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Jimmy Morales/BRT Realty Trustm MIAMIBEACH 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 aty 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. MORALES JIMMY L- NAME OF LOBBYIST: (Last) (First) (M.I) Stearns Weaver Miller Weissler Alhadeff & Sitterson, P.A. a„5~ 41ost Fl a.,l oar Ci- ~ ~,,; i-a ~~nn, Miami . FL 331 30 BUSINESS NAME AND ADDRESS ~ (Number and Street) (City) (State) (Zip Code) 305-789-3200 305-789-3395 jmorales@swmwas.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: RRT RF.AT.TY TRTTST NAME OF PRINCIPAL/CLIENT: BRT Realty Trust, Attn: Mark Lundy 60 Cutter Mill Road, Suite 303, Great Neck, NY 11021 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) S1h-77~-270 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Permitting and land use issues regarding 401 69th Street Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: n ." A) Full Name of Individual/Title 0 ~-~ o B) Any Financial, Familial or Professional Relatia~ship~ O c7 ~,~ I Buildin De artment ~' c~ ss ~~~ ~ -,-; .. Design Review Board T tV 7 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ~'•LAT RATE OR OTHERf. A) LOBBYIST DISCLOSURE: (Required) Ho ~ r 1 v - ~ 3 7 ~ D O B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). HOUr'l~ - ~ 3 7 5 _ 0 0 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": ^ Yes~}~lo• Are you lobbvina on a aresent or nendina bid for aoods, eauipment or services, or on a aresent or pending award for aoods equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes Xl~No• Are you lobbvina on a aendina application for a Development Agreement with the City or application for chanae of zoning map designation or chanae to the Citv'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 anot-for-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.. ^ Yes7dXNo• Are you representing anot-for-profit corporation or entity without special comaensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 CAL DAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR }COMPENSATION DURING THE REPORTING PERIOD. i of Lobbyist I do solemnly swear that all familiar with the provisions c requirements. Signature of Lobbyist: Signature of Principal/Client: of~he foregoing fa~ ar~ true and correct and that I have read or am mt fined in Section 482 of the Miami Beach City Code and all reporting VI. LOBBYIST IDENTIFICATION: ^ Produced ID o Form of Identification C N O O aO 0 Personally known (Lobbyist) y 0 m o ~ o v' `' ~ n VII. SIGNATURE AND STAMP OF NOTARY: c: ~ N p y h ~ i v fl E ~.,. ~ ~ State of Florida, County of Miami-Dade x a ~ ~ "' Sworn to and subscribed before me 20~ This _~day of , a~ • Qtr, o ~ ~ '~ fit' ,,s Signa r Pu lic Notary -State of Florida Notarit~tion of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLEIt~'~~SE ONLY ~~ Annual Registration fee: [ ]Yes [ ] No Amount P ' ~ ff /f) ; MCR ~_Date Paid ~ y ~ Lobbyist Registration Form received and verified by: s~:~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, fLAT RATE OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) - B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}: (Required). HOUrly - $ ~Z.`Z__ Q-~ p O 'C $ O LL ~ d m 0 ~ ~ ~ O cV L 4 ~ G ~ h ~ a`i Eo z- `- ~ ~ > K z~~~ a s 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": ^ Yes o: A in on a rese t or endin bid for Dods a ui ment or services or on a present or pendina award for Broods eauipment or service? 2) Pursuant to Miami Beach Clty Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^~ ~Wo Are you lobbvina on a oendina application for a Develooment Aareement with the City or applrcation for chance of zonina map desranation or chance 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 snot-for-profit corporation or entity withooutt of on o position tooan r item bshall register with pheaclerk as requ ~edl by~this indirect, to express supp PP y section but, shall not be required to pay any registration fees.. ^ Yes~dXNo Are you representin- " ~°` for-profit corporation or entity without special compensation or reimbursement. . ~/, SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMTi' TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE C][TY OF MIAMI BEACH FOR THE PRECEDING CAL DAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR OMPENSATION DURING THE REPORTING PERIOD. Ida solemnly swear that all of a foregoing f familiar with the provisions cost fined in Section requirements. Signature of Lobbyist: Signature of Prlncipal/Client: ~ VI. LOBBYIST IDENTIFICATION: Sigr~tur~ of Lobbyist true andt/correct and that I have read or am of the Miami Beach City Cade and ail reporting PRINCIPALIDE v ICATlvn: 0 Produced ID Form of Identification ^ Personally known (Lobbyist) VIi. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me20U` This ___f~_day of /1/!?~I ~ . _ Signa r Pu tic Notary -State of Florida Notari ion of Lobbyists signature ^ Produced ID Form of Identification _, G; -' va ~, '~- P; ^ Personally known (Principal) ~ o ~ ~; z~ ~1)J :3 C` 'l3 -Tin :... ~ State of Fler~a, County of M+ar~i-9ade- ~3 ~. 4`' ~ ~ ~ p -,r::~ Sworn and subscribed before me ~- ~ 20:;` 1 `>. ~, X01'- d ~'; :- :~- ~-. ~: r :;-~ - a This ;_~ ,~ f ~ c. 1~=~ ~~ ~ . " Signature of Pu lic No ry -State o ~.., ~ Notarization of Principal's signature FOR CLES 1~5E ONLY ~'7, / G?jDate Paid Annual Registration fee: [ ]Yes [ ] No Amount Paid ~~`_ MCR # Lobbyist Registration Form received and verified 6y: $ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYLSF fORM 05.doc O7 Revised 22/06/04