Charles Benson - Senor Frogs Miami, LLC 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 r' 3 -
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 cityclerkPmiamibeach.gov.
Lobbyist Charles Benson
Principal Senor Frogs Miami,LLC
Issue Conditional Use Permit for a Neighborhood Impact Establishment and any Land Use,Development,zoning,
design,or licensing issues/
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0
CATEGORIES OF EXPENDITURES
Food and Beverage: 0
Entertainment: 4 0
Research: V
Communications:
Media Advertising: 50
Publications:
Travel:
Lodging: 0
Special Events:
XCHECK BOX IF YOU NO LONGER RE,P,RESEN/T THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED: Amy b tap D 15
OATH
State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information osed ere' nd any attachment
hereto are true and correct.
Lobbyist Signature
SIGNATURE AND STAMP OF NOTARY:
Ct&.
Produced ID
Form of Identification Signature of Public Notary—State of Florida
Sworn to and s bscribed before me
A/Personally known This 1`� day of'l 1 0 1
,,,,,,,,, u'PIA JAKONIUK
CI ; Notary Public-State of Florida
_.; l*:11: M y Comm.Expires Jan 9,2017
71 Commission#EE 863721
,,; Bonded Through National Notary Assn.