Gordon Loader Cheryl Model
-'
lD
City of Miami Bea<h OffIce of the City Clerk
1700 Convention Centet Drive, Miami Beach, FL 33139
Emall: cltyderk@Cl,mIami-bea<h,ftU5
LOBBYIST REGISTRATION FORM
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(Clly ur MI"""I:1edOl, I;:I[Y C<XIe Lnapter l, UIVlSlCn oJ, :>eclJOO l-'l~lJ
::J Check Box if an Amendment
Loader
(Last)
Gordon
(First)
B.
(M.!) DATE QUAUFIED AS lOBBYIST
NAME OF lOBBYIST:
4220 Post avenue, Miami Beach, FL 33140
BUSINESS ADDRESS: (Number and Street) (Oty)
(State)
(Zip Code)
gbloader@bellsouth_net
EHAIl. :
305 674 7665
TELEPHONE NUMBER:
3056747663
FAX NUMBER:
L LOUYIST RETAINED BY:
Cheryl Model & Dan Kipnis
NAME OF PRJNCIPAl/UlENT:
3156 royal Palm Avenue, Miami Beach, FL 33140
l:lU51N C", ADDl\C~.
(rw..,,,,,, ""1I5U"1't)
1'-11'0
l~liJteJ
(ZIP Code)
305531 1236
TELEPHONE NUMBER:
FAX NUMBI:R: (OptIonal)
EMAIL: (Optional)
Fill out this section If princlplll II . Corpol'lltlon, Partnership or TI\lIlt [Section 242 (e))
. NAME OF CHIEF OFFICER, PNn'NER, OR BCNEFlCIARY: NA
. UST ALL PERSONS HOlDING, OIRECTl Y OR INOIRfCTt Y, A 5% OR MORE OWNEllSHIP INTEREST IN SUCH
CORPORATION. PARllIIERSHIP OR lRUST:
NA
D. SPECnC LOBBY ISSUE:
Historic Designation & subsequent Alterations of 3156 Royal Palm Avenue, Miami Beach, FL 33140
ISSue to De IOllllIeCI (uescrlDe In lIetilM):
DI. aTY AGENCI!S/INOMDUALSlO ft LOBSIED:
A) fuU NiInIe allndlvldUIII~ B) Relatlo...hlp
Historic Preservation Board Architect
Board of A<ljus1ment Architect
IV. DISCLOSURf Of T1RMS ANO AMOUNTS OF LOBBYIST COMPfNSATlON (DISClOSf WHETHfR HOURI. r,
FLAT urE 0/1 OrNER):
Al l.ClI8YIST DISCLOSURE:
Hourly rate - $95 plus incidentals
B) PRINCIPAL '5 DISClOSURE (OF LOII8't 1ST COMPENSATIONI: Hourly rate - $95 plus incidentals
1) Pur~Il"nt to OrdinallC2 No. 2003-3313 Amendino Miami Beach City Code ChilDtI!l' 2. Articlf! VII Division 5
Th~ Entitled "Camoalon FinanO! Rdorm~ Via The Addition Of rnrIP c;,.rtinn )....RR Fnfltloori "P'D"ibitod
c.moilKln Contributions Bv Lobbvlsts On Procurement Issues.:
Are YOU lobbYinG on a Dresent or _nd'n. bid for aoods. eauiDment or senl~ or on a Dr1!Rnt
or Dend'na award for GODds. eaulament or lleI"Y1at1 D Va .-!190
,
2) Pursuant to Ordinilnce No. 2003-3]15 Amending Miami Beach aN Code OlaDter 2. Miele VJJ Division 5
th..-anf l';:ntitlad -ea"'D:I.an r:~n.ance Reform,.... Vi. 'The Additkm.OP Code Section 2~'1'90 e"titteU -f'rotllbltec2
CamoalQn ContributlDl1s Bv Lobbvlsts On Real Estate Dl!Yekm~nt Issues-:
.lJW VDU 10bbv'nG on a _ndina ._Iicatlon fDr. D_loDment M..-_t with lit. Citv or
:::;X:on for chanCM! of zonlna maa desiGnation or chanae ta the City's future und Use MaD?
V. SIGNATURE ,,"Ofll OATH:
ON oc:TOal!lt 1- 01' I!ACH YU,,- EACH LOBIYIST SHAlL SUIMIT TO THE CITY CLERIC A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES IN THE CITY Of MlAMIIEACH fOR
THE PRECEDING CAlENDAR YEAR.
I CO SOlemnlY swear that all or the foregclng facts are true and correct and that J have read or am
familiar with the provisions contained in Section 2-482 of the Miami BeiICh City Code ali amended, and all
reporting requirements. ~
Signature d lobbyist:
VI.
LOAYJSf IDENTlFlC.ATJOZJ
f Produced 10 ? 1 L .
Form of Identification
Signature of Prino;i~ItClll::ll~;
o Personally Known
VU. lUGNAlUlII AND STAN" 0' NOTARY Oil OfPUTY CLfIU(:
?fJ Minhka E lopez
. . My Commission 00024714
\;OI~ Elcplr.. Mev 13, 2006
State of Florida, County of Miami-Dade
Sworn t9 and SUbsaim~e me
This I() day of '4 . 2003.
RIA CLIIUC'S use ONLY
1legiW.rlon: N- ..cCEPTED
II rejK.tl!d. !ble n!il50'i= .=
Re9lStriban fee pMd: .rq Yes ( I No
OATA ENmY DAn:: I OJ I~
1
) RfJEcrED
!>>ITE:
iW-~j~03
1. ~ 1S-S"'
I J.... I J ""'" ~
. 200J ENTERED BY:
f: n \LobbyI$l5\registrlliaNOl.doc
2nd IlevISlOn JjlB/OJ