Ryan D. Bailine Temple Beth Shmuel Montessori School MIAMI BEACH
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.
Bailine Ryan D.
NAME OF LOBBYIST: (Last) (First) (M.I)
Stearns Weaver Miller, et al. 150 W. Flagler Street, #2200 Miami, FL 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-789-4179 305-789-2635 rbailine @stearnsweaver.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office If your contact information changes.,address,phone, or a-mall address.
I. LOBBYIST RETAINED BY:
Temple Beth Shmuel Montessori
NAME OF PRINCIPA CLIENT:
1719 Lenox Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-604-9101 tbsmontessori @bellsouth.net
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section If principal Is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ii.SPECIFIC LOBBY ISSUEr
Zoning issues related to new Montessori School on Lenox Avenue
Issue to be lobbied(Describe in detail):
ul.CITY;AGENC:iES/INDIVIQ.UALS TOE L0� 1D.:
Pursuant to City Code Section 2482(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 eneral 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
City Boards and Committees X
City Commission X
Pursuant to City Code Section 2.482(8)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 Any Financial Familial or Professional Relationship
one
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) L�93 I18T[ FLQ ffE.4 yquired)
(REQUIRED).L'S COMPENSATION):
D�S�t�U�0���'{SZ
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 XNo: Are you lobbvinq 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
X Yes_No: Are you lobbvinq on a pendina application for a Development Agreement with the City or application for
change of zoning map designation or change to the Citv's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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 XNo_Are you representing a not-for-profit corporation or entity,without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO TH CLE SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATIONAECEIVED, IN THLxciTy OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E N IF THERE HAVE B N NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
i
Signature of Lobbyist R n BVL1 e, s q.
I do solemnly swear that all of the foregoing facts are true and orre and tha I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and a)I re require ents.
Signature of Lobbyist: A A `
Signature of Principal/Client:
e e a ys
VI. LOBBYIST IDENTIFICATI N: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID 1t b 2'6"Flo Lf(., 5 C9.3-j
Form of Identifigatipa,,�l,c Form of Identification
.y
ersonally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NQ Y:
State of Florida,County of Miami-Dade a Ste• FloNatacyCAatt �� r�y,�de
Sworn to and subscribed before me $ d @ e me
This =day of JS. L - ,2012 0 > n� tl�l �t74111012
t or xpires 8/D'f 2 `
/S7T r-VI �C,) ►� x•..
o p'.r�
4riza�tion Public Notary-State of Flori_ ;�,;�� ° Signature of Public Notary-State of Florida
of Lobbyist's signature °o Notarization of Principal's signature
CA 4h.
TO BE COMPLETEP B CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid MCR.# Dat Pali
Lobbyist Registration Form received and verified by: d
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jistnf:inn..t=arm db:c ':; . Revised 04/27/2012-
I A M I E A C H
City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachH.gov
CITY CLERK Office
Rafael E.Granodo, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: Ryan D. Bailine
understand that no later than February 28 of each year, I must Ole 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, or I am no
longer lobbying on that issue or for that principal, 1 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
automaticall d from lobbying until all fines are paid, unless the fine has been
appeal I t the Miami-Da County Commission on Ethics and Public Trust.
Ao- e-1_17-
Signa a Date:
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