Maria Gralia/The Palms South Beach~~
= 4 ~~~~~ ~~~~~
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 principai as well as any employee engaged in
lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I.
)
Gralia Maria A:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Shutts & Bowen LLP; 201 S. Biscayne Blvd., Suite 1500, Miami, FL 33131
TELEPHONE NUMBER: FAX NUMBER~ EMAIL
(305) 347-7328 (305) 347-7701 mgralia@shutts.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
The Palms South Beach, Inc.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
The Palms Hotel 3025 Collins Avenue Miami Beach FL 33140
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
305-534-0505 305-534-0515
Pill out this section if principal is a Corporetion, Partnership or Trust [Section 2d82 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: H2nS J02Chlm Kf2USe, P~eSldeilt
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: HanS JOaChlm KfaUSe (50%1 and UrSUIa Marla KraUSe (50%)
n. sPECiFic ~oaBY issuE: Zoning variance for rooftop addition.
Issue to be lobbied (Describe in detail):
IIL CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: :
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
~- B). ~RINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $300.00 p@C F10U1'
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 0 No: Are vou lobbvins~ on a nresent or nendina bid for aoods eauipment or services or on a present or nendins~
award for qoods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
^ Yes LJ No: Are vou lobbvina on a pendinsa a~nlication for a Development Aareement with the Citv or aopiication for
chans~e of zonina maa desianation or chanae to the Citv's Future Land Use Maq?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "IobbyisY' 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..
^ Yes Ef No: Are vou representina a not-for-nrofit corooration or entitv without special comqensation or reimbursement
V. SIGNATURE UNDER OATH:
ON OCTOBER 1" 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 COMPENSATION DURING THE REPORTING PE IOD.
. _~~ ~ ~ ~ „ ,
" Signature oTLobbyist `" ~
I do solemnly swear that ali 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 ~rrd~each City Code and all reporting requirements.
/1 ~ ~ .
Signature of Lobbyist:
Signature of Principal/Client::
VI . LOBBYIST IDENTIFICATION:
Produced ID
` Form of Identification
ers~P ona~ known (~ehW; ist)
NCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
VII SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed ~efore me
This ~7^ day of JA.„~~ , 200~
% ~ ,;,~ UZETTE PEREZ
r~~ ~"'tin MY COMMISSION #DD334163
~ublic Nota - Stat ~ ' a : JUN 30, 2008
of Lobbyis s sig a Bonded through 1st State Insu~anr~
State of Florida, County of Miami-Dade
Sworn to and subscribed befor me,~ar,
This 21a~^ day of ~'c,~uct,~
or
~c ary Punl~~ •. ; Florida
~her,a~; ~:a c;nez-Cedrez
My!;oirm;ssion DD579217
Expires 07l30/'1010
FOR CLERK'S USE ONLY •
Annual Registration fee: [] Yes [] No Amount Paid MCR # Date Paid
lobbyist Registration Form received and verified by:
Revised 12/08/04 '
MIADOCS 2532223 1