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Alexander Tachmes / CSC Traymor M_iB_ ~1tlI 'IIt' 2UU3 m 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, 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 action, decision or recommendation that foreseeably 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 Ordinance 2004-3435. rA-~I+Me..> ~~ME OF LOBBYIST: (Last)) ~lll.~1.. T:.Tc...J..",,,~ PA. :<. ~e>....Th.l'31> BUSINESS NAME AND ADDRESS ( ALt:.~A-,v[::>c:.r:Z ~ (First) (M.I) N'- $f-e 2(, ? 0 I J4 ~ i PC- ~::s I '3 / (C ty) (State) (Zip Code) 30 5" - ~ 5"""0 -{ Y1tJ t?t i f(,Lc-/-.. M.tr~&....# I. L 6"" FAX NUMBER: EMAIL: 3o?'-j ~(J~ /(('/-O TELEPHONE NUMBER: -, /-)~ ffl-D r 1<, L L c... I. LOBBYIST RETAINED BY: C S C- 1'- J NAME OF PRINCIPAL/CLIENT: (!.<5C. 1'1!.tA... II{()'/€.., L LL BUSINESS NAM AND ADDRESS 5&> I - <if 3!)- 1 Or) 3 TELEPHONE NUMBER: SfrJ/4"1 Avt.. Ji/t)() 3 v/tsre..(~ &o.J.., pc. 3 '3,/01 (State) (Zip Code) (Number and Street) (City) FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-4B2 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIAR~ YYJ 5" l- [.., I ~ s i rt1 " y, /l t... n ~ e r IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 5' Nl.- {A.. -t1-1L t../.-c4 t II-C, It., ~ 1 A )...1/ f.{ ,- ~I ft""h..J. II y<< J~r'" <-a.-h-gn "j.p ( II. SPECIFIC LOBBY ISSUE: /\T" eL/!. +.' fr < L.fe ri J< ttc 55 Issue to be lobbied (Descri III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship W\..~I"'~/O""(:S , } ()rf'L~ (41\.12. Co,.,,~ L ff-u f {-y f.U)' Y>'\. I ~S ' Me 00 ""L o V\ -<- o IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): <# 3~'; kou,l' A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 11 3.lS- J,...,~. The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On ocurement Issues": DYes or services r on a 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~o: Are vou lobbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) 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 clerk as required by this section but, shall not be required to pay any registration fees.. 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 PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~~ Signature of Lobbyist 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 Code and all reporting "",";reme"". ~ Signature of Lobbyist: Signature of Principal/Client: ./\."- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: " Prod uced ID D Produced ID Form of Identification ~ersonallY known (Principal) Form of Identification ~OnallY known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribe before me,,- Sworn ~subscrib~dore me (~tr:i1 ' 20.!..~ ~a\. Chrlatlna CoHIns This ~y of )" 2 - ~ . My CommIssIon D0051l638 Signature of Public Notary - State of Flori ~ ExpIres ~~ f Public N ry State of Florida Notarization of Lobbyist's signature Notarization of Pri cipal's signature FOR CLERK'S, USE ONLY Annual Registration fee: [ ] Yes [ it{ No Amount paid~.- -: - MCR # Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc - <? 7~ Date Paid ;,{ Ic/ku Revised 12/08/04 i "I ',' ~':.. , r i U -^~~; ':3 .: ;,~ Ii ~ ~:Li ~ i lii!~_;j \1 ~^'~ ~ t~f~ \ " en_ L / "EXHIBIT A" All persons holding, directly or indirectly, a 5% or more ownership interest in such corporation, partnership or trust are as follows: 1. The South County Trust Sole trustees: Leslie Schlesinger, Adam Schlesinger and Jason Schlesinger Sole beneficiary: Leslie Schlesinger 51% 2. Jason Schlesinger 15.50% 3. Adam Schlesinger 15.50% 4. The Robert Schlesinger Trust Sole trustee -- Richard Schlesinger Sole beneficiary -- Robert Schlesinger 15% ---