Michael Larkin/Thor ACQ, LLCm MIAM,IBEACH
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.
Larkin Michael W
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Thor ACQ, LLC
NAME OF PRINCIPAL/CLIENT:
25 West 39`" Street New York NY 10018
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 529-7415
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Joseph ]. Sitt
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Joseph J. Sitt
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 910 Lincoln Road
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
y~
Planning Dept., HPB, BOA, Planning Board, City Commission I None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 385 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 385 00 per hour
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 X No• Are you lobbvina on a present or sending bid for goods eauipment or services, or on a
present or pending award for aoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No• Are you IobbYina on a sending aaalication for a Develoament Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Maa?
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 anot-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 X No• Are you representing snot-for-profit coraoration or entity without saecial 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 EXPENDTTURES, 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 COMPE SATION DURING THE
REPORTING PERIOD.
Signatu 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 Sectio 2-482 of the Miami Beach City Code and all reporting
requirements. ~ _ ~., J,, „~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
'~ ~ Produced ID
o Form of Identification
~ ,;4.
~' ~ K Personally known (Lobbyist)
h
o s ,, a II. SIGNATURE AND STAMP OF NOTARY:
z cn ~ w
tate of F i ,County f Miam' ade
.~`~`'
~ worn subscrib befo m ,
spa his ay o _
`~' ~
ature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
_'Produced ID
r'Personally known (Principal)
,,,~-ya~ ~1•ew ~or7
State of Fleritta, County of i-bile
Sworn and subscribed before me
This ~-~day of h~ , 200 g
Signature pfiP"ubli~ Notary - Sate of~ler
Notarization of Principal's signature
FOR CLE 'S USE ONLY o'`~~~od
Annual Registration fee: [ ]Yes [ ~ No Amount Paid ~ Oa MCR # o`~ ,9~~Date Paidr ~ ~1S
Lobbyist Registration Form received and verified by: ~~ Entered By: oC-~-/a-~- ~~-~
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc ~~ Revised 12/08/04
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeochfl.gov
CITY CLfRK Office Cih~Clerk~miamibeachfl.gov
Tel: 305.673.741 1 ,Fox: 305.673.7254
LOBBYIST NAME: ~ l (~C~0.L t W • ~--~~ ~ t n
I understand that no later than October 1st of each year, f must file the following
forms, pursuant to Section 2-485 of the Miami Beach Ciry Code, with the City Clerk's
office for all active lobbying issues.
1 } Lobbyist Expenditure Form
2j Disclosure Form
Failure to file these farms on o 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.
f c.~ l ~{ 1 oK
Signature: Date: