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Jorge Sergio Kuperman - Doug Bangle Rachel's Restaurant and Cabaret City Of Miami Beach Lobbyist Fee Expenditure and Compensation Form City Code Section 2-485 . Expenditure report for period of:1/1/2015 through 12/31/2015 A statement shall be filed even if there have been no expenditures or compensation during the reporting period. This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive, Miami Beach, FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due date. If you require any assistance,please contact this office at 305.673.7411 or at cityclerk@miamibeach.gov. Lobbyist Jorge Sergio Kuperman Principal Doug Bangle Rachel's Restaurant&Cabaret Issue As Architect of record will speak to Planning Board in a status report matter at 621 Washington Ave.Assessed Fines WAIVED PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: CATEGORIES OF EXPENDITURES Food and Beverage: Entertainment: Research: Communications: Media Advertising: 9 \ Publications: Travel: Lodging: Speci Events: CHECK BOX IF YOU NO LONGER RE RES NI THE P NCIPAL R THE ABOVE ISSUE DATE REPRESENTATION ENDED: ' I 0 4 OATH State of Florida County of Miami-Dade I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disc osed herein an• y attachment hereto are true and correct. c1:04.1, Rodoifo E Sal= obbyis S': : .fie SIGNATURE AND STAMP OF NOTARY: ,a, Commission # FF1�t37 5 .,:'" Expires:December 15,2019 ��, k {%%% Bonded thru Aaron Notary a Produced ID ,�„,��� Form of Identification Sign of ublic '• ary—State,if Fl• da I Sworn to an subscribed before - Personally known This 24v day ofTAN,20 I if? 1/erf