Annie Carruthers - Tara Realty LLC 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.
Carruthers Annie
NAME OF LOBBYIST: (Last) (First) (M.I)
In-Site Design Group, 1400 E. Oakland Park Blvd., Suite 108 Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 (305) 377-6222 mlarkin @brzoninglaw.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:
Tara Realty, LLC
NAME OF PRINCIPAUCLIENT:
Tara Realty, LLC, 14 W. San Marino Drive Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-992-5847 N/A N/A
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust(Section 2.482(c)]
w NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Edmund Irvine
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Edmund Irvine(100%)
ll.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues for 126 W. San Marino Drive Property
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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 st ting 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 X
B, DRB, BOA, City Commission, as necessary None X
Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,_fa i ia1� professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city co rt�i�sian�er'or c�tr personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. 1 j�
Sec 2-482 Any Financial, Familial or Professional Relationship
None
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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":
[I ye_[x]No: Are you lobbvina on a present or pendin big id JQr goods.gauinrnent or services.or on a present or pending
award for aoods.eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
[]Yg;_[x]No: Are you lobbvina on a pending application fora Development Aorepment with the City or application for
change of zoning mama®anation or cllanae 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 [x]No: Are you representing a not-for 12139 t corporation or entity without special comngncation or reimbursement
V. SIGNATURE UNDER OATH:
QN FEBRUARY 28th OF EACH YEAR, EACH LQ13BYIET MALLMAMIT TO TIJE CITY CLERK ASIGNED STATEMENT UNDER
,OATH. LISTING LOBBYING EXEEN121TIJ13ES. Aa WELL Aaj PEN ATIQbj 13ECr;IVED. IN THE CITY OF MIAMI BEAQjJ
MB THE PRECEDINQ CALEN12AR YEAH, A Sjj& LL BE FILED EVEN IF THEM IJAME BEEN No
EXPENDITURES OR
S�i ure of Lobb ist
J do solemnly swear that aABeh g facts are true and correct and that 1 have read or am familiar with the provisions contained
in Section 2-482 of the Miaode and al reporting r equirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
[]Produced ID C- 3 Q% /��� []Produced ID
Form of Identification Form of Identification
[I Personally known(Lobbyist) 1`0? u„ om j2 � Personally known(Principal)
VII. SIGNATURE AND STAMP OFA
W?�C� Ar N w ^
w
State of Florida, County of Miami-Dade !. t o rida, County of Miami-Dade
Sworn to subscribed before me P!10 jj 10 a;ejS Q n subscribed before me
This d y of , 2014 auna��( o1aQ �'�� �,,, `L day of ,2014
rite
Signature of P O lic Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Prin=signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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f'r€'g L?�:P��.B?�iGs Li1CjICr?:t�iniaSrsii'caciS�:�=v
"rel:305.673.7-111 .Fax:305.673.725-t
LOBBYls'r NAME: Annie Carnithers
I understand that no:later than. February 28th of each year_ I must file the following
form. pursuant to Section 2-485 of ?he Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure and Co.mpensation.Form
Failure to file these forms on a timely basis will result in.my name being transmitted to the
Miami-Da.de County.Commission.on Ethics and.for code violation.evaluation.
In addition, once an issue I have registered to lobby on has been resolved, 1 atn required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to .Section 24485 (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 550:00 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 tot Miami-Dade County Commission on Ethics and Public.Trust.
Signatut-9. .Date:
F:iGLER\$ALLiaFQRMS\LOBBYIST FORMSU,obbyist Retristration Form.doc
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