Mara Gonzalez/Kenneth Levy/C&D Miami Real Estatet ~S 3
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City of Miami Beach Office of the City Clerk
1704 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retair>~ whether paid or rot, by a Pd~P~ wtw seeks ~ erxrocxa~e the passage, defeat or mod cation of
any ordinance, resolution, acion or decision of any conrressior~er; arty acion, decision, recorrunendation of the City Manager or arty city board or
committee; or any action, deasion or recomrrierxYation of arty aty persomel during the tune period of the entire decision-making process on such
action, decision or recommendation ttmt foreseeabty wi% be heard a reviewed by the city commission, or a city board or commHtee. The term
specifica!1y includes the principal as weq as any employee engaged in bbbying adiv~es. The terra °Lobby~sts° has spec~tc exdusions. Please
refer to Ordinance 2004-3435.
Gonzalez Mara E
NAME OF LOBBYIST: (Last) (First) (M-~
2742 SW 8th Street Mi am; F1 nri rla '~'~1 '~5
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-644-9121 305-643-0510 maragonzalez@bellsouth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Kenneth D. Levv & C. & D. Miami Real Estate L.L. C_,
NAME OF PRINCIPAUCLIENT:
5767 Lnr 151 4r Miami Lakes, Florida 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-208-5709 i tat gi r~i (dhal 1 cnnth nat
TELEPHONE NUMBER: FAX NUMBER: (Optronal) EMAIL: (Opbona~
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 {c))
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
Speak in front of Historical Preservation Board to obtain a certificate of appropriatene
Issue to be lobbied (Describe in detail: for demolition on 355 Washington Ave
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code Section z~sz(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be bbbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any wrrtractual relationship {paid or unpaid} from '12 months preceding the
commencement of service of City personnel to be lobbied.)
A Fu0 Name of Individual Title B) Any Financial, Familial or Professional Relationshi
~s~`'i ~~ Pry /~o ~-, .bow.-d ~ ~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
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A) LOBBYIST DISCLOSURE: (Required)
None Payment fir T obb~~i ar artivi ry
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
{Required). None Payment for Lobbyist activity
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Emitted `Protribited 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
present or pending award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Proh~ited Campaign Contributions By Lobbyists On
Real Estate Development Issues':
^ Yes ®No• Are you lobbying on a pending application for a Development Agreement with file Citv or
application for chance of zoning map designation or chance 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
"lobbyist" 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, sfiatt register with the clerk as required by this
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:
Signature of PrinapaUClient ~'
VI. LOBBYIST IDENTIFICA'
~ Produced ID r5~4-51-~5~L-911
Form of Identification
Florida Drivers License
^ Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
of Florida, County of Miami-Dade
~ to and subscribed before me
~_day of_n~_, 2008
re o Public IVotaty fate of Florida
ation of LobbyisYs signature
TO BE COMPLETED B`
Registration fee: es [ ] No Amount Paid
ct Registration F m received and verified by: S
PRINCIPAL IDENTIFICATION:
Produced ID ~-~ 7~Z~~ ~Q~`'S~'L~'`~.~,
Form of fdentficaton
~a~+we~ IACQUBLINE M. PIMENTEL
^ Personally known (Princip 1)'g MYCpMMISSION+-tDURt~
~OFt~~l~ EXPIRES:1an.24,2(11Q
(40~ 3gg-0t G3 Florlds Natery Sarvfoaa~^
Slate of Florida, County of Miami-Dade
Swom and subscribed be re me
This ~ day of V~ n , 2008
~~~
Signatur ub is Notary -State of Florida
Notarization of Principal's signature
Paid
Revised 03/27J2008
I do solemnly swear that all of the foregoing facts are true and correct and ttrat 1 have read or am familiar with the
provisions contained in e n 2 of the Mich Cod all reporting requirements.
Signature of Lobbyist
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city a$ Miami bench, 170fl Convention Center Drive, Miami Beach, Fioriria 33139, vaww.miami6eachP.gov
CITY CLrRK C>(fice
Tel: 305.673.741 1 ,Fax: 305.6737254
CilyClerk~rniarnibeachfl.ac~v
LOBBYIST NAME: ~,~~~ F ('nn ~ a l a 7
f understand that no later than Ocihober 1st of each year f must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues_
1) lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~gna ure:
4/28/2008
Date:
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