Matthew Amster/Joseph W. Blount~ 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 Ordnance 2004-3435.
Amster Matthew
NAME OF LOBBYIST: (Last) (First) (M.I)
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) 377-6236 (305) 377-6222 mamster@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Joseph W. Blount
NAME OF PRINCIPAL/CLIENT:
2535 Lake Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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:
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 2535 Lake Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS 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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
'A) LOBBYIST DISCLOSURE: (Required) $ 230.00 Der hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 230.00 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 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 "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No• Are you lobbving on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance to the City's Future Land Use
Ma°?
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, 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. /J ~ _ .. _
SigFfature ofLobbyist
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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. _/JA ~ --_
Signature of Lobbyist: `' ~~(~ti~[ ~
Signature of Principal/Client: S
LOBBYIST IDENTIFICA ON:
^ Produced ID
Form of Identification
P' Personally known (Lobbyist)
I. S GNATURE AND STAMP OF NOTARY:
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Sig a of Public Notary -State of FI 'da
tarization of Lobbyist's signature
PRINCIPAL IDENT//I/IF,,,,ICA//TION:
~roduced ID ~~'~U~ ~ ~~
Form of Identification
^ Personally known (Principal)
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Sworn and subscri ed fore me ~/ _ ~ Z= ~~
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This .~3 day of, 20~ O ~ ~'~
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Signature of Public Notary -State of Florida 2
Notarization of Principal's signature
FOR CLERK'S USE ONLY ~ (,
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Dat ,Paid ~ lS
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST (ORM OS.doc Revised 12/08/04
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City of Miami Beach, 17DO Canvenfion Center Drive, Miami $each, Flarido 33139, www.m'romibea~trfl.gav
C1~1' CLERK O;fice CityClerk~miamibeachfl.gov
Tel: 3D5_b73.741 1 ,Fax: 3t}5.b73.7254
LflBBY1ST NAME: ~~~~~~/,~ /~~~
1 understand that no later than October 1sfi of each year, i must file the following
forms, pursuant to Section 2 485 of the Miami Beach City Code, with the City Clerk's
Office far all active lobbying issues.
1 j Lobbyis# Expenditure Form
2j Disclosure Farm
Failure to file these forms an o timely basis will result in my name being #ransmi#ted to the
Miami-Dade Coun#y Commission on Ethics and for code violation evaluation.
(n addition, once an issue I have registered to lobby on has been resolved, I am required
to immediotely notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: Date: