Charles H. Benson - Whelan's Drugstore/Terminal Air Transport bldg tia MIAMI BEACH
/ AA C of Miami Beach Office of the City Clerk 't
1700 Convention Center Drive, Miami Beach, FL 33139
s' to i a,:
, 1
'%) ,
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or attained. whether paid or not by 3 principal who seeks to ertodrage the passage. defeat cr modification of
any Ordiri1330. resolution acct or decision of any commissioner; any action. diteilitta, fet4,1911113dati33 of the C. Manager or any city board or
committee; or any action, decision or recommendation of any city paneling during the time period of the Eitte decision-making process on such
action. decision or reoorftmenclation that foreseestly VA be heard or reviewed by the city CO3131351011 or a city board or committee. The term
spectioaty includes the principal as wee as any employee • engaged in lobbying aotiviles. The term "Lobbyists has specific exclusions. Please
refer to Ordinance 20044435.
Benson Charles H.
,
NAME OF LOBBYIST: (Last) (19rst) (M.I)
Charles H. Benson & Associates, Architects, P.A., 1665 Washington Avenue, 2 Floor Miami Beach, FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
0 (305) 532-6161/ C (786) 246-8180 / F (305) 532-6151 carkitect@aol.com
TELE - M40NE NUMBER eAx NUMBER: WA&
Please notify this office if your contact information changes: addtess, phone, or e-mail address.
L LOBBYIST RETAINED BY;
Lincoln Comer LLC, a Delaware Limited Liability Company
NAME OF PRINCIPALICLIENT:
11400 NW 34 Street Doral FL 33178
fiiMg.ff_yillf AND ADDRESS (Number and Street) (City) (State) (Zip Code)
'TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optonal)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (c)I
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
Eliezer Tabib, Dror Levy
• IDENTIFY AU. PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: Eliezer Tab ib
, ,,,_,, _,,,,,„,,, ,,,..,„ ,„„„, Whelan's Drugstore/Terminal Air Transport Building
MSPECIFICALOSEMISSUE Lincoln Road/161-1638 Collins Avenue, Miami Beach, FL 33139
ke for removal of non-original bus bench, new double height retail mezzanine to match original
building, removal of non-original facade and replace with original design to be heard by the Historic Preservation Board (HPB).
Issue to be lobbied (Descnim in detalit
dtW
w. 7 , ,,,. , ,, -..,„ . ,,,,,,, , „, , ,,:, . BE ,,,, . „1 ., .. Pursuant to City Code Section 2.482(g) include
a ifitentint iriiie extent leity iiiiiii, fin 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 said City personnel' commencement of service with the City to the present date, stating the general nature of the subject
antratooti relation.
C, 4 ts-
111 t me of individual/Me 0) Any Financial, Familirt or Professional Relationship
W .5M1151, c .... )
None
> EtoricAreservation board and members
....... ,c. .
LL tn =X
--.. ,,,, j
(....:: ,.... —.1. .
LL c c.)
QC c= , ,........
••••■• 5
C=9 .
C•4 C-)
*/.°
_._
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) f /()(
( ,
5) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): *WOO S
(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:
0 Yes a No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues ":
❑ Yes g No: Are you lobbying on a pending 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 a not- 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.
0 Yes No: Are you representing a not - for - profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CiTY OF MIAMI BEACH FOR THE PRECEDING CALE 'AR R. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES O MP . N URING THE REPORTING
PERIOD.
Signature of Lobbyist
Oh
I do solemnly swear that all of the fore F
i ,. f.- .. • tru • and correct and that I have read or am familiar with the
provisions contained in Section 2-482 -•f thy: MI-7i ac C` Code and all reporting requirements.
Signature of Lobbyist: )14 ,
Signature of Principal /Client: ( ..J .... .>-. 4---
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
0 Produced ID a Produced ID
Form of Identification Form of Identification
0 Personally known (Lobbyist) Personaii known(Principal) -4,, ,,, „
VIi. SIGNATURE AND STAMP OF NOTARY: !
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade , 4, , ' •
Sworn to and subscribed before me Sworn and subscribed before me
'
This day of , 2010 This 5 = day of NW , 2010 m
,, _ ■
•
Signature of Public Niota -'_
9 ry -State of Florida Sig ,m of Pu_� otary -State of Florida E = ca ; :: ,
Notarization of Lobbyist's signature • Notarization of Principal's signature
e z � .
TO BE COMPLETED BY ; . C..ERK'S STAFF O 8 o at m
Annual Registration fee: j.Yes [ ] No Amount Paid i 5 i1O MCR # ' s IA�j Date Paid LIL ]I z N o
Lobbyist Registration Fomi received and verified by: / o a,
F:},CLER \$ALL \aFORMS‘COBBYIST FORr9SkLobbyiist rtegistrG','+n ��'� I ;/' Revised 05/05/2010 W I
CA A A A A A R C H
v ;
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST.. NAME.
hang & _ 600 con
I understand that no later than February 28th of each year, I must file the following
form, 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 and Compensation 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
to immediately notify the :City Clerk's Office of lobbyist withdrawal in writing.
Signature: Date: