Julio J. Baladron/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 decision-making process on such action, dedsion 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 specific exclusions. Please refer to Ordinance 2004-3435.
Baladron Julio J.
NAME OF lOBBYIST: (Last) (First) (M.!)
9016 Dickens Avenue Surfside FL 33154
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 861-0713 (305) 867-7765
TELEPHONE NUMBER: FAX NUMBER: EMAIl:
I. LOBBYIST RETAINED BY:
Miami Beach Community Kollel, Inc.
NAME OF PRlNOPALjCUENT:
Miami Beach Community Kolle!. Inc. 3767 Chase Avenue Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 532-8991 (305) 532-8925
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 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/INDIVIDUALS 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 RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) trfOC'O r CO
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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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 oresent or oendinG bid for Goods, eGuioment or services, or on a
oresent or oendinG award for Goods, eGuioment 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 oendinG aoolication for a Deyelooment AGreement with the City or
aoolication for chanGe of zoninG mao desiGnation or chanGe to the City's Future Land Use
Mao?
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 reoresentinG a not-for-orofit corooration or entity without soecial comoensation
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, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDIN CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITUR S OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are ue and correct and that I have read or am
familiar with the' provisions co ined in Section 2-482 of the Miami Beach City Code and all reporting
requirements. 'A ('
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Signature of Lobbyist:
Signature of Principal/CUe
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced 10 OL..Ji: f34-3(, . 4-?i.\ .- '32. (,/1'1 Produced 10
Form of Identification Form of Identification
~;;-;:;:- ~;b~) Personally known (Principal
VII. SIGNATURE AND STAMP OF NOTARY:
V.MENDEZ
MY COMMISSION # DO 285215
EXPIRES: January 27, 2008
d T11N NOlaI'i PUblIC UndtJWril'rs
Signature of Pub c Nota Sta
Notarization of PrinCipal's signature
/ FOR CLER"'~ USE ONLY
Annual Registration fee: [V] Yes [ ] No Amount Paid ~.OC) MCR # '::22Si-r~
Lobbyist Registration Form received and verified~ Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIsr fORM OS,doc
Date Paid ~- \-0(0
Revised 12/08104
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
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, No;.
287179
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~Check #' 4
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Received of S. t+~ty\Q" ~~.l~ ec-....
Address
For \ob'o~JtSbs reelS~cJf\
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(THIS INFORMATION MUST BE COMPLETED) Office Finance Director
By
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Account Number: Cl \-90~' 3UA. -~
Preparer: "'~~~
Dept: C::~ DerK.
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