Maefield Holdings, LLC
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City of Miami Beach Office of the City Clerk
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 defined in any manner in this section, 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
"LobbyistsW has specific exclusions. Please refer to Ordinance 2004-3435.
Karp
NAME OF LOBBYIST:
Kobi
(Last)
(First)
(M.!.) DATE QUALIFIED AS LOBBYIST
17100 Collins Avenue
BUSINESS ADDRESS: (Number and Street)
Sunnv Isles Beach Florida
(City) (State)
33160
(Zip Code)
305-945-3636
TELEPHONE NUMBER:
305-945-3737
FAX NUMBER:
EMAIL:
I.
LOBBYIST RETAINED BY:
Maefjeld Holdinos LLC
NAME OF PRINCIPAUCLlENT:
1526 Blueiav Way
BUSINESS ADDRESS: (Number and Street)
Los Anoeles
(City)
Califomia
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
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: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Demolition Ordinance reoardino noncontributino structures
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvldualmtle B) Relationship
Joroe Gomez, Director None
Mer"" Lamazares None
Richard Lorber None
.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $150.00
') PRIN~A" D1SClDSURE (OF LOllBYlST CXJMPE""nON), (........,. :':.:
[I Ves.. . A . - ....0 a "on r entity without soecial CD 0 n tlon Dr
r:im~~~:':nr:~;,e:~~;n~ ~ ~:d~anc~~~r::-~435~
purs:nt to ~~i~nc~ No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Ther f Enti e " m aion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
;;n ;~;on~;;; ~n ;;;m; I;:":
E ve~ ~ 0/ oend~~a ~war~~:ro;oods. eau~o%ent o~ ~~~e? oDds. eauioment or services. or on a oresent
1)
~rs~~nt ~ ~rdi~n: No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
er f En itl d" m ion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
Eves ~:~~~V:oUnl;:~;~~::~ :, :~~~~ar:::~:~~:a:~:na :r:~~~~::::ea~:~e;~::~L:'~~: :ao?
2)
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
!"H~nature of Principal/Client:
: J
, " LOBBYIST IDENTIFICATION::RI
:~.. roduced ID Fl Dr ,i ( .~
I~ J J I. i Form of Identification
is J ~personallY known (Lobbyist)
::) :
-< ~'II""".- .
io. tB..YII. SIGNATURE AND STAMP OF NOTARY:
: \~~;:
L~ ~tate of Florida, County of Miami-Dade
N. ...... worn iT)! SUbscrib~efore me . /V /
This day of ny. 2O(.,!Y
,
"'-
o Personally known (Principal) [A"'1
f~~ -0:
f Nlll ~:
State of Florida, County of Miami-Dade lDI If f ~l
swor~subscribeQ~fore me /J// i~,. ~i
This day of / / .t:~120~r if i? fil. :
/),.. /J '1 /f. i~ i ~ ~ e;!
/a.{.,( P'LfA..., ae.<--, / i~ I g 11 zi
Signa~re ~f Public ~o~ry -, S~te of Floridb ~ tll ~
Notarization of PrinCipal s signature ..-........._.:
ignature of Public Notary - State of Florida
Notarization of Lobbyist's signature
FOR CLERK'S USE ONL V
Annual Registration fee: [ ] Yes [qffo Amount Paid -$ .;2S"'. ~~R # .::u.,. 93 )C) Date Paid ~ // r / or/"
Lobbyist Registration Form received and verified by: (, '
Revised 02/10/04 F: CLER\ALL\M -M\LOBBYI5l\LOBBYIST FORM 04
1 First Revision - 05-17-02