Jose Jimenez/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 prinripal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, rewmmendation of the
City Manager or any city board or rnmmittee; or any action, decision or recommendation of any dty personnel during the time
period of the entire derision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a city board or wmmittee. The term specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
JIMENEZ JOSE M.
NAME OF LOBBYIST: (Last) (First) (M.I)
Stearns Weaver Miller Weissler Alhadeff & Sitterson, P.A.
1 ~~ k+iost F1 ~1 Pr St ~ viii f P ~~nn ~, Miami, FL 331 30
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (Zip Code)
305-789-3200 305-789-3395 jmorales@swmwas.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
RRT RF.AT.TY TRTTST
NAME OF PRINCIPAL/CIIENT:
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) (Zip Code)
51h-77~-27~~
TELEPHONE NUMBER: 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, 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 St~eto
Issue to be lobbied (Describe in detail): ~ -_-+ ~
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: C ' rn
~ 7
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
CI? S~•
G` _
~ O
Buildin De artment _' ~~
N
Design Review Board
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERt
A) LOBBYIST DISCLOSURE: (Required) Hour 1 y - $1 9 0 .0 0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). HOUr 1 y - $1 9 O . 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 ~No: Are you lobbvina on a present or Dendina bid for aoods, eauipment or services, or on a
present or Dendina award for aoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~Vo: Are you lobbvina on a pending 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
Man?
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..
^ Yes X10: Are you representing snot-for-profit corporation or entity without special compensation
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 CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~~~ ~~
"re of Lobbyist
g~~;
i ~,5
~~
~LL
~j~~d
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 in~Se2-482 of the Miami Beach City Code and all reporting
requirements. ,--,c; X/ ~; ~_ / . _ ~/~
Signature of Lobbyist: ` "" ~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ 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 me
This day of ~(/f,~, 20 D
Signatur is Notary -State of Florida
Notarization of Lobbyists signature
FOR CLERK'S USE ONLY ~G / .~
Annual Registration fee: [ ]Yes [ ] No Amount Paid a'A MCR # 7~f7 Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION {DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHERf
A) LOBBYIST DISCLOSURE: (Required) Hourly - $1 9 0 . 0 0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). HOUrly - $1 9 4 . 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 tXNo: Are you lobbvina on a present or oendiina bid for aoods, eauipment or services, or on a
present 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":
i7Yes o: Are vvu Iobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or change to the Citv's Future Land Use
Map?
3) Pursuant to Miami Beach Gty Code Z-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-48i above) who only appears as a representative of snot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of ar opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
O Yes Flo: Are you representing snot-for-profit corporation or entity without svecial compensation
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 CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. 1~~ ~~
of Lobbyist
~ ` ~o
~Oc`~'
~:~~
a~ ~
~~~'`w ,
~t
. sdE`3
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 in Se 2-482 of the Miami i3each City Code and all reporting
requirements. ,
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL ID FICATION:
n Produced ID ^ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) ~ Personalty known (Principal}
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of .~[QSL 20 O
Signatu is Notary -State of Florida
Notarization of Lobbyists signature
State of FJe~ida; County of ~4iaa~i-Baele-
Sworn and subscribed before me
This ~~` d p).i,:twbP c . 20 ~`f
Signature of Public Notary - tats of F-i~a ~~,, pt(~
Notarization of Principal's signature
~' ;:, ~:
_.~;
__ Ci
~; ~~~~x
v~° °~
a ^ ~ :z ca C
~,r
_~~ ~~r
~~~~(~
-a,
,~~~0 4_,
- ^n _ +?i
_.;
:3=~ ~~
~.
FOR CLER 'SNLY '/
Annual Registration fee: [ ]Yes [ ] No Amount Paid 77 n~ MCR ~~ G v Date Paid
Lobbyist Registratfion Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc ^ ~ e Revised 12/08/04