Collins Avenue Associates LLC
SENT BV: BERCOW & RADELL, PAj
3053776222j
AUG-26-0211:38AMj PAGE 3/10
m'
'-
.-
.~
'"
!,.-{.
oty of Miami Se.dI afla of lhe City Celt
17lJO CgnnntJon Canter Drive, l"\illmi BeKh, R. 33139
E/lIiII: cltyt;:lctkOd.mi.~h.ll.u,
LOBBYIst REGISTRATION FORM
(~ of Miami Be.ch. Oty Code OIapter 2. om.ion J, SecI;iQn 1-481.)
. Check 80'](, if lIn Amendme"~
Hatlof
HAM! OF LOBBYIST: (uut)
lOa S.E. 2nd street Miami
BUSINeSS ADDRESS: {Number lInd 5trr:et} (City)
.(305) 995-5330 (305) 995-5340
TELEPHONE NUMBeR: FPoX NUMBeR:
Richard
(First)
(M.I) CA~ QUAlJRED ~ l.08BYTSr
Florida 33131
($tate) (Zip Cad.)
E/'1AIl.:
I. I.QIII8'(1ST RETAINED BY:
Collins Avenue Associates, L.L.C.
NNotE OF PRlNC1PALJCUfNT;
c/o BercoW & Radell, P.A.
200 S. Biscayne Boulevard, #850
BU~lNeSS AODFlfSS: (~, 1.1d Stt_t) (City)
Miarrii. Flori~a
(State)
33131
(Zip c:cd~)
r~o~) 374-5100
TEl.UHONE NU Me!A.:
(305) 377-6222
FA:( NJMBeR: (09t1rJ11.)
EI"\AIl.: (Optianlll)
Fill out thill_li..n II prh\cl'pal '" . COf1"Inat.iDn, P;1I11'.l'lIhi~ OJ' Trust. [SeCtion 2-&112 (eU
7 NAME OF CHIEF OffiCER,. PARTNal., OR BENEFICIAR":
Don Peebles
7 UST AU. PERSONS HOUJING, ODtECTI. Y OR INOlREc:n.. Y, A. S'Jt OR f'1QR!; OWNERSHIP IN11:ItfST 1N SUCH
CQ~A,l1l0N. PARTNEJlSHIP OR TRUST:
ll. SPEC1FlCLOBBY15SUE: Vari~nce Appli.;atiQn fox: Historic preseJ::v..atlon
Board regulati:ons, Sections '1S-SJ2(f') and '1B-564{f)(" )/Renewea
A~p11cation for Certificates of APpropriateness and Demolition .
ISSl,le to be lobbied (Describe in dl!C'llill: - .
In. ern AGENCII!S/JNDMDUAL.$'.TO II! lO'81I!D:
A) ,...U NlImll af IlUl1wicl....l(Ttde 8) ltc1ll!dllll-.ip
-
Jorge Gomez, Director .... None.
Mercy Lamazares None.
William Carey
None. -~----:-
Neither the Applicant nor its representatives will lobby members of the Historic
Preservation Board prior to the public hearing since they will be acting in their qua.~i-
judicial capacity.
SENT BV: BEACOW & AADELL, PAj
3053778222j
AUG-28-02 11 :39AMj
PAGE 4/10
-
?,-
IV. DJSC1,OSUAE OF -rEAMS AND AHOUNlS OF LO..YlST C_p~SAT10H (DI5C1OSE WHEllER HOU'U. Y.
FI.A T RA T! OIl OTHER):
B) PRINClP-' 'S DISQ..OSU~ (Of LCBO'l'15T CCl'V'fNSATlON):
SaJ,arv ..
A) LOB8YlST DISC1OSURE:
)c4/ fir-I
I
V. SlGNAT1IAE UJIIOI!R OA'1II:
ON ocTOBER 151 of EACH 't~R.. EACH 1.0BBYlST SHALL SUBMIT TO THE CITY cLERK A SIGNED
STATEMENT UNDER OATH, USTUIG 1.DBaY1NG E)C.PENDITURES IN THE CITT OF MIAMI BEACH FOR
THE PREc:EDING CALENDAR 'YeAR.
1 do solemnly swear that all or the fDreQOing facl:S are true and ~rrect and tI1at.l have read ot am
familiar with the provisions contained in SeCtiOn 2-482 of Lhe Miami Beach City Code as amended, and all
reportl~ requirements.
Signature of LDbtJvjst: .
Signature of Prindpal/Clienl:
VI.
d Prcducl!d to
Form of Identification
;( personally Known
VII. SIGPlA1URI: AND srM4P OF NOTARY OIl DaoUTY CLJtItKI
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This ~'1"'" day of A~~~( ,2002,
L. JUOITH GASKELL
NotarY Public, St8t8 of Florida
My convn. expo Jan. 23. 2004
Comm. No. CC90431~
d-~ ~~~
Signature of pCSc Notary - State of Florida
L. ::>"'0\<'-' ~f\I.~,<e. l-L..
Print, stamp or type name of Notary pub&ic
~-
FOR CLERICS USE ONLY
ReolSQ'lltion: IX'l p.CCEPTEO [) ~ECTED
DATE:
9-3:~a2.
If rcjstcd, slatIB reason: '
R~i$U1IIicln fee peld: W. l ) No I') 5 SJ::lj..
~~o..<k MeR # '- ~
?"TA EJl(R1 DATE' . _' ""', .EHT'- BY' · P
=-
.-- .-
.-
- ..,,----,.
, F!lIl11e..ision - 05/17/02