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Jason Long 2022 Fee Expenditure and Compensation Form City Of Miami Beach Lobbyist Fee Expenditure and Compensation Form City Code Section 2-485 X RECEIVED FEB 2 8 2022 Expenditure report for period of:1/1/2021 through 12/31/2021 A statement shall be filed even if there have been no expenditures or compensation during the reporting period.CITY OF MIAMI BEACH )FFICE OF THE CITY CLERK This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive, Miami Beach, FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due date. If you require any assistance, please contact this office at 305.673.7411 or atcityclerkEDmiamibeachfl.gov. Lobbyist Jason Long Principal 5333 Collins Acquisitions, LP(Jordan Kornberg) Issue Land use and zoning approvals for 5333 Collins Ave PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: p s Z ( /tic CATEGORIES OF EXPENDITURES Food and Beverage: Entertainment: Research: Communications: Media Advertising: Publications: Travel: Lodging: Special Events: CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE vt DATE REPRESENTATION ENDED: i 4 Y\ I r 2 0'L1. OATH Diu-') v, State of Flo F„ , County ofMias1 ade I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclo d her ' any attachment hereto are true and correct. Lobbyist Signature SIGNATURE AND 1d(�STAMP OF NOTARY: Produced ID nth) VIDA LIctA/Sf Form of Identification Signatu of Public Notary—State of Florida Sworn to_ 'and subscribed before me _Personally known This&s day of ,20 (fir.'. -/ C_:::/----' ' WILLIAM J. PLUCINSKI NOTARY PUBLIC,STATE OF NEW YORK Registration No.01PL4617853 Qualified in New York County • Commission Expires March 30,2023