Collins Avenue Associates LLC
SENT BY: BE~eow & ~ADELL, PAj
"
3053776222j
AUG-26-02 11 :40AMj
PAGE 9/10
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ClI.y at l'11wri Bach Oftlce 01 tit. ay aart
1:700 CorwMl:icIft c.nter I)riora, Mblrri BelICh. FL 3313g
em.l: cityclcl!1tOd.milrTi-bUC:h.ft.".
LOBBYIST REGiSTRATION FORM
(Oty of MilIl1'li Buch. dty 0:111. ChllftlV' 2, Olvlllon], Sa:!ian z..48l)
4 Check. Box if aft Arnendment
Puiq
NAMe OF LOBBYIST: (Uilt)
Dora
(Rrst)
(M.I) DATE QUAURED PiS LOBBY1ST'
;;q~7 ("'1111inQ avpnu.. Mi;::tmi Rp;::tch
BUSINESS ADDRESS: (NIUT1ber and Sb:ect) (CIty) ~Statll)
(305) 861-7444
~I.fPHCriE NUMBER: f'AX NUMBER;
F'lorida 33140
(ZIp CQde)
~
L LO..YIST RETAINED .,,;
Collins Avenue Associates, L.L.C.
f<lAME OF PRlNCP~CJENT:
.c/o Bercow & Radell, P.A.
200. S. Biscayne Boulevard, 1850
BUS[N!SS AODRE5S: (Number and Street) Cety)
Miami Florida
(Stata)
33131
(:zip Ca:Je)
(lOS) 374..-Ci300
1UI!PHONE NUMBER:
(3051 377-62~~
F=A)( I\IUI'1BER; (Optionlll~)
&tAn.: (Optloonal)
Pili OUl thla ..:don If prln..lpIIl .. . COl"pOnltian, '.nn....hlp "', Trusl [s.dian 1.....2 (el]
NNIt& OF CHIEF OFRa~ P~ER. OR. 8E1EAC1ARY: DOn peebles
UST AU. P8lS0l'6 1-IOt.DtNG, 1)1A.!CT\.'t' OR.INl)lREc:T1.Y, A~'" OR MORe; 0Wl'65I01JP ENT'EREST IN sUcH
c:oRPOAAnOff,. PAtlTNEIlSHlP OR, TlUJST: .
a.. SPEclF1CLOBaUS$UE: Var;iance Appl~cat;i.on for Historic Preservation
BOAf4 regulations, Se~tion 11B-532(f) and 118-564(f)(11)/Renewed
App lcat10n for Certificates of Appro~riateness and Demolition
Iuue to be Iobbi.d (o.ctibt.1n debil):
w. CITY AG~CIl5/INDMDUALS TC! .. LOBBUD:
A) full H.me .r l....hrldu..I/T1d. .) .........lp
Jorge Gomez, Director None
Mercy Lamazares None
W1lliAm Carey None
Neither the .APplicant nor its representatives will lobby me~bers of . the ~isto~c .
Preservation Board prior to the public hearing since they wIll be acUng 10 their quast~
judicial capacity.
SENT BY,: BERcaw & RADELL, PA;
, . ~
. ,r
3053776222;
AUG-28-02 2:28PM;
PAGE 6/6
lV. DISCLOSURE Of TERMS AND AMoUNTS Of LOB8YIST COMPENSATION (DJSC...OSI! WHrnfER HOURL Y,
FLA,. oRA TE DR OTHER):
A) LOBBYISTDISCI..OSURf; Salary and Commis.sion
S) PRINCIPALS DISCLOSURf! (Oll108lMST CXJMPENSA"ON):
64/lI7 .~ Ui~
v. SIGNATURE UND9 OATHI
ON OCTOBER 1 IT OF EAaf YEA~ EACH LOBBYI~ SHALL SUBMIT TO THE ClT'( CLERK A stGNED
~ATEHENT UNDER OATH, US11HG LOP8Y1NG EXPENDITURES IN THE CITY OF MIAMI PEACH FOR
THE PRECEDING CALENDAR Y~R.
csre true and c and that I have read or am
. mi Beac:h City Code as amended, and all
I do solemnly swear ht all of the foregoi
familiar with the provisions contained in
reporting requirements.
Signature ot Lobbyist:
Signature of Prlnclpal/CUent~
VI. L088YIST lD!NTIFICATION:
< Produced ID
Form of Identification
G~llaiIY..K;,~
VIL SIGN.\TU~ ANP STAMP OF "OTARY OR DEPl1TY CLERJ<:
State of Florida, Counly of Miami-Dade
Swam to and 5Ubscrj~~
This ~ day or ~T, 2002.
Flolida
Pubnc
'FORCLEkK'S USE ONLY
Registration: ~ ACCEPTED [] REJECTED
If rejected, 5tltte reason:
Registration fee paid: P1:'fes ( 1 No
( 1 ca 0'lCcX
DATA ENTRY DATE: C1
1
DATE:
q"'?J-O{l..
MCR# 2~7~.
2002 ENTEReO BY;:!}. ..J:>
I flirst Rl!Yisloo - OS! 17/02
SENT BV: BERCOW & RADELL, PAj
3053778~~~j
AUG-~8-0~ 4:40PM;
PAGE ~/~
'tV. Dl$CLO$URI! 01" TERMS AND AMOUNlS 01' LOBBYIST cOMPENSAnON (DUa.OSE WHmiEA #fOURL Y,
FLATRATEOR OTHER):
A) l088'f1ST0lSQ,0SlJRf: salary and Commi.ssion
5'Qluf{ ('~ tr.Mtt1/J SlY)
8) P1UNCPAL'S D1SQ.05URE (ClI" LODmsTCCHPE~SAT1ON):
v. SIGNAlUtU UNDER OATHI
ON oc;rolll':R 1" all I!ACH YEAR., EACH LOBBYIST SHAU SUBMIT TO THE C11T CLERK A SIGNED
STATEMENT UNDER OATH, LIsnNG LOallY1NG EXPI:NDITU~es IN THE CJ:TY OF MIAMI BEACH fOR.
THE PRECEDING CALENDAR. YEAR.
I do solemnly swear that all or the r'bregolng facts are true and correct and that I have read or am
familiar with the proviSions contained In Sectlon 2~B2 of the Miami Beach Oty Code as amended, and an
~portlng requirements.
SignatIJre of Lobbt'lst:
SignabJre of Principal/Clien .
VI.
~ Produced 10
Form of .Identification
)t( Personally Known
'ill. 51GI'IIATURe: AND STAHP OF NOTARY OR DEPutY ClZRK:
State of Florida, Countv of Miami-Dade
Sworn to and subscribed before. me
This a1.(" day of ~~~( ,2002.
Slgnatu blic Notary - State gf Florida
L.. '0uO\(tt (; A~e. ~~
Print, stamp or type name of ,Notary Public
L ,JUDITH GASKElL
Notary Public, Statl of Florida
My comm. expo Jan. 23. 2004
Comm. No. CC904314
.~
fOR. CLER.JC'S USE ONLY
R.egi5tl1ltion; ['<[ACCEPTED
[ ) REJECT.ED I)A TE:
~ '- :3 '- () 'l.-
If I'lt~, stale l"I!aSCln:
R.lI!g1sD'8lSon fee p"ld: ~es [ ) No
[ 1 Cash kj"01etk
MCR#
i C;-;-l:1j
DATA ErmtY DATE: _~,..
1
_, 2002
ENTERED B'I':
I PIr.t R.etmlan - 05/17/02