Juan Fernandez/Yaakov and Roza HaimovCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, f133139
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 deaision of any cormrrissio-~er; any action, decision,
reoomrriendadation of the City Manager or any aty board or committee; or any action, decision or r~eoommendation of any
city persoruiel during the time period of the entire derision-making process on such action, decision or recommendation
that foreseeably wiH be heard or revic~nred by the city oornmission, or a dly board or oommitbee. The berm spedficaHy
indude5 the prindpal as well ~ any empbyee engage+dfn lobbying activities. Ths term `L,obbyists" has spsdfic
exdusbns. Please t~efer to OrcNnanoe 20043435.
NAME OF LOBBYIST:
(M.I)
33172
BUSiNE55 NAME AND ADDRESS
(~P ~)
(786)336-0881
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
Yaakanr and Roza Haimov
NAME OF PRINCIPAL/CLIENT:
2520 NW 97th Ave Donal, Florida
(Number and Street) (City) (State)
FAX NUMBER: EMAIL:
~~57 Prairie Avenue Miami Beach Florida
33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(gyp ~)
(305)216-6457
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
out this section if prindDal is a Corporation, Partrrersh~ or Trust (5action 2-482 (c)]
.1 NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
.2 IDENTIFY ALL PERSONS HOLDING, DIRECRY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCK
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Design Review Approval from the Design Review Board
Issue bo be k:bbied (Describe in detail): '?~ ~ S ~ ~ ~ ~~~
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
Ferrsartdez Juan
(~) (F~)
B) Any Rnandal, Parr~ai or Processional Relationship
Pleating ~. ~. ~Y
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCIASE MMEI'HER
~cr,AUr~rEO,ROrHE~x
A) LOBBYIST DISCLOSURE: (Required) {~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSA ): (Required). ~J v ~
The following i~ormation must be answered:
3) Pursuant to Miami Beach City Code 2-484 (h) My person (except those exempt from the definition
of "k~byist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-
profit corporation or entity withorrt special compensation or reimbursement for tfie appearance,
whether direct, or indirect, to express support of or opposition m any item, shall register with the
deck as required by this section but, shall not be required to pay any reg~tration fees..
O Yes X No• A~ ~reabsendno a not-for-ni+ aornoration or eM~itr witl~aut soec3al
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TOn7iE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDIIU WELL AS
COMPENSATION RECEIVED, IN THE CITY ~ MIAMI BEACH FO P ING CALENDAR
YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE EEN DITURES OR
COMPENSATION DURING THE REPORTING PERIOD. 4
f ~~
I do solemnly swear the foregoing facts are tri~and correct hnd that I have read or
am familiar
in Section 2-482 of the Miami Beach Ccty Code and all
vI. LoBBYIST
D Produced ID
Form of Identification
0 Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL
D Produced ID
~rsonaly knows
Form of Identification
(Principal)
State Florida, County of Miami-Dade State of Florida, County of Miami-Dade
S and before Swom subscri before me
This day 20~ Th' day of 2Q
o ~ e°`,.•••,evn LUGAJ.MORAGA
o ~ * MY COMMISSION t DD 526512
a: ~ EXPIRES: March 8, 2010
y ~O
j in -- ~ ~~ r Thru Budget Notary Services
.. _ .`s ~ nature of Public Notary - of Florida nature blic Notary - Statc~~F'(~oriced
o ~ ~ Notarization of Lob st's
- byi signature Notarization of Prindpal's signature
z~~~
o ~ r x FOR CLERK'S L~
z cn ~ w MnUal R istration fee: ` Yes
e9 [ ] [ ] ~ Amount ~ MCR # Date Paid 1( C77
d
~ p^
~~°'S Lobbyist Registration Form received and verified by: Entered By: ~ ~ ~'~ ~ ~ ~ Z ~ ~ a
oiv. s~
F:\CLER\5~1-1~-M\Lnbbykt1~O86Yt5T IORM OS.doc RMsed 12/09/04