Jonathan Plutzikm N1IAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Lobbyist means all persons employed or
passage, defeat or modification of any o
decision, recommendation of the City
recommendation of any city personnel du
decision or recommendation that foresee
committee. The term specifically includes
term "Lobbyists" has specific exclusiol
BYIST REGISTRATION FORM
~~ 'ss~~/ox~y
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PA
ained, whether paid or not, by a principal who seeks to encourage the
lance, resolution, action or decision of any commissioner; any action,
Hager or any city board or committee; or any action, decision or
~ the time period of the entire decision-making process on such action,
y will be heard or reviewed by the city commission, or a city bond or
principal as well as any employee engaged in lobbying activities. The
Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Plutzik Jonathan _
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
The Betsy -South Beach 1440 Ocean Drive Miami Beach FL 33139
TELEPHONE NUMBER: ~ FAX NUMBER: EMAIL:
305-531-6100 305-531-9009 jonathanpiutzik@gmail. com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Betsy Ross Owner, LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Betsy Hotel 1440 Ocean Drive Miami Beach, FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional)
305.531.6100
Fill out this section if principal is a Corpori tion, Partnership or Trust [Section 2•
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Jonathan Plutzik
• IDENTIFY ALL
OWNERSHIP I~
See Exhibit "A"
II. SPECIFIC LOBBY ISSUE:
Revocable Permit application
Issue to be lobbied (Describe in detail):
EMAIL: {Optional)
(c)]
NS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
III. CITY AGENCIES/INDIVIDUALS ITO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months .preceding the
commencement of service of City personnel to be lobbied.)
A) Full Name of Individual/Title f B) An Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration; City Attorney's O
fice; None
f
Cit Committees; Cit Boards
~S
IV. DISCLOSURE OF TERMS AND''
• HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST D-SCLOSURE: (Required)
No special compensation for lobbying. Lo;
AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
st receives compensation as an officer and/or director of the
B) PRINCIPAL'S DISCLOSURE (OF~LOBBYIST COMPENSATION):
(Required). No special compensation for lobbying. Lobbyist receives compensation as an officer and/or
director of the Principal.
---
e ollowing information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues": E
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues"
^Yes Isd No: Are you lobbving on a pending application for a Development Agreement with the Citv or
implication for chance of zoning map designation or chance to the Citv's Future Land Use Maps
f
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 orb opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15` OF EACH YEAR EACH LOBBYISTS ALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH_ LISTING; I nRRVINr. FYP niTUCGC ec w~i i ee l~AAA~GAIQ ATIA\I
PERIOD.
Signature Lobbyist ~ v
I do solemnly swear that all of the foregoing re true and correct d that I have read or am familiar with the
provisions contained in Section 2-482 of th ~ I y o orting requirements.
Signature of Lobbyist: ~ ~
Signature of Principal/Clien~
x VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identifi
^ 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 , 2008
Signature of Public Notary -State of F
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to~nd subs ed e~..°.^~ ~•~~
This ? t day of 4 Qp~o7` ~,, ; -:,: ~r, State of Florida
~ c:r ..' r,i+V
,, ,~ Nt~; t;:-„~:" sion DD697983
Si nat a of P IC - P~4FF? ~f Flnnria
TO BE COMPLETED BY CITY CLERK'S S O
Annual Registration fee. ]Yes (] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by•
F:\CLER\LOBBYISlILobbyist Registration Form 32708. o ~ ...n......1 _ o...,:~..a ~„~"",,,e
~~~~t ~~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, w+www.miamibeachfl.pov
CITY CLERK office CityClerk a(~.miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Jonathan Plutzik
I understand that no later than October 1"I of each vear, 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, on an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office to 'st withdrawal iri writing.
`~'
x x - Z; ~ ~
Si ature: ~ Date:
MIADOCS 4013982 1