Collins Avenue Associates LLC
SENT BV: BERCOW & RADELL, PAj
3053778222j
AUG-28-02 11 :39AMj
PAGE 5/H)
.,
.. ..
a, 01 HI.1Ii Beadl 0Iftc:c 01 "'. t2f QIf1t
17QQ Canv.ntiqn CAnIW DrtvlI, Mian hlld\, A. 33139
err..O: l;ltyd~.rn.nl-b-=h"""
LOB8YIST ~GisTRATJON FORM
m..'
. .
. .
. .
,: . ,.
. .,
.~
(at cI Miam IIach, CltV' CDcI. o,lI!l'*r Z. Oiwisitiln J, Sc<<Icn %....1)
.4 Ch_c:k Sax If an Amenclrnent
Grimm
l'W'Ie of l.OBBYI5T; . (~It)
100 S.E. 2nd street
BUSINESS ADDrwiS: (NlJfrlMr IIid SIt..t)
Daniel
(Ant)
Miami
(~)
(305) 995-5340
FIoX NUI"IB!R:
(~.I) DATE QUAUI"1ED AS LC1I8'1'1ST
Florida 33131
(5.) (Zip Codtt)
( 305) 995 - 5 3.3 0
T!LH'HONf. NUMBeR:
El'lA4.:
L L088Y1S1' NTAl"~D .Y:
Collins Avenue Associates, L.L.C.
NAMe Of PFUNaPAlJCU&HT:
.c/o Be~coW & Radell, P.A.
200 S. Biscayne Boulevard, 'S50
BUSINess ADDItESS; . (Humbr!r and Str_t) (Cit1) .
Miami Florida
(Stabl)
3313'
(ZIp CccIe)
t:~Or.\ 174-C;JOO
i'aS'HCr IE NUMBER:
(305) 377-6222
p,.;t. /IlJMlS$; (OptIan;d)
fMAll.: (Optionll)
'iII out III. .sti." . prtncl,.1 .. . CDrp.,...., P.rtn......ip ~ TlUlIC [s.cao.. ~-4112 (e)]
'1 ~ OP CHIEF OFFICER, PAIl'rNER, OR BEelIJIICAA.'f': Don peebl e s
7 usr .-u. Pl!J<<SQl'4S HOl.DII\IG, DIRECTl.Y OR lNDlREcn..V. A S~ OR ~ QWNI!RSHIP ~ 1M sUet
C:CJfU"OMTIOI'If, PMlllERSH.tP OR TALJST:
n. 5pecIPICLO.....US...E: Variance Application for Historic Preservation
Board ~equlations, Sections 118~532(f) and 118-564(f).(11l/Renewed
APplication for Certificates of APpropriateness and Demo ition
lsIU. tD be lobbied (DeIcriIl. ill dt!l:ail): .
. .
01. art "GI!"CJES/I"DMD"A~ 'to .. LO..IIIOI
A) Ful "_me Df lndIwldual/l1tle .) ..............,
Jorge Gome2, Director None
Mercy Lama :UU: e s None
William Carey No.ne
., . .
Neither the Applicant nor its representatives will lobby m~bers of~e !listo~c -
Preservation Board prior to the public hearing since they wtll be acting in thelt quast-
j udicial cap~ity.
SENT BV: BE~eOW & ~ADELL, PA;
.
3053778222;
AUG-28-02 11 : 39AM;
PAGE 8/10
.
lV. DISCLOSURE oF TERMS AND AMOUNU OF LOBBYIST COMPEN,.T10N (DISQ.O$E wttE1HER HOUIlL r.
FlAT 1lA ~ QII D7HEAA
A) loB8'I'IST olSClOSURE:
Salary
B) PRlrc;;lPAI,:S DISCLOSURE (Of' LDBBY1ST CDMPENSATlOfol):
59 JfJ1
v. SlGNo\1UAI! ....DER C)A'IH:
ON OCTOBER 1"" Of MeH yEA.... EACH 1.0..YJST SH.~L SUBMIT TO THE CITY CLlRK A SIGNED
STATEMENT UNDER OATH, USTING LOB8Y1NG EXPENDrTURES IN THE art of MIAMI BEACH FOR
THE PRECEOIIIG CALENDAR YeAR.
1 do solemnly swear thcat all of t~ fbregoing feets are true and correct and that I have read or am
familiar with the provISions C:Dn toed in section 2-482 of the J11lam Beac:h City Code lIS amended, ilInd all
reporting requlrwJJelD.
Signature of lobbyist:
...
YL
IJ: produced IO
Form of Identification
VII. SIG..AlURE AMP !lTAM' OF NOT-.a't OR PU-U1Y CLStJ(:
X personalty Known
State of Florida, Countv of Miami-Dade
Swom to and subscribed before me
This 'a1 ""IlL day of ~Gu' ( , 2002.
L. JUDITH GASKELL
Notary Public, State of Florida
My comm. expo Jan. 23, 2004
Comm. No. CC904314
Signature blic Notary - State of Florida
L. ~C)..-c\\ (') A')-4(E'l.,-
Print, stamp Or' type name of Notary PubliC
FOR CLERK'S USE ONLY
Rcgisb1Jlion:
[v<' ACCEIFTED
[ ] REJECT i..D
DATE:
~-J~(L~
If rrajee:ted, Sl'atB reatlOl'l: - .
Reglstnltlcln fee paid: ~ Yes t J ~o f)
[A~ D4.Chcck Heft' ~S'~ h
PAT> EHll'Y OATE' -::i.f-:::> . >1102 ENTERS> ~ it-" -
-. ..-----'.
I Ant ~ - 05/17/0'2