Roberta Shevin/Center for the Advancement of Jewish Educationm 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 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.
Shevin I.oberta
NAME OF LOBBYIST: (Last) (First) (M.I)
CAJEB4200 Biscayne Boulevard Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-576-4030 X123 305-576-0307 robertashevin@caje-miami.org
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Center for the Advancement of Jewish Education
NAME OF PRINCIPAL/CLIENT:
CAJE;4200 Eiscayne Boulevard Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
305-576-4030 305-576-0307
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
EMAIL: (Optional)
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~` 4
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II. SPECIFIC LOBBY ISSUE: (~~ rw n~ ~~ n~~~A, I ~~
Issue to be lobbied (Describe in
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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A) Full Name of Individual/T'itle B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERJ: /~
A) LOBBYIST DISCLOSURE: (Required) ~ K
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). N~
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 you lobbying on a present or pending bid for goods equipment or services or on a
g~p~o.,* or oendina award for goods eguipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes lir(NO Are you lobbvina on a oendina 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
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Secticn 2-481 above) who only appears as a representative of snot-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
J section but, shall not be required to pay any registration fees..
~_ Yes ^ No Are you representing a not 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 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. c=%/~~
Si afore 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 2-48~ of the Miami Beach City Code and all reporting
requirements. /:~ ~ ,~. ~' U ,
Signature of Lobbyist: - '""""' c / """'~"'
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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^ Produced ID
^ Produced ID
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Form of Identification Form of Identification -t
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~ Personally known (Lobbyist)
^ Personally known (Principal)
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~ 'u5 VII. SIGNATURE AND STAMP OF NOTARY: U't
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i State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade ~ ~
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~ Sworn to and subscribed befor me Sworn and subscribed before me o
~ g1<'~ This ~_day of i~~'n 20 ~ ~ This day of , 20_ ~
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Signature of Pubic Notary - fate of Florida Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarizatio~~ of Principal's signature
FOR CLERK'S USE ONLY
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Date Paid
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~_ MCR #
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc
-~' ~ ~ 7 ~ ~ Revised
12/08/04
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