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David Martin - 120 Ocean Drive, 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 David Martin Principal 120 Ocean Drive, LLC Issue Development approvals and permitting issues,including but not limited to HPB, PB and City Commission,relating to approvals for modifications to design and robotic/mechanical parking for the property located at 120 Ocean PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: • O. CATEGORIES OF EXPENDITURES Food and Beverage: Entertainment: Research: Communications: Media Advertising: Publications: Travel: Lodging: Special Events: CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE DATE REPRESENTATION ENDED: OATH State of Florida County of Miami-Dade I,the undersigned lobbyist,do hereby depose under oath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 disclo ed erein :'d y hment hereto are true and correct. 0111114/0 5:'�\SSION'•. •cp 430,?DF,�9• .. ist Sig ..'t r.. SIGNATURE AND STAMP OF NOTARY: *; ip•4 �;*= :o� ,' ` Produced ID �s OF 946922: •Q. _A/11/i ,b Form of Identification 1:66,•cyAu,, e0fldd ,��� i �bf���•• ���\\\ Sworn to and sbbscrota�before me Florida ���„/If111111111���`\ r Personally known This5 day of Ala 20 /!O 6-Adi gelloW