Lynn Mathon - The Carriage Club North Condominium Assoc. C7
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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 engpged ih lobbying
activities. The term "Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Mathon Lynn A.
NAME OF LOBBYIST: (Last) (First) (M.1)
B. P. Taurinski, PE, PA, Struct. Eng. 730 S Deerfield Ave, ##1, Deerfield Bch, Fl
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954-418-3100 954-418-3986 taurinski@bellsouth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact Information:changes:address,;phone,or e=mail.address... .
1. LOBBYIST RETAINED BY:
The Carriage Club North Condominium Association, Inc.
NAME OF PRINCIPAL/CLIENT:
The Carriage Club North Condo 5005 Collins Ave, Miami Bch, Fl 33140
B�?�ES§gg�%�T�DDRESS Code
D-0 "ity' apar.edW'sa$ wpropeF�yma agemen.t.COM
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 KSUCH CORPORATION,
PARTNERSHIP OR TRUST;
ii.SPECIFIC LOBBY ISSUE:
Owner' s wish to install new metal and glass railing system
Issue to be lobbied(Describe in detail):
III.CITY AGENCIESANDIVIDUALS 1*0 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
: Deborah Tackett, HPB None X
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.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
No Current relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) Ogler No Compensation for this. However, we have a monthly fee
or the on going concrete restoration ot the buiidiHg structure.
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 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for
chancre 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
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.
X Yes No: Are you representing a riot-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 SHALLABE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
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SigKgtur f obbyi t
I do solemnly swear that ail of the regoing f c s are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mi i B City C e d all r porting requirements.
Signature of Lobbyist: J
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification o
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X Personally known(Lobbyist) Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State Florida, ounty of Miami-Dade
Sworn to and subscribed before me Sw n d su cribed before me
This day of N 4),v— ,201 /V Is y f,L �L1'L�. ,201
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Signature of Public Notary—State of Florida ature f ub i N a — tate of rida �
Notarization of Lobbyist's signature Notarizat n of Principal's signature r �
TO BE COMPLETED 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:
z . ;n; Revised 01/22/2014
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MY COMMISSION 0 FFOS6192
a EXPIRES:September 22,2017
N'dAMi REACH
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: Lynn Mathon
I understand that no later than February 28 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, 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, o fails to file the required Statement by April 301 of each year,shall be
aut matica spended from lobbying until all fines are paid, unless the fine has been
C:e;ale ; a Miami-Dad County Commission on Ethics and Public Trust.
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Date:
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