Lucia Dougherty
m 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 speclflc exclusions. Please
refer to Ordinance 2004-3435.
Dougherty Lucia A.
NAME OF LOBBYIST: (Last) (First) (M.I)
1221 Brickell Avenue, Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-579-0603 305-951-5603 doughertyl@gtlaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Please see attached
NAME OF PRINCIPAUCLIENT:
Go Column Financial, Inc. 11 Madison Avenue, 10th Floor, New York, NY 10010
BUSINESS NAME AND ADDRESS (Number and Streetl (Citvl (Statel (Zio Code)
212-325-2000
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this
or
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Stephen Yankauer
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
2301 Collins Avenue, Miami Beach: Code Violations and C.U.P.
Issue to be lobbied (Describe in detail):
nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section 2-as2(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise 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 B
Building Department /Fire Department Board of Adjustment
Planning and Zoning Department, Public Works City Manager's Office
historic Preservation Board Flood Pain Management Board
0£ ~~ ~d ZZ ~~~ OiOZ
.. ~~
tV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $675.00 Hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $675.00 Hourly
(Required).
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 pendina bid for aoods, eauipment or services. or on a
present or pendina award for aoods. eauipment 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 you lobbying on a pendina application for a Development Agreement with the City 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 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 X No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client: `'`-~
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
N ~ ^ Produced ID
~ Form of Identification
oe
$ ~ " `Personally known (Lobbyist)
g ! -
' ~ VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of dew
Sworn to and subscribed before me
F This ~"2day of, 2010
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
TO BE COMPLETED BY
~- Annual Registration fee: ]Yes [ ] No Amount Paid g
Lobbyist Registration Form received and verified by: "
F:`CLER~LQBBXZST~Lobbyist Registration dorm 327C38.doc _
~ Produced ID
Form of Identification
Personally known (Principal)
SHARON D. WILLIAMS
~1 tary Public, State of New York
State ofF County of Poe No. 01 WI6203907
Sworn a d subscribed before me Qualified in New York County
_ This day of , ~r®mission Expires April 13, 201
Signature of blic tary -State of Fier~le HEir/ yD~K--
Notarization of Principal's signature
tK'S STAFF ONLY
=MCR # O Date Paid ~~
Revised
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~te~Miami Beach City Code and all reporting requirements.
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
Lucia A. Dougherty
LOBBYIST NAME:
CityClerk@miamibeachfl.gov
I understand that no later than October 1st 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
fo immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~~~-~lro
Signature: Date:
F:ICLERILC3BBYiSTiLobbyist Registration Form 327f18.dac
ATTACHMENT TO LOBBYIST REGISTRATION
WSA South Beach, LLC; WSA Paradiso Associates, LLC; Sandy Lane Group, LLC; Sandy
Lane Senior Mezz, LLC; Sandy Lane Senior Mezz II, LLC; Sandy Lane Junior Mezz, LLC; and
Sandy Lane Residential, LLC
MIA 181,070,645v1 2-12-10