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Frederick A. Kramer - Southgate Towers Apartments.. f :; r,~.rr, r ~ f_.- - ~. - . . ~ e 5 " ~ City of~Miami .Beach office of the City Clerk ~ ~ f 1700 Convention Center Drive, Miami Beach., F~ 33139 ., .. ~_ -LOBBYISM' REGiSTRATION'FORM ~ ' Lobbyist means all persons employed;or retained;_whether paid or not, by a principal who eeks to encourage the passage,-defeat or modification of any ordinance, xesolution,,acfion or .decision of any.commissiorier; anyactiori, decisior; recommendation of the City-Manager or. any city board.or ~ ' committee; orany ,action;.decision or'recommentlatiort of`any city personnel during the time period-of th~.entire-decision-making process on.such I' . action decision or'recommendation that foreseeably will be heard or. reviewed by the city :commission, ,or a; city board or committee. The term i speafically•includes'the.principal' as well as any. employee. engaged in lobbying activities. The term `tl.obbyists° has specific exclusions.. Please - refer to Ordinance 2004-3435. .;: ,. ~~ ~ .. NAME.OE.LOBBYIST: w .E -, {Last)". (First) (M.I) F~T~~ T-.:tyt.. 2 S ~ 1~ i ~c,~Y ~1,a/. `~ L '?~" 7 to t`~~ At~n\ -"~ 1... ~ 3'~ 1~ ; ~' .4. .,.~ tc. ®~ 31 .v ~,~ ~- -BUSINESS NAME-ANO-ADDRESS ~: ~ Y - (Number and S+reet) ~ (Crt _ .. _ y). ~ {State). , . .: (Zip Code) , - ".. . _ y:~2 ~ ? O - -TELEPHONE NUMBER: FAX-NUMBER: EMAIL: _ I. HOBBYIST RETAINEDFBY; .: t r _ ~ a '~Sou^Mc=-A~rE.. Tw.E.~i+~ "r ~A'¢ThnEf:tT~, G~°. , t•1At~'g-.' e1-~ - E - NAME OF PRINGIPAL/CLIENT.~ ~; - w~<,: . _ ~G.t'~O W~~c-~~r~~ ~~: ' Surcrc. 1oO ''~cuMctz~ ~ ~l~ Z ; ::' BUSINESS; NAME AND ADDRESS (Nurrtber and Street)' (C~ty) (State) `dip Cow - ' - TELE - -PHONE NUMBER: ; ; FAX NUMBER. (Optional) ~ - EMAIL: {Op#ion~l•) ~ ~' ~ ± ' :. ,. .; - . lam: . ~ , . Fill'out this section if,principal is,a Corporation, Partnershipor Trust {Section 2-482 (c)] --'~ ..~ , ,. .. Cis , ,~.,, a - • ..NAME (OF CHIEF.:OFFICER, PARTNER;..OR BENEFICIARY: - '~~' ~ ~ ~ - ,,tt :+1 An'ti' t~ ~Sk{ ° ` : ~ - ~ - ~~ ~ i . ± a Y f • . LDENTIFY ALL PERSONSHOLDING; DIRECTLY OR. INDIRECTLY; A.5% OR MORE;,OWNERSHIP.INTEREST, ~ ' =~ ~ ' SUCH-CORPQRATION, PARTNERSHIP QR TRUST: ~ ~ ;'~' _ "``~ { .~ .. ~ -: . ~ 3 . Ii:SP"E+CIFIC LOBBY ISSUE. .., - „, ., .. ~""~i ' Issue to tie lobbied (Describe in detail): - .. : - • _ M .. r . . _ CITY AGENCIESlINDIVIDUALS TO BE LOBBIED: Pursuaritto City Code Section 2-482{gj include h _ ,.. y financial a statement of `the extent of an"~ busyness, ,familial, professtonah or .other relationship;-'giying rise to: an appearance of an impropriety with any; City personnel sought to be lobbied, -- further, pursuant 'to City Code Section 2= 482(a)(d) . )nc[ude. a statement of any ~contractuat re(ationshi ~ . p (paid or unpaid) from 72 months preceding said Gity - "' personnels'. commencement of service with.-the City #o the piresent' date, stating;` the:'general nature of the stabject contractual; relation. ~ ~ . ~. -' .. ' A :Full Name of IndeviduaUTitie ) B) Any: Financial, Familial; or Professional Relationship _ .~ A ,, to t, LJ . - 'T ' *, . G V E"P'T ~ ', . ' ,Mt~T~ ~lC-~ 'R ;E'.11~1 ~. ,~ u. ~ . ' . ~, ,. „ ,.,.. . , ., , ' . _ • .. ,. 'R-~-f~'tt- ' ri - ;:p • tick Ftoo ~'u tJ . . - ;. E•t~'- ~ - i - ` , w .; i i. ' ;~ c ' ~~ ~ y. t, .. ;~,~ : DISCLOSURE ©F-TERMS AND RATE dR OTHER): A) t_OBBYIST OISCLQSURE..(Required) ~ AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT ` ~ _ ~ ~ ; ' ~ T, `"~ CAtyS\fi°t'ti or Mu ,.'C'a~?~:.E _ : , ,:.,: '4. , , , .;, b'~ _, _ , IPA 'S DI'SCL~RE OF t_OB ~ YIST.COMPENSAT.ION): P u'ed Re ~. : ' , i F The following iDformaton must:be rswered:. 1 Pursuant to.:Miami~Be`ach`Cit Code Section 2-488 Entitled "Prohibited Cam a'i ~ tri . -P gn Can buboes By hobbyists ) ._ - . Y , ; . On Procurement ls`sues": ~, : j. ~ , ~. ;. ;. .: ^ Yes ~~No: Are you lobbying on a present or pending bid for goods equipment or services or on a ,. present~or peridina-award for goods; eguipmenf or service? 2) Pursuant to Miami Beach Cify Code 2 490:~Entitled ."Prohibited Campaign Contributions By Lobbyists~,On ~~ Real €state Development"Issues" '' _._ .. ^ Yes ~ No: =Are you'lobbying on a pending ~app66cation -for a ~Developrrieirot Aa~reement withthe-City-or; - application~for change~of zonirig map;designation or change to the~City`s Future Land Use Map? .. P _ . 3) Pursuant ;to Miami. Beach City Code 2=484 (h) Any person (except. those: exempt tram the. definition of . . ' "lobbyist" as set forthvin Section 2-481 above who only appears: as a repre5enfative of anot-for-profit corporation or entity. without special campen$aton or reimbursement for he appearance~whether_direct; or ... indirect; to express: support of or~;opposition to any .item; .shall register with the clerk. as requred by thin _ ~, sec#ion but, shall not~6e required #o pay any registration:.fees. . ,. ^ .::Yes ~~No: -Are you representing anot-for.-profit corporation or entity without special compensation or reimbursement: .. .. .. ` V: SIGNATURE UNDER OATH: ~' . 'ON OCl'OBER;'1ST OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CL.ERK~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~REPO TINE ~ __ - . .. `. :PERIOD: ~ ~ . Sign furs of Lobbyist 1 do; solemnly. swear~that'all of'the, foregoing facts are true grid core ct :and thak l have:read or am~fam'ilar with the : . provisions contained in-Section'2=4:8 ~ the Miami Bea City God nd `all reporting ,requirements. ^. . :, Signature of Lobbyist:.. ~ ,/~..~G .. _ Signature of PrincipallClient: - I. L©B'BYIST.;IDENTIFICA I® :; PRINCIPAL IDENTIFICATIONS ~ . -! N ~ .° ~ ~ ~ ° j : ^ Produced.ID. ~ Pro } , ~ _ ed I D a dui ' `° rte. ~ ~ a` y ~ _ f Forrn of Idental•;eation Form~of'Idettification •. ~.~ . ~.. V ,. .. Personally .known .{Lobbyist) ~ , ~ ~ Personally known (Principal) '~ ' ~~ a. ° ~ W ~` ,~~rv IL -SIGNATURE AND STAMP OF;NOTARY ~ ~ ` . . , .., V~ ~ ' . ~g~~ eo ~ ~ .. ,,,~,.Y,,, ~ „~ ,b,, . fate of Florida, ~Caunt of Miami-Dad State .. Y ~ ~ of Via, Count of e Y ;~~• ors • ,. worn to and sutscribed before ne Sworn and subscribed before me ~ - . . ~, o_ is`, - da of A X889 2 D ~ a ;,,~ ',~ ~. , Y This ..~o day of . ; 20r~ia ~ V I ~ ~ ~ , ~ Signature of P Ic Notary- , tats of Fto~ida Signatu e f,Public Notary State of Florida - Notariiation of ~obbvist's.signature Notariz ion of Prncipal's'sign,ature ~ x _.~.__........._ , . , ~ " ,, „ , '~ . ~ . ". ~ TO.BE COMPLETED BY CiT C ERK'S STAFF ONLY Annual Registration fee: [ ]Yes, [ ~).No Amount Paid~$ ''`. MC # Date-Paid . t ~ [,`' LobbyisC R " tratian-Form received and' verified 'by: .' ` ~, - '- . - F:\CLER\~ALL~\a~'t3rtNiS\Lt?E36YIS7 Ft)RiV15\Lobbyist Registi'a ' m 21909do '. Revised 02/11/2009 . ... ~.. . a _. J i _ ,r h. \~ City of Miami Beach, 1700 ConventionCenter Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeacfifl.gov Tel.: 305.673.741 1 ,Fax: 305.673,.7254 LOBBYIST NAME: ~~~ (~Q2 ~Ci~ - ;~~., ~~~-M~ I understand that no later than October 1st of each /ear, 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 lobbyi ng ~ 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 (;,;.have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. p i Signat re: ~ ~ Date. F:ICLERILOBBYIST1Lobbyist Regisltration Form 32708.doc j i It {