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Joy Pearlman City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, Fl. 33139 Emai1: cityclerk@ci.miami-beach.fl.us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) o Check Box if an Amendment McDowell. Carter N, NAME OF LOBBYIST: (Last) (First) 10/21/03 (M.I) DATE QUALIFIED AS LOBBYIST 200 South Biscayne Boulevard. Suite 2500. Miami. Florida 33131 BUSINESS ADDRESS: (Nwnber and Street) (City) (State) (Zip Code) (305) 350-2355 TELEPHONE NUMBER: (305) 351-2239 FAX NUMBER: cmcdowell@bilzin.com EMAIL I. LOBBYIST RETAINED BY: JOY Pearlman NAME OF PRINCIPAL/CLIENT: 1410 Shore Road. Linwood. New Jersey 08221 BUSINESS ADDRESS: (Number and Street) (City) (state) (Zip Code) (609) 653-2957 TELEPHONE NUMBER: 609) 653-2957 FAX NUMBER: (Optional) EMAIL (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: N/A . LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST N/A II. SPECIFIC LOBBY ISSUE: Appeal of Historic Preservation Board Order for the Property Located at 928 Pennsylvania Avenue. Miami Beach. Florida Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name ofIndividual/Title Historic Preservation Board & Staff B) Relationshio IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) Lobbyist Disclosure: $380.00 per hour B) Principal's Disclosure (of Lobbyist Compensation): $380.00 per hour 1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2, Article VII, Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition of Code Section 2-488 Entitle "Prohibited Campaign Contributions By Lobbyists on Procurement Issues": 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 services? 0 Yes X No 2) Pursuant to Ordinance 2003-3395 Amending Miami Beach City Code Chapter 2, article VII, Division 5 thereof Entitled "Campaign Finance Reform" Via The Addition of Code Section 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists on Real Estate Development Issues": 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? DYesXNo V. SIGNATURE UNDER OATH: ON OCTOBER Ist 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 PRECEDING CALENDAR YEAR. I do solemnly swear that all of the foregoing fac provisions contained in Section 2-482 of the t I have read or am familiar with the ded, and all reporting requirements. Signature of Lobbyist: Signature of PrincipallClient: VI. LOBBYIST IDENTIFICATION: o Produced ID Form ofIdentification ~SOnallY Known VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade SWO/J~d subscribed before me This ayo~ 2003. GISELlE PACHECO MY COMMISSION # DO 016885 EXPIRES: Apnll0. 2005 Bonded ThIll Plchlrd InM8l1Qe AQency Print, stamp or type name of Notary Public Registration vrAccepted FOR CLERK'S USE ONLY [ ] Rejected Date: /JA.u. / ().. :J....tJ03 / If rejected, state reason: Registration fee paid [ ] Yes [ ] No DATA ENTRY DATE:..tl.J { 0 2nd Revision 1127/03 [ ] Cash Check MCR# ILobbyistslregistration03.doc ,2003