Sy Chadroff/Lucky Strike LLC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, nesolution, 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 defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The tenm spedfically includes the
principal as well as any employee engaged in lobbying activities. The term ULobbyists" has specific exclusions, Please refer
to Ordinance 2004-3435,
NAME OF LOBBYIST:
VI 331ft, 0
(Zip Code)
3MC ~g-2-q64'2..
TELEPHONE NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
L IIv"y 5f"N'/t-f J1,{,4b.i Ue
NAME OF PRlNGPAL/CUENT:
3 2-1 t..f' 1. c.I { 7, 7..-
TELEPHONE NUMBER:
(City)
1'2. 3 \.U~ 7()t.~ I
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Parb1ership or Trust [SectIon 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II, SPECIFIC LOBBY ISSUE: (-
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Issue to be lobbi 'be in detail):
III, CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA TRATE OR OTHER): .
A) LOBBYIST DISCLOSURE: (Required) t{ '0 ~..r Cto cJ r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSA-JoN): (ReqUired).
DYes I"t1fO: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial com~nsation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
o Yes ~/ Are YOU lobbyina on a Dresent or Dendina bid for aoods, eauiDment or services. or on a Dresent
or Dendina award for aoods, eauiDment or service?
2)
Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
DYes
v.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRE DING CALENDAR YEAR, A STA MENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE URE ; JRfOMPEN T10N G THE
REPORTING PERIOD, ~
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 ntained in Section 2-482 0 the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal
VI. LOBBYIST IDENTIFICATION:
[] Produced ID
PRINCIPAL IDENTIFICATION:
[JproducedIDm~~~~
Form of Identification
Form of Identification
i~rSOnallY known (Lobbyist)
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Signature of Public Notary - S ate of Florida
Notarization of Principal's signature
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FOR CLER '
Annual Registration fee: ( -..rYes [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\MA
N;~R #d7~# Date Paid &?..?/~
-M\LOBBYISl\LOBBYIST FORM 04