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American Leisure Resort, Inc. .. . City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Email: cityclerk@cLmiaml-beach.fl.us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) Check Box if an Amendment Adler. Brian S. NAME OF LOBBYIST: 7/15/02 (M.!) DATE QUALIFIED AS LOBBYIST (Last) (First) 200 South Biscavne Boulevard. Suite 2500. Miami. Florida 33131 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) (305) 350-2351 TELEPHONE NUMBER: (305) 351-2206 FAX NUMBER: badler@bilzin.com EMAIL: I. LOBBYIST RETAINED BY: American Leisure Resort. Inc. - Leon Cohen Levv NAME OF PRINCIP AUCLIENT: r 5875 Collins Avenue. BUSINESS ADDRESS: Miami Beach. (Number and Street) Florida (City) 33140 (State) (Zip Code) (305) 695-8400 TELEPHONE NUMBER: (305) 695-2800 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: Leon Cohen Levy ? LIST ALL PERSONS HOLDING, DiRECTLY OR INDiRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: N/A II. SPECIFIC LOBBY ISSUE: AODroval for Construction of a New 22 StorY Condominium Buildine on a Vacant Lot Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name ofIndividualffitle B) Relationship Design Review Board And Any Subsequent Meetings Necessary Doc.#568594 v.J . . IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: $270.00 nib B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $270.00 nib V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the . ach . Co as ended, and all reporting requirements. Signature of Lobbyist: .. Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ill fOL- ..f.:=. \ 10 4$"). Lf q y b 3 - U Form ofIdentification ." ~ X Personally Known VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK State of Florida, County of Miami-Dade Sworn to and subscribed before me This~ day of JvL-, , 2002. GISEllE PACHECO MY COMMISSION t DO 016885 EXPIRES: Aprt110, 2006 BondodTl1nlPlohaRlI_.IQoncy Print, stamp or type name of Notary Public FOR CLERKS USE ONLY Registration: ~] 7-1&-~'2- REJECTED DATE: ACCEPTED [ ] If rejected, state reason: Registration fee paid: ~ Yes [ ] No 2., [ ] Cash ~ Check MCR# DATA ENTRY DATE: ilrb ,2002 I l I First Revision - 05/17/02 Doc.#568594 v.1