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Robert Fine/LG 94, LLC ~'i.... B...m b:II!ll:d ffiif .llIlI3 lD - - 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 "LobbyistsN has specific exclusions. Please refer to Ordinance 2004-3435. Fine Robe~ S. NAME OF LOBBYIST: (Last) (First) (M.!) 1221 Brickell Avenue Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0826 305-961-5826 finer@9t1aw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: LG 94, LLC. NAME OF PRINCIPAl./CUENT: LG 94, LLC. BUSINESS NAME AND ADDRESS 94 LAGORCE CIRCLE, (Number and Street) MIAMI (City) FLORIDA (State) 33140 (Zip Code) 786-208-2113 TELEPHONE NUMBER: 305-538-4302 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: TOOD GLASER IOENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: TOOD GLASER AND ALAN L1EBERMAH II. SPECIFIC LOBBY ISSUE: BUILDING & ZONING ISSUES Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Indivldual/Title B) Any Financial, Familial or ProfessIonal Relationship BOARD OF ADJUSTMENT PLANNING I ZONING DEPARTMENT FIRE DEPARTMENT IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ 3 9 5 . 00 Hour 1 y B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST eOMPENSATION): (Required). $ 3 9 5. 00 Hour ly r 1) ~rs:nt to ~rdinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5 e f Enti ed "Camoalan Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaian Contributions Bv LobbYists On Procurement Issues": 2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. ArtIcle VII Division 5 the;:;of Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY Lobbyists On Real Estate Deyelooment Issues": Yes V. SIGNATURE UNDER OATH: ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAll BE FILED EVEN IF 1MERE HAVE BEEN NO EXPE~"~flJ1''''.1ME REPORTING PERIOD. 'E==:> Signature of Lobbyist VI. LOBBYIST IDENTl ing facts are true and correct and that I have read or am ction 2- e I i Beach City Code and all reporting I do solemnly swear that all of the for familiar with the provisions co 'ned' requirements. Signature of Lobbyist: Signature of PrincipalfCr o Produced ID Form of Identification PRINCIPAL IDENTIFICATION: l=-'- ~"'. ,,-'c. -jI'roduced ID ~ ,-\"u,. - 'Bt:1;) - '0'" -0 \ \ - 0 Form of Identification ""'" Personally known (Lobbyist) VII, SIGNATURE AND STAMP OF NOTARY: o Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This ~'\ da of 20.0,\ State of Florida, County of Miami-Dade Sworn and subscribed before me This ~day of ~~. . 20.Q.'"\ .,~~r.",. Notarization of Principal. signa1;ure FOR CLE Annual Registration fee: [ 't;'es [ ] No Amount Paid Lobbyist Registration Form received and verified by: Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYISl\LOBBYIST FORM 04 E ONLY 7 C/ u.,/ MCR # d 0;;; hate Paid (/7 .;;;;2'