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Southern Shore Properties, Inc. Poli....; B..... W llIllJ to - - 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 dedslon.maklng 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 Indudes the principal as well as any employee engaged in lobbying activities. The term ~Lobbylst5. has specific exclusions. Please refer to Ordinance 2004-3435. Dougherty Lucia A. NAME OF LOBBYIST: 1221 Brickell BUSINESS NAME AND ADDRESS 305-579-0603 (Last) (First) AVenue, Miami (Number and Street) (City) 305-961-5603 (M.I) Florida 33131 (State) (Zip Code) doughertyl@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Southern Shore Properties, Inc. NAME OF PRlNCIPAl./CUENT: P.O. Box 2150 Ventnor NY 08406 BUSINESS NAME AND ADDRESS 215-740-6076 (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: 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: Anna Berbecarti~ IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNER5HIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Historic Preservation Board and Board of Adjustment Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Department Zoning Department 06.1'-'4.-04 11: .30 GREENBERG TRAURIG ~ 919544553q65 f',0.2:38 D83 IV. DllClOSUllf OHfllMS AND AMOUNlS OF LO'lnsT tOM"~H$ATlON (DI5CLOS~ WHETftIIlIlOIJRL Y, FtATRATEOIlOTIIER); ~ jI,) LOB8YlST DISC~05URf: (ReQlIl.....1 ..' '/iFt A-r ~ e..- I~O ~-1.ti. j3 I) PllJl.iClPAl'S OlSCLOSU~t (OF \.088Y1. COMPENSA1ICN)' (ktq~lred).~1g.t Tt" r __ ~ <if) API! vau ND_ntIna I.mtHar-Draflt _ration Dr AMitv withol!t sDeCllll CDmDe.Dn Dr re'IIIl1ursement. "'",!Suant to Ordl....nce ND, )004-3435. 1) ~'nt to Ol'ttin......l!jD. 21103-:1113 Armmdlna Miami Beach Clly Coll.. Chaoter 2. Anlde \II! OMslon 5 Thereor FIl'lItMd "CammjgJI Flnana! Reform" Via ThO! AddlftnnQ1~l! S&d;on 2-4811 Entitl~ .~ I:iIm!iIlan C,ontrlbubons !lIIlllbbvlstl On ProaJrl!l'r\ent r...".-, ~~fJ v. <iji) AN VlIU lobbYina On II I'.-t or IlMd1pa bid for aR.. _ulament I/: servlll8S. IW on II ~NHnt 91 DMCllna .wllNl for alllld.. ......I_"t Dr MftIlal? 2) Pul'l~'nt to 0111'..._ IIID :lJlG1.313'S Amendln. Mlamlllli!ach Ot-.. Code CIlapb!r 2 A~~ VII DMllon 5 lhered Entitled "Ca",....ID" "1~.11"" RIlfon'll". VII TItil Addition 01 CadI!! S<<!Ian 7-490 inlitlM "PI'oltlhlMd Qlmllllllln Qaqvtbutt/lrlll Bv I -"<<5 On R8il1 f'>t"ta !>>v.klllm8nt rs.ues', v"'-@ .,. YtIu-,"lIyllla on II Dendi... IllllJleatlan fer a o.veloDml!rft AaN!l!mIll'll: with the CiW...cu: aqallmtlOll 'D' dlan.. II' 8"1_ miD JlllIlanltlcm or ~hll"". tD Jill CItY- Futunl Land U!il! Mall? Y. SIGNATURE UNOER OATH; ON ocrol. I" 0" EAOl VIAR, EACH LO"YUT SHA.\.L IUIHn TO TtII CITY CI.IAIC A SIGNID "'ATEMENT UNDIR OATH, USTJNG 1.01llVlNG lX"ENDJTUItU, AS WlLL U COMPENSIlTlON ItEtEMP, 1M THI arY Of' MIAM! alACH IIOR THE PQCEDlHG CAUH YEAIl.. A STAnMINT SHALL IE FlLID MN J1I THERE 101"14 IEEN NO UJIl!NDITUIUS OR t StonON DUAlNG THE REPORnNG "EIUOD. r do aol"",nly swear thlt a" r:A the foregoin9 fact! lit true and correct and that 1 have reed or am familiar wfttt the pnlVI5Ionl contained In Section 2.-482 of the Miami !each City Code Ind alt reporting requirements, ~ SignatlJre or Lobbvist: ~~- ~C~ Signature of Prlncipal/Olent: ~ X VI, LOUYUT IDllmnCATlOIl; "Rlllla"AL IDltmfICATloN, ~'C''!o,*,~\ ~ -,(. ProduadlO~'S:. \.3.(" . e.c.-~~\;,-~S\ 0 PI'llll~t:I!d 10 Form fI Identltlatlon Fe"" of ldentiflcatlcn o Perscnlily ic.IIown (l.o~' 0 Personally known (prtntilNl1' VII. SIGNA-lUlU ANO ITAHI' Oil NOTARY; Slllte rI RoridI, ~~1ltY rI MI'II'lI-cadl! Sworn In 100 IUbKribed before me 'nIl$ 2Oc~ SQl~ of Florida. County 01 Miami-Dade Swom 1.1'Id subscribed before me Thl5~dayof 2 FOR 4nnulllltg15trllllan rH' 1 Yoi C 1 No ......OU<1t LDIIbylit AeglWJlion Form ~IVId InO verlllell by: Ilevlsed 02110104 ,: ! ,g.;l Co 'Ad/;_ - (/8'( o<L l ---1