Mikael J. Kaul/Replay USA (2).,
~t~! V ,
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST ~GISTRATION FORM assage, defeat
whether paid or not, by a principal who ~~ tdedsion~,agecommendation of the
to ed or retained, commissioner; any action, the lame
Lobbyist means all persons emp Y d ersonnel during
or modification of any ordinance, resolution, action or decision of any
ci board or committee; or any action, dedsion or recommendation of any t1' p to ~ engaged
City Manager or any tY rocess on such action, decision or recommendation that foreseeably wilt be heard or reviewed
period of the entire decision-making p
the city commission, or a city board or ~mhas specific exclus olns~.llPlease refer t r'Ordinance 12004-3435p
by Lobbyists
in lobbying activities. The term " ~~ . _ _,
~ ~ ~ (M.I)
~~ ;' . s ; (Fii
(Last)
NAME~OgF LOBBYIS~T: / ~ ~ /y~~/~,~,~,~~ r•7~..i1 S w
J I v V` ~" " ~~ ~~ t~~ NumCber~and Street) I ~i/(CNity)
BUSIN~~}ESS NAME AND ADDRESS ~~ r~~ ~~ ,~J
~V~ ~~~ ~ ~ ~ I FAX NUMBER !/
TELEPHONE
I LOBBYIST RETAINED BY:
~Z~'pU~C ~ s~
NAME OF PRINCIPAUC~ENT:
~N~~~~ ~~X ~~v~+2ls~S~" III,
BUSINESS NAME AND ADDRES~~ Z
(Z~ 2 ~~ 3
TFi FPHON NUMBER.
(Number and Street) (qty
~~~~~ c,~ X233
FAX NUMBER. (Optional)
~fi ~~~t ~ 33C~p de)
(State) C.l~~
EMAIL.
Iv. ` ` (Zp Code)
(State)
EMAIL: (Optional)
oration, Partnership or Trust [Section 2-482 (c)7
out this section if principal is a Corp
NAME OFi ~l ~ FCC ~~R~~v iNEFICIARY:
~~ I g ~'" DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
IDENTIFY ALL PERSONS HOLDING, Glt~ ~~ D
CORPORATIOp~~E 11 P ORTRUST: v l7
OIrF l." ~ 33.33 /v Si~~9tk G3U~ta~. 33.3~"/v flc° vita
rh
II. SPECIFIC LOBS I~uEn l t ~ - t ~,r,~ /~
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/T"itle
p~ ~ a~J~
B) Any Financial, Familial or Professional Relationship
1' `
:,
5
N• DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRgTEOR OTHER):
~/v ~ " (~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION); (Required).
The following information must be answered:
A) LOBBYIST DISCLOSURE: (Required)
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
present or oendi - -- ~°• ~~~ cur ooa a ui ment r rvices or on a
na award for aonds 4~~~~.....
-- •••~..~ ur service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Mao?
~~ ~
~~
W F ~ ~ 2
m
~ .
~ ~ C
y
~~ ~~
a o~
_a8 i*• M~LL= 1
~~~:
rOM1' ~. g~,,Qr
~.~~.a.
3)
or reimbu ~++e••+
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 EXPE DI7'URES OR COMPENSATION DU G THE
REPORTING PERIOD.
,~
Signature of Lobbyist
I do solemnly swear that all of the foregoing are true and correct and that I have read or am
familiar with the provisions contained h Section 2-48 of the Miami Beach City Code and all reporting
quirements. ,/ ~/
'gnature of Lobbvict• ~~//~! ~ ~~~/~lI ~ ,~ A
of Pri
/LOBBYIST IDENTIFICATION:
s~ Produced ID ~L. K~ c. j~~? ~ --r~"~ ~~ 3
Form of I entification
o Personally known (Lobbyist)
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-+81 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..
SIGNATURE AND STAMP OF NOTARY:
to of Florida, County of Miami-Dade
worn to and subscribed o e me
This , '~ 1 day of " ~ /r' ~ 20~
Signature of Public Notary -State Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ 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 CLERK'S USE ONLY ~
Annual Registration fee: [ ~ ] No Amo Paid _ i ~~; `
Lobbyist Registration Form received and verified by: _ ~~~-~--- MCR # ~~/lG c~ ~ Date Paid / ~~ ~'0 /
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISTfORM OS.doc
Revised 12J/08/04
~' ,~~ ~ ->> c~ ~~ ~`"i' ~ ~'i ~ ~ ;fir`"~~
V• SIGNATURE UNDER OATH:
Visto per la verity delle firma apposta ally mia presenza dal signor:
- BIANCARDI ATTILIO, nato a Castelmassa (RO) it giorno 5 luglio1944,
residente a Fonte (TV) via Farra n.12, della cui identity personale io Notaio
Sono certo.
~`~~'
. ~, ~
-;~,`
~_V
.~~.~`% y
~~.
~~
G ~'~
~ D
~~ ~
\a
Sri''
,>
.-.~,
~ o~~~
4 (aN D •.e-O~
DY!-
m r ~ ~e:,-.-:
¢ hJo oa~~
v s mm.- -: `~~
o nor. a
`- m.._.as ~~
F O mM ~-
- Gl o ~ ..
JJ QtV =. M1~
- robQN
Hu° ~:~ ~=
= ~„ ~ ~o-
o.'~ ~' ~ "
.,..._. _ ~ .._.._ ~_= t,~
`.~
,.
,f;
r~.~*
City of Miami Beach, 1700 Convention Censer Drive, Miami Beoch, Florida 33139, www.miomibeachfl.gov
CITY CLERK Office CifyClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBI(IST NAME: _ ~ ~ ~I~v\~~-~ ~~~1.--°
I understand that no later than October 1st of each yecir, I 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.
~~ ~~ Ug.
Signatu e: Date:
I~~;visaca Q?_;Q4l2006
.. 'r.; ,. a,.
Ij, ._N U;