Puckkey Investments L9, LLC
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City of Miami Beach Office of the City ClerK
1700 Convention Center Drive, Miami Bach, FL 33139
Email: cltyclerK@cl.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
D 15 Check Box if an Amendment
NAME OF LOBBYIST:
LarKin
(Last)
Michael
(First)
W.
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard. Suite 850 Miami
BUSINESS ADDRESS: (Number and Street) (City)
Florida
(State)
33131
(Zip Code)
(3051377-6231
TELEPHONE NUMBER:
(3051377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Puckkev Investments L 9. LLC
NAME OF PRINCIPAUCLlENT:
Andres Pukke. 11509 Dahlia Terrace
BUSINESS ADDRESS: (Number and Street)
Potomac MD
(City)
80854
(State) (Zip Code)
301-785-1788
TELEPHONE NUMBER:
301-330-6779
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership, or Trust [Section 2-482 (ell
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY: Andres Pukke
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Review bv Sinole-Familv Residential Review Board
Issue to be lobbied (Describe in detail):
III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvldual!Tltle B) Relationship
Philin Azan, Director, Buildin" Denartment None
Jome Gomez, Director, Planni"" Deoartment None
Thomas Moonev, Plannino Denartment None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSA TRION (DISCLOSE WHETHER
HOURL Y, FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE:
$275.00 HourlY
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
$275.00 Hourlv
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2 Article VII Division 5
Thereof Entitled 'Camoaian Finance Reform' Via The Add~ion Of Code Section 2-488 Entnled 'Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues':
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2 Article VII Division 5
thereof Entitled 'Camoaian Finance Reform" Via The Add~ion Of Code Section 2-490 Entnled 'Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues':
nfor
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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 contained in Section 2-482 of the Miami Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
,7l#~)~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o .oS Produced 10
Form of Identification
o .oS Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and SU~~L before me
This B... day of , 200t"7
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f~ ~o.... . ~. I
\ Jl:r;tdIII,Ja If,,_
" ........
1~1!
Signature
Print, stamp or type name of Notary Public
Registration:
/' FOR CLERK'S USE ONLY
~CEPTED [] REJECTED DATE:
loj~k
I
DATA ENTRY DATE:
1
If rejected, state reason:
Registration fee paid:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
$275.00 Hou~v
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
$275.00 Hourlv
1) Pursuant to Ordinance No. 2003-3393 Amending Miarni Beach City Code Chaater 2 Article VII Division 5
Thereof Entitled 'Carnaaign Finance Reform' Via The Addition Of Code Section 2-488 Entitled 'Prohibited
Carnaaien Contributions Bv Lobbvists On Procurement Issues':
Are you lobbvlng on a cresent or cendlng bid for goods. egulcrnent or services. or on a cresent or
cending award for goods. egUiDrnent or service? Yes No
2) Pursuant to Ordinance No. 2003-3395 Amendine Miarni Beach Citv Code Chaater 2 Article VII, Division 5
thereof Entitled 'Carnaaien Finance Reform' Via The Addttion Of Code Section 2-490 Entttled 'Prohibited
Camaaign Contributions Bv Lobbvists On Real Estate Develoarnent Issues':
Are you lobbvlng on a aending aaallcatlon for a Develoarnent Agreement with the City or aaalicatlon for
change of zoning rnaa designation or change to the City's Future Land Use Maa? Yes No
V. SIGNATURE UNDER OATH:
ON OCTOBER 1"T 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 contained in Section 2-482 of the Miami Beach City Code as amended, and all reporting
requirements.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Signature of Lobbyist:
o 65 Produced 10
Form of Identification
~ 65 Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
MD V\OIl+1Woh......,
State of Aefida, County of Miamt-'Dade
Sworn to and subscribed before me
This _ day of , 2002.
State of Florida
Signatur
Registration:
'1S hO\f\ 'L K ~ \ t( r-
Print, stamp or type name of Notary Public
~ FOR CLERK'S USE ONLY
[ CCEPTED [I REJECTED DATE: I ()) vX' !])?
{ ,
If rejected, state reason: /"" "
.....""'" "",.. t1::~ I~ 6 MeR' ;:U. '!ft/-
pATA ENTRY DATE:~' ~ ENTERED BY ._ -