Michael W. Larkin - Leroy C. Griffith �PA iffr
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M1AMIBEACH
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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 clty 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 specific exclusions.
Please refer to Ordinance 2004 -3435.
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Club Madonna 1527 Washington Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 -534 -2000 305- 531 -9160 MLarkin @BRZoningLaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
P /ease notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Leroy C. Griffith
NAME OF PRINCIPAL/CLIENT:
CI • it..onn. 27 j . line •, :venu u ami B-. i FL 3 •
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305- 534 -2000 305 -531 -9160
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)] --►
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: -�
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH .; N.)
CORPORATION, PARTNERSHIP OR TRUST: "`
II. SPECIFIC LOBBY ISSUE : p "i
•
Issue to be lobbied (Describe in detail): Amendment to Code to permit sale of alcoholic beverages in an adult entertainment estAishrOat.
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and whether the lobbyist
has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date, stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Mayor and Commissioners None X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or
professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER).
A) LOBBYIST DISCLOSURE: (Required) $435 per hour
8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 4435 Der hour
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 ":
O Yes X No: Are psi lobbying on a present or pending bid for goods, equ'pment or services, or on a present or
pending award for goods, eguipment 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 pending application for a Development Agreement with the City or application
• r 1 . 1 • ' • . • 1 1 • m. . - ' . _ • r i : i ` • h= 's,' 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 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 X No: Are you representing_a not-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ONJ EBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT IQ THE CITY CLERK A SIGNED STATEMENT
UNDER QATH, LISTING LOBBYING EXPENDITURE& AS WFLL AS COMPENSATION RECEIVED, IN THE CITY OF
I _ - • : TH_ 0 ► _. ► r - 1 - Eli k l _ ' . 1 T .AV_
NO EXPENIDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyi
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 the Miami Beach City Co and all reporting requirements.
Signature of Lobbyist: !
nature of Principal /Client: IC _ ..� / _ �_ ii i�
i LOBBYIST IDENTIFICATION: / PRINCIPAL IDENTIFICATION: ;: :: :
$ S Produced ID ❑Produced ID .'-
Form of Identification Form of Identification '
. ..'
V
Personally known (Lobbyist) VPersonally known (Principal)
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1 i' I . / SIGNATURE AND STAMP OF NOTARY: i
F m t i e of Florida, County of Miami -Dade State of Horida, County of Miami -Dade
1 i , rn to and subscribe efore me Sworn nd subscribe. before me 15 ..
.,., - a , day ►f � , 2011 This day of L. ' 1 , 2011 "' B
kit ..', ifill C c__--' ,/ , A -- 1_,/■. , ,: I I 1
"' '.=1 at e of • : is Notary `„ .,
ry —State of Florida Signature of /Public • =ry — State of Florida ____i
Notarization of Lobbyist's signature Notarization of Fr' . !pal's signature
FOR Ci„gikics USE O ii
Annual Registration fee: [ ] Yes [ ] No Amount Paid ,3 MCR # J _ O •at: 'aid ` i ✓ ,
Lobbyist Registration Form received and verified by: 1 Entered =y: 'c....- e
' Revised 1/11 /2011
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City of Miami tench, i 700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachtl,gov
CITY CLERK Office CityClerkOmiamibeachil.gov
Tel: 305.673.7411 , Fax: 305.673.725
LOBBYIST NAME: JrA I 4 di 4 4 ,
understand that no later than C,.�Stobe: Est of each ytor, 1 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 1 have registered to lobby on has been resolved, 1 am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
• /
Signature: Date:
F:ICLER\LOBBY1ST1Lobbyist Registration Form 32708.doc