Shimon Hyman/Miami Beach Community Kollel, Inc.
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....
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 city board or committee; or any action, decision 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 tenn "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
(Last)
Shimon
(First)
(M .1)
Hyman
816 W. 40th Street, Apt 2
BUSINESS NAME AND ADDRESS (Number and Street)
(City)
Miami Beach, Florida 33140
(State)
(Zip Code)
(305) 788-6558
TELEPHONE NUMBER:
(786) 276-3933
FAX NUMBER:
rosh5000@bellsouth.net
EMAIL:
I. LOBBYIST RETAINED BY:
Miami Beach Community Kollel, Inc.
NAME OF PRINQPAL/CUENT:
Miami Beach Community Kolle!. Inc.
BUSINESS NAME AND ADDRESS
3767 Chase Avenue
(Number and Street)
Miami Beach
(City)
FL
(State)
33140
(Zip Code)
(305) 532-8991
TELEPHONE NUMBER:
(305) 532-8925
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 BENEFICIARY: Rabbi Yaacov Gross
. 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 certificate of appropriateness for design and demolition to the Design Review Board (ORB).
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
Thomas Mooney None
William Carey None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~~pO.
~/~ ecdt
B) J'RINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $.("00, ro
FTJ rc~
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 reDresentinG a not-for-Drofit COrDoration or entity without sDecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG 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 bbyist
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 con ined in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Personally kno
Personally kno
VII. SIGNATURE AND STAMP OF NOTARY:
V. MEtWFZ
MY COM~?S<,I:;:; ,! n;i 285215
:', 'r::l'C.,'~: .;a,l~"l~':ry 27, 2008
r,;\i~-~lru i'btuy ~"l.ij;lic Underwriters
FOR CLERK'S USE ONLY
Annual Registration fee: [ es [ ] No Amount Paid \ ~ MCR # ~\--=t'1
Lobbyist Registration Form received and verified by: b ~ Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYlST fORM OS.doc ~
Date Paid 9- \- 6CQ
Revised 12/08/04
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
\
.. No.
287179
o Cash 0 Credit Card
_/ . ~p - 1
rg'Check # \ A
$ 8t:C>. oG
I
:~-i 20cY(1
Received of S. t\-~~ '"' ~c::!:ct-n.. J.~ C r"\ .
Address
For \ob'o~Jlsbs reelS~cJ(\
'-- ~~~ ~~h'"!D<<\ ~rno.f\~ klt.:: Iv-t.,\ Lrrl..~
(THIS INFORMATION MUST BE COMPLETED) Office Finance Director
By
...
Account Number: 0\ \-9:0t>O - 3U:A. .~
Preparer: "'~~~
Dept: c..~ C\e~
"