Jonathan Plutzik (2)AdNVaI + i~sve
y ~ ~ ~
,~ MIAMIBEA~H ~°
City of Miami Beach Office of the City Clerk
1700 Conventio I 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 orclinance, 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 dty personnel duffing 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 dty bond or
committee. The term specifically includeslthe principal as well as any employee engaged In lobbying activities. The
term "Lobbyists" has speclflc exclusions. Please refer to Ordlnantre 2004-3435.
(Last)
(state)
305-531-6100
1. LOBBYIST RETAINED BY:
Ross
NAME
305-531-9009
jonathanplu~ik(algmail.cem
'umber and Street) (City) (State) (Zip
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
305.531.6100
Fill out this section if principal is a Corporation, Partnership or Trust (Section 282 (c)]
I
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Jonathan Plutzik
• IDENTIFY ALL
OWNERSHIP Ih
"A"
II. SPECIFIC LOBBY ISSUE:
Conditional Use Pennlt application
Issue
in
JS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
III. CITY AGENCIES/INDIVIDUALS ~TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relatonship, 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) incude a statement of any cdnVadual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be bbbied.)
A- Full Name of Indivldual/Tltla 1 B An Financial, Familial or Professional Relationshi
Mayor None
Commissioners I
City Administration; City Attorney's Off ice; None
Cit Committees; Cit Boards ~
/~,
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FIAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special opmpensaton for lobbying. Lobbyist receives compensation as an officer and/or director of the
Principal. I
i
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). No special compensation for lobbying. Lobbyist receives compensation as an officer and/or
director of the Pdncipal. ~
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": I
2) Pursuant to Miami Beach City Code 2-090 Entitled °Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues':
3) Pursuant to Miami Beach City Code 2-084 (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 oppositan to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes ~ No: Are you representing snot-for-profit corporation or entity without special compensatlon or
reimbursement.
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of
provisions contained in S o
Signature of Lobbyist:
Signature of Pdncipal/Client: ~
~~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
-1/11~.~ `~.: SIGNATURE AND STAMP OF NOTARY:
v
State of Florida, County of Miami-Dade
- ~ ~ This
~tO44~
amt veriflad
I have read ar am familiar with the
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form ofldent~cation
q~,'~`0 ^ Personally known (Principal)
St~ of Florida, County of Miami-Dade
Swom to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Flodda
NotarizaUOn of Principal's signature
c~-ae
eor~nvweuc, asm)ctaf oowrroa
waal~iwansr~~,to+o
m MIAMIBEACH
City of Miami Beach. 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.cov
CITY CLERK office CitvClerk(r~miamibeachfl aov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Jonathan Plutzik
I understand that no later than October 1 `r 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 Umely basis will result in my name being transmitted to the Miami-Dade County
Commission on Ethics and for code violation evaluation.
Rion, once an issue I have registered to lobby on has been resolved, I am required to immediately noflty the
City Cle 0 for lobbyist withdrawal in writing.
I~I'I~lu
Date:
MIADOCS 3941635 1