Manuel Synalovski - MYPP Holdings, LLC A/M I cs
City of Miami Beach Office of the City Clerk 613DEr
1700 Convention Center Drive, Miami Beach, FL 33139 �.
VA(,-,(0Q4 LOBBYIST REGISTRATION FORM
OF . r,
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat ba-
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.
0-Y -rd.vrm L
NAME OF LOBBYIST: (Last) (First) (M.1)
Vim(eA� jallf" Idpa V gw-e_�
BUSINESS NAME AND ADDRESS ,Number and Street) ity) (State) jZip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please:notify this office if your:contact information changes:address phone,•or 6-mail address.
I. LOBBYIST RETAINED BY:
lief Ap
NAM OF PRI CIPAUCLIENT: '
BUSINESS OAME AO ADDRES% (Number an��e (City)Ll-
,,� �3 (State) (Zip Code)Al
TELEPHONE NUMBER: FAX NUMBER:(Optional) 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:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
n.S ECIFIC LOE.BY ISSUE ,f
4A?7- (f ev/1 Af /Vz
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Issue to be lobbied(Describe in detail):
nl.CITY AGENCIES/INDIVIDUALS T0'.BE10 BIED:
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
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.
l ' Sec 2-482(g)Any Financial,Familial or Professional Relationship
V
V
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER OURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). TGA.,
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 kNo- 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
D elopment Issues":
_Yes o: 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 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
comgpnsation or reimbursement.for the appearance, whether direct, or indirect, to express support of or opposition to any
it shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
Yes 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 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 FI D VEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature byis
I do solemnly swear that all of the going facts are true and cor c and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami c ty Code and all reporting requirements.
Signature of Lobbyist.-
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID_1F L bywe(z'S Ll C D'e Produced ID
° a Form of Identification
Form of Identification �, y
v q, Q` Z
Personally known(Lobbyist) yQ� c ' . Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTAIR .Q
-$:? .o
co J h
State of Florida, County of Miami-Dade o F, ' State of Florida, County of Miami-Dade
Sworn to and subscrib before me = Q D Sworn and subscribed before me
This y of 114CA 20 1" o This day of 2012
Signature of jublic Nota --State of Flori p, �4 Signature of Public Notary—State of Florida
Notarization f Lobbyist's signature •`S,P�;:�� Notarization of Principal's signature
TO BE CO TED BY CITY CLERK'S STAFF ONLY
Lobb ist•Re istration'Form`received and verified b : Paid
Annual Re istration fee: Yes Nic` Amount Paid$ CR#. Date
Y.. 9� Y
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER OURLY,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 i/No: Are you lobbying on a present or pending bid for goods equipment or services or on a present or Rending
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
De elopment Issues":
—Yes o: 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 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
cnsation or reimbursement.for the appearance, whether direct, or indirect, to express support of or opposition to any
register with the clerk as required by this section but, shall not be required to pay any registration fees.
Yes_ re Vou 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 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 FIL/t-DAEVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature
t
byis
I do solemnly swear that all of the going facts are true and cor c and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami c •ty Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: ;
<e i'y,� C✓sfyiac.L��si✓l c.ti;.}�t iC �• �j
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced iD 1F L 1W\0 6L S U 3ai
Produced ID F�0-^-ohs
Form of Identification °ti a y.r
I CO Form of Identification
w o 4,
Personally known(Lobbyist) Personally known(Principal)
Vii. SIGNATURE AND STAMP OF NOTAR :o kQ �' ` T
Cr. C-3
State of Florida, County of Miami-Dade o of State of Florida, County of ade �t�,
Sworn to and subscribe before me _��, c, c Sworn and subscribed before me
This y of ,c X201 .�``c �° .,• Thi /6 day 0n[em bt–, 201 --- " 00
i R Cr
Signature of ublic Nota "state of Flori � j' S gnature of Public Note lorida
Notarization f Lobbyists signature S1 Notarization of Principal's signature
TO BE CO TED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ J Yes[ J No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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1
F;\CLEI listration Form.doc Revised 04/27/2012,
City of Miami Beach, 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:
I understand that no later than February 28 of each year, 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, 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 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 Miami-Dade County Commission on Ethics and Public Trust.Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc