Puckkey Investments L 9, LLC
,.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Bach, FL 33139
Email: cltyclerk@ci.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o 15 Check Box if an Amendment
NAME OF LOBBYIST:
Bercow
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard Suite 850 Miami
BUSINESS ADDRESS: (Number and Street) (City)
Florida
(State)
33131
(Zip Code)
13051377-6231
TELEPHONE NUMBER:
13051377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Puckkev Investments L 9, LLC
NAME OF PRINCIPAUCLlENT:
Andres Pukke. 11509 Dahlia Terrace
BUSINESS ADDRESS: (Number and Street)
Potomac MD
(City)
80854
(State) (Zip Code)
301-785-1788
TELEPHONE NUMBER:
301-330-6779
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 OF BENEFICIARY: Andres Pukke
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Review bv Slnale-Famllv Residential Review Board
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvldualfTltle B) Relationship
Philio Azan, Director, Buildino Deoartment None
Jorae Gomez, Director, Plannina Deoartment None
Thomas Moonev, Plannlno Deoartment None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FL4 T RATE OR OTHER):
A) lOBBYIST DISCLOSURE:
$400.00 Hourlv
B) PRINCIPAL'S DISCLOSURE (OF lOBBYIESTCOMPENSATION):
$400.00 Hourlv
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaater 2 Article VII. Division 5
Thereof Entitled .Camaaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled 'Prohibited
Camaaian Contributions Bv Lobbvists On Procurement Issues':
2) Pursuant to Ordinance No. 2003.3395 Amendina Miami Beach City Code Chaater 2. Article VII. Division 5
thereof Entitled 'Camaaian Finance Reform' Via The Addition Of Code Section 2-490 Entitled .Prohibited
Camaaian Contributions Bv Lobbyists On Real Estate Develooment Issues':
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
PRESEDING CALENDAR YEAR.
I do solemnly swear that all of the ~
with the provisions contained in S
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o IS Produced 10
Form of Identification
~ IS 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 .tL day of S. , ,~ 2003
LISA C. STEFANONt
MY COMMISSION # OD 232758
EXPIRES: July 20, 2007
Bonded Thru Notary Public Undelwriters
c\ . ~ .
S;9",,"~F~';d'
Registration:
Lt. Sftjanonr
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY , J . J
[ ) REJECTED DATE: 10 LZ-K' L~
. ,
If rejected. state reason: /
_","00" pO' \ \ ~ ~ U"CR.6! to '!JJf/
pATA ENTRY DATE: j,Q}:>u ,iQQ2> ENTERED BY
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE:
$400.00 Hourlv
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
$400.00 Hou~v
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code ChaDter 2 Article VII Division 5
Thereof Entitled "CamDaion Finance Refonn' Via The Addition Of Code Section 2-488 Entitled 'Prohibited
CamDaian Contributions Bv Lobbvists On Procurement Issues':
Are you lobbvlna on a Dresent or Dendina bid for aoods. eaulDment or services. or on a Dresent or
oendlna award for aoods. eaulDment or service? Yes No
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code ChaDter 2 Article VII, Division 5
thereof Entitled "CamDaian Finance Refonn" Via The Addition Of Code Section 2-490 Entitled "Prohibited
CamDaian Contributions Bv Lobbvists On Real Estate DeveloDment Issues':
Are you lobbvlna on a oendlna aDDlicatlon for a DeveloDment Aareement with the City or aDDllcatlon for
chanae of zonlna maD deslanation or chanae to the City's Future Land Use MaD? Yes No
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
PRESEDING 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 Miami Beach City Code as amended, and all reporting
requirements.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Signature of Lobbyist:
o .05 Produced 10
Form of Identification
~..s Personally Known
VII. SIGNATURE AND STAMP OF~TARY OR DEPUTY CLERK:
M 1> M "If ~ "'""^-
State of Florida, County of Miami- ade
Sworn to and subscribed before me
This _ day of , 2002.
Signature of Pub
Registration:
~J Let" ~ M.~ H tJ
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
[ I ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ I Yes [ I No
[ ) Cash [ ] Check MCR #
DATA ENTRY DATE:
1
, 2002 ENTERED BY: