Mike Madden/Redevelopment 910 Lincoln Roadm 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.
Madden Mike
NAME OF LOBBYIST: (Last) (First) (M.I)
Allan T. Shulman Architect, P.A. 100 NE 36 Street Miami, Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 438-0609 (305) 438-0170 michael@shulman-design.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Thor ACQ, LLC
NAME OF PRINCIPAL/CLIENT:
25 West 39`h 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 J. 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
Planning Dept., HPB, BOA, Planning Board, City Commission ~ None
lV. Ul,I,LV~UKC Vt ICKM~AIYU AMVUIYI~Ur LVtftSTl~l GUMF'tIY~A11V1Y ~Ul~I.LV~C Wf1t117tK /'IUUKLI,
FL4TRATEOROTHERf r^y ~/~
A) LOBBYIST DISCLOSURE: (Required) I ~ " , ` O
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~
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 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 "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No• Are you lobbying on a Wending application for a Development Agreement with the Citv or
application for change of zoning man designation or change 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 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
section but, shall not be required to pay any registration fees..
^ Yes X No• Are you representing anot-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.
ignature 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 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist: ~.---~ `_
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
<c c~ o ~; Form of Identification
~ ~~,
~~o`:.
`? o M t; Personally known (Lobbyist)
i-s. U ~ N a-,
~~QNc;
~P„ ~ ~ ~ ~'/II. SIGNATURE AND STAMP OF NOTARY:
`f N "~ '`~' State of Florida, County of Miami-Dade
.--, .~
~-Y~ ~ sworn t nd subscrib d before me O Cj
~- o ~~; This day of tilt) G 20_ D
- - CJ rs
11~ ~
~- ~~, : Signature of Public tary -State of Florida
Notarization of Lobbyists signature
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLER ' USE ONLY
Annual Registration fee: [ ]Yes [ No Amount P 'd MCR # ~~ ~ I ~ Date Paid ~1p
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\~ALL\MARIA-M\Lobbyfst\LOBBYIST fORM OS.doc Revised 12/08/04
1'V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $
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 lobbying on a present or pending bid for goods equipment or services, or on a
present or uendingaward for goods, 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 lobbying on a pgnding application for a Development Agreement with the City or
application for changg of zoning map designation or change to the Citv's Future Land Use
M. au?
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 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
section but, shall not be required to pay any registration fees..
^ Yes X No• Are you representing anot-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.
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 S ct~ ion 2-482 of~he Miami Beach City Code and all reporting
requirements. ~~
Signature of Lobbyist: '
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
[, Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION: ~,,~~~"FE'R~~.,,
v IV ''~
F, '••
Produced ID '~~ - ~` ~ ~~~
'~ ~'~'~'' srATE '~~G ",
Form of Identification -' r OF NEW YORK ~!~
i?'Personally known (Principal) ~ ~-~--~(•~
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• s
~/.P~ 'g ~' .+' y4s r.
State of•Fleridc,~nty ofA4iaaR+- ~0~~'0rwuµ~MaRN++''a,~
Sworn an subscribed before me
This ay of Jw-L , 20? g
Signature of lic Notary -State of /~I~r Y~/~--
Notarization of Principal's signature
FOR CLERK'S USE ONLY ~
Annual Registration fee: [ ]Yes [ ] No Amount Paid 7 `~,~ MCR # [ ~/ ` Date Paid ~ ~ ~ /
Lobbyist Registration Form received and verified by: Entered By: .~,~~'
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04