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Ira Giller/Southern Shore Prop.MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 IX)BB~ REG~TION IrORlVl by the city commission, or a city board or committee. The term spedf'~lly includes the principal as well as any employee ~ G ~ L c ~ & iR~,, '1:>. NAME OF LOBBYIST: (La~) (First) (Iq.Z) q74~ ~~10~..~o~=0~.4 la>.. ~/~~~. F:L- BU~:[NESS NAME AND ADDRESS (Number and Street) (City) (St~3e) (Zip Code) NAME OF PRINCZPAL/CI TENT: ~.o. '~,o F 1.1 ~O V~~e~ ¢ rry, BUSINESS NAME ~D ~ (~ and S~) (~) ~E NUMAR: F~ NUMAR: (Op~al) ' (State) (2ip Code) ENAIL: (Optional) RII out t~b ~ if principal b a ~, m~mrm~an~i~ or Tnml: [~ 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: · Lssue to be lobbied (Describe in detail): · TDENT[FY ALL PERSONS HOLD:lNG, DIRECTLY OR INDIRECTLY, A 5%OR MORE OWNERSHTP ZNTEREST IN SUCH SPEa]:ZC LOBBY ]ISSUE: ~'~ ::~ ~(:'/ ~ CZTY AGENCZESITNDZVZDUALS TO BE LOBBZED: A) Full Name of ZMvk~m/TWe B) Any financial, Familial or ~ Rdationship 1V. D]SCU)SURE OF TERHS AND JdqOUNIS OF LOBBY]ST COHPENSA1/ON (DXSCIOSE WHETHER tYOURL Y, FL4 T Rd TE OR OTHER):. 1) Pursuant to Miami Beach City Code Section 2-488 Entitled 'Prohibited Campaign Contributions BY Lobbyists On Procurement issues": OYes i~: Arevou iobbvine on a oresent or eendino bid for ooods, eauimnent or Servioes. orona ,mesent or Ixmdina award for ooods, eouiDment or service? 2) Pursuant to Miami Beach C~y Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development :Issues": OYes gld~: Are you iobbvina on a eendino aeMication for a Develomnent Aareement with the City or a.nofication for (:l~nqe of zonina mad desia~ or charme to the CitY's Future Land Use HaD? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit cx)rporatJon or entity without spedal compensation or reimbursenent for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this ~ YCs IG4~: Are you reoresenUnq a .no~-for-orofi~ ~ or enUtv without seecial cmnmmsM]on er reiml~ursement.. V. S~GNATURE UNDER OA'rH: ON OCTOBER IsT OF EACH YEAR, EACH LOBBYZST SHAJ~,-'~41T TO THE CI'TY CLERK A S/GNED STATEHENT UNDER OATH, I_T=CT/NG LOBBYING ~, AS WELL AS P, EC~IR/EI), m THE CITY OF Iq]Al4]: BEACH FOR. TH~~ ,~IMj~NDAR YEAR. A STATEHEKr ! do solemnly swear I:h~ll~ii~ foj~going facts are tree and correct and that ! have mad or am familiar with the ~~Section 2-482 of the Miami Beach City Code and all reportir~ .~ O0 ~ ~orm of Iden~ficaUon ~ of ldentif~tion [] Personally known (Lobbyist) [] Personally known (Principal) VI/. SZGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of MiamH:)acle Sworn to ar~J subso'ieed before me Sworn and subscribed before me // ~~~.,~.. ~!____~" /~i ~~ ~~~'~----11 ,~ J.../..~. -, ~~,~D~ 17~491 I~ /"/'./-."~ /~:"'~"'":.~ MY COL~MISSION # DD 175491 /! / / ~ ~ ~'/// / ~ - v ~'t~: ~ .......... ' .... I~l' i v I / 17.. ~l-_"':.v'a1~',',',',',',~ :~ * ' ~ ' /E ~,,.j,,..,,.,., uuruu~K, r~.~.m~ ']ll~~U~d~,~riters "~iPmcu ......... '~"'""'Y Il,~..~ ..... '~r~ruNotaryPub!icU~L~e~vriter$ /I Lobbyist Registration Form reoeived and verified ~ - F:\CLER\$ALL\MARIA-M~Lobbyist\LO~ K)R~ 05.~ R~ 1/2/08-/1~4