HomeMy WebLinkAboutCarillon Miami Beach Holding
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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 defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
thil\hres~ly will be heard or reviewed by the dty commission, or a city board or committee. The term specifically indudes the
prlrQill a_ell as any employee engaged in lobbying activities. The term .Lobbyists" has specific exclusions. Please refer
Cl to ina~ 2004-3435.
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WN M~F L BYIST:
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WBUS SS AME AND ADDRESS
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TELEPHONE'ffUMBER:
(First)
(M.!)
33/3
(Number and Street)
NIl
(City)
(Zip Code)
FAX NUMBER:
EMAIL:
I.
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c))
N~E:;JIEF OFS~::~; B:M;;:q (/I '1 tf7~ b~r
IDENTIFY ALL PERSONS HO.DIlG, DIREctly OR INDIRf:CflY, ~5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERS:, :,TRUST: SoY, J- [ft~ She ClrJ 50 ,
II.
J..
c....e, ~N'J V
III.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division S
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions By lobbYists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division S
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By LobbYists On Real Estate Deyelooment Issues":
Yes
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST 5HALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPEND RES, AS WELL MPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR T REDING DAR A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN N ITURES MPE URING THE
REPORTING PERIOD.
I do solemnly swear that all
familiar with the provisi co
requirements.
Signature of Lobbyist:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
Form of Identification
~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
tWersonally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ':;r1-I day of
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This ~day 0
,,~V~!f.'" Denise P. Soriano
W~commisslon # 00036986
=0.' ,~= Expires June 25, 2005
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'\\"'~"'" Denise P. Soriano
I/. "CDmmIsslon # 00036986
.:: Expires June 25, 2005
Bonded Thru
AI:\IIllk: Bonding Co., Inc.
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-M\LOBBYI5T\LOBBYIST FORM 04