Julio Baladron/Miami Beach Community Kollel, Inc.
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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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Baladron \ Julio
(Last) (Rrst)
-:.;
NAME OF LOBBYIST:
J.
(M .I)
9016 Dickens Avenue
BUSINESS NAME AND ADDRESS (Number and Street)
Surfside
(aty)
FL
(State)
33154
(Zip Code)
(305) 861-0713
TELEPHONE NUMBER:
(305) 867-7765
FAX NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
Miami Beach Community Kollel, Inc.
NAME OF PRINCIPAL/CUENT:
Miami Beach Community Kollel. Inc.
BUSINESS NAME AND ADDRESS
3767 Chase Avenue
(Number and Street)
Miami Beach
(City)
FL
(State)
33140
(Zip Code)
(305) 532-8991
TELEPHONE NUMBER:
(305) 532-8925
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, PARlNER, OR BENEAOARY: Rabbi Yaacov Gross
. IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARlNERSHIP OR mUST:
II. SPECIFIC LOBBY ISSUE:
Application for variance to Board of Adjustment (BOA).
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or professional Relationship
Jorge Gomez None
Richard Lorber
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $500.00 Rat Rate
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $500.00 Rat Rate
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes X No: Are YOU lobbyinG on a present or pendinG bid for Goods. eauipment or services. or on a
present or pendinG award for Goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes X No: Are YOU lobbyinG on a pendinG application for a Development AGreement with the City or
application for change of zoninG map desiGnation or change to the City's Future Land Use
Map?
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-fur-profit
corporation or entity without special compensation or reimbursement 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
section but, shall not be required to pay any registration fees..
D Yes X No: Are YOU representinG a not-for-profit corporation or entity without special compensation
or reimbursement. .
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 EXPENDInJRES AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDIN CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE SEEN NO EXPENDInJ S OR COMPENSATION DURING THE
REPORTING 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 ntained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. /
Signature of Lobbyist:
Signature of Principa
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VI. LOBBYIST IDENTIFICATION:
~Produced I- '- B '-1.(30-7>2-0 r
v. MENDEZ ~ Fonn of Identification
MY COMMISSION # DO 285215
EXPIRE61 J~~ n (Lobbyist)
Bonded Thru Notary Public Underwnters
NAliJii'f AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
D Produced ID
State of Aorida, County of
Sworp~subsaibed fore me rl"
This ~day !>f ) 20..w;
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Florida
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~ FOR CLEI3..K'~.USE ONLY /j ("J CO ~
Annual Registration fee: [t,....-fYes [ ] No Amount pai~.;.(:) OU MCR r"- ~ ~ 70-,5 Date Paid / I J