Harold Rosen/SB Realty Investors, LLC
r.lllJ1M'lII:lC.ftl;h
b::l!r.ld
~iiP
in
-
-"lV3
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, ';'hether paid or not, by a principal who seeks to encourage ihe passage, defeat
or modification of any ordinance, resolution, action or dedslon of any commissioner; any action, decision, recommendation of the
City Manager or any dty board or committee; or any action, decision or recommendation of any' dty 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 dty 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. .
NAME OF LOBBYIS1f:
ljb7 LIN{O~,v
BUSINESS NAME ANO ADDRESS
l2o<;e.-v
(Last)
i204l? 'DH t;e-
(Number and Street)
/! 4<2 c {~ (j
(First)
.M14-A1/
(Qty)
P,e"'l< ,t-
(State)
PL.
(M.I)
33>1";31
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER:
EMAIL:
I. LOBBYI5T RETAINED BY:
sg [Z.F.4L TY :I10iJ2S7tY2S 11~L-L
NAME OF PRINCIPAl/CUENT:
~[ S S 0 [\?'+--'
BUSINESS NAME AND ADDRESS
'~UJ&' ?f\-L{
(Number and Street)
)lit IAv-'1. I l7e#H
(Qty) (State)
rL
'53139
(Zip Code)
5D5 7t {
TELEPHONE NUMBER:
1(C{r;~
FAX NUMBER: (Op~onal)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [5ection 2-4B2 (c)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY I55UE:
(()/JOiTLO/V4-1 Ilee;:;- A-PPC-l't,fltUN F~ \461 on::.A!-v
Issue to be lobbied (Describe In detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
u(Llllr?
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
PL.ANNVVG g,D-WO
NO
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL",'
FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) j ~ 600 iZ ClAW e..... '" t J.!) If) .'U'r h" w-
r ~ I
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired). 1z-r::t':>D ,71'"'7-1' ..JCM- cr+ ~ /JJP.r 110M
. . f fi . 'th' I I ,
ov S 0: Are au re rese In a no -r- r I r ra Ion or WI S cia c mensa Ion r
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv 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 LobbYists On Procurement Issues":
Are ou lobb 'n n a r s n r din bid or ods ui en or rvie or on res nt
or Dendina aw~rd for coods. eauioment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
Are ou lobb in on a en in licati n for a D velo men A r em n w' h he Ci or
aDDlication for chanae af zonina maD desianation or chanae to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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. ~
y./ Signature of Lobbyist ---..
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 contai ed in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o Prod uced lD
Form of Identification
.tRINCIPAL IDENTIFI~TI~
'''''duced lD -,L ;L\ J..J C,
/' Form of Identification
o Personally known (Principal)
o Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
om d subscri before m~ 0 .
. This ay of _ 20
/' /'
Signature of Pu tic tary - State of Florida
Notarization 0 obbyist's signature
"'\":!"" Constanza Toth
~~..'f>:'" 04
"<:'"""'~~ Commission #002872
~;;" ":):.i,:l Expires:Feb 03, 2008
....,.,~0;f\.Q'<'~".., . Bonded Thru
""1111\\\ . Atlantic Bonding Co., Inc,
'~lItv, Constanza
,~.,..~~ . Toth
g.:"""'t\..::. Collllllission#D0287204
~~;,:..~ol..i' Expires: Feb 03, 2008
",Rfl~\'" ~onded.Thru
Atlantic Bonding Co., Inc.
. L FOR CLERK'S USE ONLY . . .
Annual Registration fee: [ ] Yes [ ] No Amount Paid ) 5 P<::/ MCR # ~")T~ate Paid \ (') -;::.,.~
Lobbyist Registration Form received and verified by,,- ,p. ""-""'" 'I I
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYI5T\LOBBYIST FORM 04