Wayne M. Pathman - George Martin c�
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City of Miami Beach Office of the City Clerk U16 J.N i , 09
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM f- ICE
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any city board or committee;or any action,decision or recommendation of any city personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
( '-rv\ay-
NAME OF LOBBYIST: (Last) (First) c (M.I)
Let Lip 2 5. (�1�� ( , 2��, (lYl ili-�,` f2 33(3 i
B SINESS NAME AND ADDRESS (Number and Street) )(State) (Zip Code)
'v 5- 31 - 24 42-5- 30f 319- 2-'(w ( 44A.€ R4/4 me.- �-ew.5 • �►�.
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
•
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
tv, Aar 4-11A,
NAME OF PRINCIPAUCLIENT: J j� Ia-ctz) • 1) r. nn i D
BUSINESS NAME AND ADDRESS , and Street) (City) I (State) (Zip Code)
'3 c
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Av
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR IN-IRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ,k)( t
ii SPECIFIC LOBBY:ISS
( Id
Issue to be lobbied(Descri 'n detail):
Ill.'CITY'AGENCIES/INDIVIDUALS TO. BE LOBBIED,:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
1,7 cre5 4- Commifia2.5
ecANUA(55 i 4- S4-44
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship A/'o
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc /
1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) q--61) / h-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): r
(REQUIRED). -
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes. i4 o: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes_4 o: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set
forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
it m,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
Yes No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL.• : = - • ION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH• BE FILED N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
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Signature of Lobbyist
I do solemnly swear that all of the oregoing fa are true and correct d that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code a ,• all -•ortin• requ'ements.
Signature of )t----"-- z , .
Signature of Principal/Client: A FIAr
VI. LOBBYIST IDENTIF - • ION: .PRINCIPAL IDENTIFICATION:
Produced ID Produced ID `'il 'Pf''•- DORINDATRIPONEY
I••ag•I1 d �ISSION#FF 224382
Form of Identification � ��:��,�ctif�
-- ,a,. EXPIRES: 10,2019
i _,I^'�R�,� •`'• Bonded Thru Notary p.!i;Undorwrltere
Personally known(Lobb 4\141";:.
t\1"1;'°'� ;: DORINDATRIPONE2 ' Personally kno - ' •. `°-
:t. 4:, :r MY COMMISSION#FF 224382
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VII. SIGNATURE AND STAM r i . .5 A od Thru Noiar:'.:'F':inderwriters
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade
Sworn to aryl subscribed before me Sworn and subscribed before me
This i day of 1A-N. ,201 4 This ltC ay of 'A Iv ,2014
Anfr;‘,14—, 1;1--;g 1h �r�J _/�ii�� _Signature of Public Notary State of Fl rida Sign lure of Public Notary-St It e of Florid;
Notarization of Lobbyist's signature Notarization of Principal's si•nature
• TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 2 ♦ 00 MCR# •� b IA 0 Date Paid r— P-- I b
Lobbyist Registration Form received and verified by: raid 1 - ire.,_k___
F:\CLEF\$ALL`aFO MS\LOBBYIST FORMS\Lobbyist Annual Registration Forrindoc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
M BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: O . (4041441/t0,1^-
I understand that no later than February 28 of each year, I must file the following form,
pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for
all active lobbying issues.
1) LOBBYIST EXPENDITURE AND COMPENSATION FORM
Failure to file these forms on a timely basis will result in my name being transmitted to
the Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d),the City Clerk shall notify any lobbyist(or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
a• • s -.mi-Dade County Commission on Ethics and Public Trust.
Effige■1111 --- /)-I6
Signature: i Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach-Florida r IN --� ? a.
Finance Department m ca
[..'- '1 City Hall : 4: m y� 1
1601213-1 01/12/2016 BR1 T121 f° . . - V V
Tue Jan12,2016 11:13AM Trans#19-19
19 $350.00 MCRCLERK - MCR-City Clerk ` V
MCR#: 468620 Y y r- _.:.> -� (.
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1 ITEM(S): TOTAL: $350.00 ,
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Check (029 95) PAID $350.00 _
Have a nice day!
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PATHMAN
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LEWIS, LLP
ATTORNEYS AT LAW 2016 JAN 1 2 10: 09
WAYNE M.PATH MAN,P.A. , ,; I ONE BISCAYNE TOWER• SUITE 2400
HAROLD L.LEWIS,P.A. �� i ` .� ' 2 SOUTH BISCAYNE BOULEVARD
DAVID E.SACKS MIAMI, FLORIDA 33131-1803
LOUIS P.ARCHAMBAULT*
JOHN A.MOORE** TELEPHONE(305)379-2425
RICHARD N.SCHERMER FACSIMILE(305)379-2420
AARON W.TANDY*** www.pathmanlewis.com
PETER L. MELTZER
SALOME A.BASCUNAN January 5, 2016 DORINDA TRIPONEY
LAURA LEFEBVRE dtriponey@pathmanlewis.com
•Board Certified Specialist in Real Estate Law
also admitted to practice in Texas
also admitted to practice in New York
The City of Miami Beach
Lobbyist Registration
1700 Convention Center Drive, 1St Floor
Miami Beach, FL 33139
Re: Lobbyist Registration —Wayne Pathman for George Martin/DRB matter
Dear Sir or Madam:
Enclosed for processing please find a Lobbyist Registration form on behalf of our
client, George Martin, along with this firm's check in the amount of$350.00.
Please do not hesitate to contact me should you have any questions or
comments.
Very truly yours,
PATHMAN LEWIS, LLP
Dorinda Triponey