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Bernard Zyscovich/TGNCRECEIVED 03 16 I0:58 CITY CLERK'S OFFICE City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Bach, FL 33139 Email: citycie rk~ci.miami-beach.fl, us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) [] ~ Check Box If an Amendment Zyscovich Bemard NAME OF LOBBYIST: (Last) (First) 100 N. Biscayne Boulevard. 27m Floor Miami BUSINESS ADDRESS: (Number and Street) (City) (~)~) 577-4521 ~ ~ ¢305~ 372-5222 TELEPHONE NUMBER:~~'"~ FAX NUMBER: Io LOBBYIST RETAINED BY: 9~02 (M.I.) DATE QUALIFIED AS LOBBYIST Florida 33132 (State) (Zip Code) T(~N(~ Develooment. LLC NAME OF PRINCIPAL/CLIENT: 60 Cutler Mill Rqad, ~308 Great Neck New York 11559 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) (305) 674-0600 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 OF BENEFICIARY: See Exhibit A LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OVVNERSHIP INTEREST iN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit A II. SPECIFIC LOBBY ISSUE: Substanl;ial Amendment to Conditional Use Permit Aoolication Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Relationship Jorge Oomez None Mercy Lamazares None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (~ ) ~ ~11~11~, B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION): t'~/~ ~'/~V ($ ) V. SIGNATURE UNDER OATH: ON OCTOBER 1~r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRESEDiNG CALENDAR YEAR. I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions cont_J~in Section 2-482 of the~iami Beach City Code as amended, and all report~ Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: [] ~ Produced ID Form of Identification -~ Personally Known VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade Sworn to and subscribed before me This ..~ day of J~/~i/ , 200~ Signature'~ - State"Of Florida Print, stamp or type name of Notary Public FOR CLERK'S USE ONLY Registration: ~ ACCEPTED [ ] REJECTED / If rejected, state rsason: , Registration fee paid: [~JCYes [ ] .No [ ] Cash [~Check MCR # DATA ENTRY DATE: ,2002 ENTERED BY: I First Revision - 05-17-02 Iv. DISCLOSURE OF TERM-'= AND AMOUNTS OF LOBBYIST CQMI~Nu'r~o# (DWCI.O~E WI.I;THER HOURLY, FLAT i:~A TE OR OTHER): B) PRINCIPAL'8 DI~CLOSLIRE (OF LOBBYIEST COMPENSATION): V. 81GNATURE UNDER OATH: ON OCTOBER 1~' OF EACH YEAR, EACH LOBBYIST 8HALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LI'STING LOBBYING EXPENDITURE~ IN THE CITY OF MIAMI BEACH FOR THE PRE~EIDING CALENDAR YEAR. Signature ~ Principal/Client: VI. I do solemnly swear that ail of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: ~ ~ LQ~BYIST IDENTIfiCATION: ~ r-i ~ Produ(;ed ID Form of Identif'maflon VII. 81GNATtJR~ AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade SworA~l~and aula~'.rtb~l before me ThtsU_:- ,y Signat~-re of Public Notary - State of Florida P~t, stamp or type name of Notary Public FOR CLERK'S USE ONLY Registration; ~LACC;PTED []REJECTED DATE: If mjaeled, abit~ Regl~mtion fee paid: ~ Yes [ ] No /3 ~.q .,~ ,.~ ['] C~)sh/~l:Check _MCR# "-7~. U ~.'~ ' 1 Flit Rl1~lml - 0~-17.~2 P. ~2 B) PRINC~PAL'9 {)I~C~t.,O,gUR:E (OF LOGB¥~F. STCOMPb'NBA'TI(~): v. :IGNATURP. UNDI~ oATH: ON O~UBE~ t~ ~CH ~R~ ~H ~IT~T~ ~U~T ~ ~B C~ CLE~ A ~GN~D eT~ U~ OA~, Lm~NG LOBBING ~E~ ~ CI~ OF UlAmr IUCH F~THI F~EDJNG C~ND~ ~ I do sol~nly ~=r ~t .11 d ~e fo~o~; ~ m e~a and ~ and that ] h~ve m~d or.m ~mlller ~ t~ ~n~ ~n~in~ ~ ~on 2~ ~ the M~ml C~ c~e m amendS, and all m~lng ~ulmma~. Signature of ~bbyieb Signature of P~n~Cllen/: [] ,~ Produced ID Form of Idenl~o.¢on vu. 8IGM&TUME AND STAMP OF NOTARY OR DEPU'W CLERK: ~ba~ of Florkla, Co~Jnty M MlemI-Da6e Public Pr'mt, stamp or type name of Notary Publk3 ',,' TOTAL P. 82 · '~': ' ' TOTAL P.02 EXHIBIT A DISCLOSURE OF INTEREST INFORMATION Lots 2 and 4 and east 25.5 feet of Lot 6: TGNC Development, LLC: Irrevocable Trust for the Benefit of David Craig Brodsky, Jeffrey Holden Brodsky, Jessica Brodsky Miller, Lee Jared Brodsky. Each of the beneficiaries holds an equal share in the trust. Muriel Brodsky is the guardian of the trust. 26 Harbor Park Drive, Port Washington, NY 11050 Paul Anton, 60 Cutter Mill Road, Suite 308, Great Neck, NY 11201 GSB Holdings Corp. (100% owned by Steven A. Boughner) 60 Cutter Mill Road, Suite 308, Great Neck, NY 11201 Michael Groothius 60 Cutter Mill Road, Suite 308, Great Neck, NY 11201 50% 16.667% 16.667% 16.665% Lots 1 and 3: POP Development, LLC: Irrevocable Trust for the Benefit of David Craig Brodsky, Jeffrey Holden Brodsky, Jessica Brodsky Miller, Lee Jared Brodsky. Each of the beneficiaries holds an equal share in the trust. Muriel Brodsky is the guardian of the trust. 26 Harbor Park Drive, Port Washington, NY 11050 Paul Anton 60 Cutter Mill Road, Suite 308, Great Neck, NY 11201 GSB Holdings Corp. (100% owned by Steven A. Boughner) 60 Cutter Mill Road, Suite 308, Great Neck, NY 11201 50% 16.667% 16.667% Michael Groothius 60 Cutter Mill Road, Suite 308, Great Neck, NY 11202 16.665% Lot 8 and west 50 feet of Lot 6: Just Around the Corner, LLC Paul Anton 60 Cutter Mill Road, Suite 308, Great Neck, New York 11201 Michael Groothius 60 Cutter Mill Road, Suite 308, Great Neck, NY 11202 Lee Lazenus 60 Cutter Mill Road, Suite 308, Great Neck, NY 11202 Dean Fierro 60 Cutter Mill Road, Suite 308, Great Neck, NY 11202 Michael Meyers 60 Cutter Mill Road, Suite 308, Great Neck, NY 11202 19.5% 26.5% 9.5% 2.5% 2.0% South Beach Garage, LLC 26 Harbor Place Drive, Port Washington, NY 11050 (Ownership Breakdown of South Beach Garage, LLC) Hugh Freund 26 Harbor Park Drive, Port Washington, NY 11050 Irrevocable Trust FBO David Craig Brodsky (beneficiary) 26 Harbor Park Drive, Port Washington, NY 11050 Irrevocable Trust FBO Jeffrey Holden Brodsky (beneficiary) 26 Harbor Park Drive, Port Washington, NY 11050 40% 3.0% 5.625% 5.625% guardian of the trust.) Barnett Brown P.O. Box 987, East Hampton, NY 11937 Gerald Angowitz 37 Fieldstone Lane, Oyster Bay, NY 11771 2.5% 1.0% Irrevocable Trust FBO Jessica Heather Brodsky Miller (beneficiary) 26 Harbor Park Drive, Port Washington, NY 11050 5.625% Irrevocable Trust FBO Lee Jared Brodsky (beneficiary) 26 Harbor Park Drive, Port Washington, NY 11050 5.625% (Each of the beneficiaries holds an equal share in the trust. Muriel Brodsky is the David Gershen 26 Harbor Park Drive, Port Washington, NY 11050 Adam Caslow Old House Lane, Sands Point, NY 11050 Emily Caslow 26 Harbor Park Drive, Port Washington, NY 11050 Gerald Shapiro 26 Harbor Park Drive, Port Washington, NY 11050 Joel Mair 83 Winthrop Road, Plainview, NY 11803 Edward Miller 7 Sunset I.ane, Garden City, NY 11530 0.5% 1.25% 1.25% 4.0% 1.5% 2.5%