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Silvia Coltrane VO/V4/V~ ~~.~I r~ ~JU~JIOOVLV I.dll<::>.r.l\. _10_ ttiW ZlIU lD .J ./I-~ Oty of'Mlami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 ':..;, C) ,.1;- LOBBYIST atGISTRATlON FoaM ;- L.obb)'lst I1I9fI5 all pMllIlS empioyl!d or mained, whelMr paid or rIOt, by a princiPal who _lis III _rage the pHSIlII!, ~:', or modiliallion d any on!inMc:II, resalution, adion or ds:i5ion ot any tllITlllIissillner; any attion, declslon, roc...,.,lII,dalion 01 ~:. CIty MllIllgtOl" or I/nf dty board at mmmlLtllr, or any adIon, decision or ~ d lIlIV dt)' ~ dellned 1ft 1fIP(j, Il1iIl1nef ir1 this Sl!dion, durlng the lime period of 1M Inlin! dedsilllH1lilldr1g process on such adion. dtdsion or ,tcXlIMlI!nd~f"") that toraeellbly wID be helrd or I'e'Iiewed by !he dty commission. or a city bolIrd or conmi\tee. The l1Imt splICIlIclIlly iI1dlldes mr-ii prindpal as we. as any employee engi/(led In lobbving aaivilie5. T1ul tenw"l.OlIIIyisIS- h..1IIHIdIIC eJCd....... ...... nl'er-rl to OrdIunCe 2004-1435. c=; Kasdi.n Neisen O. ("l"i NAME Of'~: ~ (UIst) G.1nl'iter 'iOli.\U.ey. .2_ S:_ Bi.~cgy'?e Blvd., BUSINESS NAME AND ADOlWS (Number and SCreel) 305-376-6062 305-376-6010 (FIl'5t) }3~QO. MIami (Oty) (M.I) .33.131 .FL (SllitIl) (Zip c:acr.) nka~gunster ,can TELEPHONE "'UM8ER: FKI( NUMBER; EMA1l: L LOUYI$T RITAlNED aT: Silvia COltrane NAME OF P1UNClPA1/QJEN'1": Miami Beach (City) FL (Sme) 33140 (ZIp Code) 5025 COllins Avenue, #2309 BUSII'lESS NAMe AND AOORESS (Number and Sln!I!l) 305-866-7707 305-866-9594 TElEPHONE NVMllER: FNl NUMB: (Optional) l!MAIl: (Optional) Fill Ollt this Hdion if prllldplIllls III Corporation, ...".,lInllIip or Trust [SlBction 2-411 (e)] . NAME OF CHIEF OFFICER, PAlfmER. OR IIENEFlClARY: IDENTIFY AU PERSONS HOLDING, DIRECTLY OR INDIREcn Y, A 50/0 OR MORE OWNERSHIP II\11'EllEST IN SUCH CORPORATION. PARTNERSHIP OR lllU$T: u. !Plane; LOlI_V!SSUE: Golden Sands Hotel site plan approval IS5U' to be lobbied (Describe in detaU): ID. CITY AGENaES/INDMDUALS TO BE lOBBIED: A) Full Name Dr lndivicluallTrtfe 8) Any Financia', Familial or Pral'usianill Relation_ P1.ann1ng Depart1nE'.nt None liP Board None IgJ002 ..,...... -'':- )'J ,..11 '":;; :'") <.J1 "..,..,..."; i It .- 'XP :.<1:. ,p. ()'\ CP .~ rn o V~/V~/V~ 1~:~1 ~AA lJV~Jt~OV1V \'~&:;.Y,A.. ISJ vua IV. IDliCL05URE OF TUMS AND AMOUNTS OF Loal'tlSr COMPENSATION (DUCLOS! WHlmtER IiOURL Y, I'L4T RATE OR OTHtR): A) LOllSYIST DISa.OSURE: (RIIquired) 8) PRlNCIPAL'S otSCLOSURE (Ol'l.Oll8't1gCOMPENSAnON): [Required). $375.00 per boUt ~a ==,I'IID- .......1lCl a ~Mlnlfita....-atian or entitv without Sl"'"- mm.......ation or I Pumanl: to Orclin_ No. ZOOot-3435. Pursuant to 0nIn_ fCo. 2003-3393 Amendin9 Miami Beach CItv Code Challb!l' 2. Artide VII DM5iDn 5 TherP.Df ~nIItt"" "OImnai9n F111111la! Rebm" VIII Thl! Addition Of rnM -on 24118 EntIl:Ied "Prohlbillld :::~::rf.=::::r=ea"nto[~'" oron8~ ____nG aw8Jd for - aauiament or YrVia!' 1) Y_~ 2) ~ y, $375.00 per hour Pursuant to 0nI1nlmaI No 20113-3395 Am8ndino MlamllleJlch CJtv Code Chaob!r 2 ArtidI! VII DMsion 5 thereof EnlIIIBd ~ign FinlllU RefIlnn" Via Thl! Addltion Of Code Sedion 2-490 Ent!Ifed "ProhIIlIII!d Clmlllllan ConIribuIlans 9v l1lbbvIst!; On Rsal - 0eveIaIImI!nt lssues"~ A,.. vau IobIwIna an a aendlna .1IIII~ment~wiItI the atv or fgJIlad:iart ,.. duI... DI:mnI... Ift.D deslarGItIan Dr dtanae to tfIe City's FutoN Uild 11M MaD? SIGNAlVU UNDeR 0A1Il1 ON OCTOBER 1ST Of !ACH Y!AR, EAOf 1.088YJST SHALL SUBMIT TO 1ltE CITY CU!RK A SIGNED srATEMflN1' UNDER OATH, LISTING LOBBYING EXPENDITUMS, AS WELL AS COMPI!NSA'IJON RECElVED, IN THE an OF MIAMI BEAOi FOR THE PREaDJNG CALENDAR YEAR. A srA1EMENT ...u... ..... .- .. "".. ..... - NO -r""'" ....... "" REPORTING PERIOD. Signawn! of obbyist I do solemnly swear that all of th foregoing facts are true and correct and that I have read or am . familiar With the proviSions con i Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Oient: VL LOImsr IDENlD'ICATIONI PIUNCIl'AL IDElIl11F1CATIONl ~ Produald ID o Produald ID L Form of IdentJflcatton ally kngwn (Principal) Form of IdentlRcatlon L! Personally known (lobbyist) VIL 5IGNA11JRE AND STAMP OF NOTARY: OlGA C,;,sTlUO MY Cm~MISS'ON . 00 053916 EXPIRES: .'UGusl29. 2006 Bonded Thru Nola!)' Public ~ers ./' FORC~ONI.Y 7/2 Y7 Annual Regislration fee: [ !-{Yes [ 1 No Amou1!:' ". MCR II J ~le Paid Lobbyist RegislroUon Form reQeivelI and verifled by: ' "2- l\eVised 02/10/04 F: UER\All\MAIUA-M\lOBBYIST\LOIlBYJ$T FORM 04 g~5-0t.f