Michael Larkin/928 Jeffferson Avenue LLC
G
MIAMI BEACH
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
"LobbyistsR has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Larkin
(Last)
Michael
(First)
(M.!)
200 South Biscavne Boulevard. Suite 850
BUSINESS NAME AND ADDRESS (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
(305) 377-6220
TELEPHONE NUMBER:
(30S) 377-6222
FAX NUMBER:
mlar1<in(ij)brzoninolaw.com
EMAIL:
I. LOBBYIST RETAINED BY:
928 Jefferson Avenue LLC
NAME OF PRINCIPAL/CliENT:
c/o Bercow & Radell. P.A. 200 S. Biscavne Blvd.. Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6231
TELEPHONE NUMBER:
305-377-6222
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: Itshak Ankonina
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Aoolication for certificate of aoorooriateness for demolition and desion with reaard to orooertv located at 928 Jefferson
Avenue. Miami Beach. FL 33139
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional
Relationship
William Carey NONE
Thomas Mooney NONE
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $360.00 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $360.00 oer hour
I- Yes X No: Are vou reDresentinG a not-for-Drofit corDoration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2, Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
I Yes X No: Are vou 10bbvinG on a Dresent or DendinG bid for GOods. eGuiDment or services. or on a Dresent
or DendinG award for Goods. eauiDment or service?
Pursuant t~ ~rdinan~e No. 2~03-3~95 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof EO-.:tLd "Cam_aion Fin_nce R_form". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
~Yes X N:: A~V:~ I~:~~in~:n : D~n~inG aDDlica~ion f~r a DeveloDment AGr~ement with the City or
_DDh_ _ n ___...ha _e _f z nlnG maD deSIGnation or chanGe to the City'S Future Land Use MaD?
2)
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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 THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
<:!2t~~
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 contained in Section 2-482 of the Miami Beach City Code and all
reporting requirements.
Signature of Principal/Client:
/J11W~
.~
Signature of Lobbyist:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID
Produced 1D:r:sRAE-U ~l2.lVt:1Z..S
LA WJ~ntification
Personally known (Principal)
Form of Identification
~rSOnallY knOW~bYist)
VII. SIGNATURE AND STAMP OF NOTARY:
;.
Notary Public State of Florida
Salome Otegui
My Commission 00489780
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First Revision - 05-17-02