Andrew Frey/Plaxico, LLC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL,33139
LOBBYIST REGISTRATION FORM
Lobbyist means aU persons empIoved or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification rX any ordnance, resolution, action or decision rX any cammissioner; 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-malcing process on such action, decision or r~
that foreseeably will be heard or reviewed by the city commisSion, or a city board or committee. The term specifically indudes the
principal as wen as any employee engaged in lobbying activitieS. The tenn -LobbJists- has specific exclusions. PIeHe refer
to Ordinance 2004-3435.
NAME OF LOBBYISr:
Frey
(Last)
.~Andrew
,. I ........
(First)
W.
(M.I)
Gunster, Yoaklev & Stp-w~rr p n 2 S.
BUSINESS NAME AND AODRE5S (Number and Street)
Biscayne Blvd., Miami, FL 33131
(Oty) (State) (Zip Code)
(305) 376-6000
TELEPHONE NUMBER:
(~nt;~ <7t:.._hn1(1
FAX NUMBER:
afrey gunster.com
EMAlL:
L LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/OlENT:
Pl ~xi ron, T.T.r'
BUSINESS NAME AND ADDRESS
2 S. Biscayne Blvd., Miami, FL 33131
(Number and Street) (Otv) (State)
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this sec:tion if principal is a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF 0i1EF OFFICER, PARTNER, OR BENEFlOARY:
Henry Batievsky
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Henry Batievsky, Mark Poses and Todd Poses
Do SPEaFle LOBBY ISSUE:
Lot Split for 110 First San Marl-'no Terr.. San M T'~
. ar;nn ~ ~nn
Issue to be lobbied (Describe in detail):
m. aTY AGENCIES/INDMDUALS TO BE LOBBIED:
Mi :::1m;
'Qa~,.....'h
.
FL 33139
A) Full Name of Indiwidual/Tltle B) Any Finanaal, Familial or Professional Relationship
Planning Department NO
Planning Board NO
Public Works NO
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y.
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $10,000.00
B) PRINClPAL'S OISO..OSURE (OF LOB~ COMPENSATION): (Required). $1 0,000.00
Yes Q ::=. rea&~ntlna a not-for-orofit co, DOIlIlion or entitv without, saecial camlll!!llSBtian or
~bu_ _ Pursuant to Onfmanc:e No. 2004-3435. .
~=E== No. =~ Amendina Miami Beach Otv CDde Chaoter 2. Article VIT. Division 5
___~ _ _ _ion A __ _" Via The AdcfJtion ct CntIP c:;..man 2-488 Entit:I8:I "ProhIbiIr!d
CamoaiQn Qriributions BY Lobbvists On Pnxurement Issues-:
Are vou Iobbvina on a Dresent or Dendina bid for GOOds. eauiament or services. or on a a-- nt
or gendina award for aaads. eauiament or service?
1)
Yes ~
2)
Yes ~
v.
= =~=. 2:::" Amendina Miami Beach Otv Code ChaDtel' 2. Article VIT Division 5
~ _ _ ~ An_ _-. Via The Adcfltion ct Code 5ed:ion 2-490 Entitled "Prohibilr!d
~~caian C"nntributions BY lobbvists On Real Estate DlNeIooment Issues-:
::.~ ~ ~ -:;a~n:-::cation far a Develaament Aareement with the CItY or
_=--=- _ _ zoni _D desianation or manae to the Catv's FutUre unci Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EAOt YEAR, EAOt LOBBYIST SHALL SUBMIT TO THE CITY a.ERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAl1ON
RECEIVED, IN THE CITY OF MIAMI BEAOt FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDnuRES OR COMPENSAl1ON DURING THE
REPOImNG PERIOD.
I do solemnly swear that all of the foregoing facts are true and correct nd 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. t!4
Signature of Lobbyist: ' ~
Signature d 1'liJlc1laVc&ent: .k::J---
VL LOBBYIST IDENlIfICATlON: PRINaPAL IDEN11FICATlON:
: Produced ID
Fonn of Identification.
~ Personally krown (Lobbyist)
vu. SIGNATURE AND STAMP OF NOTARY:
Sign re of Public Notary - e Aorida
Notarization of Lobbyist's signature
(i)~ PAULAMA.k)R()S
,: ~ ~1'-\ MY COMMISSION '. DO 37034 1
. . ~ EXPIRES: November 8, 2006
. IlondId 'lllru HolIry NJIc UncI8IWrtI8Ia
FORCLE 'S U~ONLY 2B( ",,~ ,^,
Annual Registration fee: [ ] Yes [ ] No Amount..Paid MCR # ~ Oate Paid ~
Lobbyist Registration Form received and verified by:
Revised D2IID/04 . ER \ M\LOBBYIST\LOBBYIST FORM 04