Michael Larkin/Seth Gadinsky (3)~ 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, deasion, recommendation of the
City Manager or any dty board or committee; or any acton, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeabiy will be heard or reviewed
by the dty commission, or a city board or committee. The term specifically includes the princpal as well as any employee engaged
in lobbying activities. The term'Lobbylsts" bas spedfic exduslons. Please refer to Ordinance 2004-3435.
Larkin Michael W
NAME OF LOBBYIST: (Last) (Flrst) (M.I)
Bercow, RadeU A Fernandez 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (~P Cam)
377-6222
MBER:
LOBBYIST RETAINED BY:
Seth Gadinsky
NAME OF PRINCIPAUCLIENT:
1680 Michi~ Avenue~~ite 1001 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-23B7 (305) 675-7759 SethClaGadinskvrealestate.com
TELEPHONE NUMBER: FAX NUMBER: (OptionaQ ~ EMAIL. (Opbonap
Fill out this section if prindpal is a Corporation, Partnership or Trust jSection 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Development approvals for new Walgreens Store at property located at NE comer of BiaMtz Drive and 71 Street.
Issue to be lobbied (DescHbe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Fpmilial or Professional Relationship
Planning and Zoning Department Staff, DRB, BOA, Planning I None
Board, City Commission
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETNER HOl/RLY,
FLAT RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) 5375 00 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). S3j5 00 oer t,~gr
The following information moist be ansv+ret+ed:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Devebpment Issues":
V, SiONATURE 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 EXPENDITURES OR OOMPENSATION DURING THE
REPORTING PERIOp. ,.. ~,
Signature of lobbyist
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I do solemnly swear that ail of the foregoing facts are true and correct and that I have read or am
familiar with the provisions rnntained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. _ ^ ~ ,
of Lobbyist:
of Principal/orient:
LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
~ersonaly known (Lobbi/ist)
STAMP OF NOTARY:
This
of Public Notary ~
tbn of Lobbyist's
PRINCIPAL IDENTIFICATION:
^ Produced ID ~''" ~ ""t~
Form of Identification ~"~
`~.~~
~ Personally known (Principal) ~' .~ ~
~~ o
y 3 =
~ ~
State of Florkia, County of Miami-Dade ~ $ 3
Swom and subscribed befo a me
This ~.'~day of 20Q~
Signature of ublic N ry -State of Fbrida
Notarization of Principal's signature
FOR CLERK . ~NLY ~,i 4' Z ~
Annual Registration fee: [ ]Yes [ ] No Amount Paid s'` MCR # ~ /' d ~ Date Paid
3) Pursuant to Miami Beach City Code 2484 {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-profd
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..