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James Rauh/SB Realty Investors, LLC hollnml ~'Cl.o..t1 btftd ~iiP >00. lQ - 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 no~ 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 city commission, or a city board or committee. The tenn spedfically indudes the principal as well as any employee engaged In lobbying activibes. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. . rgAuv!- NAME OF LOBBYIstr: -9 DI (yv[oL-N BUSINESS NAME AND ADDRESS 60S) Cj>,"-f - Y 117 7 TELEPHONE NUMBER: (Last) fW.>t () 'P L-t (Number and Street) ..::JItI\1I?S (First) Sf? MIAMI (City) P64lJ1 f L (State) C- (M.I) -; 31 .39 (Zip Code) FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: S ~ fZ. l? 1ft. T'/ I IU IJB-Slea( , L--LC- NAME OF PRINQPAL/CUENT: i l( 51? OCe--t,.v BUSINESS NAME AND ADDRESS ))(U Vi> P If Ll (Number and Street). (City) .M I-"vv/ I -bc,;'4C IT (State) H '53/S7 (Zip Code) ~()5 7f16 Lfqr;LJ TELEPHONE NUMBER: FAX NUMBER: (Opbonal) EMAIL: (Optional) fill out this section if principal is a Corporation, Partnership or Trust [5ection 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY I55UE: (n tJ 0 ITWrJ-t-<- U.~b Issue to be iobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A'f'Pw LA j{() IV fo f2- , L{ 6 J 0 U?"f,..J Dfl-l V~T A) Full Name of Individual/Title B) Any financial, Familial or Professional Relationship plA-IV"" ,,.,, '" (),o~() NO . IV. DI5CL05URE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DI5CLOSE WHETHER HOURLY,' FLAT RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ d ~)U {2...o=-r- tt I--.J~.(\ A 7 $ d?S ~/ ir"'<r ( B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), 11;) ?; <-'0 (l..~ -;-c( ,..u.-- No: Are 0 re rese ti n n -for- rofit r rati reimbursement, Pursuant to Ordinance No. 2004-343S. 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2, Article VII, Division 5 Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaion Contributions Bv Lobbvists On Procurement Issues": . I I . 5 CI com ensa 1 n or ,,-I!/fCl; W ~ , ui or e ic or on a e n 2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2, Article VII Divi~ion 5 thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibi ed Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues"; DYes ~o: Are YOU 10bbYino on a oendino aDDlication for a DeyeloDment Aoreement with the City or aDDlication for chanoe of zonino maD desionation or chanoe to the City's future Land Use MaD? V. 5IGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING 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 EXPEND URES OR COMPENSATION DURING THE REPORTING PERIOD. a true and correct and that I have read or am 2 of the Miami Beach City Code and all reporting I do solemnly swear that all of the foregoing fa familiar with the provisions contai d in Section requirements. Signature of Lobbyist: Signature of PrincipaljC VI. LOBBYIST IDENTIfICATION: D Produced lD ~ Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: PRINCIPAL IOENTIFIC~TI~. . >.toduced lD 7/c...\.U-L. 1'\' Form ofIdentification D Personally known (Principal) Signature of Public No Sta e of Florida Notarization of Lobbyist's signature Signature of Public Not State of Florida otarization of Principal's signature \111111, C tanza T th _.......,,'...'.'.",,;~ Coostanza Toth ...\~~~v.~"4?~... ODS 0 ....~~..,,_ L<:'~'r-~ Coffi!Jlission #00287204 f#;~~"':. Commission #00287204 "'''''' '. '1!:.O.~ ExpIres: Feb 03, 2008 ~~.. 'J,i} Expires: Feb 03. 2008 ....':?OFFt.~~'.... Bonded Thru "ll"'6~~,'''' 8ond. Thru "Irlll' Atlantic Bonding Co., Inc. IllA111 t" AtImtIoBondJnaCOl,ltilt1 . / ~~~~OO~ . . L Annuai Registrationfee:.[ vfYes [ ] No AmountPaldL~"" MCR # ~g:r~Date Paid \'1<3.J:5~ Lobbyist Registrabon Fonn received and verified b~~ I ' Revised 02/10/04 F: CLER\ALL\ 'M\LOBBYIST\LOBBYIST FORM 04