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Maxwell Joel/El Ad Group FL LLC ~ , Oty of Miami Beach Office of the Oty aerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM I.dlbylst means II persons empICJyed or retained, whether paIc:I or not, by a principal who seeks to erlCXIU"IIge the passage, derut or modIIc:ItIon d Wtt Clfdkance, resolution, Id:Ion or decision rllny commissioner; any lld:Ion, decision, recommendation of the CIty MInIger or InY city board or commft:tee; or Iny 1CtIon, dedslon or recarnmendatIon of any city perSOMeI du'lng the time perIocI of the mtIre decIsIan-rnaldng process on sudllld:lon, decision or reconvnendItfon that flnreelbly wI! be hunt or reviewed by the city awnmiSSIon, or a city board or CXlIMlittee. The term speclflcaiiy Includes the principii IS well . lIny empIovee etPIJIId In lobbying Id:MtIes. the term .~ .... .,.cIftc uduslons. PluM reIer to Ordlnanm 2004-3435. MAXWELL JOEL NAME OF LOBBYIST: (Last) (FIrst) ONE S.E. THIRD AVENUE, 28th FLOOR, MIAMI, FLORIDA BUSINESS NAME AND ADDRESS (Number and Sb'eet) (ety) (M.I) 33131 (State) (Zip Code) ":ln~_":l"..d._I::;.&..nn TBDHONE NUMBER: '1nC;_"2iA_c:.nOr; FAX NUMBER: EMAIL: L LOBIYIST RlTAlNED IY: EL AD GROUP FLORIDA, LLC NAME OF PRINOPAl/alENT: l:tJ 0 {U () IJ'-A'- ~ BUSINESS NAME AND ADDRESS (Number and Street) Lj1lJf~~~-r~ i-L ) (State) 8'2/31 (2Ip Code) TB.fPHONE NUMBER: FAX NUMBER: (Optional) EMAll: (Optional) FlU out thls.-ctkNIlf principal Is . ~ Partnership or Trust [SectIon 2-412 (e)] . NAME OF 0iIEf OFFICER, PARTNER, OR BENEFIOARY: . IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5~ OR MORE OWNERSHIP INTCREST IN SUOi CORPORATION, PARTNERSHIP OR TRUST: 0. SPECIfIC LOllY ISSUE: BOARD OF ADJUSTMENT APPLICATION Issue to be lobbied (DeIa1be In detaII): ID. CITY AGENCIES/INDMDUALS TO II! LOIIIED; A) Fun Name 01 JncIlvlclual/TItIe .) Ally Flnanc:81, Fllll'ln... or Prof....ouI R..tIonshlp BOARD OF' ADJUSTMENT ... IV. DISCLOSURE 01' TERMS AND AMOUNTS OF LOalYlST COMPENSAnOH (DISCLOSI WHETHER HtJIIIU.Y, RAT~"" OIl D'1HIIO A) LOBBYIST DISO.OSURE: (...........) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST OOMPENSATION): C....uIred). HOURLY RATE HOTT1:/I,Y :R1I~ S350.00 The following InfonMtlon must be answered: I) ~ = CIty QxIe SeclIon 2-488 EnlIIlod -_ CampoIgn ~ons By LabbyIsIs ~ =: Iobbvlna an a .......nt ar aendlna bid for aaads. I!aUIDment ar _rul,... ar an a ...-esent ~r aendlna IIWIIrd far aaadL eaulDm.nt Dr ...-vIm? 2) Pu~ to Miami Beach CIty Code 2-490 EntlUed "ProhIbited Campaign ContrIbutIons By LcbbyIsts On Real ~ 0eveI0pment Issues'": nY_ .l"t Ant vaulabbvlna an a ..ndlna aDDlbtlan far a DevalaDment AanNHllf!nt with the CItv ar ~ aDDlleatlan for chan. of zanlna maD deslanatlan ar chana. to the! CIlv's 'utu,.. Land u.. HIRZ 3) Pursuant to Miami Beach CIty Code 2-484 (h) Any person (except those exempt from the definition d "'lobbyist'" as set forth In Sed:Jon 2-481 above) who only appears as a representative of a not-for-protit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or IndI to express support d or oppcsItJon to any Item, shall register with the clerk as required by this but, shaD not be required to pay any registration. fees.. Dr reimbursement. . V. SIGNATURE UNDER OATH: ON ocroBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY a.!RK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAltON RECEIVED, IN THE CITY OF MIAMI lEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL IE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSAltON DURING THE REPORTING PERJOD. tJ:? ~ and that I have read or am Oty Code and all reporting VI. o Produced ID o Produced 10 Form fA IdentJftcatJon It.. PersonaBy known (Lobbyist) Form 01 IdentIftc:atJon o Personally known (PrIncipal) AMuII RegIstrMlan fee: [ ] Yes [ ] No LobbyIst Reglstratfon Farm raMld and verIIed br: F:\Cl.ER\$ALL\MARIA-M\LobbvIst\LOB fORM ON~ ~76"r/! Date PaId Revised 12/08104