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Michael W. Larkin - Shawn Vardi , . . 0 como,Avc, , DocuSign Envelope ID:EF4D9636-9350-4070-A594-62A69663044C 2 0° _ _____ __ . DocuSign Email:94,1D:5F9CE986-F95D-4834-A190.6FECE24BACC7 . JAN 2 5 2023 . - RECEWED MIAMI BEACH Office of the City Clerk JAN 2 3 2023 iToo Convention Center Drive 0:TY: 10.F. .MIA)1/11-BEACH . . , '-•' .. .•.' '4••'. ' •• ." '' • ' ' Miami Beabh,FL 33139,'',..,., . .,i,., . . . , -. „. . . . , ,, ...-...1.,','.,...,2.,•. ,..,. .' ' -,' s.- ' 305.673,741i- OFFICE OF THE CI tY CLERK • LOBBYIST REGISTRATION FORM ',.., :. • L .`,. . ' . ;'• • • , . . Lobbyist means al persons employed or retained,whether paid or not,by a principal who seeks to encourage the passage,defeat or modification of any ordinance,resolution,action or decision.of any commissioner;any action,decision',recommendation of the City .. Manager Or any City board or committee;or any action,.decision or recommendation of any City personnel during the time Period of the. entire decision-making process on such tuition, decision or recommendation that foreseeabty will be heard or reviewed by the City commission,or a'City board or committee.The term specifically Includes the principal as well as any employee engaged in lobbying activities.The term-Lobbyists"has specific exclusions.Please refer to City Code Chapter 2,Article VII,Division 3,sniffled'Lobbyists," for additional information. , Instructions: Please'complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City Clerk. If you need more space to complete an answer,use a separate sheet(s)of paper. If you have nothing to report in a particular section, you Must write "none" or -n/a" in that section. Any change to any information originally filed, or any additional City 'Commissioner or personnel who are also Sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate rwaistration forms shall be required for each principal represented on each specific issue.,.-.,, , . ,. •:.) -. I. 'LOBBYIST INFORMATION: • ' ''" ", ' )' ' ' ., .. -,%•.. •• --,,,,. ., ,, • ' , ' •; ..,.,, .-..H.-1 ry:P• • ., - .- - . ,I .,. . --.,..--•'• , ' ' . . -- •:, •, . . - ..- .Larkin •-.,. ,,.,. . „,Michael. . • . , , • ..,,W... NAME OF LOBBYIST (Last) (First) - (Middle Name) .. . • ... ... _ . „ „ _.. Bercow Radell Feritandei'Larldri&Talianes,PLLC 200 South Biscayne Blvd:,Ste.300 Miami,Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS ' '(Number and Street) • • ,-(City)...... - - ..-. (State) _ .. . . (Zp Code) -,-- (305)374-5300 ,i. „ ?. ,... ,,. , . , ;• ,, , ., ,„ .,. , , -- mlarkin@brioningla14-.COM - — LOBBYIST BUSINESS TELEPHONE NUMBER .- ' - • , ' -CELLULAR TELEPHONE NUMBER • • .• - -- EMAIL ADDRESS , . IL PRINCIPAL INFORMATION t' • - . . • . . • . . . . . . . . . ... .. .... . ..... ..,....... . .. . . • , NAME OF PRINCIPAL- , „ . ,...(Last)._ . _ _„ . ,„,- .(First) . . . _ (Middle Name). 237 Parking LLC 425 Madison Avenue,19th Floor New York,New York 10017 PRINCIPAL BUSINESS NAME AND ADDRESS z-..i).: (Number and Street) •. • -,: ,, ,, (City)lz.,. •,„ , i,,,, (State) ..-' ;, -. (Zip Code)---.. !.., .-,:' -' .- • ", . , ,, -. - : "'' '-,, l'. - -."-;',..:• .'' 17.. , , r.1-.., f.. ., 42-453.6715,,,. ;-,,, ' -..,, , ,,,,...11,,,, , ,., , !. -,1 , -, . ., • . . • . . -,. svardi@thinkhospitality.com PRINCIPAL BUSINESS TELEPHONE NUMBER- 1:- : ., ..: CELLULAR TELEPHONE NUMBER EMAIL ADDRESS L') cv ' Krsu-aSiTo-dlikrcod—e7Sialiir2T-42V1YftiItirkii*liraraqfrY'r:":fkrWratiliinTfeitz'ie-rst,irpToT:6FviriitififP:Vlie:appearra"ratiiiifiiifBrttTai entity wittiiiut special compensation Or reimbursement for the,appearance,whether direct indirect,or contingent,to expfeSs:supportg§roppositio*, 'WI*shal!Te9isigr with thO.Ctelk a,s.reOlgred..billiti,"Obsacliell bUt shall noi.00*Illirezi.to,PaY.ilnYsreclisiratiolifee* -. -- . ... _ , 5 ,_ ,.., ,-, If the Principal is a•Corporation, Partnership or Trust, the following information MUST be provided' pursuant to City Code Section.2-482(c): ._ „ . ,•• -. .. • ..... . .....• . ILI c'S ..• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA): S.Vardi ,.._ 6 • NAME OF ALL PERSONS HOLDING,DIRECTLY,OR INDIRECTLY,450A 013w:4m OW • .. NERSHIP INTEREST IN SUCH '.- - , 6 CORPORATION,PARTNERSHIP OR TRUST Of none,write WA): Please see the attached. 9 , , 0 ., - . .. ' . . .. _ .. ..... ,.. _ _ ,....... ._. u., . Page 1 of 5 w "--"---.•.".NIEIBEF-49C3-43DO-A466-7DF281EA868E Page 1 of 6 117DF281 EA666E 1 1111 Ifil#1211111 1 ... DocuSign Envelope ID:EF4D9636-FB50-4070-A594-62A69663044C antiuv+y .;.rmv,ro.v..n o.".ov.rl vw-,.m.rT'ov-vI r%0 W&M-.vvr III.ISSUE TO BE LOBBIED: : :.r• Describe with as much detail as is practical,including but not limited to a Specific description where applicable of a pending request for proposal,Invitation to bid,or public hearing number: Development Approvals&Permitting Issues,including but not limited to the Historic Preservation Board, Design Review Board,Planning Board,Board of Adjustment,Land use Development,City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 2000 Collins Avenue in lvhami Beach,Florida: " • ' 1 ` } ' - J' ..0 . . `Yl C' 51;, u } ill _. IV.CITY AGENCIESIINDNIDUAL$'TO BE'LOBBIED '' Pursuant to City Code Section.2.482(a)(4),list the City Commissioner or City:personnel sought to be lobbied, and'whether the lobbyist has entered into any'contractual relationship (paid or"unpaid)with said City Commissioner or City personnel from 12'months preceding such commencement of service with the City to the present date,stating the general nature of the subject contractual relationship..• .-Full Name of Individual and'. Contractual Relationship(If yes,explain) YES No Title of Person to be Lobbied Staff for the-Planning&Building Depar`rtment . 3 .None X Public Works&City Administration,PB,HPB,BOA., ,'None.; - , X- DRB,City Coaiayssion,and Mayoras necessary' ' "'•None ` J X .. Land Use&Sustainability Committee :r' ° r None% . '• : X - r ... --r.d.. ...<.. .. . ..y. -. ., ,.. a.-o.. �.�..�.- .�..... .a..-.-� Pursuant to City.Code Section 2-482(g), every registrant shall be required to state the extent of any, business, financial, familial or, professional relationship, or;other.relationship ,giving rise` to an appearance of an Impropriety,with any-current City.Commissioner or.City personnel who is sought to be lobbied as identified on the lobbyist registration form filed. List any Business, Financial, Familial or Professional Relationship,{or other.relationship giving rise: to an `° appearance of impropriety(if none,write NIA): . . . - .. . . - ... - 0 None __. _ .. r - ....-... ---. �_. _ O ' w . ..-I' LL V. .DISCLOSE RATE AND AMOUNT:OF LOBBYIST COMPENSATION -Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec.2-485.3): Page 2 of 5 W DocVerify ID:24EBFBEF-49C3-43D0-A466-7DF281EA868E I Page2of6 L 27DF281EA868E III EM IIII www.docverify.com U , . DocuSign Envelope ID:EF409636-FB50-4070-A594-62A69663044C DocuSign Envelope ID:5F9DE9116-F950.4834419c.-6fEc6z4eAuur • The following tilt(6)questions MUSY,be answered: • 1) Pursuant to City Code Section 2488.entitled'Prohibited Campaign Contributions By Lobbyists On Procurement Issue:et, . ••. , • , . , . . •YeS X No' Ant von lobbvinsi On a Present,or pending bid for goods.eaulpment or services or On*Present or , . ' pending award for moods eguloment or service? • r- , . .... .. . . ' ' -2) Pursuant to City Code Section 2.490,entitled Prohibited Campaign Contributions By Lobbyists On Real Estate Development 'Issue% • , .. —Yes No: Are you lobbying on a pending application for a Development Acireement with the CRY or application for chancre of zonino mao designation or chancre to the City's Future Land Use Map?. . ,. . . . . . ..• 3) • Pursuant to City'Code Section 2482(6), any person(except those exempt from the definition of lobbyist'as set fuel in Section 2.481)who only appears as a representative of a not-for-profit corporation Or-entity without special compensation or reimbursement for the appearance,whether direct or Indirect to express support of or opposition to any item,shall register with the city clerk as required by this section,but shall not be required to pay any registration fees. Yes k No'•-• ' Are you -representing a nOt-for-orofit corporation or entity ,without special compensation or reimbursement?, , . ,. • 1 4) Pursuant to City Code Section 2-481,the term"lobbyist'specifically exdudes the following persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears .as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, - indirect or Contingent,to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or ...reimbursement for the appearance. :- :-• .., Yes x No: Are you providing only scientific, technical or other specialized Information: appearing as a . .„, , • -• representative of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the Purpose of requesting a grant without =';•,-.°-.-'•- . .. A special compensation or reimbursement? - . . ... .....— '' I 5) Pursuant to City Code Section 2491(1),no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services within the past election cycle.See Section 2-491 for more Information. - ', • • - ' •. --1.--,': ' ? Yes ANO: '. Have you provided campaign consulting services to an incumbent member of the City Commission •- . within the past election cycle?if yes,please list the Incumbent member(st of the City Commission: ' ? - • 7 6 .":-1 'F '. ' •- , .- .. . , .7.77.77,;f7,-1.n-0,47:1-417'.•4."''''fit,; ',".i.,,P.;El:7:7:.,,,'..r..:.---,f•-:.','.7.7.7-7....,--.-, ...,-,-.,,,,-.;_.,71 Yes No. - Jf Ves..has it been less thee-AZ:months since the'elected Officialfel*horn irou'provided campalan NM. .IMM. • . Consulting services was Swam in? , ,... .. . • • - • - . . • 6) Pursuant to City Code Section 2.482(a)(4)a.,a lobbyist who has within the past election cycle provided campaign consulting • services to an incumbent member of the City Commission(which lobbying activib)is not otherwise prohibited by Code section 8 2-491) shall disdose such particular,service on histher lobbyist registration form and shall orally disclose such particular 69 service before lobbying the City Commission at a public meeting. Yes x No. " Have you provided campaign consulting services to an incumbent member of the Cihr Commission •• — — • within the oast election ovate?If VOS,P1138811 list the incumbent memberfsl of the City Commission: ,,, • - , . . ___. ........_ ,n. - -.' .' "--..T.,--•- -7'• .;::,7:,:•".7:, .;---7-..., ....„. . . . ,,, . • 0 ,.. . . ,.,.. -• • - .•:--.,--i-----z--..,r,?•p,figr.-7. . . ...:77f.•••AW"..0,4-7.. .-,7--.-----fk•-••y,-'.---.it,•-•---,--,•,•,.., - e :l Yes X No: - If vie;were Vou'proffilied or did'You.t economic eceive. 'consideration'In tidier** for'Cintogign .., . .- — 'consulting services? ,, - • ' , - • —TO SE CONIPLETED Bit CITY CLERK'S STAFF ONLY ''• im..ifit c-0• 5.- - ' - , ,n. Annual liefilstration fee:.rri,),Yie 1 _,'''._____-__:Feld g"-'•-,, -It MCRitn!' -i,.3, ., _ .p),,•Date paid!'3:--:C.217.1.i.•3: d.c?..:,3., , 7 Lobbyist Registration 00171"MC/Wed and verified by i' ,-,, -4.F. ' ‘'' 0111. ! •C ' ' ....5 ,,.p. __:.,,,,,, ,, ,,.1:, m FACLEIA$A11UFORMSILGBBYIST.FORMS1Lebbylst Reeistretion Form Revised 09-20-18 REG ,,..--,,• -,,,:.-.,.. ,,,..-..-,-1,. , .,,i.Revised 09/2042919 . -,- Page 3 of 5 Lu , , . . 1 DoeVerIfy ID:24EBFBEF-49C3-43D0-A466-7DF281 EA868E T www.docverify.corn 1 Page 3 of 6 I 37DF281EA868E 1 1111 IffiNtiall HI • DocuSign Envelope ID:EF4D9636-FB50-4070-A594-62A69663044C DocuSign Envelope ID:5F9CE98695D-48344‘19C-6FECE24BACC7 ; • VI. SIGNATURES UNDER OATH: ,.: .,, ON FEBRUARY 28 OF EACH YEAlt EACH LOBBYIST SHALL SUBMIT To THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY.A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING T_HE REPORTING PERIOD.1 Signature of Lobbyist: .,. 32132D33..,53C64,0... Date 01/23/2023 1 do solemnly swear or affirm that all of the foregoing facts,statements,and disclosures in this form are true and correct, and that 1 have read or am familiar with the provisions contained in Chapter 2,Art VII, Division 3, entitled'Lobbyists"of the Miami Beach City Code artrullTerieribig •,..uire ents. „.„ e, , `• , • „ . „. , .... Signature of Lobbyist t Date 1/23/2 3 . .. . 32525,45o,- e... . Signature of Principat-. - . . •-' '. Date i ,,ZA ' . • : . f ,,.-•--:, ,,,,.6 ,II,{:-Z) '',r'i:.:: 1.:.., ''' '''.. .:' :*..r : ..'''-'' . s -, • ' ; .'-'2' 1.',i.: 11 '.... ' ,' i'..:`.3.;3 "i).2 :.;.i,.:. •':;,' ,..- i• .° -:;.- , ., , VII. NOTARY SIGNATURE AND SEAL:...' .n..,'• .,/ •:., ,,,, 1,,',.;...s,?i-,-c.:,,,,i•s! :, C,;.:c,,... '...;..: - . . ,.- . .... .,, ,,,-., ., . , , • 1.', 1 i.;' — ,-..., , - . ,. 1,..) t,.. , ., LOBBYIST: • PRINCIPAL State of Florida . State of Florida • • County of: Miami-Dade . •'.•••;- '','1%. .4...',' ''', . . ,,'County of-.:•( Miami-Dade-.'• • - ••;k.;,, 74:: 1:.:- . . , I c.', - , ',, ' ,..-..' ',.. .• •ii Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means Of 0 physical presence .;.,. r; .i ,'- ,, t:, t .-,, ‘,, 1 Py means of,0 physical presence ;.:.. .:-. r. ,,,.... Or El online notarization; ,.- ..% / ..,..?,;.,,- 4,.,.-7-., 7.. ,i _., . , orp online notarization„. this______day of -- - 01/2312023' "''' •-• • •••20_,by • this day of :01P36;023" ' ,292_,by Michael W.Larkin :.•-; ', Shawn Vardi NAME OF LOBBYIST NAME OF PRINCIPAL :c- :, ., j :1 ;'.'... :" F:.:',1? Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION • • `-- ••I ' 1 ;,‘•:1 :!•,;, i-...s.;••,,,::::‘ ; .! ., , ., x personally Knt--' '— -- --i.• , • , , ' ,- .. x Personally,KnoL---- -,,,,--; '• . , V 0 \ . . , . , Signature of Notary Public Signature of Notary Public -. Diana.Ramos Diana Ramos o .-.:!..1...r.i l•V''1' '" ''•--' '' '' . ,‘ '. . '• . , . - s. W':,, M Name of Notary,Typed,Printed or Stamped ' ',,,- ' ',''' -Name of Notary,Typed,Printed or Stamped . ,r. • ,--., ..- -A i.-II I.-AIL-A,-II 1...-16- A.... ..M. .11, Ill,_...... ..II,,11._,I,.... AIL Lu Diana Ramos , Diana Ramos Commission*GG 308355 commission#GG 308355 Lu a Ootary Public-State of Florida _Notary Public-State of Florida My Commission Expires Apr 10,2023 My Commission Expires Apr 10,2023 = persons: - ,.. 0 d,- ' wrgnomirn ague peT • -"".." -r• "7,-''''-T--..r..7.- .r -Mxsec ......,—.......--....Ti or other specialitaxAmirgagg, "al. ^. "3/3 .. . y person who 6 O only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether ▪ direct,indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. 'Page 4 of 5 DocVerify ID:24EBFBEF-49C3-43DO-A466-7DF281EA868E ,6) 1 Page 4 of 6 1 47DF281EA868E I 11111 Emu Hi i .:,.. www.docverify.com DocuSign Envelope ID:EF4D9636-FB50-4070-A594-62A69663044C • u0Qi`.Aon enveoipe M. 71dL OrttitL4IIMA./ • M1AM1BEAH ., throat'IMiami Be0ch,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miomibeochfigov Office of the City Clerk Rafael E Gonad*,City Clerk CiyClerk@miamibeochfl.gov Tel:305.673.7411,Fax 305.6737254 NAME OF LOBBYIST: Michael W.Larkin 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to. City'.Code Section 2-485(d), the City Clerk shall notify any lobbyist (or principal)who fails to file.timely a Lobbyist Fee Expenditure and Compensation Statement '(Statement). In addition to any' other penalties that may be imposed as provided in Section.2-485.1,'a fine of$50.00 a day shall be assessed for Statements filed after the due date. Me'city Clerk'shall notify the Miami-Dade County Commission on Ethics and Public Trust-of the failure'of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who'fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been' appealed to the Miami-Dade County Commission on Ethics and Public Trust I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a signed Statement under oath listing all lobbyist expenditures, as well as compensation received,for the preceding calendar year with regard to the specific issue on which I have been engaged to lobby. 2) LOBBYIST WITHDRAWAL Once an issue 'I have registered to lobby has concluded or I am no longer lobbying on. that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. 0 .3) ANNUAL LOBBYIST REGISTRATION FEE o ' I understand annual registration of all lobbyists shall be required for each 12-month period commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. DocuSlgned by: 01/23/2023 Signature of Lobbyis`r'tb4N Date 0 F.1CtERLSALL1WORMSILOBBYIST FORMnottr ls1 Raplsbatlon Fenn Rated 03.11.20 RE0.da0 co Page 5 of 5 • DocVeraverfycomBFBEF•49C3.43D0-A466-7DF281EA868E Pege5ot6 57DF281EA868EJ II F1 1 II UI I DocuSign Envelope ID:EF4D9636-FB50-4070-A594-62A69663044C u cuoign CI1tlEopeU.P.O1-OYCJOUn-a:MJ-OJrn IJV'VrGAaw...IwV/ 237 Parking LLC Disclosure of Interest NEUNION LLB - SHAWN VARDI 25°% • 1220 STIL'LWATER.DRIVE . MIAMI BEACH, FLORIDA 33141. . - HUNTER GELLIN.25% • 7 HANNAHS COURT `, SOUTH HAM PTON, NEW'YORK.1.1968 • MARK SHEMEL 25% . ' 38 EAST 32 STREET,SUITE.6. . • , NEW YORI, NEW YORK 10017 • NAVIN.MAHTANI 25% 3 ISLAND AVENUE,APT.•14D �' MIAMI BEACH, FLORIDA 33139 • 0 N i 0 0 w w • 0 O cc � 4 . 0 0 r� + r • U rn . • m w • c • • DocVerify ID:24EBFBEF-49C3-43D0-A466-7DF281 EA868E L-Page EA 6 of 6 67DF287B68E l III www.docverify.com — J �t��ll � y� �F docv'erify. z .,F ° OCCVER'i Lobbyist Registration Form - MWL - 237 Parking LLC -executed.pdf DocVerify ID: 24EBFBEF-49C3-43D0-A466-7DF281'EA868E Created: January 23, 2023 06:02:58 -8:00 Pages: 6 Electronic Notary: Yes /State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary.and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. E-Signature Summary ESignature Notary:Diana Ramos(DR) January 23,2023 06:05:15-8:00[4FE3E2380B8C][74.220.90.117] dramos©brzoninglaw.com t . r : f• t, Li 0 Alrf I IIIIII IIIIII IIIII IIIIIIIIII IIII IIII)IIIII IIIII IIIIII IIII IIIIII III IIII DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. I DocVerify ID:24EBFBEF-49C3-43D0-A466-7DF281EA868E ----- ---281E 11QI 11IIII I www docvenfy.comenerated Cover Page] 7DF281 EA868E 1BF City Hall • ° 1700 Convention Center .Dr. C Miami Beach , FL 33139 . 305-673-7420 . ' u W Welcome 005914-0005 Adrian V. 01/23/2023 04:14PW d' .. C ,' ` 71;1 . a) :° r MISCELLANEOUS c' - ,` {, Reference 1 MCR431253 z �"'`� ( . t• • • NCR OPEN (NCR) _ 2023 Item: NCR z 1 350.00 _ MCR OPEN (NOR) 350.00 1. a, ,4 # o 350.00 x , 4.� i.s3'_ i � Sat ,,;5 f } . i.T � . ,P Subtotal 350.00 d 3 li { < '� 'aG e 2` g ,t 07, a' p kxx� 21n� - � ` %4 Total 350.00 � �t . '� ` ¢a • CHECK 350.00 .�,, � � Check Number00007837 Change due 0.00 k yC. -., y' Y ? .0 $� r ; �, a r M o • Paid by: BERCOW RADEEL FERNANDEZ & LARKIN ,, ,o ° `` � ,` �� I�IIIOIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIl01111illlllll ;,,,,,,,4 H V r >V met }r. t } N . a ~4 .L - � "'ir ',°- ______8_8 , __ _ _, CES k -` Q V °t'O. ....$n _Q C O -3 .,,, c p 07R R1PilL��Cit . '""`N ��e"^^iroYi4lGI S * — H :Y f0v. V T3 .{'� iu' _ :V �" <murwwa 4 �- z V4• V �. Q� L1 i.L '.N ,;� > Q f a Qom, f-#. ���� , o :._x � vE < a:a.0 .a sr its s "rya �"`� r " �� ��', s.._.,__,.,x_....i..•:...:.`t'�,I*�'F'_;.._,._� ....:.u.:`�•` ..:.��3:' n, air ( mV + 9, �_ Cie '5 ,s '.°w,' .'°'�� `�� "�ta ��. M• � { �,,, „,:_�� �,a:v,,-f , < � �> 3; Thank you for your payment CUSTOMER COPY