Monika Entin - 420 Lincoln Road Development, LLC bot Daexc-L A-Qc-
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Office of the City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
305.673.7411
LOBBYIST REGISTRATION FORM
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 City Code Chapter 2,Article VII, Division 3, entitled"Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Entin Monika
NAME OF LOBBYIST (Last) (First) (Middle Name)
Bercow Radell Fernandez &Larkin, PLLC, 200 S. Biscayne Blvd., # 850, Miami, FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6237 305-542-3445 MEntinaBRZoningLaw.corn
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Cejas Paul
NAME OF PRINCIPAL (Last) (First) (Middle Name)
420 Lincoln Road Development, LLC, 420 Lincoln Road, Miami Beach, FL 33139
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
C,E4��tZN►M4 ��ci NY. COM
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY: Paul Cejas
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Paul Cejas, 100%
III. ISSUE TO BE LOBBIED:
Describe•with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for
p ... • •• • . rin• number.
�`"` ,, '`' ,, :''r`• ''' .r , including, but not limited to the Historic Preservation
Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development
Committee, City Commission, and any City Workshops or Committees, if necessary, relating to the
property located at
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'-
Signature of Lobbyist: Date / /fl
Y /
I do solemnly swear or affirm that all of the forego' = -- , statements, and disclosures in this form are true and correct,
and that I have read or am familiar with •- - - ions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all •ortin. -quire -nts.
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Signature of Lobbyist: ��� Date
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Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of C\UA Cta) State of C70 r-1c/Q
County of: MACllµ,t-- s i.e) County of: Alze n,/i 2 ad .
Sworn to(or affirmed)and subscribed before me Sworo,>;9(or affirm ) nd subscribed before m
this q day of c . 7(V C�wV1,- ,28 6, by this o`y`day of Q , 20X, 6y
Monika Entin Paul Cejas
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION — -- FORM OF IDENTIFICATION
Personally nown personally Known
iqgri/A / • .• Atige dor 41
Sign zture ' otary Public Signatur- f Notary Public
-- —�——- - 71 ' 6
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Na-;e; ��tpe ti�ik 6P tamdp_. Name of Notary, Typed, Printed ortile'
4,41* ary ub is- tate of Flori a
(N°1--‹,etas L)My Comm.Expires Mar 5,2018 (NOTARY SEAL) tp� ****. + IRANUlsIRQ
Commission# FF 078662 # *MY COMMISSION#FF940078
�� EXPIRES:March 26:2020
TO BE COMPLETED BY CITY CLERK'S T•FF ONLY )4.0F ft9 ft. Bonded Thru Budget Notary Sento
Annual Registration fee: [ ]Yes( J No Amount Paid$ )O,00 MCR# 510 Date Paid O 2.•
Lobbyist Registration Form receivetl and verified by: :. -
F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc Revised 08/18/2016
1 The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
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