Corey Lafferty/The Palms South 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Lafferty Corey
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Shulman + Associates 100 NE 38`h Street, Space 2 Miami, Florida 33137
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(305) 438-0609 (305) 438-0170 corey@shulman-design.com
I. LOBBYIST RETAINE D BY:
NAME OF PRINCIPAUCLIENT:
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
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Hans Joachim Krause, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Hans Joachim Krause (50%) and Ursula Maria Krause (50%)
~~. sPECiFic ~osBV issue: Zoning variance for rooftop addition.
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
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):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) ~v ~~~
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 ~ No• Are vou lobbvinq on a present or pendinq bid for qoods eauipment or services or on a present or pendinq
award for ~oods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
^ Yes ~ No• Are vou lobbvinq on a pendinq application for a Development Aq~eement with the Citv or application for
chanae of zoninq map desis~nation or chanqe to the Citv's Future Land Use Map?
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 0 No• Are vou representinq a not-for-profit corporation or entitv without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15S EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A S NED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATI RECEI D, IN THE CITY OF
MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL E ED VEN IF THERE HAVE
BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERI . ~
of
I do solemnly swear that all of the foregoi f
provisions contained in Section 2-482 of e Mi
Signature of Lobbyist:
Signature of Principal/Client::
true and correct and that I have read or am familiar with the
~h City Code and all reporting requirements.
VI . LOBBYIST IDENTIFICATION:
Q ~o"~ Produced ID
~ Q M N~ of Identi i ion
w V Q c.i ,o
C ~ Q ~`~ ~ ersonally known (Lobbyist)
~ ~~ ~
~~ o~.°~/II SIGNATURE AND STAMP OF NOTARY:
_ ~ ...
~aN ~ ~ ~
~ W~.~: ~State of Florida, County of Miami-Dade
.~ c~ Sworn to and subscribed efore
~: ~ ~"~ ~.~This ~~1~ day of , 20 ~~
~
~ ~
~ ~ c~
Signature of ublic otary - State of Florida
Notarization of L bbyist's signature
NCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to a~d subscri ed befo e m~~;;;~ Public State o( Florida
This ~rL~ day of ~y Martinez-Cedrez
~a - o y Cammission D0579217
o °" ires 0?I'30/2010
gnature ubl otary - Sta of Florida
Notarizatio of Principal's signature
FOR CLERK'S USE ONLY ~ ~ ~~ ~~
Annuai Registration fee: [] Yes [] No Amount Paid ~~ MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 12/08/04
MIADOCS 2547167 1