Allan Shulman/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 20043435.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Shulman Allan T.
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: EMAII
(305) 438-0609 (305) 438-0170 allan@shulman-design.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
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-082 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Hans Joachim Krause, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTIY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Hans Joachim Krause (50%1 and Ursula Maria Krause (50%)
ii. sPECiFic ~oBSV issuE: Zoning variance for rooftop addition.
Issue to be lobbied (Describe in deiail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Fuli Name of Individuai/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) ~~~ Y
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) ~ S~ ~~~
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 lobbvinq on a aresent or pendina bid for qoods equipment or services or on a present or pendinq
award for qoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
^ Yes m No• Are vou lobbvinq on a pendinq aqplication for a Development Aqreement with the Citv or application for
chanae of zoninq map desianation 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 representina a not-for-profit corporation or entitv without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1St 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 SHALI BE FILED EVEN IF THERE HAVE
SEEN NO EXPENDITURES OR COMPENSATION DURINC THE REPORTING PERIOD.
!~ /~-f~_<~~~ ,
~~ 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/ "° l Miami Beach City Code and all reporting requirements.
!~y`~` ~~~~~~_-~-~-,
~gnature of Lobbyist: ~ 7r ~
q ~ ° ~ignature of Principal/Client:: ~
q O M N ¢
~ U q ~ ~I . LOBBYIST IDENTIFICATION:
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~„ ~ ~ a Produced ID
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~~ c~s '° ~ ~ ' ation
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=' ~ ~ ~ ~ Personally known (Lobbyist)
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V~'' ~:VII SIGNATURE AND STAMP OF NOTARY:
~ ~
o Q tate of Florida, County of Miami-Dade
~~ ~Sworn to and subscribed efore me
This ~~ day of , 20~
Signature of Public otary - State of Florida
Notarization of Lo byist's signature
IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
_. , .._,.,-----"~.'""'-.--
State of Florida, County of Miami-Dade
Sworn to a~nd_ subscri ed bef P public State ot Fionda
This 5 day of ~~~~y Mar6nez-Cedrez
_ ~ My Commission DD579217
,~,; i , . ~ o- .. ~xairea'07/301'L010
8i"gnature of~bli~ Notary -~ of Florid
Notarization of ~'~incipal' ature '
FOR CLERK'S USE ONLY ~~
Annual Registration fee: es [] No Amount Paid ~ M #~ ~ Date Paid ~~~
•
Lobbyist Registration Form received and verified by: ~
Revised 12/OS/04
NIIHVVI.J L04/1i50 -I