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Gary S. Reshefsky/C&Y GarciaCity of Miami Beach Office ol~the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Emaih cityclerk@cL miami.beach.fl, us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) ~ Check Box if an Amendment Reshefsky Gary NAME OF LOBBYIST: (Last) ~ (First) ~A 1,?.21 Brickell Avenue Miami BUSINESS ADDRESS: (Number and Street) (City) ~ 305-579.0737 305-961-5737 TELEPHONE NUMBER..I~ FAX NUMBER: (M.I) DATE QUA'm'~LIFIED AS LOBBYIST Florida 33131 (State) (Zip Code) reshefsk~ EMAIL: I. LOBBYIST RETAINED BY: Carlos & Yasmin Garcia NAME OF PRINCIPA--I~NT: 5860 Pine Tree Drive. Miami Beach, Florida BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 305-970-7494 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] · NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: · LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Variance for 5860 Pine Tree Drive Issue to be lobbied (Describe in detail): I I I. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Relationship SEE ATTACHED · 'FLAT RATE OR OTHER): $235.00 , A) LOBBYIST DISCLOSURE: B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}: $235.00 1) 2) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2, Article VII, Division 5 Thereof Entitled "Campaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaiqn Contributions Bv Lobbyists On Procurement Issues": Are you Iobbvinu on a present or oendinu bid for aoods, eoui~,~ent or services, or on a present or Dendinu award for o_oods, euuiDment or service? Ye~ {No) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaign Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaion Contributions By Lobbyists On Real Estate Develooment Issues": Vo Are you Iobb¥inu on a Dendinu application for a Development ADreement with the City or annlicat~ chano~e of zoninu mad de$iunation or chano_e to the City's Future Land Use MaD? S I GNATURE 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 facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-4182/e~f the Miami Beach City Code as amended, and all reporting requirements. ~JS~eshefs Signature of Lobbyist: ky Signature of Principal/Client: Carlos Garcia VI. LOBBYIST IDENTIFICATION: [] Produced ID Form of Identification VI I. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: Yasmin Garcia Personally Known~'''~ State of Florida, County of Miami-Dade ~ ~a Sworn to and subscribed before me This 15th day of January, 2004. Print, stamp or type name of Notary Public Registration: If rejected, state reason: Registration fee paid: [ j Yes [ No 2nd Revision 3/18/03 I FOR CLERK'S USE ONLY [a' CCEPTEO[] REJECTED DATE'. ~ ENTERED B~~ n 03 d~ F:~HA~Lobbyists~regis~atio ~ · · FLAT RATE OR OTHER): $235.00 · · A) LOBBYIST DISCLOSURE: B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTCOMPENSATION):. $235.00 Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chapter 2, Article VII, Division 5 Thereof Entitled "Campaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions Bv Lobbyists On Procurement Issues": 2) Are you Iobbvina on a present or Dendina bid for aoods, e~_L_'__u~nt or services, or on a ~resent or Dendina award for goods, eauiDment or service? Yes Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division thereof Entitled "Campaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Campaign Contribut;ions By Lobbyists On Real Estate Development issues": Are you Iobbvina on a Dendina aDDlication for a Development Aareement with the City or aoolicatJ~ for chanae of zonin_o mad desianation or chanqe to the City's Future Land Use Map? Yes 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 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 Cod~l~lS amended, and,~ll reporting requirements. // Signature of Principal/Client: 3( ~a~or~i& VI. LOBBYIST IDENTIFICATION: / ~ Produced ID Personally Known Form of Identification VI I. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of MiamFDade Sworn to and subscribed before me This 15th day of January, 2004. ~ ~ p~lRE~ember 4, 20~ } ~ , -:,:,~:~ ,.:~,~:~?~.~ Print, stamp or type name of Nota~ Public ? Registration: [ ~EPTED If rejected, state reason: Registration fee paid: [ ] Yes [ ] No DATA ENTRY DATE: 2nd Revision 3/18/03 FOR CLERK'S USE ONLY []Cash [~"~eck MCR# 2003 ENTERED BY: F:\CLE R\HATL\Lobbyists\registrationaO3.doc