Allan Schulman - Greystone Terra Firma, LLCr
MiAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 Leo
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.
Shulman Allan
NAME OF LOBBYIST: (Last) (First) (M.I)
Shulman and Associates 100 NE 38th Street, Space 2, Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-9216 (305)374-9217
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
Greystone Terra Firma, LLC
NAME OF PRINCIPAUCLIENT:
The Greystone Hotel c/o Trans Inns Management 31525 W. 12 Mile Road, Farmington Hills, MI 48334
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)438-0609 (305)438-0110 info @shulmanarchitect.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:Laszlo Fazekas
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:Laszlo Fazekas
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues,including,but not limited to variance from the Board of Adjustment and Historic Preservation Board
approvals for the Greystone Hotel at 1920 Collins Ave., Miami Beach,FL
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 Contractual Relationship(Explain) YES NO
title of person to be lobbied
Tanning Department and Building Department Staff None
B, HPB, BOA, City Commission, as necessary* None
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 CRrpmi�ji,g 1
ner p ,city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. I, '•1 __ J �. ��
Sec 2-482(g)Any Financial,Familial or Professional Relationship
9Z :I U I S 10
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(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 Xn No: Are you lobbvina on a present or pendina bid for aoods.eauioment or services.or on a present or pendina
award for goods.eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes eNo: Are you lobbying on a oendina application for a Development Aareement with the City or application for
chanae of zoning map desianation or chanae to the Citv'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 (R No: Are you reoresentina 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 BEAQ
EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NQ
EXPENDITURES OR COMPENSATION DURING THE RTING PERIOD,
/9_/A�_ ' 5��
Si nat re o Lobbyi t
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 Be City Code and all reporting requirements.
Signature of Lobbyist: at-7
Signature of Principal/Client: �r
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
o x •�
Produced ID �= =° Produced ID $w
orm of Identification �•,; ''.,` Form of Identification
y ( ) ,�, Personal) •
Personal) known L b 'st b y known(Principal)VII.
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SIGNATURE AND STAMP OF NOTARY:a ter+',g Cam!n V e O1
State of Florida,County of Miami-Dade rt" >° State of Florida, County of Miami-Dade 3:d
Sworn to a crib a me o Sworn and subscri ed before me o.Co
This of ,2012 U �n is day o /�v J ,2012 N rn N A
IV O S,
O N C,4 O N -n
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Signature of Public Notary—State f onda r''A'" Signatur of Public Nota —State of da FL
Notarization of Lobbyist's signs ure ization of re
TO BE COMPLETED§Y CITY CLERK'S STAF ONLY
Annual Registration fee: Yes No Amount Paid$ ---MCR# Date Paid
Lobbyist Registration Form received and verified by. ,
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V ilk D L A C H
Cih,of Miami Beach, 1.700 Convention Center Drive, Miami Beach,Florida 331.39,ww-,v.miamibeachfl.gov
CITY CLERK Office CityClerk@,,miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Allan Shulman
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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
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