Monika Entin - Ministerio International El Rey Jesus `"730 Sd-
'n �V 1 I A/ v I EACH Office of the City Clerk
JUN
1700 Convention Center Drive �02o
Miami Beach, FL 33139 CITY OF
305.673.7411 OFF;0E _MIAMI BF4C
LOBBYIST REGISTRATION FORM OI THE C 1,v ri-C K
Lobbyist means all persons employed or retained, whether paid or not, by a`'principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any City board or committee; or any action, decision or recommendation of any City personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the City
commission, or a City board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities.The term "Lobbyists" has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee, to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Entin Monika
NAME OF LOBBYIST (Last) (First) (Middle Name)
Bercow Radell Fernandez Larkin& Tapanes, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6237 305-542-3445 MEntinaB RZoningLaw.corn
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Seibane Rachelle
NAME OF PRINCIPAL (Last) (First) (Middle Name)
Ministerin Internacional F,l Rey Jesus 7.30 77 Street Miami Reach FT, 33741
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-877-9790 c/o SandyPineda@ElReyJesus.org
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant•to City Code Section 21'482(1i)(91)(5);.A principal of elit0.corporation;patnersl%ip;Cie other entitywho =pe- m a lobbyist cal behalf of'that�
entity,without special compensation cp reimbursement for Cl)p-,'appearance,whether(3101,indirect,01'contingent,93( :su. ort C1Cp o..osition to
=n;tagadia(0112205,S the alail3,M re•uired Il subsection bt shall not tn,re•uired Q pa &'re.istration 5
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): Rachelle Seibane, COO
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): See attached.
;t
Page 1 of'5
�I
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Development approvals and permitting issues, including, but not limited to the Historic Preservation Board, Design
Review Board, Planning Board, Board of Adjustment, Land Use and Sustainability Committee, City Commission,
any City Workshops or Committees, and City Departments, if necessary relating to the property located at
730 71 Street, Miami Beach, Florida.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Staff for the Planning Department, Building Department None. X
Public Works, and City Afministration, PB, HPB, BOA None. X
DRB, City Commission, and Mayor as necessary None. X
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or professional relationship, or other relationship giving rise to an
appearance of an impropriety, with any current City Commissioner or City personnel who is sought to
be lobbied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise toan
appearance of impropriety (if none,write N/A):
None.
None.
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
$525.00 per hour.
Page2of5
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes XNo: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or
pending award for goods,equipment or service?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application
for change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to City'Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481) who only appears as a representative of a not-for-profit corporation or entity without special compensation or
reimbursement for the appearance,whether direct or indirect to express support of or opposition to any item, shall register with
the city clerk as required by this section, but shall not be required to pay any registration fees.
_Yes_XNo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes XNo: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle. See Section 2-491 for more information.
_Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes, please list the incumbent member(s)of the City Commission:
—Yes No: If:yes,Chas it'been less than 1r2 months since'the elected official(s) whom you provided campaign,
consulting services was sworn ina.
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
•within the past election cycle?If yes, please list the incumbent member(s)of the City Commission:
Yes No: If._yes, were you promised'.or,did you receive economicconsideration`in exchange for campaign
— — ,cones i ting s� reM -TO BE COMPLETED BY CITY CLERK'S S STAFF( ONLY
Annual Registration fee: [ ]Yes FC]No Amount Paid$ ) `-�'? ` MCR.# `i l/ L�1 (r Date Paid O(y i c - 2C
Lobbyist Registration Form received and verified by: ) AYsf:'
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018
Page 3 of 5
•
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'
Signature of Lobbyist: Date
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: , / Date +�
Signature of Principal: �i� Dated fr-
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of State ofAY.'ria
County of: County od'Tht ' OUd 4'
Sworn to (or affirmed) and subscribed before me, Sworn to(or affirmed) and subscribed before me,
by means of 0 physical presence by means ofphysical presence
or 0 online notarization, or 0 online notarizations,.
this day of ,20 2Q by thisZla day of 1 Yl I , 202Q by
Monika Entin Rachelle Seibane
NAME OF LOBBYIST , NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION v FORM OF IDENTIFICATION
_Personally Known 'P:r pnally rKn• I D
, iLA .` ! . .ate
Signature of Notary Public Sig W' re of V•tary''l'ub'p
•
0
A (/111 I I I LL ,4„��I I `'( 4
Name of Notary, Typed, Printed or Stamped Name o �k,i o ted or Stamped
•$ '�, q i
(NOTARY SEAL) (NOTARY,• 34? � ., �';
y z tGG 087061
1 The term"lobbyist"specifically excludes the following persons: o. ;°; ,. �0 nd 0�y.:Q
Expert witnesses who provide only scientific,technical or other specialized inforrf ti br• tuno' #blic meetings; any person who
only appears as a representative of a neighborhood association without compensrlie6r:S ���@A�ent for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and an�liatb*1114 only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page4of5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED! FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST'HAS BEEN ENGAGED TO LOBBY- A. STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSAT e ' DURING THE R • , -TING PERIOD.1
Signature of Lobbyist: ` • Date ,1:3 I ( LoD
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar wit - provis':4s contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all jag ing requireme,ts.
Signature of Lobbyist: / I 6h� Date
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of 1.-- l t)1l�� State of
County of: l' kt awl NQ County of:
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of 0 physical presence by means of 0 physical presence
or 0 Anline notarization, or 0 online notarization,
this o&() day of A , 20 2Q by this_day of .202Q by
Monika Entin Rochelle Seibane
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Known 'i1/ _Personally Known
livii
Signatur of Not TyPullic 4` Signature of Notary Public
b� t6 ri
Name f No ary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
Yeidy Wives.nc,Perez
(NOTARY SEAL) V\'''?'\o0 �,Ic��•,.:.. , ,;;IO (NOTARY SEAL)
`ia;:1.-.;/7
.,'L'i71STA fI-r ' CLORIDA
t /r C•grne".. .;L3o65548
4
The term"lobbyist"specifically exclu� lie fd4Ibl)irti p14
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov
Tel:305.673.7411,Fax:305.673.7254
NAME OF LOBBYIST: Monika Entin
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.0' a•rsua o - tion 2-482 of the Miami Beach City Code.
74.W s aga0
Signature of Lob syist Date
F:\CLERV$ALL\aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doo
Page 5 of 5
alIRS b.portmont of the Treasury
�(�'1/� Internal Revenue Service
P.O. Box 2508, Room 4010 In reply refer to: 4077556534
Cincinnati OH 45201 Apr . 28, 2011 LTR 4168C C3
65-0605906 000000 00 X
00036000
BODC: TE
MINISTERIO INTERNACIONAL EL REY
JESUS INC
PHILIP S HANEY ASSOCIATES
X PHILIP S HANEY
1437 SOUTH BOULDER STE 105D
TULSA OK 74119-3616
027204
Employer Identification Number: 65-0605906
Person to Contact: SHARON LENARD
' - Toll Free"Te'ieph-one-Number-:--1 B77--129•--550.0_ - .. _— .
Dear Taxpayer :
This is in response to your Sep. 22, 2010, request for information
regarding your tax-exempt status.
Our records indicate that you were recognized as exempt under
section 501(c) (3) of the Internal Revenue Code in a determination
letter issued in August 1996.
Our records also indicate that you are not a private foundation within
the meaning of section 509(a) of the Code because you are described in
section(s) 509(a) (1) and 170(b) (1) (A) (1) .
Donors may deduct contributions to you as provided in section 170 of
the Code. Bequests, legacies, devises, transfers, or gifts to you or
for your use are deductible for Federal estate and gift tax purposes
if they meet the applicable provisions of sections 2055, 2106, and
2522 of the Code.
Please refer to our website www.irs.gov/eo for information regarding
filing requirements. Specifically, section 6033(j) of the Code
provides that failure to file an annual information return for three
consecutive years results in revocation of tax-exempt status as of
the filing due date of the third return for organizations required to
file. We will publish a list of organizations whose tax-exempt
status was revoked under section 6033(j) of the Code on our website
beginning in early 2011. •
4077556534
Apr. 28, 2011 LTR 4168C C3
65-0605906 000000 00 X
00036001
MINISTERIO INTERNACIONAL EL REY
JESUS INC
PHILIP S HANEY ASSOCIATES
X PHILIP S HANEY
1437 SOUTH BOULDER STE 1050
TULSA OK 74119-3616
If• you. have any questions, please call us at the telephone number
shown in the heading of this letter.
Sincerely yours,
14/141.4 T:41)"1
4/1.1
Cindy Thomas
Manager, EO Determinations
State of Florida
Department of State
I certify from the records of this office that MINISTERIO INTERNACIONAL
EL REY JESUS, INC. is a corporation organized under the laws of the State of
Florida, filed on June 23, 1995.
The document number of this corporation is N95000003016.
I further certify that said corporation has paid all fees due this office through
December 31, 2018, that its most recent annual report/uniform business report
was filed on September 7, 2018, and that its status is active.
I further certify that said corporation has not filed Articles of Dissolution.
•
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capital, this
the Third day of December,2018
,. LC t3
f
, 0#0%
Secretary of State
Tracking Number:CU1110732468
To authenticate this certificate,visit the following site,enter this number,and then
follow the instructions displayed.
https://services.sunbiz.org/Filings/CertificateOfStatus/CertificateAuth entication
20:19• FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED
DOCUMENT#N95000003016 Apr 16, 2019
Entity Name: MINISTERIO INTERNACIONAL EL REY JESUS, INC. Secretary of State
5247512836CC
Current Principal Place of Business:
14100 SW 144TH AVENUE
MIAMI, FL 33186
Current Mailing Address:
14100 SW 144TH AVENUE
MIAMI, FL 33186 US
FEI Number: 65-0605906 Certificate of Status Desired: No
Name and Address of Current Registered Agent:
MARIANNE SALAZAR ESQ
14100 SW 144TH AVENUE
MIAMI,FL 33186 US
The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida.
SIGNATURE: MARIANNE SALAZAR •
04/16/2019
Electronic Signature of Registered Agent Date
Officer/Director Detail :
Title PD Title SD
Name MALDONADO,GUILLERMO Name LAFFITTE,JOHN
Address 14100 SW 144TH AVENUE Address 8421 SW 202 STREET
City-State-Zip: MIAMI FL 33186 City-State-Zip: MIAMI FL 33189
Title D Title COO
Name HECHAVARRIA,FRANK Name SEIBANE,RACHELLE
Address 14100 SW 144TH AVENUE Address • 14100 SW 144TH AVENUE
City-State-Zip: MIAMI FL 33186 City-State-Zip: MIAMI FL 33186
•
I hereby certify that the Information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 817,Florida Statutes;and that my name appears
above,or on an attachment with all other like empowered.
SIGNATURE:RACHELLE SEIBANE COO 04/16/2019
Electronic Signature of Signing Officer/Director Detail Date
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH - `
No 426646t a (5,
1:1Cash ° O Credit Card `0 Check# , -
1,-)6` _ 20 C,
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Payment Am4 nit 1,200.00.
'(THIS INFORMATION MUST BE COMPLETED) - Office of Finance Director
Account.Number. ;
Prepares t i. Dept . , . EXT% �7 1 I k