Zeb Jarosz/Mitchell Rubinson & Edna Rubinson
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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, 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 specific exclusions. Please refer to Ordinance 2004-3435.
Jarosz Zeb
NAME OF LOBBYIST: (Last) (First)
Z.W. Jarosz Architect / Development 3326 Mary Street Coconut Grove
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(305) 446-0888 (305) 447-1177
TELEPHONE NUMBER: FAX NUMBER:
I. LOBBYIST RETAINED BY:
Mitchell Rubinson and Edda Rubinson
NAME OF PRINCIPAl.jCLIENT:
3525 Flaminao Drive Miami Beach
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(M .I)
Florida
(State)
33133
(Zip Code)
zwjarosz@jaroszarch.com
EMAIL:
Florida
(State)
33140
(Zip Code)
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:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Board of Adjustment Application
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
DRB BOA HPB. PB Commission None ....
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Iy".~ _.E>:~<;'L~~~~~.?F TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
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A) LOBBYIST DISCLOSURE: (Required)
1Ji (1 $
oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). lIt)[) 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":
n Yes X No: Are you lobbvina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
nYes X No: Are yOU lobbvina on a oendina aoolication for a Develooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae 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..
n Yes X No: Are yOU reoresentina a not-for-orofit corooration or entity without soecial comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf 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 EXPENDITU S OR COMPENSA.9<>N DURING THE
REPORTING PERIOD. /
VI.
LOBBYIST IDENTIFICATION:
I do solemnly swear that all of the foregoing fa
familiar with the provisions contained in S ion
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
Form of Identificati
~rSOnallY known (Principal)
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~ Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
tate of Florida, County of Miami-Dade
worn to and subscribed before me
his Il\ da of , 20Q]
State of Florida, County of Miami-Dade
Sworn and subscribbefore me f, 7
This ~day of &V , 20!!.J
Signature of Public Notary - State of Florida
Notarization of Principal's signature
/ FOR CLERK'S U~ONLY ~=R-~ ~
nnual Registration fee: [VJ Yes [ J No Amount Paid 1f3(). MCR #.. Date Paid.....J ::J.
obbyist Registration Form received and verifier}by: ~~ Entered By:
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