Louis Terminello/999 Wash Ave
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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, 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 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 dty board or committee. The term specifically indudes the
prindpal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exdusions. Please refer
to Ordinance 2004-3435. .
Terminello
Louis
J.
,
NAME OF LOBBYIST: (Last) (First)
Terminello & Terminello, P.A., 2700 S.W. 37th
BUSINESS NAME AND ADDRESS (Number and Street) (aty)
(305) 444-5002 (305) 448-5566
TELEPHONE NUMBER: FAX NUMBER:
(M.!)
Avenue, Miami, FL 33133
(State) (Zip Code)
ljt@terminello.com
EMAIL:
I. LOBBYIST RETAINED BY:
999 Washington Avenue, LLC
NAME OF PRINCPAl/CUENT:
999 Washington Avenue, LLC, 999 Washington Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) (Zip Code)
(305) 532-0036 (305) 672-3141
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: Mitchell Rubinson, Mgr
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCK
CORPORATION, PARTNERSHIP OR TRUST: Mitchell Rubinson (10.0%), Jaime Rubinson {13.5%
Roman Jones (31.5%), Eric Milon (22.5%), and Francis Milon (22.5%)
II.
SPECFIC LOBBY ISSUE:
Conditional Use permit application for neighborhood impact establishment
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full N"me of Individual/Title B) Any Financial, Familial or Professional Relationship
City of Miami Beach Planning Department
/
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL)j
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $6,000.00
$6,000.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
nor
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv LobbYists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled \\Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By LobbYists On Real Estate Develooment Issues":
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. (f
Louis J.
Signature of LObbyistTerminello
I do solemnly swear that all of the foregoing facts are true and correct and that I haye read or am
familiar with the provisions contained in Section 2-482 of mi Beach City Code and all reporting
requirements.
o Produced ID
o Produced ID
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATI
~ Personally known (lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
~rsonally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of 20.J!5
ignature of Public Notary - t te f Florida
Notarization of Lobbyist's nature
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~~\:3.j'l.Jh'pins' AUG. 26 2008
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State of Florida, County of Miami-Dade
Swo d SUbSCriO ~,ore me
Thi day of , 2005
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S~ . tate of Florida
."ottr~ ~.Q in~al's signature
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FOR ClERI.<~ USE ONLY
Annual Registration fee: ~Yes [ ] No Amount Paid 1'ZtO~ MCR # 2.::=J-9~ Date Paid L.J.1-t-'O~
Lobbyist Registration Form received and verified by:", jr.t ~~
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04