David E. Sacks - Alton 633 Properties )
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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 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 specific exclusions. Please refer to Ordinance 2004-3435.
Sacks David E.
NAME OF LOBBYIST: (Last) (First) (M.1)
Pathman Lewis, LLP, One Biscayne Tower, Suite 2400, 2 S Biscayne Blvd, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) .(Zip Code)
305-379-2425 305-379-2420 dsacks @pathmanlewis.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY: i
Alton 633 Properties, LLC "
� r<� C
NAME OF PRINCIPAL/CLIENT:
6200 NW 167th Street, Building B, Miami Lakes, FL 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
X05-665-9600 305-667-5041 potamkincoQgmail.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporption,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY: Alan Potamkln
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Alan Potamkln 50% and Robert POtamkln 50%
ii.SPECIFIC,LOCBY.ISSU:E,:
To obtain approval to modify CD-2 Zoning Code permitted uses to include self-storage. 4a,ine
Issue to be lobbied Describe in detail): 5 A z iii.-CITY-AGENCIESONDI.VIDUAL.S,TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any 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 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Land Use and Development Committee, Historic Preservation Board None] 11'.,",x
Richard Lorber, Acting Dir, Plan & Zoning; Tom Mooney, Design & Preservn Mgr. None X
City Planners - Joyce Meyers, Michael Belush Non X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial.;fkni 1i�l?fir---ofessional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personn wtid Ls
sought to be lobbied as identified on the lobbyist registration form filed. _ N
Sec 2-482(g)Any Financial, Familial or Professional Relationship a V'
None
xj 6
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 specific exclusions. Please refer to Ordinance 2004 -3435.
Sacks
David E.
NAME OF LOBBYIST: (Last) (First) (M.I)
Pathman Lewis, LLP, One Biscayne Tower, Suite 2400, 2 S Biscayne Blvd, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 -379 -2425 305 - 379 -2420 dsacks @pathmanlewis.com
TELEPHONE NUMBER:
FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
Alton 633 Properties, LLC
NAME OF PRINCIPAL /CLIENT:
6200 NW 167th Street, Building B, Miami Lakes, FL 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
30- 665 -9600 305- 667 -5041
TELEPHONE NUMBER: FAX NUMBER: (Optional)
potamkinco(a�gmail.com
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Alan Potamkin
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Alan Potamkin 50% and Robert Potamkin 50%
ii SPECIFIC `LOBBY ISSUE:
To obtain approval to modify CD -2 Zoning Code permitted uses to include self-storage
Issue to be lobbied (Describe in detail
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any 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 2- 482(a)(4) Full Name of Individual and
title of person to be lobbied
Contractual Relationship (Explain)
YES
NO
Land Use and Development Committee, Historic Preservation
Board None
X
Richard Lorber, Acting Dir, Plan & Zoning; Tom Mooney,
Design & Preservn Mgr. None
X
City Planners - Joyce Meyers, Michael Belush
None
X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial;fi ni1ial ?orprpfespi9nal
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city pefsonAlo *H.oist,s'
sought to be lobbied as identified on the lobbyist registration form filed. i f • )1 t ru
Sec 2- 482(g) Any Financial, Familial or Professional Relationship - it we
INZIOZ
None
/ r
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Hourly - $350.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): Hourly - $350.00
(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 n No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending
award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
❑ Yes El 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.
❑ Yes El 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 CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN T,bI E HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD , ( �y
CG
Signa ure of e byist
I do solemnly swear that all of the foregoing facts are true and cone ,t,and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami Beach City Code and all re.• �'., equirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION:
❑ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade
Sworn to and subscribed before me
This .epY) day of t / /f /22/Ccf , X XX 2012
�t1z- ZR,le
Signature of Public Nota�ty — State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
Personally known (Princi
;'''
M. IC NAYLOR ,
EXPIRES: September 207 014
• d�` Bonded Thru Notary Public underwriters
State of Florida, County of Miami -Dade
subscri a before me
day ; � aux 2012
Si. nature of Public o'.ry — State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S S' TAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ MCR #
Lobbyist Registration Form received and verified by:
Date Paid
2- 97/ z-
Revised 1/11/2011
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Hourly - $350.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): Hourly - $350.00
(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 n No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending
award for goods, equipment 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.
❑ Yes ,l 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 CALENDAR YEAR. A STATEMENT SHALL BE FILED EVE E*IF T ° E HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signa ure of Lobbyist
I do solemnly swear that all of the foregoing facts are true and corre :land that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami Beach City Code and all re ing equirements.
Signature of Lobbyist:
Signature of Principal /Client: /
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade
Sworn to and subscribed before me
This ,,T4 day of IleR674 , a01X 2012
Signature of Public Notar,/y — State of Florida
Notarization of Lobbyist's signature
Produced ID
Form of Identification
I Personally known (Principal)
State of Florida, County of Miami -Dade
Sworn and subscribed before me
This day of , 201X 2012
Signature of Public Notary — State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ MCR #
Lobbyist Registration Form received and verified by:
1v; crP ll'ALL iu6' OF.3':'S &_ - ,T. _:. i Oilt 4; Lobbyist Ann cton ,.., .doc
Date Paid
Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 , Fax: 305.673.7254
CityClerk @miamibeachfl.gov
LOBBYIST NAME: David E. Sacks
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: