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Wayne Pathman/Atlantic Pacific lD - - RECEIVED 03 NOV I 2 Mi 9: I 8 (City of Miami Beach, Oty Code Chapter 2, Division 3, Section tW~ CLERK'S OFF ICE City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Email: cityclerk@ci.miami-beach.fl.us LOBBYIST REGISTRATION FORM o Check Box if an Amendment Pathman, Wayne NAME OF LOBBYIST: (Last) (First) (M.!) DATE QUAllFIED AS LOBBYIST 2 So. Biscayne Blvd., Suite 2400~ Miami, FL 33131 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) 305-379-2425 TELEPHONE NUMBER: 305-379-2420 FAX NUMBER: wpathman@pathmanlewis.com EMAIL: I. LOBBYIST RETAINED BY: Atlantic & Pacific Property Management & Alan Cohen NAME OF PRINCIPAl/CLIENT: 1025 Kane Concourse, #210, Bay Harbor Island, FL 33154 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) 305-867-2245 TELEPHONE NUMBER: 305-867-2246 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-4S2 (c)) NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Howard Cohen LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR 1RUST: How a r d Cohen n. SPECIFIC LOBBY ISSUE: Certificate of Appropriateness, Variances, Conditional Use for : Issue to be lobbied (Describe in detail): Parking Garage & Design Review nl. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Relationship Historic Preservation Board Board of Adjustment Planning Board Desian Review Board . .LV. LlI.:K..LU;:'UKC ur IICKPl3 "'AU 14....UUrtI3 ur L.UDD,...:t1 \",U...t"Crt3",..lUn \UCt\..LU~ WnClnCK nVUK~r, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: $275/220 '~r B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $275/220 L!/' 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 Addition Of Code Section 2-488 Entitled "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 Addition Of Code Section 2-490 Entitled "Prohib ited Camoaian Contributions BY Lobbvists On Real Estate Develooment Issues": V. SIGNATURE UNDER OAnt: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING 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'se . n 2-4 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: VI. Form of lcentification ~~~~~~~~~~~--') o Produced ID VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK' State of Florida, County of MiamWade Sworn tq;md SUbscriffi before me This {( ('" day of o//fhL ,20Q3. - State of Florida ~4~!<> Bonded Thru N<Aary Public Underwrilors Public FOR CLERK'S USE ONLY Registration: [)<J ACCEPTED If rejected, state reason: Registration fee paid: Q<J: Yes [ ] No DATA ENTRY DATE: ~ IL 2nd Revision 3[18[03 [ ] REJEffiD DATE: \\~(1,03 [ ] Cash ~] Check MCR # . 2003 ENTERED BY: cA I b 'l~Lf8gg F: \CLER\HA 11 \Lobbyists\registrationa03.doc