Michael Larkin/Miami Beach Community Kollel, Inc.
~
...,
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 prindpal 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, 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 dty board or committee. The term specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Larkin
NAME OF LOBBYIST:
(Last)
Michael
(First)
W.
(M.!)
Bercow & Radell, P.A. 200 South Biscayne Blvd., suite 850
BUSINESS NAME AND ADDRESS (Number and Street) (City)
Miami, Florida
(State)
33131
(Zip Code)
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
mlarkin@brzoninglaw.com
EMAIL:
I. LOBBYIST RETAINED BY:
Miami Beach Community Kollel, Inc.
NAME OF PRINCIPAl/CliENT:
Miami Beach Communitv Kollel. 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 HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
.11-;;' 7~ 00
BJ PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$ ::J-7S: 00
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, LIsnNG 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.
,/YJf tv~
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
requirements.
Signature of Lobbyist:
Signature of Principal/Client: f\L
~CV'---
r-
PRINCIPAL IDENTIFICATION:
VI.
LOBBYIST IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
~nally ~(lobbyist) (<< 7; Personally kno
VII. SIGNATURE AND STAMP OF NOTARy;l tr:I n '""' ~ DEZ
~ ~ S' l.. .J C ~""""f'",~ V. MEN
. . . ~ ;::;.8 ~.~ . . lr.A.~~ MVCOMMISSION#DD285215
State of FlOrida, County of Miami-Dade ~ ~ g. p.~tate of FlOrida, County of Mia .~jJ EXPIRES: January 27, 2008
Swon:~to and subscribed before me R' g;:: 5- ~ ~-?worn a~d subscrib d ~for 1 m "'1.~',,:~ BondedThruNotaryPubllcUnderwrllers
This .:S\St" dayofOv~~..:t ,20...Q...~ ~;:;~ t:::J;rhis/...lL.-dayof . ,
R. '*1:' .
. c::::-, _. t::1 Cl 0 . .
~.It-""_~~ ~~vo"rl .
Signature of Public Nota - St@te of~lorida ~:: ~ ~ 5Signatur f Public otary - Stat Florida
Notarization of Lobbyist's signature s- 8 c: ~ sNotarization of P 'ncipal's signature
!'" 000 N ;:0.
FOR CLEB5~SE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount PaicJib. ,s:) MCR #
.....
Lobbyist Registration Form received and verified by.. ~~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISf fORM OS.doc
2.87-\~ate Paid 9-=i-cx..o
Entered By:
Revised 12/0B/04
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
j
, No.
287179
"
D Cash 0 Credit Card
~/ ~p - 1
rn'Check # ~
$( L~EO. oC
i
:~-i 20Cy0
Received of S. ~\'f\Q(;"\ ~~.1.~ ~.
Address
For \Ob'o~:rlS~ r-eelS~c>f\
'--~<<~~~h'~~~~ ktkrv-,,,,\ Lc~~
(THIS INFORMATION MUST BE COMPLETED) Office Finance Director
By
...
Account Number: C\ \~~O - 3UFt -~
Preparer: "'~~~
Dept: G.:~ Der"t<...
\