Les Bellison/Puckkey Investment
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Bach, FL 33139
Emall: citycierk@ci.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
D 6S Check Box If an Amendment
Belllnson
NAME OF LOBBYIST: (Last)
790 NW 107th Avenue
BUSINESS ADDRESS: (Number and Street)
Les
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
Miami
(City)
Florida
(State)
33172
(Zip Code)
(305\ 559-1250
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
(305\ 551-1740
FAX NUMBER:
EMAIL:
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 oullhls secllon If principal Is a Corporallon, Partnership, or TrusllSecllon 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-Famllv Residential Review Board
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvldualfTIlle B) Relallonshlp
Philio Azan, Director, Bulldina Department None
Jorae Gomez, Director, Planninn Deoartment None
Thomas Moonev, Planninn Denartment None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLA T RA Tf: OR OTHER):
A) LOBBYIST DISCLOSURE:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIESTCOMPENSATION):
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":
Are you lobbvlna on a oresent or oendlna bid for aoods, eauloment or services, or on a oresent or
oendlng award for goods. eguioment or service? Yes No
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 Addition Of Code Section 2-490 Ent~led "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develoomentlssues":
Are you lobbvlng on a oending aoollcation for a DeveloDment Aareement with the City or aDDlication for
change of zoning maD designation or change to the City's Future Land Use MaD? 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 Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o .fIf Produced 10
Form of Identification
f'.flf Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
I'\~ MOI\~~1JNLi
State of Flu. ideo, County of Mis,"i aae
Sworn to and subscribed before me
This _ day of , 2002.
ic Notary - State of Florida
Sign at
Registration:
\? I I {1. /\ [(Vltt f I (r-
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
[ ] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No
[ ] Cash [ ] Check MCR #
DATA ENTRY DATE:
1
, 2002 ENTERED BY:
09/24/2003 10:52
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BERCOW AND RADELL
PAGE 03/04
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IV. DISCLOSURE OF TERMS AND AMOUNTs OF LOBBYIST COMPENSATMlON (DISCLOSE WHETHER
HOURL Y, FLAT RA TE OR OTHi
A) LOBBYIST DISCLOSURE:' ./ tJB / hr
B} PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPeNSATION).
(
1) Pursuant to Ordinance No. 2003-3'1' Amendioo Miami !leach Citv Code CI'IaDler 2. Artlela VII Division 5
TharllOt' Entitled 'Camoaian Finance Reform" Via Tha Addition Of Coda Section 2-488 Entitled "Prohibited
Cllmoalan Contributions Bv lobbYists On Procurement Issuas':
2) Pursuenllo Ordinance No. 2003-3315 Amendina MIami BeRch Citv Code ChaDler 2. Artie/e VIL DIvision 5
thereof Entitled "Camoalan Finance Reform' Via The Addition Of Code Section 2-490 EntItled 'Prohlblted
CamDai!ln Contributions Bv lobbYists On Real Estate DeveloDmant Issueg":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1" 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 YEA!{.
I do solemnly swesr that all of the fcregoing facts sre true and correct and that I have read or am familiar
with the provisions contained In clion 2-492 of the Miami Beach City Code as amended, and all reporting
requirements.
---------....
-- )
Signature of lobbyist
Signature of PrincipaVCllent:
VI. LOBBYIST IDENTIFICATION:
o E Produced 10
Fonn of IdentificatIon
X .IS 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~daYOf~;;m03
OFFICIAL NOTARY SEAL
MARY.EVE VENDRYES
NOTARY PUBUC STATE OF PLORlDA
COMMISSION NO. DO 028704
tdYCOMMISSION EXP. JUNE 17, 2005
-~~
mAR~-EVE Vf::l\JbR\{S,S
Print, stamp or type name of Notary Public
~ FOR CLERK'S USE ONLY
ReglslnlllOll: MACCEPTED [ 1 REJECTED DATE: IDpar! () 3
If rejected, slate reeson: ....--.
............"", ~..! 1~ cB""".n1 ~ L/ ~
pATAENTRYDAts:~:30 ~ ENTERED BY: _