Robert Brown/Seth Gadinsky (2)m MIAMIBEACH
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 derision of any commissioner; any action, derision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any rity personnel during the time
period of the entire derision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the princpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Brown Robert
NAME OF LOBBYIST: (Last) (First) (M.I)
Robert Brown Architect 6710 SW 80"' Street, Suite 101 Miami Florida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 622-1940 (3052662-1327 o4adareCa~aol com ~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Seth Gadinsky
NAME OF PRINCIPAL/CLIENT:
1680 Michigan Avenue Suite 1001 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-2387 (305) 675-7759 SethCa~Gadinskyrealestate.com
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:
Conditional Use Approval for Walgreens Store at 1011-15 Alton Road
Issue to be lobbied (Describe in detail):
III. CM AGENCIES/INDIVIDUALS t0 BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Jorge Gomez None
Mercy Lamazares None
Richard Lorber None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 100.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 100.00 per 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":
^ Yes X No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment 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 cending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Map?
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 anot-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 representing goof-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 EXPEND RE OR MPENSATION DURING THE
REPORTING PERIOD.
Signature of lobbyist
I do solemnly swear that all of h foregoin acts are true and correct and that I have read or am
familiar with the provisions con i iry 2-482 of the Miami Beach City Code and all reporting
requirements. ~_
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
`~, Personally known (Lobbyist
VII. S ~RE AMi91SiRACN~1'~~ ~ TI
`2 "~ MY COMMISSION #DD2738
State of Fld "' _ my d`Pl~i~ifl~~tl~eoo7
Sworn ~Q ,and subscribed before°me~
This / //,!. day ofSEf 20b`Y
~~ ~ ~
Signature of Public Notary - fate of on
Ci Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR K'$ l,(S~ ONLY _
Annual Registration fee: [ ]Yes [ ] No Amo nt ai MCR Date aid , Z
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\~ALL\MARL1-M\LObbyist\LOBBYIST foRM OS.doc Revised 12/08/04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WNETHER /SURLY, ' ,,. I
fLAT RATE OR OTHERf f~6GE/~`rL'~~~''~ N
A) LOBBYIST DISCLOSURE: (Required) $ 100.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 100.00 per 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":
^ Yes X No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
present or cending award for goods, equipment 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 cending application for a Development Agreement with the Citv or
application for chance of zoning map designation or drange to the C'fir's Future Land Use
Map?
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 anot-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 representing coot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SYGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYLST 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 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
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: ~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
P Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me „ Marc Haim
This day of , 20_
My Commission DD301094
'~ a n Expires March 2g, Y008
Signature of Public otary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid