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Neisen Kasdin/Plaxico, LLC .. M.~'""'"'!i Be~-::h bd:d 'ifll' m - - ;W3 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 dty personnel defined in .., 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 tenn -Lobbyists- has speclfte exclusions. Please refer to Ordinance 2004-3435. NAME OF LOBBYIST: Kasdin (Last) Npi~pn (Rrst) o. (M.!) Gunster, Yeakley & Stewart. P.A. ? S BUSINESS NAME AND ADDRESS (Number and Street) "Ri <:::r'rllTn~ ~, ur1 M; iU+li Flgr:h~'p311 ~l (City) . (State) . (Zi CoOe') (305) 376-6062 TELEPHONE NUMBER: (iOe:;) i7f1-f10l0 FAX NUMBER: nkasdin gunster. <X>IIl EMAlL: I. LOBBYIST RETAINED BY: NAME OF PRINCIPAl/WENT: Plaxirn. T.Tr BUSINESS NAME AND ADDRESS 2 S. Biscayne Blvd., #3800, Miami, PI 33131 (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: 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 n. SPEaFle LOBBY ISSUE: Lot Split for 110 First San Marino Terr., San Marl.'no Island, M' . l.aml. Beach, FL 33139 Issue to be lobbied (Describe in detail): m. aTY AGENCES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Finandal, Familial or Professional Relationship Planninq Department 1\11"1 Planning Board NO - . ..~ " IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST eOMPENSAll0N (DISCLOSE WHETHER HOUR L Y, FLA T RA TE OR OTHER): $10,000.00 A} LOBBYIST DISClOSURE: (Required) B) PRINOPAL'S DISQ.OSURE (OF LOBBYIST COMPENSATION): (Required), $10,000.00 Yes ~ Are YOU rearesentina a not-for-orofit c::orDOICIlion or entitY without, saecial comnensation or reimbursement. Pursuant to Ordinance No. 2004-3435. ' Pu=~== ~.A=-3393 Amendina Miami Beach Otv Code Chaoter 2, Article vn. Division 5 Th_f _.....:.-- _-__ia_ _~ e Refonn" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaiqn Contributions By LobbYists On Procurement Issues": 1) Yes B 2) Yes ~ v. Are YOU lobbYinG on a DreSeI1t or aendina bid for GOOds. eauiDment or services. or on a oresent or oenclna award for aoods. eauioment or senrice? =~=~"::R 2003-3395 Amendina Miami Beach Otv Code ChaDter 2. AlticE vn Division 5 m' ~ Refonn-. Via The Addition Of Code Section 2-490 Entitled ''Prohibited Camoaian Contributia1s By LobbYists On Real Estate DeveIooment Issues-: AreVOUlobbvinaonaoend~~ca~with~ ;';"i~~ ~~ of zonina maD desianation or chanae to the CitY's Future unci Use MaD? SIGNATURE UNDER OATH: ON ocrOBER 1ST OF EAOI YEA~ EACH LOBBYIST SHALL SUBMIT TO THE aTY CLERK A SIGNED STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDnuRE5, AS WELL AS COMPENSAllON RECEIVED, IN THE aTY OF MIAMI BEACH FOR THE PRECEDING CALEN R YEAR. A STATEMENT SHAU BE FILED EVEN IF THERE HAVE BEEN NO EXPENDnuRES OR N5AllON DURING THE REPOR11NG PERIOD. 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 i 'on 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: PRINCIPAL IDENllFICAll0N: VL LOBBYIST IDENl1F1CAll0N: -- Produced 10 ::. Produced 10 Form of Identification Form of Identification ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: -"personally known (Principal) State of Rorida, County of Miami-Dade Sworn and subscribed before me This ~dayof ALf.~~20f?!P' J-I~~ Signature of Public Notary - State of Rorida Notarization of Princi ai's si ",~II""" MARIA E. SMrTH f! ~~ MY COMMISSION II DO 550660 . \. . eXPIRES: June 19, 2010 Bonded Thru Notary Publlo underWltltra blic Notary - State of Florida 'on of Lobbyist's signature ~....... ~~ PAUlA MAJOROs J"1 MY COMMISSION I DO 37C341 J,i1l EXPlijES: November 8, 2Oll8 ~'fil" Bonded thill NoIaty PublIc UIldonwtIers _ / FORCLERK'S~ONLY ~ f I~ Annual Registration fee: [v' ] Yes [ ] No Amount Paid. ~,(5 MeR # Date Paid l~/2f''?- Lobbyist Registration Form received and verified by:. ~ Revised 02/10/04 F: C'i1R\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04