Ralph Choeff - Paul T. Cappuccio Page 1 of 3 DX- .-
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 20043435.
Ralph Choeff
NAME OF LOBBYIST: (Last) (First) (M.I)
Choeff+ Levy p.o. 8425 Biscayne Blvd. Miami, FL 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.434.8338 305.892.5292 rchoeff@choeffievy.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
Paul T.Cappuccio
NAME OF PRINCIPAUCLIENT:
375 West End Avenue,Apt.2AB.New York.NY 10024
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Stale) (Zip Code)
212-484-7980 212-484-7167
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section it principal is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER.OR BENEFICIARY::F-lo(_ L^PPv�( c)
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE`OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
uSPECIFIC LOBBY ISSUE:
Design Review Approval for a new 2-story Residence
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 stab the eneral nature of the subject contractual relationship.
Sec 2482(x)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO
tttle of person to be lobbied
Design Review Board none X
Pursuant to City Code Section 2482(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. ry
0
Sec 2482 Any Financial,Familial or Professional Relationshipw
NO
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY.FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$)75/Hf
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $175/Hr
(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 XNo: 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 Section 2490 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 for
change of zoning map designation or change to the ClWs Future Lend Use Map?
3) Pursuant to Miami Beach City Code Section 2482(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.
YesXNO: 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 70 THE CITY CLER -SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENS R EIV THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILEII I 'HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. 'AV ANY
r
Signature of Lob t
I do solemnly swear that all of the foregoing f are true a co t d that I have rea ,pdq_ iliar with the provisions contained
in Section 2-482 of the Miami Beach City Co II repo In e ents.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LO YIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
n I Sgt _v
roduced ID RIJe(LS (,t s° w, Produced ID Y �i
Form of Identification �. Form of Identification yr
o_Personally known(Lobbyist) � '� _Personally known(Principal) °�a }
VII. SIGNATURE AND STAMP OF NOTARY:
Ia., ri e.v `�c,l-f� Z if�.5
State of Florida,County of Miami-Dade State of+ReH#e,County of 4Miamr-t�ede C% 35 N'-
Sworn 1 a d subscribed fore me Vt Sworn and subscripd before a
This day 2012 6 This O ey of �G'lud► 2012 a
r y V
jNot2 f Pu is ry—State of Flo Signature of Pu c Notary—State of�IeA�ia•N aw
t lon oyj4§§Asrs signature , Notarization of Principal's slgnature
BX CITY CLERK'S STAFF ONLY
Annual Registration tee: ( ]Yes[ ]No Amou $ MCA A Palid
Lobbyist Registration Form received and verified by:
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F: CLEI pc.tr.n.nFormAm Revised 04 127/2012
City of Miami death, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: Ralph Choeff
I understand that no later than February 26 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) L01313YIST 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, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485(d),the CIV 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 2465.1,a fine of$50.80 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 lobbyis who fails to file the required Statement by April 30th, 2012, shall be
aubrm2- t, suspended from lobbying until all fines are paid,unless the fine has been
appaafMiami-Dade County Commission on Ethics and Public Trust.
Signature: ate:
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