' � .fir
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 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 X No: 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.
YesXNo: 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.
Signature of obbyist
I do solemnly swear that all • tie f, gal g fa are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 • "If o nd all reporting requirements.
Signature of Lobb ist:
y
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced JD Produced ID
Form of Identification Form of Identification
,Personally known(Lobbyist) Personally known(P
� /if9MICHELLE BRADY
VII. SIGNATURE AND STAMP OF NOTARY: MY COMMISSION 07896
MICHELLE BRADY EXPIRES:AUG 09,2019
State of Florida,County of Miami-Dade r-"% MY COMMISSION#Ff907B96 State of Florida,County o armed Rough 1st Bile Insurance
Sworn to and subscribes(before me x. EXPIRES:AUG 09,2019 Sworn 9.0 subscribed be ore me
This la day of Pi 0M1444,241 I 0.0.04r Bonded through 1st State Insurance This � Le day of ' • ,201
attut1. 14.A A
Signature of Public Notary-•State of F• da Signature of Public Notary—State of F•rida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLE"""-" 1TY CLERK'S STAFF 0 Y
Annual Registration.fee (! es:( ]Na Amount Pais 1ACR# g b : '"►) bate Paid_
Lobbyist Registration Fo eceived and Venfied by -. _-
-_:.Y t G f`a v; ''4 .s-_F'3 tiw11_4a y,`-•?s Y yl.,: 't r r �:S;S'74: - :Revise, 01/22/2014
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granath),City Clerk CityClerk@miamibeachfi.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Robert Moehring
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.to the Miami-Dade County Commission on Ethics and Public Trust.
/0/7--h g—
Signature: Date:
•
•
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`° OWNER AFFIDAVIT FOR INDIVIDUAL OWNER
STATE OF
COUNTY OF
I, ,being first duly swom,depose and say that I am the owner of the property descrind and which is the suit
matter of the proposed hearing;that all the answers to thequestions in this application and all sketches data and other supplementary matter attached to
and made a part of the application are true and correct to the best of my knowledge and belief.I understand this application must be completed and
accurate before a hearing can be advertised. I also hereby authorize the City of Miami Beach to enter my property for the sole purpose of posting a
NOTICE OF PUBUC HEARING on my property as required by law and I take the responsibility of removing this notice after the date of hearing.
PRINT NAME SIGNATURE
Sworn to and subscribed before me this day of ,20 .The foregoing instrument was acknowledged before me by
,who has produced as identification and/or is personally known to me and who dldlcld not take an
oath.
NOTARY PUBLIC
NOTARY SEAL OR STAMP
PRINT NAME
My Commission Expires:
ALTERNATE OWNER AFFIDAVIT FOR
CORPORATION or PARTNERSHIP
ci � � (Circle one)
STATE OF
f
COUNTY OF,M t I Ni 191
O k c m and that I am the 1 c ' of )Li ��lltl.
T°jJ d swam, say
duly �'V
and as such,have been authorized by such entity to this application that all answers bthe questions in the
application and all sketches,data and other supplementary matter attached to and made a part of the application are true and correct to the best of our
knowledge and belief;that the corporation is the ovmerltenant of the property described herein and is the subject matter of the proposed hearing.We
understand this application must be completed and accurate before a hearing can be advertised.I also hereby authorize the City of Miami Beach to enter
the subject property for the sole purpose of posting a NOTICE OF PUBUC HEARING on the p operiy as required by law and I take the responsibility of
removing this notice after the date of hearing. ,_
J i 6 tf-st- _,,,stil
PRINT NAME S NATURE
before me this P.
of fi�'r 20 ! .The foregoing instrument was acknowledged • •re me b
Sworn to and subscribed day + 99 9 by
, of , on behalf of such entity, who has produced
as identification and/or is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP: +s""� S
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DAVID.,OLajYtOi! L-
NOTARY
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d=•g r iP_My Comm.Expires Aug 10.2018E NOTARY PUBUC
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My Commission Expires:
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E,Ci7CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1.CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION,list ALL of the stockholders,and
the percentage of stock owned by each. Where the stockholders consist of another corporation(s),trustee(s),partnership(s)or
other similar entity,further disclosure shall be required which discloses the identity of the individual(s)(natural persons)having
the ultimate ownership interest in the entity.*
)11)1 rflA((ME PA flArtar, L t�
CORPORATION NAME
NAME AND ADDRESS %OF gOCK
TO11 6 ORA Pool 0i4)41 MPRL3)t90 `io
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Maim' rL 3301
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CORPORATION NAME
NAME AND ADDRESS %OF TOCK
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(GritaLtr rt g4T is 10670 Q-f 607n )
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IF THERE ARE ADDITIONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP.NAME(S)AND EACH INDMDUAL
STOCKHOLDER'S NAME,ADDRESS, OFFICEAND PERCENTAGE OF STOCK ONA SEPARATE PAGE
NOTE:Notarized signature required on page 8
6
Miscellaneous Cash Receipt , i.. ,j ,/Q2/20 it 0;0 1
• -1-curt-OF MIAMI BEACH rt s C. st C ar$ 4200 A.10 :
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❑ Cash O Credit Card :Check# . oC.:):
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(THIS INFORMATION.MUST BE COMPLETED) Offic of finance Director
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City of Miami Beach-Florida
Finance Department
1 City Hall
1530613-1 11/02/2015 BR1 T113
Mon Nov02,2015 04:32PM Trans#15-15
15 $1200.00 MCRCLERK - MCR-City Cler
* MCR#: 408080
1 ITEM(S): TOTAL: $1200.00
Check (1401) PAID $1200.00
Have a nice day!