Michael Larkin/928 Jefferson Avenue LLC
-e~ MIAMI BEACH
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 dty board or committee; or any action, dedsion or recommendation of any city personnel during the time
period of the entire dedsion-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 spedfie exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Larkin
(Last)
Michael
(First)
(M.!)
200 South Biscayne Boulevard, Suite 850
BUSINESS NAME AND ADDRESS (Number and Street)
Miami
(Oty)
Florida
(State)
33131
(Zip Code)
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
mlarkin@brzoninglaw.com
EMAIL:
I. LOBBYIST RETAINED BY:
928 Jefferson Avenue, LLC
NAME OF PRINOPAl/CUENT:
c/o Bercow & Radell. P.A. 200 S. Biscavne Blvd.. Suite 850
BUSINESS NAME AND ADDRESS (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
..."
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Itshak Ankonina
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Application for variances with regard to property located at 928 Jefferson Avenue, Miami Beach, FL 33139.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Jorge Gomez None
Richard Lorber None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
. FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$360.00 oer hour
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$360.00 oer hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes X No: Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGUiDment or services. or on a
Dresent or DendinG award for Goods. eGuiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes X No: Are YOU lobbyinG on a DendinG aDDlication for a DeyeloDment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe 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..
Yes X No: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 sr 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. /J'7fi
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Signature of Lobbyist
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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
requirements.
Signature of lobbyist: ~~
~ Signature of Principal/Client: ... . .
Produced 10 _1< tJOW Produced 10 ~ N () w rJ
Form of Identification Form of Identification
m s:: en z Personally known (Lobbyist)
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Annual Registration fee: [ ] No
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\lobbyist\LOBBYIST fORM OS.doc
Revised 12/08/04