Phillips South Beach, LLCQb/of Miami Beach Office of the City Clerk
:[700 ConvenUon Center Drive, Miami Beach, FL 33:[39
Emaih cib/clerk&~d.miami-beaCh.fl.us
LOBBY/ST REGZSTRATJ:ON FORM
(Oty of Miami Beach, City Code Chapter 2, Dlv~on 3, Section 2-481)
Check Box if an Amendment
RECEIVED
03/I, pR 29 PH 2;
CiTY CLERi'('S OFFICE
ROSEN ~AROLD
NAME Og~~NEY (Last) (Rmt)
407 LINCOLN ROADf PENTHOUSE S.E..
BUS[NESS ADDRESS: (Number and Street) (City)
(305) 534-4757 (305)
TELEPHONE NUMBER: FAX NUMBER:
Attorney
Z. ~~(R~rA~NED BY:
pHTT,TPS SOUTH. BEACH.
NAME OF PR/NCIPAL/C~ENTi
(M.[) DATE QUAL[F[ED AS LOBB¥ib-T
MTAMT R'FI. ARR'_ PT,nRTnA
(SLaLe) (Zip Code)
538-5504
LLC d/b/a THE SHORE CLUB
1901 COLLINS AVENUE, MIAMi BEACH: FLORIDA .q~1~9
BUSINESS ADDRESS: (Number and Street) (Qb/) (Sm~e) (Z~p Code)
(305) 761-0775
TELEPHONE NUMBER:
FAX NUMBER: (OpUonal)
ElVlATL: (OpUonal)
Fill out this section if principal is a CorporaUon, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFF~CE , PARTNER, OR BENEF[CZARY:
SEE ATTACHED
· I/ST ALL PERSONS HOLD]NG, DZRECTLY OR [NDLRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATZON, PARTNERSI-I/P OR TRUST:
ATTORNEY
PLANNING BOARD/CONDITIONAL I'I'RR
L~sue to be IAl~Des~be in detail):
C11'Y AGENC[ES/I'ND1V~DUALS TO BE LOBILTF. D:
A) Full Name of Zndividual/Title
MEMBERS OF PLANNING BOARD
B) Relationship
ATTORNEY
I'V. DZSCLOSURE OF TERMS AND AMOUNTS OF ~COMPENSAI'ZON (DZSCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
ATTORNEY $ 450.00 per }}our -
A) ]t[Ol~'t~,.'~ DZSCLOSURE: -
ATTORNEY
B) PRINCIPAL'S DISCLOSURE (OJKL~ COMPENSATION):
$450.00 per hour
V. S~GNATURE UNDER OATH:
ON OCTOBER Isr OF EACH YEAR, EACH LOBBYIST SHALL SU'BHI'r TO THE CI'TY CLERK A SZGNED
STATEHENT UNDER OATH, L:[STZNG LOBBYZNG EXPENDZTURES ZN THE CI'TY OF HZAHZ BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are tree and correct and that I have read or am
familiar with the provisions contained i~n 2-482 of the Miami Beach City Code as amended, and all
reporting requirements. ~_~,/ ~ .....
ATTORNEY
Signature of~'igt~ '
SignatureATTORNEY of Principal/Client:
VZ. ~,~~ ZDEN'I/FJ;CATION:
a Produced TD i~ersonally Known
Form of Identification
SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of MiamlLDade
Sworn to and subscribed before me
This c:~(~ jday
of ~1' 2003.
Registration: [ ]~D
If mJectecl, state reason:
Registration fee paid: [~.~_ [ ] No
2nd Revision ~?/0~
..
FOR CLERK'S USE ONLY .._,~.//.,~/~ %.
!' ] REJECTED DATE: -
..,.-. /
/
R\O.~\F~TL\i. ol~yis~\regiff~'aU on 0 3 .doc
'CITY OF MIAMI BEACH
DEVELOPMENT .REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
If the property which is the subject of the application is owned or leased by a TRUSTEE, list the
beneficiaries 'of the trust and the percentage of interest held by each. Where the
beneficiary/beneficiaries consist of corporations(s), another trust(s), partnership(s) or other similar entity,
further disclosure shall be required which discloses the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the entity.*
TRUST NAME
NAME, ADDRESS, AND OFFICE
% OF STOCK
3. PARTNERSHIP/LIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED
PARTNERSHIP, list the principals of the partnership, including general and limited partners. Where the
partner(s) consist of another partnership(s), corporation(s), trust(s) or other similar entity, further
disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the entity.*
Philips South ,Beach, LLC d/b/a The Shore Club
PARTNERSHIP or LIMITED PARTNERSHIP NAME
NAME, ADDRESS. AND OFFICE
Clark S.B.II, LLC, a Delaware Co~p'.
~evin Moore~ 1 Rockerfeller Center, N.y..,
N.Y.
% OF STOCK
56.17
Ph~]~p.~ .q_R_ A~oc.: LLC ' a Delaware Corp·
phi ] ~ p p~ ] v.~Wy~ 475 5th 'Av~_nue. N.Y.: N.Y.
Shore Club Holdinqs, LLCr a Delaware. Corp.
Michael Overington, 475 10th Avenue,.N.Y.,
N.Y.
6_79
NOTE: Notan'zed signature required on page 8