Michael Larkin/Elena Feldenkreism MIAMIBEACH
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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 prindpal who seeks to enoourage the passage, defeat
or modification of any ordinance, resolution, action or derision of any commissi~er; any action, decision, recommendation of the
City Manager or any rity board ar committee; or any action, derision or recommendation of any aty 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 aty commission, or a aty board or oixnmittee. The term speaficaly includes the prinripal as well as any employee engaged
in lobbying activities. The term "Lobbyists' has spedfic exdusiars. Please r+eFer to Ordinance 2004-3435.
Lartdn Michael W.
NAME OF LOBBYIST: (Last? (First) (M.I)
Bartow, Radell A Fernandez P.A. 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Elena Feldenkreis
NAME OF PRINCIPAL/CLIENT:
5222-5224 North Bay Road Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 873-1310
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Approval for 5222-5224 North Bay Road
Issue to lie lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Profe~ional Relationship
Planning Department, BOA, City Commission * None
9t.:W rtY ~ ,.. ..
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not bbbied outside ~ ~blit hearing setting.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER MOV/RLY
FLAT RATE OR OTHERx
A) LOBBYIST DISCLOSURE: (Required) $ 385.00 cer hair
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $385.00 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 X No: Are you lobbying on a present or pending bid for goods" eauiument or services, or on a
present or pending award for goods, eauiornent or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No: Are yQu lobbying on a cendina aRplication for a Develoo~greement with the City or
application for chance of inning map desianadon or d~anae to the Cup's Future Land Use
Man?
3) Pursuant to Miami Beach City Code 284 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 281 above) who ony appears as a representative of anot-for-profit
corporation or entity without speiaal compensation or reimbursernent for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the derk as required try this
section tart, shall not be required th pay any registration fees..
^ Yes X No: Are You reort'senting a not-for-profit corporation or entity witlttout 1 compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER i~ 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
Signature
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. _„ ~ ~ ~ ~ _ p
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
IDENTIFICATION:
~~
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom~~d sut,scri me
This y of 2~
,~
Sign ture o b c ry -State of Florida
Noffirizati Lobbyist's signature
FOR CLERK'S USE ONLY 9 ~j
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~_ MCR #~~ / 0 ~ Date Pai f
Lobbyist Registration Form received and verified by: Entered By: ~
F:\CLER\BALL\MARIA-M\Lobbyist\LOBBYISTfORM OS.doc Revised 12/08/04
^ ProducedID
Form of Identification
personally known (Principal)
State of Florida, County of Miami-Dade N~
Swom a d cribed before me ~
Thi day u- 20~
. ~ Public Notary -State of Fkxida
Notarization of Principal's signature
,4 ~~ ~~ e
qty of Miami Beath, 17rJC? Cor:vention Center Drive, Miom's Beads, flori~a 33 i 39, v+vrw.m€amibeochfl.gov
CiiY CLERK Office
7e1: 3£15.673.741 I ,fox: 34S.b73.7254
C iiyC{erk~m+om i beach fl. g av
LOBBYIST NAME: ~ 1 C~~G,~.~~ (+C~ n
I understand that no (ester than October 1st of each year, 1 must file the following
forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
I ~ Lobbyist Expenditure Form
2~ Disclosure Farm
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 tv lobby on has been resolved, I am required
to immediately notify the City Clerk's C>fFice of loE~byist withdrawal in writing-
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Signature: Date;
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