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Alexander Tachmes - Betsy Ross Owner, 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 citvclerk@miamibeach.gov. Lobbyist Alexander Tachmes Principal Besty Ross Owner,LLC Betsy Hotel Issue Conditional Use Permit application PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: CATEGORIES OF EXPENDITURES Food and Beverage: Entertainment: No expenditures; received compensation Research: based on fee rate as reported in lobbyist registration. Communications: Media Advertising: Publications: Travel: Lodging: Special Ev s: HECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE DATE REPRESENTATION ENDED: OATH State of Florida County of Miami-Dade I,the undersigned lobbyist,do hereby depose under oath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 informat' disclosed herein and any attachment hereto are true and correct. Lobbyist Signature SIGNATURE AND STAMP OF NOTARY: Produced ID . Form of IdentAb — — — — — — — — — — ignature of Public otary—State of Florida d ,,,,,021;2_,„P - SUSAN C. ate of Swor o ands d before me 1' Notary Public•State of Florida This Ll day of ' -fGI r Q Personally known ., ,.r M I y ����-�+' r� y Comm.Expires Feb 11,2016 I -,1,i LETS Commission•EE 161755 Bonded Through National Notary Assn. 0 Ow■epwsmerlepowNp•qp.mffsimipmeirish /40