Wayne M Pathman - Goran Rostad v
MIAMI
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.
Pe44 ma,iN. LA)a.41.4.-L— ell
NAME OF LOBBYIST: (Last) (First) �?)Le24OD,(MI) •
� LiS L" Z S. 5c & i , FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) 1 (State) (Zip Code)
"31:35-
._3°c '7 3- f 2-C 3a r - 311- 2-1(1-0 U d' r�r @ Inc yr �-��f s.
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Mr. (-1:or' Ko 5'ha
NAME OF PRINCIPAL/CLIENT:
P _ Dr. �`c�rn; 6. 4-w- F T331gi
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Ei 0 r Z.-)Q51-54 c a/1 O
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: iv
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: i
u.SPECIFIC LOBBY ISSUE:;
De 51 A 12.e fro vcek 7 /i G._ „Ae -
Issue to be lobbied(Descfibe in detail):
uLCITY 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,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
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Pursuant to City,Code Section 2-482(g)Every registrant shall bey 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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) E li e„�.,
our B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):,�tjr� l
(REQUIRED). �r
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, t o: 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_/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 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.
Yes,/N o: 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 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 FILE!,Im_,N IF T ERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
ignature of Lobbyis 4017
I do solemnly swear that all of the foregoing facts are true and correc :nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beac " _ -_J.nd all -••iC i• re•uirements.
Signature of Lobbyist: J.�%
Signature of Principal/Client: Amor/
VI. LOBBYIST IDENTIFICATI b4': PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND ST PcFMQTARY: DORINDA TRIPONEY
".;°`,, *11? Notary Public-State of Florida
State of Florida,County of Miami- - :-_ My Comm.Expires Jul 10,2015 State of Florida,County of Miami-Dade
Sworn to apd subscribed before rrie=;'_'_` };: Commission#EE 82555 Sworn and subscribed before me
This ..day of ��2r.. ,201.:. Bonged Through National Notary Assn. This day of ,201
iiiDAA4-4-k---". ,
Signature of Public Notary State of F rids Signature of Public Notary—State of Florida
Notarization of Lobbyist's signatu Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid$ , . 0&00 CR# Q �3 Date Paid i bf .20/y
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual ; �,.1 •a' rd.do � Revised 01/22/2014
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)
Oo;�N
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 1
(REQUIRED). 9b �(-
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./No: 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_/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 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.
_Yes./N o: 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 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 FILEaE-,_ N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobby's
Z.,/
I do solemnly swear that all of the foregoing facts are true and correc :nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beac, -:.: nd all r-..s' . re•u rements.
Signature of Lobbyist: gr:
iffir
Signature of Principal/Client: „` !/.�.G ` A
VI. LOBBYIST IDENT1FICATI!I PRINCIPAL IDENTIFICATION:
Produced!D_ _Produced ID CA(t L.'-CT Lt,C C-e..
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND ST P Q.F!,(QTARY: OORINDA TRIPONEY
,
•° `•= Notary Public-State of Florida
State of Florida,County of Miami- `;� �
y : My Comm.Expires Jul 10,2015 State of Florida,County of Miami-Dade
Sworn to apd subscribed before me:.°L_ Commission#EE 82555 Sworn and subscribed before me
This t -- day of j 201 5onoed Through Nalional Notary Assn. T 's.2 Kat- ay of Dec. ,2014
01t..f_ r �� •�
Signature of Public Notary ' Stale of F rida Signature of Public tibtary—State of Florida 4
Notarization of Lobbyist's signaiu Notarization of Principal's signature' O�
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY C
• j Annual Registration fee: [ j Yes[ )No Amount Paid$ MCR# Date Paid I 7 c"
Lobbyist Registration Form received and verified by: - \6
F:1C ER1$ALLloFOUISILGBByIST FOl r1s\LabbyistAnn al Registration rorm.duc Revise. I, y 2/2I J 4
F:ICLER\SALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Ben Fegran
Tingrettsdommer/nestleder
JudgeNice President of the District Court
.
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: j0 fa4m -
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, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed o th- Miami-Dade County Commission on Ethics and Public Trust.
kA11111111 Pee_ 2-0/
Signatc Date:
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I 2/0112014 001 ,
Miscellaneous Cash Receipt u, t; 7,;4223 i:350.09
CITY OF MIAMI BEACH
No 3 6 2 2 3
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Cash inCredit Card eheak# (9(5670 $ 35), CZ--)
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Received of i f,,)e c PrA.)
Address
For Lail bq ;5 71- I-ilea/5 f!?11-1-7-0-7A- e b-rk ,N;e4-
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(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By
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Preparer: 1.‘_)n C t I Dept: I I '7\ -N. En: /
PATHMAN
LEWIS, LLP
ATTORNEYS AT LAW
WAYNE M.PATHMAN,P.A. ONE BISCAYNE TOWER• SUITE 2400
HAROLD L.LEWIS,P.A. 2 SOUTH BISCAYNE BOULEVARD
DAVID E.SACKS MIAMI,FLORIDA 33131-1803
LOUIS P.ARCHAMBAULT
JOHN A.MOORE* TELEPHONE(305)379-2425
RICHARD N.SCHERMER FACSIMILE(305)379-2420
BRUCE L.BENNETT** www.pathmanlewis.com
SARA WALTERS
ANTHONY VICTOR DE YURRE WAYNE M.PATHMAN
JONATHAN C.BROWN wpathman@pathmanlewis.com
PETER L.MELTZER December 1, 2014
SALOME A.BASCUNAN
also admitted to practice in Texas
°Member Washington,D.C.Bar
Via Hand Delivery
City of Miami Beach
Lobbyist Registration
1700 Convention Center Drive, 1st Floor
Miami Beach, FL 33139
Attn: Silvia
RE: Lobbyist Registration — Wayne Pathman
Dear Silvia:
Enclosed for processing please find a Lobbyist Registration form on behalf of our
client, Goran Rostad, along with this firm's check in the amount of $350.00.
Please do not hesitate to contact us should you have any questions or comments.
Very truly yours,
j)-1-w
Dorinda Triponey
Legal Assistant
Enclosures