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Neisen O Kasdin - Florida Fine Wine and Spirits, LLC \ 5 A �: Y _ \1 O , 1 d Y 3 ss '�£«r r""":1/ ), 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. Kasdin Neisen 0 NAME OF LOBBYIST: (Last) (First) (M.I) Akerman, LLP 1 S.E. 3rd Avenue,25th Floor, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5600 305-374-5095 neisen.kasdin @akerman.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address,phone, or e-mail address. LOBBYIST RETAINED BY: Florida Fine Wine and Spirits, LLC _- NAME OF PRINCIPAUCLIENT: —' ,1") Florida Fine Wine and Spirits, LLC 11325 Seven Locks Road, Suite 214, Potomac, MD 20854 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) rir -- .) 301-795-1000 T'I c T' TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] rt '• • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: see Exhibit A • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: see Exhibit A II.SPECIFIC LOBBY ISSU.E:- Request for a variance from the 300'distance separation requirement between a retail package store and a place of worship. C41 I I OI &•I Issue to be lobbied(Describe in detail): 54-eff 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,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 City of Miami Beach Planning Department staff none X City of Miami Beach Board of Adjustment 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 none r • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $675/hour (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 ®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 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 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 ®No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS COwEN11•TION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL , I 39 EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature o Lobbyist I do solemnly swear that all of the fit=�o' g acts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be-,'• .it, i •+e and all reporting requirements. Signature of Lobbyist: / Signature of Principal/Client: ./ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID 0 Produced ID Form of Identification ��b::+;ti•. Form of Identification ( A�.s �HERYL A. COLE `V!. ''' Y PUBLIC Personally known(Lobbyist) <:��*'�,•• )ief Personally known(Principal) CHERYL VII. SIGNATURE AND STAMP OF NOTARY: I � � Commission Expires 07/11/2015 Q1-C i A 8 C itt IaA J /-,Dn��IiIG �/ State of Florida, County of Miami-Dade i l v State of , County ofMiarx�r.Da4e ,—J Sworn t• -nd subscri•-• •-f•r m- H Sworn an subscribed before me This •- o ���L.� 01�, This day ofUpx) , 9 Z�/S_ , g g-g 11110( 4•r'ature of blic Notary— t- e • on•a Signature Public otary—State of FJ /ar- J/aA)d Notarization • obbyist' gnature Notariz n of Principal's signature J �J TO BE COMPLETED B(CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ No Amount Paid$ MCR# Lia/q/A- Date Paid ///.5ii S Lobbyist Registration Form received and verified by: C/4, .� F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration For .doc Revised 1/11/2011 I 441 Y City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Neisen Kasdin I understand that no later than February 28th 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, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. ia tSignature: e: Exhibit A FLORIDA FINE WINE AND SPIRITS,LLC-Ownership NAME TITLE Ownership Beneficiary ADDRESS 11417 Skipwith Lane David J.Trone Managing Member 5.00% Potomac,MD 20854 9829 Avenel Farms Drive Robert L.Trone Managing Member 5.00% Potomac,MD 20854 11325 Seven Locks Road,Ste 214 Robert L.Trone Member 22.50% Potomac,MD 20854 11325 Seven Locks Road,Ste 214 MCT 2013 LLC Receiving Trust Member 11.25% Michelle Cynthia Trone Potomac,MD 20854 11325 Seven Locks Road,Ste 214 JET 2013 LLC Receiving Trust Member 11.25% Julia Elaine Trone Potomac,MD 20854 11325 Seven Locks Road,Ste 214 NRT 2013 LLC Receiving Trust Member 11.25% Natalie Rachel Trone Potomac,MD 20854 11325 Seven Locks Road,Ste 214 RJT 2013 LLC Receiving Trust Member 11.25% Robert Joseph Trone Potomac,MD 20854 11325 Seven Locks Road,Ste 214 SPT 2013 Receiving Trust#2 Member 22.50% Sophia Parisi Trone Potomac,MD 20854 100.00% lhiC is=.x# lalnaggraMMEMPUDISSIMSMEMT City of Miami Beach-Florida Finance Department 1 City Hall 1501313- 1 01/13/2015 BR1 T121 Tue Jan13,2015 04:32PM Trans#33-33 33 $350,00 MCRCLERK - MCR-City Clerk • MCR#: 401412 ITEM(S):1 ITE TOTAL: $350.00 Check (30015035) PAID $350.00 Have a nice day! • . iS <03 f 121, Miscellaneous Cash .Receipt CITY OF MIAMI BEACH • No. 4,;0412 D .Cash Cred it Card ©Check# : 20 Received of • Address p For c-71 • (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By- Account Huber: , r. .(/' {'�. • -. :-- - - ,, _. '.•1, .,ter' - .-. J i�� • r /rO Dept. ? � • Preparersr ::,r, r EXT.