Alexander Tachmes/Marlo Courtney 760 Collins Associatesm 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 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Tachmes Alexander I.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Shutts & Bowen LLP; 201 S. Biscayne Blvd., Suite 1500, Miami, FL 33131
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(305) 347-7341 (305) 347-7754 atachmes@shutts.com
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
760 Collins Associates, Ltd.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
c/o Mario Courtney 804 Ocean Drive, 2"d Floor, Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(305) 531 - 4411 (305) 534-9080 marlo@goldmanproperties.com
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: R. Anthony Goldman, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Please see attached
II. sPECIFIC LossY IssuE: Variance from Section 130-35 in order to remove parking spaces.
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
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
MIADOCS 2881843 1
A) LOBBYIST DISCLOSURE: (Required) $400.00 per hOUr
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $400.00 per hour
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 pending bid for aoods, equipment 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":
^ Yes ~ No: Are you lobbying on a pendina application for a Development Agreement with the City or application for
change of zoning map designation or chancre 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 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 D No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15f 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 REP TING PERIOD.
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 contained in Secti~2~482 of the Miam~ea~lylrity Code and all reporting requirements.
Signature of
Signature of Principal/Client::
VI . LOBBYIST IDENTIFICATION:
NOTARY PUBLIC - STATE OF FLORIDA
Produced ID ~,,~.~~., _
~'CQomtn>ssttin a 651416
Personally knoirtr, ~~ '~jd1¢3~8; ~, 23, 2011
HONDEU TNRU ATLANTIC 80ND9VG CO.~ INC.
VII SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribe befo e me
This ~ day of t~_~ , 20 08
r !S ~t-d~-~
S~atuFe of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ J Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 12/08/04
MIADOCS 2881843 1
A) LOBBYIST DISCLOSURE: (Required) $400.00 per hOUr
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $400.00 per hour
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 0 No: Are you lobbvinq on a present or pendina bid for goods, equipment or services, or on a present or pending
award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
^ Yes 0 No: Are you lobbvinq on a pending application for a Development Agreement with the Citv 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 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 0 No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15~ 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.
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 contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
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 , 20 08
PRINCIPAL IDENTIFICATION:
Produced ID ~ • -~i~I~L8i2 t ~leerr pe
Form of Identification
Personally known (Princ'
-v, Notary Public State of Flarida
`~' ~; Rcxtolfo Perez
`-~~"` K n>fy Cammission DD554416
~or t`~ Ex!7+res 0712612010
State of Florida, County - - -~"
Sworn to and subscribec~.,be~ore me
This_~ day of ,Ju y , 20e~
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Signature of Pt)b'1]' tary -State of
Notarization of P nct 's signatu
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 12/08/04
MIADOCS 2881843 1
m ~~IAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CityClerk(a~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Alexander I. Tachmes
LOBBYIST NAME:
I understand that no later than October 15` of each year, I must file the following forms, pursuant to Section 2-485 of
the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County
Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
Signature:
Date: July 8, 2008
MIADOCS 2884866 1
760 Collins Associates, Ltd.
Disclosure of Interest
760 Collins, Inc. General Partner 25%
Charles Joseph Goldman Limited Partner 25%
Jessica Goldman Limited Partner 25%
Janet Goldman Limited Partner 25%
R. Anthony Goldman President 100%
760 Collins, Inc.
MIADOCS 2881843 1