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Kasdin, Neisen / Terra Inv. GY&S.P.A. I4J 002 11/05/04 10:26 FAX 13053766010 _0,... .,;..,...... Ik;..;.~ 'itW m . - - .;&IU~ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ,,- L.gbbyist means an pef5Ql\S empIllyed or retained. whether paid or "or.. by a prindpal who seeks to encourage the passage, defeat or modi~ of iII1Y ordnal1te. resolution. KtiOn or decision gt any l;ommissiol'lel'i iIf1Y amDn. decision. recommendillion of the CIty Manager or MY d\y baiIrd or eammiltel!i or MfY ildion, dedSlon or recommendation of any Of!f personnel defined in ilny maMef' io this se<;tion, during !he lime periCld af the entire decision-making p~ on such aet;an, deCislon Dr ~ that foreseeebly will be h8i1rd or nNiewed by ltle city <;OlMlission. or a dty board or committee. The term iiJ)e'dfic:il1ly Includes the princip;ll as well iI$ any emQIoyee tmgaged in lobbyiog activitieS. The term -Llll)byistS" hilS specific ndusioru. PlIIaSe refer tv OnIinanCII 2....3435. JU\-?,p J rJ NAME Of lOBBYlSf: (last) o. (M.I) BUSINESS NAME AND ADDRESS 30S~51&~ (PO~).. TElEPHOItE NUMBER: 1. LOIIYIST RETAlftED IY: :r~A. I tJf(Z;,6TNf.,N~S ( (t0C- NAME OF PlUNCIPAU'OJENT: 50~"5 Co ~IrJ S A1r~. :Jl-Z,:30Q rvuirnJ f!:xA.d\ (:L 3"3 Jet 0 BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) (Zip Cede) 305. 3&lo w770, 305 . fSloG, - qSq tf TELEPHONE NUMBER: FAX NUMBER; (Optlonal) EMAlL: (Opdonal) Fin out this sectiOn If printip8llls II eorp.tation, PiJrt11ershlp or Trust [SediOn 1....2 (e)] . N,lV4E OF OUeF OFfICER, PAl{fNER, OR. BENEFICIARY: . lDetmFY ALL p~ONS HOLDING. DIRECT\.Y OR INDIRECTlV, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPOAAl1ON. PARTNERSHIP OR. TRUst: D. SPECIflC LOBIY JSSUE: ~OLh~ s-arI\JDS ~k1 5t~ NtU'l ~vctL Issue to be lobbied (Describe In detail): P III. CI1Y AGENClES/INDMDUAlS TO IE LOI8IED: A) F. Nilme 0' JndmclualJlltle II) Any fi".nciill, Filmilial or Proressio".1 kellltian5llip NOf\J~ rJONE- 11/05/04 10:26 FAX 13053766010 i' GY&S,P.A. @003 IV. DISCLOSURE OF TRMS AND AMOUMTS Of' LOI8Y1ST COMPeNSATION (DISCLOSE WtlElHER ~OURL y, FLA T IlA TE 011 OTHER.): A) LOBBYtST DISClOSURE: (Required) B) PRlNCPAl. 'S DISCLOSURE. (OF L061MSr COMPENSATION): (lleqUired). e .=,:OU reansentlna a not.for-drofit mnKlnltion or entitv wItha&lt saeaal comlH!!Mation ar bu nto Pursuant to ordinance No. 2004.3435. . Pursuant to Ordinance No. 2003.33'3 AmendlnQ Miami Beach Oty Code Chaoter 2. Article vn. ~ S Thereof EntltlEld "Carnpalon Anance Reform" 'Ira The Addition Of Code Section 2-488 Entitled "Ptohibiled Camnaign CDnrrll;!utions BY Lobbylsts On PnnJO!ment Issues": Yes Yes S 2) Yes ~ Y. J 875,0'0 4f. 375,0-0 1) Are YOU Jobbvinq on a Dresent CH' _ndind bid far aoods. _uiDment or services. or on a Dr ~ 9r Dendina @Ward for 9DOdS. eauhllnent or set'Vic:e? PI.Irwant to Ordinance No. 2003-3395 Amendlna Miami Beach my rmp ChaDter 2. Article vn Division 5 ~ Entitied ~CamDaian Finance Reform" Via The Addition or Code ~on 2-490 Entitle:! "Prohibib!d Campaign Contnbutlons B\I Lobbvists On Real Estate DevelODrTEnt ls!aJes": Are YOU lobbying on a pendina apalimtion for a DeveIoDment AGreement with the C1tv or .QDlkation for chanae Dr zonina maD desiGnation or chanae to the City's Future 'JInd the Maf? SIGNATURE UNDER OA1M: ON OCTOBER 1" OF EAOt YeAR" EAot LOBBYJST SHALL SUBMIT TO ntE CITY CLERK A SIGNED STATEMENT UNDER OATH, usnNG L088YING EXPENDtTlJRES, A5 WELL AS COMPENS&1l0N RECEIV!D, IN THE CITY OF MJAMJ BEAOI FOR THE PRECEDING CAlENDAR YEAR. A STAlEMENT SHALL IE FILED EVEN IF THERE HAVE BEEN NO EXPENDrru~!7/rPENSATJON DURING THE REPORIlNG PERIOD. 'f!f!':( _ Sigl1ilture of lobbyist 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 contain in Section 2-482 of the Miami Beach aty Code and all reporting requirements. Signature of Lobbyist: Signature c;I Prindpal/Oient: VI. LOBBYIST lDEN1IFJ:CATlON: PRlNQPAL IDENTIFICATION: :: Produced ID :: Produced ID Form rI Identification 'f Personally known (Lobbyist) vn SIGNATURE AND STAMP OF NOTART: Form of identification v"rsonally known (Prindpal) Slate of Florida, County of Miami--Oade Swam and subscribed before me ,/ This ~ay of ;V tilJF'/I/,bGiflO.!?. Lf 0). ~ NYDlAR. MARTW . . ~ MY COtM.tSSION # DO m13l1l - . . - EXPIRES: July 17, _ 8IMHTfmI~ P....llIlde_ ~~ MY COMMISSION II DO 053918 EXPIRES: AugUSl29, 2005 lIondecI Thnl NcltiJy Pub/lQ Undllw11lerl ____ FOR MllU~ R.eglstratiOl1 I'ee: ( ] Yes [ ] No Amgunt Lobbyist ReglstratiOll Form receiYl!d and verified by: Revised 02110/01 F: ER: ~~ "~te P~id lIl816 ~ ( , M\I.OeaVlST\I.OeavIST FOR.M 04