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The Kabbalah Centre - " \ lD - CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 cityclerk(1ilci,miami-beach.f1.us AFFIDAVIT 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 ANY CITY BOARD OR COMMmEE; OR ANY ACTION, DEOSION OR RECOMMENDATION OF ANY 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 CITY COMMISSION, OR A CITY BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT, ATIORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVrnES FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATIORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL." Llorente Jezabel 1) lobbyist Name: la~ Name '- First Name Middle Initial Business Phone (305) 358-6300 Message Phone (305) 347-7399 Business Name and Address: Shutts & Bowen LLP 1500 Miami Center, 201 South Biscayne Boulevard Miami FL 33131 No. Street Suite Oty State Zip Code Email Address: jllorente'ilShutts _law. can The I<"hh>llah Centre, Principal Retained by: 5401 Collins Avenue, If different from above Miami Beach a not-for-profit Florida Corporation 2) Units CO llA&B Street FL State Suite 33140 Zip Code City (a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner, beneficiary or interests. See Exhibit "A" Mt-+-rt~hPrl. 3) Subject Matter (Describe in Detail): Application :tor Conditional Use Approval to operate a religious institution in an J<M.j cU.SUl.ct; Appll.cation fOr \..eI.U!i<.:ate of l1Se; ~uLlcltlumii WiU, 0-.1<1", CUuplicul"t: ~~'t 4.' Identify each individual (Commissioners, Bard, Committee, Authority member or City staff) to be lobbied: / 'C 5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or individual): \J The City Commission on .2001 \J City Commission Subcommittee on ,2001 \J City Staff on .2001 \J City Board or Committee on 10/30 ,2001 \J Personnel on .2001 \J Identify Others on ,2001 6. State the extent of any business, financial, f~ilial, professional or other relationship which exists with any individual identified in number (4) above: N A ON OCTOBER 1ST OF EACH YEAR, EACH lOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBB'IING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. 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 as amended, and all reporting requirements. Sig~ure of Lobbyist: rf Personally known \J Produced ID ~OIo r.y:sq u.CW Identify \J Did take an oath, or \J Did not take an oath State of Florida, County of Miami-Dade Sworn to and subscribed bpfpre me This flit day of Oe.wbW' , 2001. Clerk If Notary, prin ed Registration: [ ~CCEPTED FOR CLERK'S USE ONLY [ ] REJECTED DATE: I U J <1 J tJ j I / If rejected, state reason: Registration fee paid: [vfYes [ ] No [] Not-for-Profit Organization [ ] Cash [ "rCheck MCR # 2- '-fCJ 1- 2- L- DATA ENTRY DATE: I' , 2001 ENTERED BY: p'ivision of CorporatioT''' . Page 1 of3 Exhibit "A" ~ "'-""'''""' Florida Non Profit \. THE KABBALAH CENTRE OF FLORIDA, INC. ...,..-........-...-.............".-...,-- ............." PRINCIPAL ADDRESS 8411 PALMETTO PARK RD. BOCA RATON FL 33433 Changed 04/20/1999 MAILING ADDRESS 8411 PALMETTO PARK RD. BOCA RATON FL 33433 Changed 04/20/1999 -.-----...-. Document Number FEI Number Date Filed N95000002712 650638140 06/12/1995 State Status Effective Date FL ACTIVE NONE Last Event Event Effective AMENDMENT Event Date Filed AND NAME 11/09/1999 Date NONE CHANGE ......----.--., Registered Agent .../cordetexe?al=DETFIL&n1 . N95000002712&n2 NAMFWD&n3=II0/5/01 Division of Corporations Page 2 of3 I Name & Address I THE KABBALAAH CENTER 8411 W,PALMETTOPARKRD. BOCA RATON FL 33433 I Name Changed: 03/02/2001 I I Address Changed: 04/20/1999 I ".m__,......., Officer/Director Detail I Name & Address II Title I BERG, KAREN 8 7411 WEST PALMETTO PKRD BOCA RATON FL 33433 SARFATI, SHIMON 8 8411 WEST PALMETTO PK RD BOCA RATON FL 33433 SOLOMON, BETTY 8 1062 S ROBERTSON BLVD LOS ANGELES CA 90035 '- Report Year Filed Date Intangible Tax I 1999 II 04/20/1999 II I I 2000 II 07/12/2000 II I I 2001 II 03/02/2001 II I Annual Reports "'. "---, . . Previous Filing I . . Return to List Next Fillll!! I View Events View Name History ".lcordet.exe?al=DETFIL&nl N9500000Z712&nZ NAMFWD&n3=10/5/01