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Miguel Diaz de la Portilla - MIA FL 2013 Holdings 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 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 Miguel Diaz de la Portilla Principal MIA FL 2013 HOldings LLC. c/o Willoughby Capital Holdings, LLC Issue Assistance with permitting matters at 120 Ocean Drive, Miami Beach, FL I PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: CATEGORIES OF EXPENDITURES Food and Beverage: 47 4J Entertainment: K Research: /w Communications:Media Media Advertising: Publications: Travel: A 71 Lodging: Special Events: CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE DATE REPRESENTATION ENDED: OATH State of Florida County of Miami-Dade I,the undersigned lobbyist,do hereby depose under oath and affirm that the information dis ny attachment hereto are true and correct. jeyist Signatu SIGNATURE AND STAMP OF NOTARY: Produced ID ■sr Form of Identifi. lion ����wa,, THERESA F.JOHNSON Signature of Public Nota —State of Florida ' Notary Public-State of Florida savor o and su c ibed before me i = Commission•FF 201099 Personally known az COMM.Expires Feb 19,2019 This-3— day o 24/� -�� MY Co A ��in'-• Bonded through National Notary Assn. ,011;